Glucosamine Revisited, Again
Our OrthoBuzz report of the “near-death” of glucosamine/chondroitin may have been premature, according to a recent study published online in the Annals of the Rheumatic Diseases. The randomized, double-blind study assigned 606 patients with knee osteoarthritis and moderate-to-severe pain to receive either glucosamine (500 mg) and chondroitin (400 mg) three times a day, or one daily dose of the COX-2 inhibitor celecoxib (200 mg).
The study was designed to discern noninferiority between the supplements and celecoxib, and the results over six months showed equivalent benefits in both groups. WOMAC measures of pain decreased by 50.1% in the supplement group and 50.2% in the celecoxib group. Both groups also showed a >50% reduction in the presence of joint swelling, and adverse events were low in both groups.
One thing readers may want to consider when mulling over these results: The study was sponsored by the manufacturer of the glucosamine/chondroitin product used in the trial, and all authors disclosed financial relationships with that manufacturer.
An additional perspective on these and other glucosamine/chondroitin findings comes from JBJS Deputy Editor for Research Tom Bauer, MD, an ultra-marathon runner who’s free of arthritis symptoms and does take glucosamine/chondroitin supplements. Dr. Bauer emphasizes the distinction between preventing osteoarthritis and treating it. “Most published studies in humans, like this recent one, have tested glucosamine/chondroitin in patients with pre-existing osteoarthritis,” he said. “It’s a tall order to expect any oral medication to induce actual restoration of the articular surface, so I’m eager to see a decent chondroprotective study of these supplements in athletes who do not have osteoarthritis.”
Another Nail in the Glucosamine/Chondroitin Coffin
Add findings from a recent study in Arthritis & Rheumatology to the growing body of evidence indicating that glucosamine and chondroitin supplements have no measurable impact on relieving knee osteoarthritis (OA). These findings add support to existing guidelines that recommend against the use of these supplements for OA treatment (see related OrthoBuzz article).
Utilizing a so-called “new user” design, researchers analyzed four-year follow-up data on more than 1,600 people who were not using glucosamine/chondroitin at baseline. In addition to measuring joint space width, researchers captured knee symptoms with WOMAC pain, stiffness, and function scales. They also employed marginal structural models to control for time-varying confounders. In the end, there were “no clinically significant differences” between supplement users and non-users, and the study authors claimed that, in addition to being consistent with meta-analyses of glucosamine/chondroitin, these findings extend the data set to include “a more general population with knee OA.
A Reminder about What Orthopaedic Surgeons Should Not Do
The Choosing Wisely campaign seeks to bring more awareness to tests and procedures that should be discussed between physicians and patients. The campaign was spearheaded by the ABIM Foundation, and the American Academy of Orthopaedic Surgeons (AAOS) partnered with the campaign to develop a list of the five things physicians and patients should question.
- Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.
- Don’t use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief.
- Don’t use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.
- Don’t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.
- Don’t use post-operative splinting of the wrist after carpal tunnel release for long-term relief.
The list was developed after review of approved clinical practice guidelines and included input from specialty society leaders.
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