Joseph A. Markenson, MD, FACP, MACP
Do glucosamine or chondroitin, alone or in combination, reduce joint pain in osteoarthritis of the hip or knee?
Included studies compared glucosamine sulfate, glucosamine hydrochloride, chondroitin sulfate, or a combination of 2 of the drugs with each other or placebo and included ≥ 100 patients with osteoarthritis of the hip or knee in each treatment group. Treatment groups with subtherapeutic drug doses (glucosamine < 1500 mg/d, chondroitin < 800 mg/d) were excluded. Primary outcomes was pain intensity.
MEDLINE, EMBASE/Excerpta Medica, CINAHL, and Cochrane Controlled Trials Register (all to Jun 2010); Science Citation Index (1981 to 2008); conference proceedings; textbooks; and reference lists were searched for randomized controlled trials (RCTs). Experts were contacted. 10 RCTs (n = 3803) met the selection criteria (median age 62 y, median 68% women); 8 involved the knee joint, 1 the hip joint, and 1 both joints. Duration of follow-up ranged from 1 month to 36 months. Data from direct and indirect treatment comparisons were combined using Bayesian network meta-analysis. Pain was evaluated using different scales, combined using effect sizes, and converted to a 10-cm visual analogue scale (VAS). A minimal clinically important difference between treatments of 0.9 cm was prespecified to facilitate interpretation. Pooled effect sizes and corresponding 95% credible intervals (CrIs) were estimated from the median and 2.5th and 97.5th centiles of the posterior distribution.
Meta-analysis showed that glucosamine reduced joint pain intensity more than placebo; the difference was not clinically important, with an upper 95% CrI limit < −0.9 cm (Table). Chondroitin alone or combined with glucosamine did not reduce joint pain intensity more than placebo (Table).
Glucosamine and chondroitin, alone or in combination, do not clinically improve joint pain in patients with osteoarthritis of the knee or hip.
Drug treatment vs placebo for joint pain in osteoarthritis of the knee or hip*
*CrI = credible interval.
†Based on direct and indirect treatment comparisons over different periods, and calculated using network meta-analysis and Bayesian random-effects models with minimally informative priors. Negative values indicate a benefit for drug treatment.
Markenson JA. Review: Glucosamine and chondroitin, alone or in combination, do not clinically improve knee or hip pain in osteoarthritis. Ann Intern Med. 2011;154:JC3–4. doi: 10.7326/0003-4819-154-6-201103150-02004
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Published: Ann Intern Med. 2011;154(6):JC3-4.
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