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Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4675 (Published 16 September 2010) Cite this as: BMJ 2010;341:c4675

Rapid Response:

Oral chondroitin sulphate and glucosamine vs. diet modification

Literature on glucosamine (Ga) and chondroitin sulfate (Cs) is
controversive, and recent publications tend to be less affirmative than
earlier industry-sponsored trials. The meta-analysis by Wandel et al. [1]
has summarized existing knowledge: "Chondroitin, glucosamine, and their
combination do not have a clinically relevant effect on perceived joint
pain or on joint space narrowing." [1], which is in agreement with a
recent trial [2]. Logically, it is concluded that "coverage of costs by
health authorities or health insurers for these preparations and novel
prescriptions to patients who have not received other treatments should be
discouraged." [1]

In the Rapid Response by Wood [2] is written: "Given that there is an
effect, understanding the biochemical basis of this effect might lead to
more useful supplements." [3]. The thing is that the biochemical basis is
incomprehensible. Ga is an aminosaccharide acting as a substrate for the
biosynthesis of articular glycosaminoglycans (GAG). Cs undergoes
fermentative hydrolysis in the intestine; therefore it is, in fact, also a
potential substrate for biosynthesis. GAG are produced in the organism,
being ubiquitous in the ground substance of connective tissue; it appears
doubtful, whether supplementation can shift the equilibrium between their
synthesis and degradation in the whole organism to such an extent that it
would be significant for metabolism of articular cartilage. Moreover,
source materials, e.g. shellfish chitin or phytogenic material for Ga [4],
contaminants etc., can influence biological and pharmacological properties
of manufactured substances [5].

In Russia, treatment with Cs and Ga is not covered by medical
insurance. The drugs are prescribed to osteoarthritis patients, including
those with low incomes and pensioners, who purchase them for a prolonged
use. Patients are often misled by advertizing and commercially influenced
physicians. The question is, therefore, whether it would be more or less
the same to recommend them a diet rich in natural GAG: beef and pork legs
and joints, tails, chicken wings and legs etc. Apparently, biologic
properties of natural GAG would be similar to those of manufactured
analogues and precursors. This idea is not new, it was discussed at
conferences. To support the placebo effect, patients should be advised
that the modified diet would saturate their organism with precursors of
articular cartilage similarly to drugs or dietary supplements, although an
effect is not guaranteed [6].

References

1. Wandel S, Jueni P, Tendal B, Nueesch E, Villiger PM, Welton NJ,
Reichenbach S, Trelle S. Effects of glucosamine, chondroitin, or placebo
in patients with osteoarthritis of hip or knee: network meta-analysis.
BMJ. 16;341:c4675. doi: 10.1136/bmj.c4675.

2. Sawitzke AD, Shi H, Finco MF, Dunlop DD, Harris CL, Singer NG,
Bradley JD, Silver D, Jackson CG, Lane NE, Oddis CV, Wolfe F, Lisse J,
Furst DE, Bingham CO, Reda DJ, Moskowitz RW, Williams HJ, Clegg DO.
Clinical efficacy and safety of glucosamine, chondroitin sulphate, their
combination, celecoxib or placebo taken to treat osteoarthritis of the
knee: 2-year results from GAIT. Ann Rheum Dis. 2010;69(8):1459-64.

3. Wood MJ. Conclusion not consistent with results. BMJ Rapid
Response of 24 September 2010.
http://www.bmj.com/content/341/bmj.c4675.abstract/reply#bmj_el_242086

4. Black C, Clar C, Henderson R, MacEachern C, McNamee P, Quayyum Z,
Royle P, Thomas S.. The clinical effectiveness of glucosamine and
chondroitin supplements in lowing or arresting progression of
osteoarthritis of the knee: a systematic review and economic evaluation.
Health Technol Assess (Rockv) 2009;13(52):1-148.

5. Volpi N. Quality of different chondroitin sulfate preparations in
relation to their therapeutic activity. The Journal of pharmacy and
pharmacology 2009;61(10):1271-80.

6. Jargin SV. Re: Osteoarthritis of the knee. Vol 13 (52) Health
Technology Assessment Report. HTA Correspondence, Apr 16, 2010.
http://www.hta.ac.uk/correspond/viewtopic.php?t=346

Competing interests: No competing interests

30 September 2010
Sergei V. Jargin
Researcher
Peoples' Friendship University of Russia, Moscow