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CLINICAL EFFECTIVENESS OF GLUCOSAMINE AND CHONDROITIN SULPHATE IN TREATMENT OF OSTEOARTHRITIS

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CLINICAL EFFECTIVENESS OF GLUCOSAMINE AND CHONDROITIN SULPHATE IN TREATMENT OF OSTEOARTHRITIS

Fakhra Batool 1, Muhammad Sohail *1, Fizah Ashraf 2, Beenish Rana 1, Fahad Mahmood 1 and Sana Tanveer 1

Department of Pharmacy 1, The Islamia University of Bahawalpur, Hasilpur Road, Bahawalpur, Pakistan

Department of Pharmacy 2, Bahauddin Zakariya University, Multan, Pakistan

ABSTRACT: Osteoarthritis is a form of arthritis, and is the most common form of arthritis. Persons suffering from osteoarthritis have symptoms of pain, stiffness, decreased range of motion of affected joints. Although NSAIDS are the most commonly prescribed agents for this disorder but can cause of serious adverse effects. Two compounds Glucosamine and chondroitin which are extracted from animal products have been used in various forms for OA. To assess the clinical effectiveness of glucosamine and chondroitinsulphate in treatment of osteoarthritis symptoms like joint pain, joint space narrowing, reduced walking time, swelling etc. We searched articles separately for glucosamine and chondroitin sulphate using internet. Fifteen articles met the inclusion criteria. Data from articles was extracted using a standardized data extraction tables i.e. table1 and table 2. Glucosamine and Chondroitin sulphate are effective in the treatment of Osteoarthritis because these canreducepain, prevent further joint space narrowing and solve other related problems of this disease. The two agents can be used in osteoarthritis treatment as their safety is already assured as compared to other symptomatic treatment for OA. But these agents can take more time to treat disease as compared to conventional medicine like NSAIDS.

Keywords: 

Glucosamine, chondroitin sulphate, osteoarthritis, NSAIDS, osteoarthritis symptoms

INTRODUCTION: Osteoarthritis is a form of arthritis, and is the most common form of arthritis. 1, 2. In 2010-2011, over 4.6 million Canadians (16.7% of those 15 years and older) reported suffering from arthritis 39. Osteoarthritis is classified on the basis of its cause. Two classes of osteoarthritis are primary or idiopathic osteoarthritis and secondary osteoarthritis. Primary osteoarthritis occurs due to unknown causes but is strongly associated with age.

Secondary OA develops as a result of joint injury, infection, hereditary, developmental, metabolic or neurologic disorders.  Secondary osteoarthritis occurs less frequently 3, 4. Friction between the bones is resulted by gradual wear and loss of cartilage in the joints, which Causes pain and swelling in affected joints. For a long time it was thought that in osteoarthritis only cartilage is affected. But, now it is known that the underlying bone synovium also undergoes changes 5-7.

In Osteoarthritis joint movement suffers additional restriction due to the reaction of prearticular bone with osteophyte formation. It predominates in weight-bearing joints, such as the knee and hip 8.  There are many risk factors known of OA which include; age 9, Over weight and obesity 10, genetic determinants 11, 12. Persons suffering from osteoarthritis have symptoms of pain, stiffness, decreased range of motion of affected joints 13. It is the leading cause of pain and physical disability in older people 14. A biomechanical abnormality to the joint or limb may be present in osteoarthriris 40. There are still questions concerning the causal factors of OA. The nature of the initiating event is often unknown, although many processes involved in the progression of OA are known. Due to disruption of the cartilage collagen matrix, the water content of the cartilage increases 43.

Osteoarthritis-affected joints are commonly tender. Patients suffer from morning and/or prolonged fixed body position stiffness. Swelling and crepitus may also be evident. Generally, pain escalates with increasing activity throughout the day and many patients need frequent breaks to rest the involved joint 41. The use of NSAIDs has a palliative effect and can cause adverse effects in the long-term. Therefore, effective and safe treatments for the control and management of osteoarthrosis of the Temporomandibular Joint are the use of Chondroitin sulphate and Glucosamine 44. For treatment of osteoarthritis only few effective remedies are available. 15 Primary concern of currently available medical therapies of osteoarthritis is treatment of joint pain in patient.16

Analgesics as well as traditional and cyclooxygenase-2–selective non-steroidalanti-inflammatory drugs (NSAIDs) are effective and are widely used 17, 18. Although NSAIDS are the most commonly prescribed agents for this disorder but can cause of serious adverseeffects19, 20. Two compounds Glucosamine and chondroitin which are extracted from animal products have been used in various forms for OA 21. These compounds are found modestly effective but because of their safety, these would have high utility in the treatment of OA 22, 23. Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy. 42

MATERIALS AND METHODS:

Data Sources

To search the original articles of both glucosamine and chondroitin sulphate we searched the electronic data bases from 1980 to 2011 including: Science direct.com, American college of rheumatology (arthritis and rheumatism), Pub Med and American medical association. From there we selected the articles which met our inclusion criteria.

