Article Most Likely to Change Clinical Practice - Week Ending Oct 8th, 2010

Glucosamine and Chondroitin either Separately or in Combination Appear to Lack Efficacy for Improving Pain in Osteoarthritis of Hip or Knee Glucosamine and chondroitin, alone and in combination, have become popular in recent years as both prescription and over-the-counter supplements for joint pain. A recent systematic review of 10 randomized trials evaluated their efficacy in 3,803 patients with hip or knee osteoarthritis. The review excluded trials with fewer than 100 patients in each arm. Neither supplement was found to produce clinically significant reductions in pain in any formulation (level 2 [mid-level] evidence). In all studies, pain was measured on a 10 cm visual analog scale, with a change of > 0.9 cm deemed clinically significant. The mean reductions compared to placebo were 0.4 cm (95% CI -0.7 to -0.1 cm) for glucosamine alone in analysis of 7 trials, 0.3 cm (95% CI -0.7 to 0 cm) for chondroitin alone in analysis of 4 trials, and 0.5 cm (95% CI -0.9 to 0 cm) for the combination in 1 trial. There were no significant differences in adverse events in comparisons of either drug to placebo (BMJ 2010 Sep 16;341:c4675 full-text). In an earlier review of 25 randomized trials with significant statistical heterogeneity, there was inconsistent evidence for pain relief with glucosamine, but there was no significant improvement in analysis of 11 trials that had adequate allocation concealment (Cochrane Database Syst Rev 2009 Oct 7;(4):CD002946). For more information, see the Degenerative joint disease of the hip andDegenerative joint disease of the knee topics in DynaMed.