Glucosamine and Chondroitin Use and Mortality Among Adults in the United States from 1999 to 2014

Introduction: Glucosamine and chondroitin are supplements that are often, but not always, used in combination for arthritis and joint pain. Multiple studies have suggested that glucosamine and chondroitin may be associated with reduced risk of several diseases, as well as all-cause, cancer- and respiratory disease-specific mortality. Methods: Nationally representative data from the National Health and Nutrition Examination Survey (NHANES) were used to further evaluate the association between glucosamine and chondroitin with mortality. Participants include 38,021 adults, ages 20+ years and older, who completed the detailed NHANES between 1999 and 2014. Participants were followed for death through linkage with the National Death Index through the end of 2015, over which time 4905 deaths occurred. Adjusted hazard ratios (HRs) for overall and cause-specific mortality were estimated using Cox regression models. Results: Despite glucosamine and chondroitin use appearing to be inversely associated with mortality in the minimally adjusted models, no association was observed in multivariable models (glucosamine: HR = 1.02; 95% confidence interval [CI]: 0.86-1.21, chondroitin: HR = 1.04, 95% CI: 0.87-1.25). No association with cancer mortality or other mortality rate was observed after multivariable adjustment. There was a suggestive, nonsignificant inverse association for cardiovascular-specific mortality (glucosamine HR = 0.72; 95% CI: 0.46-1.15, chondroitin: HR = 0.76; 95% CI: 0.47-1.21). Conclusion: The lack of significant relationship between glucosamine and chondroitin use and all-cause or cause-specific mortality after adjusting extensively for multiple covariates in this nationally representative adult population was in contrast to prior literature. Given the limited power to explore the cause-specific mortality, future well-powered studies will be needed to better understand the potential association with cardiovascular-specific mortality.

Chondroitin/Lactoferrin-dual functionalized pterostilbene-solid lipid nanoparticles as targeted breast cancer therapy

Breast cancer remains the leading cause of cancer-associated mortality in women. Research investigating novel therapeutic approaches is thus crucial, including phytotherapeutics. Pterostilbene (PTS) is a phytochemical agent with promising efficacy against breast cancer. Poor solubility, low bioavailability and chemical instability are major drawbacks compromising PTS functionality. Herein, novel PTS-loaded solid lipid nanoparticles (PTS-SLNs) were fabricated using the ultrasonication technique. Dual-functionalization with lactoferrin (Lf) and chondroitin-sulfate (CS; CS/Lf/PTS-SLNs) was adopted as active-targeting approach. CS/Lf/PTS-SLNs demonstrated nanoparticle-size (223.42 ± 18.71 nm), low PDI (0.33 ± 0.017), acceptable zeta potential (-11.85 ± 0.07 mV) and controlled release (72.93 ± 2.93% after 24 h). In vitro studies on triple-negative MDA-MB-231 revealed prominent cytotoxicity of CS/Lf/PTS-SLNs (2.63-fold IC50 reduction), higher anti-migratory effect and cellular uptake relative to PTS-solution. The in vivo anti-tumor efficacy in an orthotopic cancer model verified the superiority of CS/Lf/PTS-SLNs; achieving 2.4-fold decrease in tumor growth compared to PTS-solution. On the molecular level, CS/Lf/PTS-SLNs enhanced suppression of VEGF, down-regulated cyclin D1 and upregulated caspase-3 and BAX, compared to PTS-solution. Also, immunohistochemical assay confirmed the higher anti-tumorigenic effect of CS/Lf/PTS-SLNs (5.87-fold decrease in Bcl-2 expression) compared to PTS-solution. Our findings highlight CS/Lf/PTS-SLNs as a promising nanoplatform for phytotherapeutic targeted-breast cancer therapy.

Clinical Efficacy and Safety of Chondroitin Combined with Glucosamine in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Objective

This analysis was aimed at providing evidence-based medicine basis for systematic evaluation of chondroitin combined with glucosamine in the treatment of knee osteoarthritis.

Methods

The randomized controlled trials (RCTs) of chondroitin combined with glucosamine in the treatment of knee osteoarthritis (KOA) were searched in PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) online database. The retrieval time ranges from the database creation to the present. Two investigators gathered the information individually. The risk of bias was assessed using the criteria of the Cochrane back review group. RevMan5.4 statistical software analyzed the selected data.

