Very near
to the end of the ACR 2013 Meeting in San Diego I went to a Satellite Symposium
with the full title of "Prognosis and Treatment of Knee Osteoarthritis
Update 2013". Let's have a closer look at some of the data presented at
this event.
V. Byers
Kraus presented a cell study that concluded: "Chondroitin sulfate ...
suggesting that it may inhibit an inflammasome component, assembly, or action"
and "this mechanism may also play a role in Osteoarthritis ...“ Too much
suggesting and may!
J.
Martel-Pelletier presented: "Effects of Glucosamine and Chondroitin
Sulfate on Knee Osteoarthritis Structural Changes over Time: Data from the OAI
Cohort". It isn't a blinded trial but retrospective data was used. Out of
1300 patients 600 were selected. The presentation showed charts with an extreme
amount of numbers. Comparing joint space width (JSW) in patients not taking
analgesics two parameters showed a significant difference, but ... 13 other
parameters didn't show a significant difference! If you looked at MRI changes
and JSW you also had some effects, but these were different, when examined at
12 and at 24 months! Conclusion: "Data from this study provide support for
the structure-modifying effects of Glu/CS combination in knee osteoarthritis
subjects. [...]". Please no; these effects are more likely to be due to
chance. Besides, how can you tell if people taking glucosamine and chondroitin
sulfate aren't more health orientated and do more exercises, change diet, and
so on?
C.W. Wu
presented a study on oral hyaluronic acid for the treatment of osteoarthritis
knee pain. The study was small sized and of 51 patients only 40 completed the
study. The WOMAC has been non significant or even identical at month 2 and
conveniently made a big leap in the next four months to show a significant
difference; now explanation for this inconsistent data. A comparison between
hyaluronic acid turnover in placebo and verum group has been made, but only in
nine placebo patients and ten verum patients. I'd be more careful with
conclusions on this set of data. A test on 12 cytokines and chemokines has been
done, placebo had an increase and verum a decrease in ALL parameters, but no
values were given. Role of each in osteoarthritis? Significant changes or not?
There were
other studies, but only on comorbidities, drug utilization, and a DNA-based
test.
I don't
think that the studies, which I've outlined above, prove anything that warrant the use of glucosamine and/or chondroitin sulfate in knee osteoarthritis. Or maybe
they prove indirectly how in vain the drug companies try to find something to
base their advertisements on.
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