Is glucosamine effective in reducing OA joint pain?

A BMJ study found that 2 popular supplements, glucosamine, chondroitin and their combination are no better than placebo at reducing joint pain.

The study, funded by the Swiss National Science Foundation, was a meta-analysis based on 10 randomised controlled trials with more than 3800 patients with hip or knee osteoarthritis treated with either glucosamine, chondroitin or both, followed up for 1 to 36 months. The outcome measures were pain intensity and joint structure. The analysis of data was by network meta-analysis, a relatively new statistical technique.

The researchers found that all these 2 supplements have been prescribed by GPs and rheumatologists and used widely by patients for treating osteoarthritis (OA), their study showed that glucosamine, chondroitin and their combination do not have a useful clinical effect in treating osteoarthritis. They wrote "we believe it unlikely that future trials will show a clinically relevant benefit of any of the evaluated preparations".

Critics say that the study results may be biased by the heterogeneity of the varying studies included and the network meta-analysis it used to do the calculation. Furthermore, the small size of the trials could also have large effect on the overall results.

Some patients, based on their own experience, are convinced that these supplemnets are beneficial and have written to the BMJ in response to the findings, some doctors pointed out that glucosamine has 2 different formulation, the favourable response of glucosamine to knee OA involves glucosamine sulphate not hydrochloride and that many of the recommendations of use of glucosamine are on knee OA not hip, but the study included both knee and hip OA in the analysis.

It was also noted that the conclusion of the study on the efficacy of glucosamine on knee OA is questionable because it does not include the data of the LEGS trial which investigates glucosamine sulphate in knee OA, the study is yet to be completed.

Source:

1). Wandel S, Jüni P, Tendal B et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ 2010; 341:c4675 ( f/t via Athens)

2). The Long-term Evaluation of Glucosamine Sulphate Study (LEGS) - study to be completed in October 2011

HRT can increase joint problems

A study funded by Cancer Research UK, the NHS Breast Screening Program and the Medical Research Council followed 1.3 million women for an average of 6.1 years and collected information on reproductive history, use of hormonal therapies, other medical history and lifestyle.


Researchers found that women using HRT are more likely to need a knee replacement due to arthritis than women who have never used HRT. There is also increased risk of hip replacement. The researchers conclude that ‘hormonal and reproductive factors increase the risk of hip and knee replacement, more so for the knee than for the hip. The reasons for this are unclear.’


Critics say that there are limitations of its data collection method and the findings conflict with those of previous studies.


Source: Liu B, Balkwill A, Cooper C et al. Reproductive history, hormonal factors and the incidence of hip and knee replacement for osteoarthritis in middle-aged women. Annals of Rheumatic Diseases 2008; Oct 28 ( via press release)

Knee surgery had no benefit for osteoarthritis

Two studies raising doubts about the effectiveness of knee surgery were published in the New England Journal of Medicine (NEJM).


About 200 patients with moderate-to-severe osteoarthritis of the knee were randomly assigned to receive either surgery, drugs and physical therapy ( as treatment group with arthoscopic surgery ) or drugs and physical therapy alone ( as control group ). (1)


At the end of the study, researchers found that patients in the treatment group had slightly less pain than those in the control group after 3 months, but no significant differences between the two groups after 2 years. Researchers concluded that “arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy”. A previous study published in 2003 had similar results.

Another study in the same journal found that MRI scan of middle-age and older people show that meniscal tears in the knee are more common in this age group than previously thought and often without pain or stiffness. The author said "Clinicians who order MRI of the knee should take into account the high prevalence of incidental tears when interpreting the results and planning therapy". (2)


Source 1 :"A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee." NEJM 2008; 359(11):1097-1107 ( abstract only)


Source 2: "Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons Volume" NEJM 2008. 359(11) :1108-1115 ( abstract only)

Rosehip for osteoarthritis pain reduction

Researchers conducted a meta-analysis of randomised controlled trials into the use of Rosa canina hip powder treatment compared with placebo for osteoarthritis, reported a newspaper.


They combined and analysed the results from these studies and found that use of Rosa canina reduced pain to about a third compared to the placebo group. People taking the powder were also less likely to use "rescue" medication, ie painkillers.


Critics say the study provides good evidence that rosehip reduces pain associated with osteoarthritis, however it was not set up to determine whether rosehip was better than current treatments.


Source: "Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients? – a meta-analysis of randomized controlled trials" Osteoarthritis and Cartilage April 2008 Ahead of print