The symptoms and changes to joint structure associated with osteoarthritis could be moderated by the long-term effects of glucosamine sulphate, conclude investigators in a study published in Saturday's issue of the Lancet.Osteoarthritis is a major cause of disability and is among the most frequent forms of musculoskeletal disorders. Several short-term to medium-term clinical trials in osteoarthritis have shown the symptom-modifying effect of glucosamine sulphate and its good safety profile.
However, the need for long-term clinical trials with this compound has been emphasized. Consequently, treatment of osteoarthritis has been limited to short-term symptom control.
Now Jean Reginster and colleagues from CHU Centre Ville, Liege, Belgium, have assessed the effects of glucosamine sulphate on the long-term progression of joint structure changes and symptoms in osteoarthritis.
In their randomized placebo-controlled trial, 212 patients with this disease were randomly assigned 1500 mg sulphate oral glucosamine or placebo once daily for 3 years. Weightbearing radiographs of each knee were taken at enrollment and after 1 and 3 years.
The 106 patients on placebo had progressive joint-space narrowing, with an average loss of space after 3 years of 20 mm; there was no significant loss in the 106 patients on glucosamine sulphate.
Those who completed treatment with this substance had a 20-25% improvement in symptoms, compared with slight worsening of symptoms in the placebo group.
There were no differences in safety or reasons for early withdrawal between the treatment and placebo groups.
In an accompanying Commentary, Tim McAlindon from Boston University Medical School comments that Reginster and colleagues' study is a landmark in osteoarthritis research, and he emphasizes the importance of the improved pain and disability scores in patients given glucosamine. He concludes by pointing out that the nutritional food industry will be more directly involved than the medical profession and the pharmaceutical industry, since glucosamine is available in many countries as a food supplement rather than as prescribed medication.
Furthermore, he comments: "It is time for the (medical) profession to accommodate the possibility that many nutritional products may have valuable therapeutic effects and to regain the credibility of the public at large."
[Contact: Professor Jean Reginster, Dr. Tim McAlindon]
26-Jan-2001
