Background
Osteoarthritis (OA) is the most common form of arthritis and is often associated with significant disability and a deterioration in quality of life.
Buck Mountain Glucosamine Sulfate for Animals
Goals
To review all randomized controlled trials (RCTs) that evaluate the effectiveness and toxicity of glucosamine in OA.
Search methods
We searched MEDLINE, PREMEDLINE, EMBASE, AMED, ACP Journal Club, DARE, CDSR and in the CCTR. Charts were also written to the subject experts and hand searches were made of the reference lists of the identified RCTs and the relevant review articles. All searches were updated in January 2005.
Selection criteria
The relevant studies fulfilled the following criteria: 1) Randomized clinical trials (RCTs) that evaluated the effectiveness and safety of glucosamine in OA, 2) Comparative and placebo-controlled studies were eligible, 3) Single and double studies were eligible blind.
Obtaining and analyzing the data
The summary of the data was carried out independently by two researchers and the results were compared according to the degree of agreement. The Gotzsche method and a validated tool (Jadad 1996) were used to qualify the quality of the RCTs. Continuous outcome measures were combined using standardized mean differences (SMD) as the measure of effect size. The dichotomous outcome measures were combined using the relative risk ratios (RR).
Main results
The analysis limited to eight studies with adequate concealment of allocation failed to demonstrate the benefit of glucosamine for pain and function according to the WOMAC. Overall, the 20 RCTs analyzed found that glucosamine outperformed placebo with an improvement of 28% (change from baseline) in pain (SMD -0.61, 95% CI -0.95, -0). , 28) and 21% (change with respect to the initial value) in the function using the Lequesne index (SMD -0.51, 95% CI -0.96, -0.05). However, the results are not positive in a uniform way and the reasons have not yet been explained. The results of pain, function and rigidity according to the WOMAC did not reach statistical significance.
In the 10 RCTs in which the Rotta preparation of glucosamine was compared with placebo, glucosamine was found to be superior for pain (SMD -1.31, 95% CI -1.99, -0.64) and the function with the Lequesne index (DME -0.51, 95% CI -0.96, -0.05). The combined results for pain (SMD -0.15, 95% CI -0.35, 0.05) and function with the WOMAC index (SMD 0.03, 95% CI -0.18; 0.25) in those RCTs in which a non-Rotta preparation of glucosamine was compared with placebo did not reach statistical significance. In the four RCTs in which the Rotta preparation of glucosamine was compared with an NSAID, glucosamine was superior in two and equivalent in two. Two RCTs using the Rotta preparation showed that glucosamine was able to reduce the radiological progression of knee OA over a period of three years (SMD 0.24, 95% CI 0.04, 0.43).
Glucosamine was as safe as placebo in terms of the number of subjects who reported adverse reactions (RR = 0.97, 95% CI 0.88, 1.08).