Results

A total of 6 RCT articles were obtained. Overall, 764 samples were evaluated by meta-analysis. The clinical efficacy of chondroitin combined with glucosamine was significantly better than that of routine treatment by meta-analysis. The confidence interval of 95% was (4.86, 17.08) (Z = 6.89, P < 0.00001). The scores of joint pain, tenderness, swelling, and dysfunction in patients with knee osteoarthritis treated with chondroitin combined with glucosamine were significantly lower than those treated with routine treatment. There was no significant difference in the incidence of adverse reactions between chondroitin combined with glucosamine and single treatment of KOA. Due to the small number of documents included in the analysis, it is not suitable to make a funnel chart, but there may be some publication deviation in the analysis.

Conclusion

Chondroitin combined with glucosamine is more effective than chondroitin or glucosamine alone in the treatment of KOA and deserves clinical promotion. However, this conclusion still needs to be supported by multicenter, high-quality, double-blind, large-sample randomized controlled clinical trials due to the limitations of the six trials included.

Comparative effectiveness of glucosamine, chondroitin, acetaminophen or celecoxib for the treatment of knee and/or hip osteoarthritis: a network meta-analysis

OBJECTIVES

To compare the efficacies of oral glucosamine, chondroitin, the combination of glucosamine and chondroitin, acetaminophen and celecoxib on the treatment of knee and/or hip osteoarthritis.

METHODS

We searched electronic databases including PubMed, Embase, and Cochrane Library and the reference lists of relevant articles published from inception to October 23, 2017. A Bayesian hierarchical random effects model was used to examine the overall effect size among mixed multiple interventions.

RESULTS

We identified 61 randomised controlled trials of patients with knee and/or hip osteoarthritis. There was no obvious difference in the results between the traditional meta-analysis and the network meta-analysis. The network meta-analysis demonstrated that celecoxib was most likely the best option (SMD, -0.32 [95% CI, -0.38 to -0.25]) for pain, followed by the combination of glucosamine and chondroitin. For physical function, all interventions were significantly superior to oral placebo except for acetaminophen. In terms of stiffness, glucosamine (SMD, -0.36 [95% CI, -0.67 to -0.06]) and celecoxib (SMD, -0.29 [95% CI, -0.51 to -0.08]) were significantly better compared to placebo. In view of safety, compared to placebo only, celecoxib and acetaminophen presented significant differences.

CONCLUSIONS

Given the effectiveness of these non-steroidal anti-inflammatory drugs and symptomatic slow-acting drugs, oral celecoxib is more effective than placebo on relieving pain and improving physical function, followed by the combination of glucosamine and chondroitin. Acetaminophen is likely the least efficacious intervention option. This information, accompanied by the tolerability and economic costs of the included treatments, would be conducive to making decisions for clinicians.

A prospective study to evaluate the efficacy of Cistiquer in improving lower urinary tract symptoms in females with urethral syndrome

AIM

The aim of the study was to compare Cistiquer, a new phytotherapeutic product developed for chronic bladder inflammatory diseases, and intra-vesical administration of gentamicin plus betametasone, in females with urethral syndrome.

METHODS

Between september 2013 and may 2014, 60 women with urethral syndrome and trigonitis were incuded in this study. Patients were randomly assigned to treatment with intra-vesical administration of betametasone 8 mg plus gentamicin 80 mg (group A), and oral administration of Cistiquer (group B) for 7 weeks. Before and after the therapeutic protocol, symptoms were assessed by three days voiding diary, the overactive bladder questionnaire short form and a ten points visual analogic scale adopted to assess the micturition discomfort. Histologic findings were assessed by the examination of specimens obtained by cold bladder biopsies of the bladder trigone at baseline in all the subjects.

RESULTS

The two groups had significant and comparable symptoms improvement. However, the score obtained from the visual analogic scale decreased significantly only in the group submitted to oral therapy. Furthermore, in the group treated with endovesical approach, higher drop out rate and higher incidence of urinary infection were observed.

CONCLUSION

Patients with urethral syndrome and trigonitis improved symptoms either with oral therapy with Cistiquer and with intra-vesical administration of gentamicin plus betametasone. However, treatment adherence resulted higher for patients treated by oral therapy and rate of adverse events resulted higher for those submitted to endovesical treatment.

