BACKGROUND: Osteoarthritis (OA) is a disorder involving deterioration of articular cartilage and underlying bone and is associated with symptoms of pain and disability. Glucosamine is a component of articular cartilage naturally synthesized in the body from glucose and incorporated into substances contained in the cartilage. It has been suggested that consumption of glucosamine may reduce the pain of OA and may have favorable effects on structural changes in the cartilage. This article presents a systematic review and meta-analysis of the effectiveness of orally consumed glucosamine sulfate (GS) on OA-related pain and joint structural changes.
METHODS: PubMed and Ovid Embase were searched using specific search terms to find randomized, double-blinded, placebo-controlled trials on the effects of GS on pain and/or joint-space narrowing. The outcome measure was the standardized mean difference (SMD), which was the improvement in the placebo groups minus the improvement in the GS groups divided by the pooled standard deviation.
RESULTS: There were 17 studies meeting the review criteria for pain, and the summary SMD was -0.35, with a 95% confidence interval (95% CI) = -0.54 to -0.16 (negative SMD is in favor of GS). Of the 17 studies, 7 showed a statistically significant reduction in pain from GS use. Four studies met the review criteria for joint space narrowing with a summary SMD = -0.10 (95% CI = -0.23 to +0.04). Studies without involvement of the commercial glucosamine industry had a lower (but still significant) pain reduction efficacy (summary SMD = -0.19, 95% CI = -0.39 to -0.02) than those with industry involvement. Several smaller dosages throughout the day had larger pain reduction effects than a single daily large dose (1500 mg).
CONCLUSION: These data indicate that GS may have a small to moderate effect in reducing OA-related pain but little effect on joint-space narrowing. Until there is more definitive evidence, healthcare providers should be cautious in recommending use of GS to their patients. Because GS dosages used in studies to date resulted in mild and transient adverse effects, and these were similar to that experienced by patients receiving placebos, larger GS doses possibly could be investigated in future studies.
Osteoarthritis (OA) of the knee is one of the main causes of mobility decline in the elderly. Non-surgical treatments such as administration of supplements to strengthen the joint cartilage matrix have become popular not only for pain relief but also for joint preservation. Glucosamine has been used in many countries based on the increasing evidence of its effectiveness for OA. Although there are many previous studies and systematic reviews, the findings vary and different conclusions have been drawn. We aimed to review recent randomized controlled trials on glucosamine for knee OA to reveal up-to-date findings about this supplement. We also performed a meta-analysis of some of the outcomes to overcome the unsolved bias in each study. Eighteen articles written between 2003 and 2016 were analyzed. Many used visual analogue scale (VAS) pain scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which were assessed in our meta-analysis. We found a marginally favorable effect of glucosamine on VAS pain scores. The effect on knee function, as measured by the WOMAC, was small and not significant. A newly established knee OA scale, the Japanese Knee Osteoarthritis Measure (JKOM), is commonly used in Japan. Although the number of subjects was small, the JKOM meta-analysis indicated that glucosamine is superior to a placebo in alleviating knee OA symptoms. Given this, we concluded that glucosamine has the potential to alleviate knee OA pain. Further studies are needed to evaluate the effect of glucosamine on knee function and joint preservation, as well as to evaluate the combined effect with other components, such as chondroitin.
ANTECEDENTES: Para llevar a cabo una revisión sistemática y metanálisis en red de ensayos controlados aleatorizados (RCTs) con el objetivo de comparar resultados clínicos relevantes (es decir, las escalas visuales análogas (EVA), puntajes totales y parciales de Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), índice de Lequesne, cambio en el amplitud del espacio articular, y eventos adversos) entre diacereína, la glucosamina y el placebo.
MÉTODOS: Las bases de datos Medline y Scopus fueron revisadas desde su inicio hasta el 29 de agosto de 2014, usando los motores de búsqueda de PubMed y Scopus e incluyeron RCTs o diseños cuasi-experimentales que comparasen los resultados clínicos entre los tratamientos. Los datos fueron extraídos de los estudios originales. Un metanálisis en red fue realizado aplicando de regresión ponderada para variables continuas y una regresión de Poisson de efectos mixtos para los resultados dicotómicos.
RESULTADOS: Treinta y uno de los 505 estudios identificados eran elegibles. En comparación con el placebo, la glucosamina mostró una mejoría significativa con diferencias de medias no estandarizadas (UMD) en WOMAC total, WOMAC de dolor, WOMAC de funciòn y score de Lequesne de -2,49 (intervalo de confianza del 95% (IC) -4.14, -0.83), -0,75 ( IC del 95%: -1,18, -0,32); IC -4,78 (95%: -5,96, -3,59) y -1,03 (IC del 95%: -1,34, -0,72), respectivamente. Diacereína mejora clínicamente puntajes en escala visual análogas, WOMAC de función y WOMAC de rigidez con valores UMD de -2,23 (IC del 95%: -2,82, -1,64), (IC del 95%: -10,50, -2,78) -6,64 y -0,68 (95 % IC: -1,20, -0,16) comparado con placebo.
