Nonsteroidal anti-inflammatory medication is effective treatment
for the symptoms associated with osteoarthritis. However, potentially
serious toxic effects limit its use in some individuals. Glucosamine
and chondroitin represent normal components of articular cartilage
that have been under investigation as potential disease-modifying
and symptom-ameliorating agents.
McAlindon and colleagues have investigated the potential benefits
of glucosamine and chondroitin for osteoarthritis symptoms in a
rigorous meta-analysis and concluded that both appear to relieve
pain and improve function more than placebo. One study included
hips and knees, while all others evaluated knees only. Dosage information was
not well summarized. It seems, however, that 800 to 1200 mg of drug
was given daily. It is unclear whether any of the trials used combinations
of glucosamine and chondroitin.
The authors noted that a drug manufacturer supported most studies.
They also found evidence of publication bias1.
Although chondroitin and glucosamine seem to relieve pain and improve
function, the magnitude of this benefit is probably smaller than
generally reported.
Few side effects have been attributed to glucosamine and chondroitin2. While these agents are likely better
tolerated than nonsteroidal anti-inflammatory drugs, no reported
trials have compared them with the newer cyclooxygenase-2 (COX-2)
inhibitors that are also associated with few toxic effects.
Chondroitin and glucosamine sulfate may be considered for the
control of knee arthritis symptoms, along with cox-2 inhibitors,
for those unable to tolerate nonsteroidal anti-inflammatory drugs.
At present, there is little evidence that disease progression may
be modified3.
Hans J. Kreder, M.D., M.P.H., F.R.C.S.(C)
Sunnybrook & Women's College Health Sciences Centre
University of Toronto
Toronto, Ontario, Canada