Glucosamine and Chondroitin for Treatment of Osteoarthritis
A Systematic Quality Assessment and Meta-analysis
Timothy E. McAlindon, DM; Michael P. LaValley, PhD; Juan P. Gulin, MD; David T. Felson, MD
JAMA. 2000; 283:1469-1475.
Context Glucosamine and chondroitin preparations are widely touted in the lay press as remedies for osteoarthritis (OA), but uncertainty about their efficacy exists among the medical community.
Objective To evaluate benefit of glucosamine and chondroitin preparations for OA symptoms using meta-analysis combined with systematic quality assessment of clinical trials of these preparations in knee and/or hip OA.
Data Sources We searched for human clinical trials in MEDLINE (1966 to June 1999) and the Cochrane Controlled Trials Register using the terms osteoarthritis, osteoarthrosis, degenerative arthritis, glucosamine, chondroitin, and glycosaminoglycans. We also manually searched review articles, manuscripts, and supplements from rheumatology and OA journals and sought unpublished data by contacting content experts, study authors, and manufacturers of glucosamine or chondroitin.
Study Selection Studies were included if they were published or unpublished double-blind, randomized, placebo-controlled trials of 4 or more weeks' duration that tested glucosamine or chondroitin for knee or hip OA and reported extractable data on the effect of treatment on symptoms. Fifteen of 37 studies were included in the analysis.
Data Extraction Reviewers performed data extraction and scored each trial using a quality assessment instrument. We computed an effect size from the intergroup difference in mean outcome values at trial end, divided by the SD of the outcome value in the placebo group (0.2, small effect; 0.5, moderate; 0.8, large), and applied a correction factor to reduce bias. We tested for trial heterogeneity and publication bias and stratified for trial quality and size. We pooled effect sizes using a random effects model.
Data Synthesis Quality scores ranged from 12.3% to 55.4% of the maximum, with a mean (SD) of 35.5% (12%). Only 1 study described adequate allocation concealment and 2 reported an intent-to-treat analysis. Most were supported or performed by a manufacturer. Funnel plots showed significant asymmetry (P .01) compatible with publication bias. Tests for heterogeneity were nonsignificant after removing 1 outlier trial. The aggregated effect sizes were 0.44 (95% confidence interval [CI], 0.24-0.64) for glucosamine and 0.78 (95% CI, 0.60-0.95) for chondroitin, but they were diminished when only high-quality or large trials were considered. The effect sizes were relatively consistent for pain and functional outcomes.
Conclusions Trials of glucosamine and chondroitin preparations for OA symptoms demonstrate moderate to large effects, but quality issues and likely publication bias suggest that these effects are exaggerated. Nevertheless, some degree of efficacy appears probable for these preparations.
Author Affiliation: The Arthritis Center, Boston University School of Medicine, Boston, Mass.
March 15, 2000
Alerta
A condroitina com suas associações químicas tem sido usada como uma panacéia, como medicamento de cura para todos os problemas de cartilagens, no esporte e no envelhecimento. Infelizmente virou moda, é usado para pacientes reumáticos que equivocadamente tem ingerido grandes quantidades destes medicamentos numa triste ilusão. Pois perdem o tempo e deixam de tomar medicamentos apropriados, continuam sob intensa produtividade de agentes agressores físicos,dai constatam que suas deformidades aumentaram ! Desde o início experimental da condroitina com suas associações na decada de 90 nos USA, tenho acompanhado seus verdadeiros "falsos milagres", o pior de todas é a coincidência de alterações renais em muitos atletas de idades variadas que tem sido encaminhados para os centros de cuidados renais.
A Systematic Quality Assessment and Meta-analysis
Timothy E. McAlindon, DM; Michael P. LaValley, PhD; Juan P. Gulin, MD; David T. Felson, MD
JAMA. 2000; 283:1469-1475.
Context Glucosamine and chondroitin preparations are widely touted in the lay press as remedies for osteoarthritis (OA), but uncertainty about their efficacy exists among the medical community.
Objective To evaluate benefit of glucosamine and chondroitin preparations for OA symptoms using meta-analysis combined with systematic quality assessment of clinical trials of these preparations in knee and/or hip OA.