CONCLUSIONES: El metanálisis en red sugiere que la diacereína y la glucosamina son igualmente eficaces para el alivio sintomático de la artrosis de rodilla, pero que el primero tiene más efectos secundarios.
OBJETIVO: Determinar las eficacias de diferentes preparaciones de glucosamina para el tratamiento de la artrosis (OA).
MÉTODOS: búsquedas sistemáticas de las bases de datos bibliográficas MEDLINE, EMBASE, el Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials, CENTRAL) y la Base de Datos Cochrane de Revisiones Sistemáticas por ensayos aleatorios, doble ciego, controlados con placebo (RCTs) sobre el tratamiento de glucosamina de la OA. Tamaño del efecto (ES) se estimó mediante la diferencia de media estandarizada de Cohen. La consistencia se evaluó a través de la índice I(2).
RESULTADOS: Diecinueve ensayos (3159 pacientes) contribuyeron al metanálisis, que revela un alto grado de inconsistencia entre los ensayos en términos de resultados de reducción de dolor: el ES combinado en ensayos de sulfato de glucosamina (GS) fue -0,22 [intervalo de confianza del 95% (CI) -0,48, 0,04], I(2) de 82,3%. El ES combinado en ensayos con hidrocloruro de glucosamina (GH) fue -0,03 (IC del 95% -0,14, 0,08), con una ausencia de heterogeneidad. Ningún ES en tratamiento mostró ES [-0,38 (IC del 95% -0.99, 0.23)] favorecer GS en los ensayos de menos de 24 semanas de duración y el I (2) se mantuvo alto (I (2) = 88,5%). Ningún ES de tratamiento fue seginificativo -0,09 (IC del 95%: -0,21, 0,03) en los ensayos de más de 24 semanas de duración en comparación con el placebo, con una heterogeneidad de cero. En términos de resultados de modificación de funcionalidad, GS no mostró ningún efecto significativo en la reducción del Índice de Lequesne frente a placebo en los ensayos de menos de 24 semanas de duración (ES -0,55 (IC del 95% -1.22, 0.11)) con un alto grado de heterogeneidad (I (2) = 92,9%). El agrupamiento de los datos de estudios con una duración de más de 24 semanas presentó un significativo ES combinado de -0,36 (IC del 95%: -0,56, -0,17) con una ausencia de heterogeneidad. No se detectaron riesgo de sesgo de publicación mediante la prueba de Egger.
CONCLUSIONES: GH no es eficaz para la reducción del dolor en pacientes con artrosis de rodilla. GS puede tener efectos modificadores de la función en pacientes con artrosis de rodilla cuando se administra durante más de 6 meses. Sin embargo, no mostró beneficios de reducción de dolor después de 6 meses de terapia.
Osteoarthritis (OA) is a disorder involving deterioration of articular cartilage and underlying bone and is associated with symptoms of pain and disability. Glucosamine is a component of articular cartilage naturally synthesized in the body from glucose and incorporated into substances contained in the cartilage. It has been suggested that consumption of glucosamine may reduce the pain of OA and may have favorable effects on structural changes in the cartilage. This article presents a systematic review and meta-analysis of the effectiveness of orally consumed glucosamine sulfate (GS) on OA-related pain and joint structural changes.
METHODS:
PubMed and Ovid Embase were searched using specific search terms to find randomized, double-blinded, placebo-controlled trials on the effects of GS on pain and/or joint-space narrowing. The outcome measure was the standardized mean difference (SMD), which was the improvement in the placebo groups minus the improvement in the GS groups divided by the pooled standard deviation.
RESULTS:
There were 17 studies meeting the review criteria for pain, and the summary SMD was -0.35, with a 95% confidence interval (95% CI) = -0.54 to -0.16 (negative SMD is in favor of GS). Of the 17 studies, 7 showed a statistically significant reduction in pain from GS use. Four studies met the review criteria for joint space narrowing with a summary SMD = -0.10 (95% CI = -0.23 to +0.04). Studies without involvement of the commercial glucosamine industry had a lower (but still significant) pain reduction efficacy (summary SMD = -0.19, 95% CI = -0.39 to -0.02) than those with industry involvement. Several smaller dosages throughout the day had larger pain reduction effects than a single daily large dose (1500 mg).
CONCLUSION:
These data indicate that GS may have a small to moderate effect in reducing OA-related pain but little effect on joint-space narrowing. Until there is more definitive evidence, healthcare providers should be cautious in recommending use of GS to their patients. Because GS dosages used in studies to date resulted in mild and transient adverse effects, and these were similar to that experienced by patients receiving placebos, larger GS doses possibly could be investigated in future studies.
