By Greg Arnold, DC, CSCS, February 6, 2015, abstracted from “Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib” printed online January 14, 2015 in the Annals of the Rheumatic Diseases.
In 2005, osteoarthritis was diagnosed in 26.9 million US adults, a 28% increase from 21 million cases in 1990 [1]. US healthcare costs amount to $5700 per patient annually, plus $13.2 billion each year from lost work capacity [1]. Initial treatment uses over-the-counter nonsteroidal anti-inflammatory drugs. However, serious kidney [2][3] and stomach [4][5] adverse effects lead physicians to prescribe arthritis drugs such as Celebrex, whose 2013 sales reached $2.18 billion [6].
A new study [7] suggests glucosamine plus chondroitin supplements are comparable to Celebrex for pain in severe knee arthritis. It included 465 patients with moderate-to-severe knee arthritis pain scoring over 300 on WOMAC, the Western Ontario and McMaster Universities Osteoarthritis Index [8]. For six months, 240 patients received 1200 mg chondroitin sulfate plus 1500 mg glucosamine hydrochloride daily in three doses of 400 mg and 500 mg respectively, while 225 received 200 mg Celebrex daily. WOMAC questionnaires continued through completion.
After four months, researchers noted statistically significant pain reductions: 43.6% with glucosamine/chondroitin (372 to 209.9) and 50.7% with Celebrex (372 to 183.5). At six months, WOMAC reductions were similar: 50.1% with supplements (185.7 points) and 50.2% with Celebrex (186.7 points), although statistical significance could not be achieved.
The researchers consider the combination beneficial for knee osteoarthritis and a potentially safe and effective alternative for patients with cardiovascular or gastrointestinal problems.
Reference:
[1] “Osteoarthritis” posted on the CDC website
[2] Clive DM, Stoff JS. Renal syndromes associated with nonsteroidal anti-inflammatory drugs. N Engl J Med 1984;310:563-72
[3] Perneger TV, Wheiton PK, Klag MJ. Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs. N Engl J Med 1994;331:1675-9
[4][4] Sol AH, Weinstein WM, Kurata J, McCarthy D. Nonsteroidal anti-inflammatory drugs and peptic ulcer disease. Ann Intern Me 1991;114:307-19
[5] Wilcox CM, Shalek KA, Cotsonis G. Striking prevalence of over-the-counter nonsteroidal anti-inflammatory drug use in patients with upper gastrointestinal hemorrhage. Arch Intern Med 1994;154:42-5
[6] Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis 2015 Jan 14. pii: annrheumdis-2014-206792. doi: 10.1136/annrheumdis-2014-206792. [Epub ahead of print]
[7] “Celebrex Sales Data” posted on drugs.com
[8] Pham T, van der Heijde D, Altman RD, et al. OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartilage 2004;12:389–99