BMJ  2005;330:673 (19 March), doi:10.1136/bmj.330.7492.673-a

Letter

Managing osteoarthritis of the knee

Glucosamine-chondroitin should be prescribed by doctors

EDITOR—In his editorial on the management of osteoarthritis of the knee MacAuley recommended glucosamine-chondroitin as an off prescription preparation.¹ Can anyone explain why it is usually recommended so, despite evidence of efficacy that is as good or better than most non-steroidal anti-inflammatory drugs (NSAIDs), which cause a huge burden of morbidity and mortality)?

Yet NSAIDs, and cleverly marketed variations of the theme, continue to be licensed and adopted for NHS prescription for osteoarthritis, and I am sure will continue to do so despite the debacle surrounding the cyclooxygenase 2 inhibitors. Remember also benoxaprofen 25 years ago.²

Most patients with osteoarthritis will qualify for free prescriptions and are in the age group with least income flexibility. Most do not need surgery but are still suffering. I understand that glucosamine is prescribable, but rheumatologists and general practitioners seem to advise patients to buy their own—why? I fear that the background to this is the huge threat to NSAID sales that is posed by any form of help that patients with osteoarthritis may receive from other sources. But why spend on many expensive NSAIDs, with no convincing overall benefit to patients over cheaper alternatives (and sometimes major harms), and not on glucosamine-chondroitin?

Bury St Edmunds, Suffolk IP31 3TE rachalmers{at}onetel.com

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Competing interests: RC is concerned about the damaging effect of drug companies' influence on NHS and doctors' decisions in the interest of patients.

References

1. MacAuley D. Managing osteoarthritis of the knee. BMJ 2004;329: 1300-1. (4 December.)[Free Full Text]
2. Benoxaprofen. In: Sweetman SC, ed. Martindale: the complete drug reference. 34th ed. London: Pharmaceutical Press, 2005: 21.1.

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Relevant Article

Managing osteoarthritis of the knee

Domhnall MacAuley
BMJ 2004 329: 1300-1301. [Extract] [Full Text] [PDF]