Longitudinal use of complementary and alternative medicine among older adults with radiographic knee osteoarthritis

BACKGROUND

Osteoarthritis (OA), a chronic and often painful disease for which there is no cure, accounts for more mobility issues in older adults than any other disease. Cross-sectional studies have found that arthritis is the most common reason for older adults to use complementary and alternative medicine (CAM). Although previous research has profiled the sociodemographic and clinical characteristics of CAM users, few studies have provided information on variation in CAM use over time and most only considered use of any CAM, which was often a mixture of heterogeneous therapies.

OBJECTIVES

This study sought to describe the longitudinal patterns of CAM use among older adults with knee OA and to identify correlates and predictors of different commonly used CAM therapies.

METHODS

The Osteoarthritis Initiative included 1121 adults aged ≥65 years with radiographic tibiofemoral OA in one or both knees at baseline. Annual surveys captured current use of conventional therapies and 25 CAM modalities (grouped into 6 categories) for joint pain or arthritis at baseline and during the 4-year follow-up. We assessed longitudinal use of CAM modalities by summing the number of visits with participants reporting use of each modality. Correlates of CAM use under consideration included sociodemographic indicators, body mass index, overall measures of mental and physical well-being, and clinical indices of knee OA. Generalized estimation equations provided adjusted odds ratio estimates and 95% CIs.

RESULTS

Nearly one-third of older adults reported using ≥1 CAM modality for treating OA at all assessments. With the exception of glucosamine and chondroitin (18%), few were persistent users of other CAM modalities. One in 5 of those using nonsteroidal anti-inflammatory drugs or glucosamine and/or chondroitin were using them concurrently. Adjusted models revealed the following: (1) adults aged ≥75 years were less likely to use dietary supplements than those between ages 65 and 75 years; (2) persons with more severe knee pain or stiffness reported more CAM use; (3) better knee-related physical function was correlated with more use of chiropractic care or massage; and (4) older adults with more comorbidities were less likely to report use of dietary supplements.

CONCLUSION

Patterns of CAM use are, to some extent, inconsistent with current guidelines for OA treatment. Evaluating the potential risks and benefits in older adults from commonly used CAM modalities, with or without combination use of conventional analgesics, is warranted.

Prevention of recurrent urinary tract infections in women

Around 40-50% of women experience at least one urinary tract infection (UTI) during their lifetime and 20-30% of these have a recurrence within 3-4 months of the initial infection.¹ Recurrent UTI (usually defined as three episodes in the last 12 months or two episodes in the last 6 months) can have a considerable impact on a woman's quality of life. Each episode of acute UTI in young women is typically associated with about 6 days of symptoms, 2.4 days of restricted activities and 0.4 days of bed rest.¹ Antibacterial prophylaxis is effective in preventing recurrent episodes, but at the expense of unwanted effects and a risk of promoting bacterial resistance. Here we assess the efficacy of different antibacterial regimens and non-antibacterial alternatives (cranberry, probiotics, oestrogens, immunostimulation, hyaluronic acid and chondroitin, acupuncture and herbs) in the prevention of recurrent uncomplicated UTIs in women.

Prevalent dietary supplement use in older New Zealand men

AIMS

Because of a lack of recent data from New Zealand older men, we examined dietary supplement use in this demographic.

METHODS

We surveyed men aged $gt;40 years who were participating in a trial of calcium supplementation on bone and cardiovascular outcomes.

RESULTS

Forty-seven percent reported using at least one supplement and 30% of users took more than two different supplements. Amongst users, median monthly expenditure on these products was NZ$20 (interquartile range: $10-$45). The most common supplements used were vitamins or minerals (49%), followed by nutritional oils (22%) (including fish oils, 13%) and glucosamine/chondroitin preparations (13%). Supplements were mainly taken for reasons of non-specific prophylaxis or health maintenance (58% of reasons), although 21% of reasons cited treatment or symptom alleviation for a medical condition. Daily requirements for vitamins A, D and E were exceeded, from supplement intake alone, by 12%, 10% and 40% of supplement users respectively.

CONCLUSIONS

Many older New Zealand men spend substantial amounts of money on dietary supplements despite uncertain health benefits. Health professionals should remain alert to supplement use by their patients, including males.

