Mixed Results, and Mixed Messages, for Patients Using Supplements for Arthritis Pain

It’s no secret that the market for health care and nutritional supplements is booming; Consumer Reports estimates annual sales of supplements to be more than $26 billion (http://bit.ly/lhKfNx). A large chunk of that money is spent each year on products that claim to promote and improve joint health, especially the supplements glucosamine and chondroitin. The Nutrition Business Journal (http://bit.ly/vhPpx2) estimated that sales of these supplements topped $830 million in the US in 2007.

However, the evidence for the effectiveness of these supplements in the treatment of pain associated with osteoarthritis is mixed at best, with several recent trials showing little or no benefit from their use. A recent article in the Journal of Family Practice (http://bit.ly/v16wjr) by Stevermer and Rogers noted that although some smaller studies have shown that these supplements can help to relieve joint pain, “Larger and higher quality studies have found little or no effect.” The authors reviewed a meta-analysis of 10 randomized controlled trials (http://bit.ly/c6skoW) and reported that, although treatment with glucosamine alone, chondroitin alone, or a combination of the two was “statistically better than placebo,” the benefits to patients did not meet the authors’ standards for minimum clinically significant improvement. They concluded that “Glucosamine and chondroitin, used alone or in combination, provide little benefit in terms of pain relief of [osteoarthritis] of the knee or hip compared with placebo,” and recommended against their use by patients with osteoarthritis.

A study by Rozendaal and colleagues, published in the Annals of Internal Medicine (http://bit.ly/uTKxwJ), evaluated the effect of glucosamine on the symptoms (including pain) and progression of osteoarthritis of the hip. The authors followed more than 200 patients over the course of two years and reported that they “did not find glucosamine sulfate to be more effective than placebo in modifying the symptomatic and radiographic progression of hip osteoarthritis over 24 months of daily therapy.” Another study, the widely publicized Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), found that not only did the combination of glucosamine plus chondroitin sulfate “not provide significant relief from osteoarthritis pain,” the supplements, together or alone, “Appeared to fare no better than placebo in slowing loss of cartilage in osteoarthritis of the knee.” The authors did report that “A smaller subgroup of study participants with moderate-to-severe pain showed significant relief with the combined supplements” (http://1.usa.gov/3oKVsx).

What Are Your Thoughts on the Use of Glucosamine and Chondroitin in Patients with Osteoarthritis?

• What percent of your patients with arthritis use these (or other) supplements?
• Do you recommend the use of glucosamine and chondroitin to your patients?
• Do you sell supplements to your patients?

E-mail tkunkler@mdmag.com to share your opinion.

Several guidelines have recommended against the use of these supplements for the management of osteoarthritis pain. The American Academy of Orthopedic Surgeons 2008 guidelines for knee osteoarthritis “recommend glucosamine and/or chondroitin sulfate or hydrochloride not be prescribed for patients with symptomatic [osteoarthritis] of the knee” (http://1.usa.gov/rNy8wP). An Evidence Report from the Agency for Healthcare Research and Quality (http://1.usa.gov/v0APuT) concluded that “the best available evidence found that glucosamine hydrochloride, chondroitin sulfate, or their combination provide no clinical benefit in patients with primary OA of the knee.”

Yet, despite the evidence that these popular supplements may be little more effective than placebo for patients with osteoarthritis, patients and physicians have received mixed messages regarding the efficacy of these supplements for relieving pain associated with osteoarthritis of the knee. For example, the Osteoarthritis Research Society International recommendations for the management of hip and knee osteoarthritis (http://bit.ly/aZlkY3) specify that “Treatment with glucosamine and/or chondroitin sulphate may provide symptomatic benefit in patients with knee OA” and that “In patients with symptomatic knee OA, glucosamine sulphate and chondroitin sulphate may have structure-modifying effects.” The Work Loss Data Institute guidelines for treatment of acute and chronic knee and leg conditions (http://1.usa.gov/rWZMrG) state that glucosamine/chondroitin “may provide effective symptomatic relief for patients with osteoarthritis of the knee. In addition, glucosamine has shown promising results in modifying the progression of arthritis over a 3-year period.” The European League Against Rheumatism guidelines for the management of osteoarthritis of the knee give a strong recommendation to the use of glucosamine and chondroitin to alleviate symptoms (http://1.usa.gov/tk9Nxo).