Glucosamine Sulfate and Chondroitin Sulfate for the Treatment of Osteoarthritis

Young Ho Lee; Jong Dae Ji; Gwan Gyu Song

doi:10.4078/jkra.2008.15.3.179

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Lee, Ji, and Song: Glucosamine Sulfate and Chondroitin Sulfate for the Treatment of Osteoarthritis

Original Article

J Korean Rheum Assoc 2008;15(3):197-203.

Published online: 20 September 2008

DOI: https://doi.org/10.4078/jkra.2008.15.3.179

Glucosamine Sulfate and Chondroitin Sulfate for the Treatment of Osteoarthritis

Young Ho Lee, Jong Dae Ji, Gwan Gyu Song

Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea

Received 29 August 2008 Accepted 4 September 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Osteoarthritis (OA) is the most common form of arthritis often associated with morbidity, disability, functional impairment and impaired quality of life. A new perspective in OA management is to delay disease progression by modifying joint structure. Glucosamine sulfate (GS) and chondroitin sulfate (CS) have attracted a lot of interest as a specific drug for OA. Glucosamine is a constituent of glcosaminoglycans in cartilage matrix and synovial fluid and is involved in cartilage formation. Chondroitin sulfate (CS) belongs to the glycosaminoglycan group and is a major component of the articular cartilage. The meta-analyses have shown that GS (but not glucosamine hydrochloride) and CS have small-to-moderate symptomatic efficacy in OA. With respect to the structure-modifying effect, there is some evidence that GS and CS may interfere with structural progression of OA.

Keywords: Glucosamine, Chondroitin, Osteoarthritis

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Fig. 1.

Meta-analysis on the symptomatic efficacy of glucosamine in osteoarthritis.

Fig. 2.

Standard difference in means and 95% CI of individual studies and pooled data for structural effect of glucosamine sulfate on minimum JSN of knee OA at follow-up period of 1 yr (A) and 3 yrs (B).

Table 1.

Characteristics of individual studies on the structural efficacy of glucosamine sulfate and chondroitin sulfate in patients with osteoarthritis

Study^Ref Dose Age∗ Sex (%) BMI (kg/m²) Drop rate (%)^Numbers OA C OA C OA C OA C OA C	Follow-up period	Variables analyzed	ITT analysis	Quality score
Pavelka et al. 2002¹⁴ GS 1,500 mg once a day 61.2 (7.3) 63.5 (6.9) 80 (79) 77 (76) 25.7 (2.1) 25.7 (1.8)34.6 45.5 101 101	3 yrs	Minimum JSN Severe narrowing	Yes	5
Reginster et al. 2001¹³ GS 1,500 mg once a day 66.0 (8.1) 65.5 (7.5) 79 (75) 83 (78) 27.3 (2.6) 27.4 (2.7)33.0 35.8 106 106	3 yrs	Minimum JSN, Mean JSN Severe narrowing	Yes	5
Kahan et al. 2006²⁰ CS 800 mg once a day NA NA 68 68 NA NA 30.1 25.6 309 313	2 yrs	Mean JSN	Yes	NA
Michel et al. 2005²¹ CS 800 mg once a day 62.5 (9.1) 63.1 (10.7) 76 (51) 78 (52) 27.7 (5.2) 28.1 (5.5)26.6 27.3 150 150	2 yrs	Minimum JSN, Mean JSN	Yes	5
CS 800 mg 2 periods of 3 m during 1 yr Ubelhart-1 et al. 2004²³ 63.2 (9.1) 63.7 (8.1)79.6 82.1 NA NA 28.3 31.6 60 60	1 yr	Minimum JSN, Mean JSN	Yes	3
CS 400×2 mg a day Ubelhart-2 et al. 1998²² 6,013 5,711 47.8 56.5 NA NA 8.7 8.7 23 23	1 yr	Minimum JSN, Mean JSN	No	3

Ref: Reference, OA: Rheumatoid arthritis, C: Control, ITT: Intention-to-treat, GS: Glucosamine sulfate, CS: Chondroitin sulfate, NA: Not available, JSN: Joint space narrowing ∗Mean (Standard deviation)

Table 2.

Meta-analysis of the structural effects of glucosamine sulfate and chondroitin sulfate on cartilage in osteoarthritis

			Test of association			Test of heterogeneity
Drug	Group	No. of Studies	Std diff in means	95% CI	p-val	Model	Q	p-val	I2
Glucosamine sulfate	Follow-up for 1 yrs Follow-up for 3 yrs JSN＞0.5 mm	2 2 2	0.078 0.432 0.361^∗	−0.116∼0.273 0.235∼0.628 0.204∼0.640	0.429 0.000 0.000	FFF	1.14 0.03 0.05	0.284 0.848 0.810	12.7 0 0
	Minimum JSW	3	0.317	0.136∼0.497	0.001	F	2.14	0.342	6.9
Chondroitin sulfate	e Mean JSW Follow-up for 1 yrs	4 2	0.236 0.295	0.148∼0.386 0.000∼0.590	0.000 0.050	FF	0.07 0.00	0.995 0.965	0 0
	Follow-up for 2 yrs	2	0.261	0.131∼0.392	0.000	F	0.02	0.864	0

^∗ Odds ratio F: fixed effect model, R: random effect model, JSW: Joint space width, JSN: Joint space narrowing

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