Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: A randomized, controlled trial

Abstract

Objective. To determine whether chondroitin sulfate (CS) is effective in inhibiting cartilage loss in knee osteoarthritis (OA).Methods. In this randomized, double-blind, placebo-controlled trial, 300 patients with knee OA were recruited from an outpatient clinic, from private practices, and through advertisements. Study patients were randomly assigned to receive either 800 mg CS or placebo once daily for 2 years. The primary outcome was joint space loss over 2 years as assessed by a posteroanterior radiograph of the knee in flexion; secondary outcomes included pain and function.Results. Of 341 patients screened, 300 entered the study and were included in the intent-to-treat analysis. The 150 patients receiving placebo had progressive joint space narrowing, with a mean ؎ SD joint space loss of 0.14 ؎ 0.61 mm after 2 years (P ‫؍‬ 0.001 compared with baseline). In contrast, there was no change in mean joint space width for the 150 patients receiving CS (0.00 ؎ 0.53 mm; P not significant compared with baseline). Similar results were found for minimum joint space narrowing. The differences in loss of joint space between the two groups were significant for mean joint space width (0.14 ؎ 0.57 mm; P ‫؍‬ 0.04) and for minimum joint space width (0.12 ؎ 0.52 mm; P ‫؍‬ 0.05). CS was well tolerated, with no significant differences in rates of adverse events between the two groups. Conclusion.While there was no significant symptomatic effect in this study, long-term treatment with CS may retard radiographic progression in patients with OA of the knee. However, the clinical relevance of the observed structural results has to be further evaluated, and further studies are needed to confirm the structural effects of CS.

Efficacy of Chondroitin Sulfate for Painful Knee Osteoarthritis: A One-Year, Randomized, Double-Blind, Multicenter Clinical Study in Japan

“…[4][5][6][7][28][29][30][31] Recently, various biomarkers have been developed to detect the articular alterations in OA, and accumulating evidence suggests that there are associations with changes in ECM protein components in the cartilage and synovium as disease progresses in knee OA. 45,46) Finding the level of COMP in serum allows defining the degree of cartilage damage in OA 47,48) and observing effectiveness of the treatment.…”

“…Only a few medications have been recognized by clinical trials as potentially influencing the course of OA beneficially. These include chondroitin sulfate (CS), [4][5][6][7] glucosamine, [8][9][10] diacerein, 11) doxycycline (an antibiotic belonging to the tetracycline family), 12) cyclooxygenase/5-lipoxygenase inhibitors, 13) and intra-articular injections of hyaluronic acid (HA). These approaches, however, have frequently produced insufficient benefit and excess risk of adverse effects.…”

“…[25][26][27] Furthermore, the clinical efficacy of CS has been shown in improving OA joint function and in reducing cartilage destruction. [4][5][6][7][28][29][30] Singh et al recently conducted a review of randomized trials of OA interventions in the Cochrane Database of Systemic Reviews and concluded that CS may improve pain, that it probably improves QOL, and that it probably slows down narrowing of the joint space in patients with knee OA. 31) However, there have also been reports showing no effects of CS on pain or cartilage structure.…”

“…31) However, there have also been reports showing no effects of CS on pain or cartilage structure. 6,32,33) It is possible that differences in disease severity among patients caused the discrepancy in the effect of CS on OA symptoms among studies. The large-scale study by Clegg et al 34) showed that the combination of CS and glucosamine was not effective on pain for all patients (mild-to-severe pain) when using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), but in post-hoc subgroup analyses showed that it was effective for patients with moderate-to-severe pain according to the WOMAC score.…”

The place of chondroprotectors in the treatment of osteoarthritis of the spine

“…В другой части исследований был проанализирован структурно-модифицирующий эффект ХС у больных с остеоартрозом коленных суставов. В двухгодичном двойном слепом ран-домизированном исследовании с оценкой динамики суже-ния суставной щели у 300 пациентов с гонартрозом, при-нимавших ХС в суточной дозе 800 мг или плацебо (по 150 больных в каждой группе), отмечено, что в группе ХС наблюдалось значимое замедление прогрессирования гонартроза: ширина суставной щели (как минимальная, так и средняя) в конце исследования статистически не отлича-лась от исходной величины в отличие от группы плацебо [39]. В одном из недавно завершенных исследований с участием 600 пациентов с манифестным остеоартрозом коленных суставов, которые в течение 2 лет получали ком-бинированную терапию глюкозамином и ХС, структурно-модифицирующий эффект оценивался с помощью МРТ.…”