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Chondroitin sulphate for osteoarthritis

 

Clinical bottom line

Chondroitin sulphate given orally was found to be effective in reducing pain, improving function, and reducing NSAID and analgesic consumption in seven randomised double-blind trials involving 702 patients with osteoarthritis of hip or knee over three months or more.


Chondroitin sulphate described complex molecules found in cartilage. Like glucosamine , this has been considered as a possible modifier of symptoms in osteoarthritis, though mechanisms are not understood, nor doses well worked out, nor pharmaceutical standards available.

Reference

BF Leeb et al. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol 2000 27: 205-211.

Review

Searching of several electronic databases was for randomised, double-blind studies of chondroitin sulphate in osteoarthritis of hip or knee. Outcomes of interest were: Lequesne index, patient or physician global evaluation, pain, or walking time, or NSAID or analgesic drug use. Baseline characteristics had to show that patient characteristics were homogeneous.

Results

Information on 16 studies was available, but only seven of these, with 702 patients, were included in the meta-analysis. All were comparisons with placebo, in which additional analgesic drugs could be used. Doses were 800-1200 mg a day.

Pain and Lequesne index fell from baseline over 30 to 180 days in both groups, but the decreases were always greater for chondroitin sulphate than for placebo. These differences were statistically significant after two to four months, and by six months the level of significance was very high (a chance result had a likelihood of less than 1 in 200).

In all trials patients and/or physicians rated chondroitin sulphate better than placebo.

In all trials chondroitin sulphate resulted in a significant reduction in NSAID or analgesic use, and this was much more marked than for placebo.

Adverse events were reported more frequently with placebo than with chondroitin sulphate.

Comment

This is a nice review of a complicated area. The number of trials and patients are limited, but the results for all outcomes point decidedly in the direction that chondroitin sulphate was superior to placebo. The limitations on what type of chondroitin sulphate, and what dose, limit the general applicability of the review, but it is at least a start in answering the question about whether chondroitin sulphate is any use in osteoarthritis. Like glucosamine, the answer seems to be that it is.