Clinical Scenario A 75-year-old o...

Clinical Scenario

A 75-year-old obese woman readys with chronic, severe knee pain from osteoarthritis. She would like to know whether glucosamine sulfate therapy is beneficial.

Clinical Question

Is glucosamine sulfate safe and effective for osteoarthritis?

Evidence-Based Answer

This review (1) indicates that, compared with placebo, glucosamine sulfate breeds a moderate, clinically significant reduction in pain and improvement in function for patients with osteoarthritis. However, close attention results were not consistent. in the greatest degree studies in the review used preparations of glucosamine sulfate marketed in Europe by the agency of Rotta pharmaceutical company. Subgroup analysis showed that the Rotta preparation had benefit through the whole extent of placebo, whereas non-Rotta preparations did not. Glucosamine does not cause more side forces than placebo. (1)

Practice Pointers

Osteoarthritis is the chiefly common arthritis, affecting an estimated 121 percent of Americans 25 years and older (1) Therapy includes nonpharmacologic interventions as it was as weight loss, physical and occupational therapy, and surgery Medication options include acetaminophen, nonsteroidal anti-inflammatory remedys (NSAIDs), intra-articular injections, opiates, and glucosamine sulfate. (2) Glucosamine exists naturally in the corpse as a building block of cartilage.

This review (1) is an update of a Cochrane review published in 2000 (3) That review of 16 studies (with a total of 2029 patients) demonstrated that patients who took 1500 mg of glucosamine sulfate by day for six weeks had a 60 percent improvement from baseline in pain and a 33 percent improvement in function. (3) The update, (1) which included single the higher quality studies and eight fresh studies (2,570 patients), showed les consistent and somewhat les favorable deductions regarding improvement in pain and function with use of glucosamine sulfate for sum of two units to three months. (1)

The Rotta pharmaceutical company sponsored 65 percent of the studies in the updated review. Studies of the Rotta prescription preparation revealed significant improvements across placebo in pain and in the Lequesne function index, on the contrary not in the WOMAC pain, stiffness, and function indices. Non-Rotta preparations showed no benefit athwart placebo in any of the three issue measures. Because glucosamine sulfate is not a prescription unsalable article in North America, it is not regulated; therefore, the purity and contented can vary greatly. (4,5) united study (4) of glucosamine and chondroitin correlatives showed that label claims differed from the actual peace by up to 115 percent The Rotta pharmaceutical company brand is available in the United States and from prescription in European countries.

couple studies of the radiologic progression of osteoarthritis set up that this was slowed according to glucosamine over a three-year period. However, the clinical significance of this finding remains uncertain. The authors did not compare the drifts of glucosamine on patients with osteoarthritis of different on a levels of severity and duration, brace factors that might affect replication to glucosamine.

The safety profile of glucosamine is superior to that of NSAIDs and similar to placebo. In single study, (6) 88 percent of patients had no adverse effects; in the remaining patients, the majority of side issues were gastrointestinal and resolved onward discontinuation of glucosamine. Concerns have been raised about whether glucosamine causes abnormal grape-sugar metabolism, asthma, hypersensitivity, or arteriosclerosis; there is no evidence to support these concerns

REFERENCES

(1) Towheed TE Maxwell L Anastassiades TP Shea B Houpt J Robinson V et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005;(2):CD002946

(2) Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American association of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum 2000;43:1905-15

(3) Towheed TE Anastassiades TP Shea B Houpt J Welch V Hochberg MC Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2000;(2): CD002946

(4) Adebowale AO, Cox D Liang Z Eddington ND Analysis of glucosamine and chondroitin sulfate satisfy in marketed products and the caco-2 permeability of chondroitin sulfate raw materials. J Am Nutraceutical Assoc 2000;3:37-44

(5) Russell AS, Aghazadeh-Habashi A, Jamali F Active ingredient consistency of commercially available glucosamine sulfate works J Rheumatol 2002;29:2407-9.

(6) Tapadinhas MJ Rivera IC, Bignamini AA. Oral glucosamine sulphate in the management of arthrosis: report in succession a multi-centre open investigation in Portugal. Pharmatherapeutica 1982;3:157-68

CHEN GATTI, MD heavenly-minded Cross Hospital Home Care and Hospice, Silver Spring, Maryland

JASMINE CHEN GATTI, MD is inpatient hospice medical director at godly Cross hospital home Care and hospice in silver spring, Md where she is also a family practitioner and geriatrician. she complet a combined fellowship in Australasian Cochrane Collaboration and Medical Education at the Australasian Cochrane midst Adelaide, Australia.