Osteoarthritis year 2010 in review: pharmacological therapies

This review highlights a selection of original studies related to the treatment of osteoarthritis in 2010.

Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis

OBJECTIVE

To determine the effect of glucosamine, chondroitin, or the two in combination on joint pain and on radiological progression of disease in osteoarthritis of the hip or knee. Design Network meta-analysis. Direct comparisons within trials were combined with indirect evidence from other trials by using a Bayesian model that allowed the synthesis of multiple time points.

MAIN OUTCOME MEASURE

Pain intensity. Secondary outcome was change in minimal width of joint space. The minimal clinically important difference between preparations and placebo was prespecified at -0.9 cm on a 10 cm visual analogue scale.

DATA SOURCES

Electronic databases and conference proceedings from inception to June 2009, expert contact, relevant websites. Eligibility criteria for selecting studies Large scale randomised controlled trials in more than 200 patients with osteoarthritis of the knee or hip that compared glucosamine, chondroitin, or their combination with placebo or head to head. Results 10 trials in 3803 patients were included. On a 10 cm visual analogue scale the overall difference in pain intensity compared with placebo was -0.4 cm (95% credible interval -0.7 to -0.1 cm) for glucosamine, -0.3 cm (-0.7 to 0.0 cm) for chondroitin, and -0.5 cm (-0.9 to 0.0 cm) for the combination. For none of the estimates did the 95% credible intervals cross the boundary of the minimal clinically important difference. Industry independent trials showed smaller effects than commercially funded trials (P=0.02 for interaction). The differences in changes in minimal width of joint space were all minute, with 95% credible intervals overlapping zero. Conclusions Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged.

Osteoarthritis - management options in general practice

BACKGROUND

Osteoarthritis, characterised by joint pain and stiffness, is a common and significant chronic disease, reducing mobility and causing considerable impact on quality of life. Multiple evidence based management options are available.

OBJECTIVE

The aim of this article is to summarise the main management options suggested in The Royal Australian College of General Practitioners Guideline for the nonsurgical management of hip and knee osteoarthritis and to also highlight those that are not recommended.

DISCUSSION

Following diagnosis based primarily on history and examination, management focuses on optimising quality of life by providing self management advice combined with appropriate pharmacological and nonpharmacological strategies, aiming to reduce acute exacerbations, prevent complications and delay progression.

Arthritis disease - the use of complementary therapies

BACKGROUND

While effective drugs are available to deal with the symptoms and modify the progress of osteoarthritis and rheumatoid arthritis, these may cause serious adverse events and not all patients will obtain relief. Many people with these diseases use complementary medicines.

OBJECTIVE

This article presents an overview of the evidence for the most promising complementary therapies for osteoarthritis and rheumatoid arthritis, with other information that general practitioners need to know.

DISCUSSION

There is reasonable evidence to support the use of glucosamine, avocado/soybean unsaponifiables and chondroitin in osteoarthritis, and omega-3 fatty acids and gammalinolenic acid in rheumatoid arthritis. However, no current evidence does not equate to lack of effectiveness. Rigorous research into the use of complementary medicines in arthritis is evolving and many of the systematic reviews used in preparation of this article are being updated every few years to incorporate new trial evidence as it becomes available.

Arthroscopic surgery for knee osteoarthritis? Just say no

For most patients with osteoarthritis of the knee, arthroscopic surgery offers little benefit.

Dietary supplements commonly used for prevention

The use of complimentary and alternative medicine is on the rise. This article reviews some of the commonly used herbal supplements and others focusing mainly on disease prevention. A summary table of medical conditions is provided, and when possible, a summary of efficacy and safety is provided to facilitate decision making.

The biological role of chondroitin sulfate in cancer and chondroitin-based anticancer agents

Chondroitin sulfate proteoglycans (CSPGs) such as versican accumulate in tumor stroma and play a key role in tumor growth and invasion. The high expression of CSPGs in fast growing tissues and cells is correlated with chondroitin sulfate (CS) chains and the sulfation pattern. The negatively charged CS chains interact with a large number of ligands and receptors and activate signalling pathways which stimulate tumor growth. However, the role of chondroitin sulfate in cancer promotion seems to be controversial, as recent studies support the use of modified CS as a potent anticancer agent. In this review, the biological roles of CSPGs in cancer and the anticancer effects of modified CS are presented and discussed.

