Friday, September 17, 2010

Glucosamine/Chondroitin useless for arthritis?

The popular supplements glucosamine and chondroitin don't do much to relieve the pain associated with hip or knee osteoarthritis (OA), according to a new analysis of 10 studies. This is not the first time that research has cast doubt on the effectiveness of these two supplements. The heavily anticipated, government-funded Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) also showed that overall they did not improve knee OA pain. A follow-up arm of this study showed that they did not do any better than placebo in slowing loss of cartilage that occurs in osteoarthritis of the knee. A smaller subset of GAIT participants with moderate-to-severe OA pain, however, did get some relief with the combined supplements. Because this group was small, researchers said the findings were preliminary and needed to be confirmed in further studies. The new analysis of 10 studies, comprising 3,803 people, reinforces the negative findings of the GAIT trial.Glucosamine, chondroitin, or their combination are no better than placebo (dummy pill) when it comes to joint pain and joint space narrowing, the new study shows. But the supplements are safe, the study researchers write. The findings appear online in BMJ.

"We see no harm in having patients continue these preparations as long as they perceive a benefit and cover the cost of treatment themselves," write the researchers, who were led by Peter J√ľni of University of Bern in Switzerland. Second Opinion "The jury is in, and we have given these supplements a fair try," says David Pisetsky, MD, chief of rheumatology at Duke University Medical Center in Durham, N.C. "I don’t think there is a strong impetus for more study." Pisetsky does have a number of patients who take, and will likely continue to take, these supplements. "If you want to take them and perceive a benefit, that's fine, but tell your doctor," he says.

According to supporters, the safety of these supplements has never been doubted. You have to ask yourself, would you take a supplement containing glucosamine and chondroitin, have about two-thirds of a chance of getting significant relief, with some evidence that you can slow your disease progression, or just numb your symptoms with acetaminophen or anti-inflammatory drugs and risk ulcers, allergies, kidney or liver damage, hypertension, heart attacks and possibly death. The risk/benefit for glucosamine and chondroitin far outweighs that of the FDA-approved drugs for osteoarthritis.

Marc C. Hochberg, MD, MPH, professor of medicine and head of the division of rheumatology and clinical immunology at the University of Maryland School of Medicine in Baltimore, points out that the statistical techniques used in the new study were really not designed to be applied to groups, which may cast some doubt on the way the findings are being interpreted. "These supplements did have a very small effect," he says. "This effect was very similar or identical to what is seen with acetaminophen, which is the first line treatment of OA according to the American College of Rheumatology and other professional organizations." His advice? "If patients want to use glucosamine, then they should discuss this with their physician who may recommend a particular brand and manufacturer."

Bonnie - we have commented on this issue numerous times. Our clients only see benefits for minimizing the degradation of cartilage over time, not for treating pain unless the OA is mild. It does not do anything for moderate to severe OA pain.

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