Data Sources We searched for human clinical trials in MEDLINE (1966 to June 1999) and the Cochrane Controlled Trials Register using the terms osteoarthritis, osteoarthrosis, degenerative arthritis, glucosamine, chondroitin, and glycosaminoglycans. We also manually searched review articles, manuscripts, and supplements from rheumatology and OA journals and sought unpublished data by contacting content experts, study authors, and manufacturers of glucosamine or chondroitin.
Study Selection Studies were included if they were published or unpublished double-blind, randomized, placebo-controlled trials of 4 or more weeks' duration that tested glucosamine or chondroitin for knee or hip OA and reported extractable data on the effect of treatment on symptoms. Fifteen of 37 studies were included in the analysis.
Data Extraction Reviewers performed data extraction and scored each trial using a quality assessment instrument. We computed an effect size from the intergroup difference in mean outcome values at trial end, divided by the SD of the outcome value in the placebo group (0.2, small effect; 0.5, moderate; 0.8, large), and applied a correction factor to reduce bias. We tested for trial heterogeneity and publication bias and stratified for trial quality and size. We pooled effect sizes using a random effects model.
Data Synthesis Quality scores ranged from 12.3% to 55.4% of the maximum, with a mean (SD) of 35.5% (12%). Only 1 study described adequate allocation concealment and 2 reported an intent-to-treat analysis. Most were supported or performed by a manufacturer. Funnel plots showed significant asymmetry (P .01) compatible with publication bias. Tests for heterogeneity were nonsignificant after removing 1 outlier trial. The aggregated effect sizes were 0.44 (95% confidence interval [CI], 0.24-0.64) for glucosamine and 0.78 (95% CI, 0.60-0.95) for chondroitin, but they were diminished when only high-quality or large trials were considered. The effect sizes were relatively consistent for pain and functional outcomes.
Conclusions Trials of glucosamine and chondroitin preparations for OA symptoms demonstrate moderate to large effects, but quality issues and likely publication bias suggest that these effects are exaggerated. Nevertheless, some degree of efficacy appears probable for these preparations.
Author Affiliation: The Arthritis Center, Boston University School of Medicine, Boston, Mass.
March 15, 2000
Alerta
A condroitina com suas associações químicas tem sido usada como uma panacéia, como medicamento de cura para todos os problemas de cartilagens, no esporte e no envelhecimento. Infelizmente virou moda, é usado para pacientes reumáticos que equivocadamente tem ingerido grandes quantidades destes medicamentos numa triste ilusão. Pois perdem o tempo e deixam de tomar medicamentos apropriados, continuam sob intensa produtividade de agentes agressores físicos,dai constatam que suas deformidades aumentaram ! Desde o início experimental da condroitina com suas associações na decada de 90 nos USA, tenho acompanhado seus verdadeiros "falsos milagres", o pior de todas é a coincidência de alterações renais em muitos atletas de idades variadas que tem sido encaminhados para os centros de cuidados renais.
Os não comprovados benefícios do uso destas substâncias tem somente ocasionado o enriquecimento da industria internacional e nacional, algumas até de fundo de quintal que descarregam os maléficos resultados deste sugestivo placebo.
o alerta tem sido dado há alguns anos em nosso centro de recuperação e treinamento,
onde há centenas de casos que após anos de uso destes medicamentos nada mais obtiveram que doenças associadas no sistema gastrointestinal, queda de cabelo, alterações funcionais urinárias. Deve se manter uma rígida observação sobre os verdadeiros efeitos de milhares de medicamentos que mesmo quando aprovados ou não pelo fda, coincidem com muitas perdas físicas e emocionais de milhares de pessoas.
Os prejuízos e danos a saúde do atleta mais ou menos jovens são agravado quando por inúmeras razões da corrida contra o envelhecimento ou ação inexorável do tempo, como dos efeitos desastrosos de treinamentos físicos e esportivos inadequados. Estas pessoas associam a condroitina com alguns anti inflamatórios,ou com aplicações de cortisona intra e extra articulares, ou com injeções para "melhorar" a viscosidade e elasticidade de algumas articulações. Tem ocasionado febres, inchaços, taquicardia, alterações da pressão arterial, precordialgias, alterações respiratórias,alergias,rash, alterações renais,alterações severas vasculares periféricas e até desmaios.
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