[Arthroscopic treatment for osteoarthritic knee]

Osteoarthritis (OA) is the leading cause of knee morbidity. Age and overweight are the main risk factors for development of knee OA. The majority of patients respond to conservative treatment. For those who don't, surgical treatment is the only alternative. Arthroscopic surgery for the osteoarthritic knee is a well known procedure. Recently, numerous publications addressed the advantages of arthroscopic treatment for this indication. Some of the publications concluded that arthroscopic treatment for knee OA equals placebo. Others found temporary relief of symptoms. Among special subgroup of patients, in which acute pain exacerbation, mechanical block or early OA, utilizing arthroscopic techniques revealed satisfactory results. In this review, we discuss the indications and contraindications for arthroscopic treatment of the osteoarthritic knee according to the latest literature.

Soft-shell technique using Viscoat and Healon 5: a prospective, randomized comparison between a dispersive-viscoadaptive and a dispersive-cohesive soft-shell technique

PURPOSE

To compare the efficacy of the dispersive-viscoadaptive soft-shell technique using Viscoat and Healon 5 to the dispersive-cohesive soft-shell technique in reducing corneal endothelial cell damage during cataract surgery.

METHODS

In this prospective randomized study, 207 eyes of 171 cataract patients underwent phacoemulsification using the dispersive-viscoadaptive soft-shell technique (V-group, 102 eyes) with Viscoat and Healon5 or the dispersive-cohesive soft-shell technique (C-group, 105 eyes) with Viscoat and a cohesive agent (Opegan-Hi). Each group was divided into two subgroups depending on the amount of ultrasound (%Min) used during phacoemulsification. Corneal endothelial cell density was examined preoperatively and 3 months postoperatively. The endothelial cell loss was compared between the two groups, and also between the subgroups.

RESULTS

The mean endothelial cell loss 3 months after surgery was 8.4 +/- 5.6% standard deviation (SD) in the V-group and 8.2 +/- 6.2% in the C-group (P = 0.787). In the subgroups with ultrasound of 10 %Min or less, the mean endothelial cell loss 3 months after surgery was 6.6 +/- 4.6% in the V-group and 5.5 +/- 5.0% in the C-group (P = 0.104). In the subgroups with ultrasound of over 10 %Min, this value was 10.6 +/- 6.3% in the V-group and 11.9 +/- 5.7% in the C-group (P = 0.413). The correlation coefficient of the endothelial cell loss rate and %Min was 0.245 (P = 0.0129) in the V-group and 0.501 (P < 0.0001) in the C-group.

CONCLUSION

The dispersive-viscoadaptive soft-shell technique is as effective as the dispersive-cohesive soft-shell technique in protecting corneal endothelial cells during phacoemulsification regardless of the amount of ultrasound energy used.

Ochronosis, arthroscopy of a black knee: a case report and review of the literature

Ochronotic arthropathy is a rare condition found in patients with alkaptonuria. Due to the accumulation of homogentisic acid, cartilages get a dark discoloration and become brittle and more vulnerable to mechanical stress (Centinus et al. Rheumatol Int 3:127-131, 2004; Hamdi et al. Int Orthop 23:122-125, 1999; Phornphutkul, N Engl J Med 347:2111-2121, 2002; Thacker, Arthroscopy 19:14-17, 2003). This case report is about a patient first diagnosed for ochronosis by arthroscopy of the knee. Her brother was having similar complaints during follow-up. Both patients were prescribed to take glucosamine and chondroitine. Although no report is found in the literature, regarding the success of this therapy in patients with ochronosis, both patients reported a positive effect on articular pain and daily activities.

Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study

OBJECTIVE

This preliminary study sought to determine whether using 1500/1200mg of glucosamine hydrochloride and chondroitin sulfate (GH/CS) is effective, both separately and combined with exercise, compared to a placebo plus exercise program in improving physical function, pain, strength, balance, and mobility in older adults with knee osteoarthritis (OA).

METHODS

This double-blind, placebo-controlled, randomized clinical trial lasted 12 months. Participants included 89 older adults (age>/=50 years) with knee OA randomized to either GH/CS or placebo group. Phase I was a 6-month trial comparing the effects of assignment to either GH/CS or placebo. Phase II added 6 months of exercise for both groups. The primary outcome measure was Western Ontario and McMaster University Osteoarthritis Index (WOMAC) function, and secondary outcome measures included WOMAC pain, 6-min walk, balance, and knee strength.

