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#276 Glucosamine & Chondroitin: Natural remedies for osteoarthritis?


CLINICAL QUESTION
Does glucosamine and/or chondroitin improve pain for patients with osteoarthritis? 


BOTTOM LINE
Glucosamine and chondroitin do not appear to be effective in higher-quality, larger and/or publicly funded studies. If studies at high risk of bias are included, at best ~10% more people will have meaningful reduction in pain with either treatment over 35-45% of people with placebo. There is reason to doubt the effectiveness of either treatments.  



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EVIDENCE
Results statistically significant unless indicated. 
  • Glucosamine: 
    • 11 systematic reviews:1-11 glucosamine 1500mg/day versus placebo [2-25 randomized controlled trials (RCTs), 414-4963 patients]: 
      • Proportion of patients attaining meaningful pain reduction (generally ≥30% reduced pain) from two meta-analyses: 
        • Most recent meta-analysis (9 RCTs, 1643 patients).1After 4-156 weeks: 
          • 47% glucosamine versus 37% placebo, number needed to treat (NNT)=11. 
          • Other analysis found similar.2 
    • Change in 100-point pain scale: meta-analysis3 re-run by PEER. Baseline pain of 52, placebo reduced pain ~13, glucosamine reduced pain: 
      • Larger RCTs, same as placebo. 
      • Smaller RCTs, ~12 better than placebo. 
  • Chondroitin: 
    • 11 systematic reviews:1,3,4,10-17 chondroitin 800-1200mg/day versus placebo (6-18 RCTs, 362-4044 patients): 
      • Proportion of patients attaining meaningful pain reduction: 
        • Most recent analysis (9 RCTs, 2477 patients).1 After 12-48 weeks: 
          • 57% chondroitin versus 45% placebo, NNT=9. 
        • Other meta-analysis found no difference (1 RCT, 330 patients).12 
    • Change in 100-point pain scale: meta-analysis3 re-run by PEER. Baseline pain of 56, placebo reduced pain ~19, chondroitin reduced pain: 
      • Larger RCTs, ~4 better than placebo. 
      • Smaller RCTs, ~12 better than placebo. 
  • Combination: 
    • 6 systematic reviews:4,10-12,18 glucosamine/chondroitin combined versus placebo: 
      • Only one RCT examined meaningful pain reductions: effect similar to components alone.12 
      • Change in 100-point pain scale: not different from placebo.3,18 
  • Limits: mostly knee osteoarthritis studied.1 No benefit of glucosamine or chondroitin over placebo in publicly funded1, high-quality, or larger RCTs.4,12 
Context: 
  • Many meta-analyses report “standard mean differences” which are difficult to apply clinically and are not reported here.2,4,5,7,9-17 
  • Pain studies should consider both percentage of patients reaching meaningful improvement and changes in scale. 
  • Adverse events infrequently reported. 
  • Osteoarthritis online calculator19 or PEER simplified decision aid20 can assist with patient-informed decision making. 


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Author(s):

  • Anthony Train MBChB MSc CCFP
  • G. Michael Allan MD CCFP
  • Samantha Moe PharmD

1. Ton J, Perry D, Thomas B, et al. Can Fam Physician. 2020; 66(3):e89-e98.

2. Towheed T, Maxwell L, Anastassiades TP, et al. Cochrane Database Syst Rev. 2005; Issue 2. Art. No.:CD002946.

3. Simental-Mendia M, Sanchez-Garcia A, Vilchez-Cavazos F, et al. Rheumatol Int. 2018; 38:1413-28.

4. Black C, Clar C, Henderson R, et al. Health Technol Assess. 2009; 13(52).

5. Eriksen P, Bartels EM, Altman RD, et al. Arthritis Care Res. 2014; 66(12):1844-55.

6. Kongtharvonskul J, Anothaisintawee T, McEvoy M, et al. Eur J Med Res. 2015; 20:24.

7. Ogata T, Ideno Y, Akai M, et al. Clin Rheumatol. 2018 37:2479-87.

8. Poolsup N, Suthisisang C, Channark P, et al. Ann Pharmacother 2005; 39:1080-7.

9. Runhaar J, Rozendaal RM, van Middelkoop M, et al. Ann Rheum Dis. 2017; 76(11):1862-69.

10. Zhu X, Wu D, Sang L, et al. Clin Exp Rheumatol. 2018; 36:595-602.

11. Zhu X, Sang L, Wu D, et al. J Orthop Surg Res. 2018; 13:170-9.

12. Singh JA, Noorbalochi S, MacDonald R, et al. Cochrane Database Syst Rev. 2015; 1:CD005614.

13. Bjordal JM, Klovning A, Ljunggren AE, et al. Eur J Pain. 2007; 11:125-38.

14. Honvo G, Bruyere O, Geerinck A. Adv Ther. 2019; 36:1085-99.

15. Knapik JJ, Pope R, Hoedebecke, et al. J Spec Oper Med. 2019; 19(1):113-24.

16. Liu X, Machado GC, Eyles JP, et al. Br J Sports Med. 2018; 52:167-75.

17. McAlindon TE, LaValley MP, Gulin JP, et al. JAMA. 2000; 283;1469-75.

18. Gregori D, Giacovelli G, Minto C, et al. JAMA. 2018; 320(24):2564-79.

19. PEER. Comparing Treatment Options for Pain: The C-TOP Tool. https://pain-calculator.com/. Accessed: 2020 Oct 18.

20. Lindblad AJ, McCormack J, Korownyk CS, et al. CFP. 2020; 66(3):191-3.

Authors do not have any conflicts of interest to declare.