Glucosamine for Knee Osteoarthritis
Knee osteoarthritis is a common condition causing pain and limited function. This study explores the effectiveness of glucosamine sulphate tablets in reducing symptoms and improving function in adults with knee osteoarthritis. Cochrane reviews indicate a modest improvement in pain and function compared to placebo, with some formulations showing potential in slowing radiological progression of the disease. Overall, glucosamine appears to be a safe treatment option with minimal adverse reactions.
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Presentation Transcript
Osteoarthritis: A pain in the ...KNEE Emma Thomas June 2017
Osteoarthritis Knee osteoarthritis affects 4.1million people in the UK (6.7 million including other joints) Significant associated morbidity Additional secondary morbidity? Cost estimated to be around 30 billion
Clinical scenario 65 year old gentleman Known knee osteoarthritis Worsened by physical activity and pain limiting function would like to be able to go on a hiking holiday Wondered if glucosamine tablets would help? Decided to check the evidence...
Question Population: Adults with knee osteoarthritis Intervention: Glucosamine sulphate tablets Control: No supplement Outcome: Reduced symptom and improved function
Search strategy Glucosamine AND Arthritis OR osteoarthritis OR arthropathy OR osteoarthrosis AND Knee LIMIT: Human AND English Language DATABASES: Cochrane, Medline (from 2008)
Cochrane Review Published 2001, updated 2005 and 2008 25 studies with 4963 patients RCTs only, those with inadequate allocation concealment not included Generalised osteoarthritis, not knee specific Various formulations of glucosamine sulphate (not just tablets) Databases: CENTRAL and the Cochrane Database of Systematic Reviews (The Cochrane Library), MEDLINE, PREMEDLINE, EMBASE, AMED, ACP Journal Club, DARE; contacted content experts, and handsearched reference lists and pertinent review articles.
Cochrane Review Collectively, 22% improvement in pain (SMD -0.47; 95% CI -0.72 to -0.23) and a 11% improvement in function compared to placebo using the Lequesne index (SMD -0.47; 95% CI -0.82 to -0.12) WOMAC pain, function and stiffness outcomes did not reach statistical significance compared to placebo RCTs in which the Rotta preparation of glucosamine was compared to placebo found glucosamine superior for pain (SMD -1.11; 95% CI -1.66 to -0.57) and function (Lequesne index SMD -0.47; 95% CI -0.82 to -0.12) Two RCTs using the Rotta preparation showed that glucosamine was able to slow radiological progression of OA of the knee over a three-year period (mean difference (MD) 0.32; 95% CI 0.05 to 0.58) Glucosamine was as safe as placebo in terms of the number of participants reporting adverse reactions (relative risk ratio 0.99; 95% CI 0.91 to 1.07)
Glucosamine for knee osteoarthritis--what's new? Drug Ther Bull. 2008 Nov;46(11):81-4. doi: 10.1136/dtb.2008.10.0025. 2002: Concluded that unlicensed oral glucosamine sulphate 1,500 mg OD probably provides modest symptom relief in patients with osteoarthritis of the knee and its efficacy appears similar to that of NSAIDs update; moderate relief, safe (unless on warfarin) but probably not cost effective Glucosamine hydrochloride licensed as a medicine in the UK for symptomatic relief of mild to moderate osteoarthritis of the knee but no trials as yet so don t prescribe
No treatment effects of oral glucosamine for subgroups of knee and hip osteoarthritis patients; an individual patient data meta-analysis from the OA trial bank Runhaar, J. et al. Osteoarthritis and Cartilage, Volume 25 , S408 - S409, Apr 2017 21 eligible studies, 6 shared data with trial bank, 5 compared glucosamine with placebo No affect of glucosamine on pain or function in short or long term Stratification for site of OA or type of glucosamine did not alter outcomes
Clinical decision making Level 3 evidence Glucosamine sulphate is unlikely to do any harm, main side effects GI related or joint pain May improve pain and / or function Rotta preparation seems more likely to give benefit
Next step The real question is probably more complex Many more RCTs if you include comparators other than placebo Glucosamine hydrochloride has recently been licensed for use in the UK to improve pain and function in OA, but no trials yet Recent studies focus on glucosamine hydrochloride, generally in combination with chondroitin Recent cochrane review re chondroitin Also studies looking at reducing the risk of OA development rather than management
References Glucosamine therapy for treating osteoarthritis. Towheed T, Maxwell L, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC, Wells GA. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002946. DOI: 10.1002/14651858.CD002946.pub2 Glucosamine for knee osteoarthritis--what's new? Drug Ther Bull. 2008 Nov;46(11):81-4. doi: 10.1136/dtb.2008.10.0025. No treatment effects of oral glucosamine for subgroups of knee and hip osteoarthritis patients; an individual patient data meta-analysis from the OA trial bank Runhaar, J. et al. Osteoarthritis and Cartilage, Volume 25 , S408 - S409, Apr 2017