RESULTS

Of the 89 randomized participants, 72 (81%) completed the study. The median pill compliance was 94% and 95% in Phase I, and, in Phase II, 97% and 91% for the GH/CS and placebo groups, respectively. Median exercise compliance during Phase II was 77% for the GH/CS group and 78% for the placebo group. WOMAC function and pain did not differ significantly between the groups at 6- or 12-month follow-up. There were also no significant differences between the groups in 6-min walk or knee strength; however, balance was better in the placebo group with approximately a 10% difference compared to the GH/CS group.

CONCLUSIONS

The GH/CS group was not superior to the placebo group in function, pain, or mobility after both phases of the intervention (pill only and pill plus exercise).

Treatment of primary and secondary osteoarthritis of the knee

OBJECTIVES

Systematic review of outcomes of three treatments for osteoarthritis (OA) of the knee: intra-articular viscosupplementation; oral glucosamine, chondroitin or the combination; and arthroscopic lavage or debridement.

DATA SOURCES

We abstracted data from: 42 randomized, controlled trials (RCTs) of viscosupplementation, all but one synthesized among six meta-analyses; 21 RCTs of glucosamine/chondroitin, 16 synthesized among 6 meta-analyses; and 23 articles on arthroscopy. The search included foreign-language studies and relevant conference proceedings.

REVIEW METHODS

The review methods were defined prospectively in a written protocol. We sought systematic reviews, meta-analyses, and RCTs published in full or in abstract. Where randomized trials were few, we sought other study designs. We independently assessed the quality of all primary studies.

RESULTS

Viscosupplementation trials generally report positive effects on pain and function scores compared to placebo, but the evidence on clinical benefit is uncertain, due to variable trial quality, potential publication bias, and unclear clinical significance of the changes reported. The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), a large (n=1,583), high-quality, National Institutes of Health-funded, multicenter RCT showed no significant difference compared to placebo. Glucosamine sulfate has been reported to be more effective than glucosamine hydrochloride, which was used in GAIT, but the evidence is not sufficient to draw conclusions. Clinical studies of glucosamine effect on glucose metabolism are short term, or if longer (e.g., 3 years), excluded patients with metabolic disorders. The best available evidence for arthroscopy, a single sham-controlled RCT (n=180), showed that arthroscopic lavage with or without debridement was equivalent to placebo. The main limitations of this trial are the use of a single surgeon and enrollment of patients at a single Veterans Affairs Medical Center. No studies reported separately on patients with secondary OA of the knee. The only comparative study was an underpowered, poor-quality trial comparing viscosupplementation to arthroscopy with debridement.

CONCLUSIONS

Osteoarthritis of the knee is a common condition. The three interventions reviewed in this report are widely used in the treatment of OA of the knee, yet the best available evidence does not clearly demonstrate clinical benefit. Uncertainty regarding clinical benefit can be resolved only by rigorous, multicenter RCTs. In addition, given the public health impact of OA of the knee, research on new approaches to prevention and treatment should be given high priority.

Systematic review of clinical trials of treatments for osteoarthritis in dogs

OBJECTIVE

To identify and critically evaluate the quality of evidence of the most commonly used pharmacologic, nutraceutical, and purported slow-acting drugs of osteoarthritis for the management of osteoarthritis in dogs by use of the FDA's evidence-based medicine scoring system.

DESIGN

Systematic review.

SAMPLE POPULATION

16 clinical trials.

PROCEDURES

A broad bibliographic search was performed prior to May 2006. Inclusion criteria focused on prospective trials evaluating commonly used medical treatment interventions for the management of osteoarthritis in dogs and published in peer-reviewed journals. The analysis consisted of the following: study design rating, quality factor rating, quantity rating, consistency rating, relevance to disease risk reduction rating, and cumulative strength of evidence ranking.

RESULTS

4 trials evaluating meloxicam were rated as type I. Three trials evaluating carprofen were rated as type I, and 2 trials were rated as type III. One trial evaluating each of the following agents was rated as type 1: etodolac; P54FP; polysulfated glycosaminoglycan; and a combination of chondroitin sulfate, glucosamine hydrochloride, and manganese ascorbate. Two trials evaluating pentosan polysulphate and 2 trails evaluating green-lipped mussels were rated as type I. One trial evaluating hyaluronan was rated as type III.

CONCLUSIONS AND CLINICAL RELEVANCE

A high level of comfort exists for meloxicam that the claimed relationship is scientifically valid and that its use is clinically efficacious for the treatment of osteoarthritis in dogs. A moderate level of comfort exists for carprofen; etodolac; pentosan polysulphate; green-lipped mussels; P54FP; polysulfated glycosaminoglycans; and a combination of chondroitin sulfate, glucosamine hydrochloride, and manganese ascorbate. An extremely low level of comfort exists for hyaluronan.

Glucosamine in osteoarthritis: questions remain

Glucosamine is now widely used in the hope that it will relieve symptoms of osteoarthritis and stop its progression, yet studies have so far failed to prove convincingly that it works, how it might work, or whether it is safe to take long-term. This is an overview of the evidence to date for currently available glucosamine preparations, as well as for glucosamine used in combination with another popular nutraceutical, chondroitin sulfate.

DMOAD developments: present and future

Osteoarthritis (OA), by far the most common form of arthritis, has a growing impact on health care. Progress in understanding its pathophysiological processes has led to the identification of promising therapeutic targets, with disease-modifying osteoarthritis drugs (DMOADs) having the most potential. Numerous nonpharmaceutical measures and pharmacological interventions that slow the progression of the disease also have been developed. Several new classes of molecules that inhibit one or more OA pathophysiological processes have been discovered, and a number of these are under clinical evaluation to test their potential to alter the disease process in humans. Recent data from clinical trials have demonstrated that agents able to specifically block key disease mechanisms can effectively retard the progression of structural changes in knee OA patients. These studies are ushering the field into a new era in the development of DMOADs and, hence, the prospect of a cure for this disease.

Carpal tunnel syndrome, diabetic neuropathy, fibromyalgia, glucosamine and chondroitin, hypnosis in pain management, marijuana for pain

This feature presents information for patients in a question and answer format. It is written to simulate actual questions that many pain patients ask and to provide answers in a context and language that most pain patients will comprehend. Issues addressed in this issue are carpel tunnel syndrome, fibromyalgia, glucosamine and chondroitin, hypnosis, marijuana.

Osteoarthritis in 2007

Osteoarthritis (OA) is often a progressive and disabling disease resulting from a combination of risk factors, including age, genetics, trauma, and knee alignment, as well as an imbalance of physiologic processes resulting in inflammatory cascades on a molecular level. The synovium, bone, and cartilage are each involved in the pathophysiological mechanisms that lead to progressive joint degeneration, and, thus, also serve as targets for therapies. Efforts to identify disease-modifying osteoarthritis drugs (DMOADs) have been hampered by several factors, but the focus has now shifted toward the validation of chemical and imaging biomarkers that should aid in DMOAD development. In this review, we summarize current pathological mechanisms occurring in the individual but interconnected compartments of OA joints, as well as discuss related therapeutic interventions that are currently available or on the horizon.

[New methods of medicine phonophoresis in therapy of osteoarthritis patients exposed to physical overload at work]

The authors studied efficiency of chondroxide and phinalgel phonophoresis in osteoarthritis patients with roentgenologic stages I and II, aged 40 to 66. Recommendations are to use these treatment modalities in accordance with severity of joints inflammation.

Evidence-based practice: Review of clinical evidence on the efficacy of glucosamine and chondroitin in the treatment of osteoarthritis

PURPOSE

To evaluate past and current evidence from randomized controlled trials on the efficacy of glucosamine sulfate (GS), glucosamine hydrochloride (GH), and chondroitin sulfate (CS) for the treatment of osteoarthritis (OA).

DATA SOURCES

An extensive review of four meta-analyses and a review of the findings of the recently published Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) funded by the National Institutes of Health.

FINDINGS

Review of previous studies on the efficacy of GS, GH, and CS in the treatment of OA showed inconclusive results because of weak research design. The GAIT attempted to provide clarity on the use of GH and CS in treating knee pain from OA by using a rigorous research design to elicit cause and effect. The GAIT results showed that GH and CS were not effective in reducing knee pain in the study group overall; however, these may be effective in combination for patients with moderate-to-severe knee pain.

IMPLICATIONS FOR PRACTICE

There is now clinical evidence indicating that recommending GS, GH, and CS for the treatment of mild knee pain from OA is ineffective. Further research needs to be done to identify specific characteristics in patients that results in a positive response. Until the findings of the GAIT undergo further peer review, the results of the research needs to be interpreted with caution.

Effect of incisional friction and ophthalmic viscosurgical devices on the heat generation of ultrasound during cataract surgery

PURPOSE

To determine the thermal features of the Legacy (Alcon) and Sovereign (Advanced Medical Optics) phacoemulsification machines in a cadaver eye and with 7 ophthalmic viscosurgical devices (OVDs).

SETTING

In situ and in vitro study.

METHODS

Temperature without occlusion was recorded at the sleeve placed in the wound of a cadaver eye, and temperature over baseline was determined after 60 seconds. The result was then compared with the results in a previous study that used balanced salt solution (BSS) in artificial chambers. In the second portion of the experiment, with irrigation and aspiration lines occluded, temperature was recorded at the sleeve placed in an artificial chamber filled with sodium hyaluronate 2.3% (Healon5), sodium hyaluronate 1.4% (Healon GV), sodium hyaluronate 1.0% (Healon), sodium hyaluronate 1.6% (Amvisc Plus), sodium hyaluronate 1.0% (Provisc), sodium hyaluronate 3.0%-chondroitin sulfate 4.0% (Viscoat), or hyaluronate 3.0% (Vitrax). Temperature over baseline was also determined after 60 seconds. These results were compared with each set of OVD data and with the results in the prior BSS study.

RESULTS

In the eye-bank model, the Legacy machine had a 62% temperature increase from incisional friction and the Sovereign machine had a decrease of 8.6% over results in an artificial anterior chamber. The OVD temperature increases were greater for the Sovereign (P<.001) and followed the same general trend for the Legacy. The least temperature increase was with Amvisc Plus, Healon, and Healon GV; the intermediate increases were with Provisc and Vitrax; and the greatest increases were with Viscoat and Healon5. The OVD findings did not correlate with viscosity or pseudoplasticity.

CONCLUSIONS

Incisional friction alone increased heat generation in the Legacy, a stroke-length driven instrument, more than in the Sovereign, a power-driven instrument. Ophthalmic viscosurgical devices are not only a concern due to outflow occlusion but can also add up to 6 times the heat in comparison with BSS. The need to aspirate the OVD before using ultrasound is thus verified.

Chondroitin product selection for the glucosamine/chondroitin arthritis intervention trial

OBJECTIVE

To select a high-quality chondroitin dosage form and/or an appropriate source of sodium chondroitin for the National Institutes of Health's Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT).

DESIGN

Controlled experimental trials.

SETTING

Laboratory.

PATIENTS OR PARTICIPANTS

Not applicable.

INTERVENTIONS

Commercially available chondroitin products were reviewed, and purified sodium chondroitin from two suppliers was evaluated through tests (infrared and near-infrared identification, moisture content, pH, optical rotation, color and clarity of aqueous solutions prepared from the powders, protein contamination, total residue following ignition and nitrogen content, determination of sodium chondroitin molecular weight, disaccharide analysis, and measurement of chondroitin, sodium, and total glycosaminoglycan content) and an onsite supplier audit.

MAIN OUTCOME MEASURES

Purity, potency, and quality of sodium chondroitin powders.

RESULTS

No commercially available chondroitin product was deemed appropriate for use in GAIT. Samples of sodium chondroitin powder from two suppliers exhibited similar disaccharide and glycosaminoglycan content. Each contained approximately 2% hyaluronic acid and 8%-9% unsulfated disaccharide. Potency was inconsistent across groups, which might have resulted from different analytical methods and choice of reference standard. Mean potency obtained by five separate methods ranged from 82.2% to 95.5% for one supplier, 92.5% to 110.1% for another, and 95.1% to 112.5% for a commercially obtained reference standard. Critical issues raised by the results include choice of reference standard, selection of assay method, and the consistent appearance of an unidentifiable contaminant present in all three lots from one supplier.

CONCLUSION

This blinded study determined methods to identify acceptable agents and provided results, which, in addition to regulatory compliance supplier audits, formed the basis for chondroitin product selection in GAIT.