Inclusion criteria

All the published trials on arthritis of various parts of body and in which preparations were given orally (in form of tablets or powder) were included. Comparisons in trials of glucosamine and chondroitin were mostly with placebo but trials for comparison of glucosamine and chondroitin with NSAIDS were also included. Duration of study should be at least one month because these agents may take time to produce effect.

Data extraction                

Thirteen articles met the inclusion criteria. Data from that articles were extracted using a standardized data extraction table. In Table 1 and Table 2, we notified the author/year of article, duration of study, dose of agent tested, outcome measured and conclusion of the article. And from the Table 1 and Table 2, having all material for review, we drew conclusion of our review.

RESULTS:

Table 1 and table 2 summarizes prospective data based on the use of glucosamine and chondroitin sulfate in the treatment of osteoarthritis in which names of authors along with years have been given. Table 1 and table 2 also contains number of patients, their dosage, duration of intervention, type of intervention and conclusion based on these interventions.

DISCUSSIONS: Objective of this review is to assess the clinical effectiveness of glucosamine and chondroitin sulphate in reducing pain and preventing joint space narrowing and other problems that OA patients face, hence the overall effectiveness of these agents for osteoarthritis treatment and their role in progression of osteoarthritis disease. To collect articles we set inclusion criteria, according to which published articles of glucosamine and chondroitin sulphate were collected and reviewed by forming standard tables i.e. Table 1 and Table 2

In three articles of glucosamine sulphate 24, 25, 29 outcome measure is joint pain and from the conclusions of two articles in which study was conducted by comparing glucosamine to placebo we can see that glucosamine is superior to placebo to reduce pain. In one article study was conducted by comparing glucosamine to ibuprofen both agents showed almost equal success (glucosamine: 48%, ibuprofen: 52%) but ibuprofen showed effect sooner than glucosamine sulphate

TABLE 1: SHOWS THE USE OF GLUCOSAMINE IN OSTEOARTHRITIS TREATMENT

Glucosamine
Author, year No. of patients Dosage Duration Type of intervention Conclusion
Drovanti A et al. 1980  24 80 500mg t.i.d 30 days Articular Joint pain, Joint tenderness Swelling, and Range of motion Interventions were found to be significantly improved in the GS group than in the placebo group.
Pujalte JM et al. 1980 25 20 500mg t.i.d 6 to 8 weeks Joint pain, Joint tenderness, and Swelling. GS is superior to placebo in improving outcome measures.
Noack W et al.1994 26 252 500mg t.i.d 4 weeks Lequesne’s index Decreased by 3.2 points in the GS group and only 2.2 points in the placebo group.
Reginster JY et al.2001 27 212 1500mg o.d 3 years Joint space width Joint space narrowingIn GS group: 0

In placebo: -.31mm
Pavelka K et al.2002 28 202 1500mg t.i.d 3 years Worsening osteophytes 20% in placebo group and 6% in GS group
Fassbender HM et al.1994 29 200 GS: 1500mg o.dIbuprofen: 1200mg o.d 3 months Joint pain 52% pain reduction observed in ibuprofen group while  48% in GS group but effect occurred sooner in ibuprofen group
Bruyere et al. 2004 30 319 postmenopausalWomen 1500 mg o.d 3 years Radiographs of the knee: joint space narrowing. GlcN·S: no significant joint space lossPlac.: Progressive joint space narrowing.
Kawasaki 2008 31 142 1500 mg o.d 18 months Joint space width 0.0 mm in GS group and -0.31 mm in control group

TABLE 2: SHOWS THE USE OF CHONDROITIN SULPHATE IN OSTEOARTHRITIS TREATMENT

Author, year No. of patients Dosage duration Type of intervention Conclusion
         
Bourgeois P et al.1998 32 127 1200mg o.d 3 months Joint pain Improved mean spontaneous joint pain was observed
Uebelhart D  et al. 1998 33 46 800 mg o.d 1 year Joint space width 0 mm in Cs group but increased by 0.4 mm in placebo group
Author, year No. of patients Dosage Duration Outcome measures Conclusion
Bucsi L et al. 1998 34 80 800 mg o.d Pain VAS,Lequense’s index

Walking time

 Pain and lequense’s index decreased in CS group. Walking time improved in CS group.
Verbruggen G et al.1998 35

 

 119

 

 

 400 mg t.i.d

 

 

 3 years

 

 

 New erosive OA of finger joints

 

 CS protect from the development of erosive changes in patients with finger joint OA.
Cem Gabay et al. 2011 36 162 800 mg o.d 6 months Hand pain Decrease in the hand pain in the CS group than in the placebo group is observed.
Kahan et al. 2009 37 622 800mg o.d 2 yrs joint space narrowing 28% CS pts. Versus 41% Plac. pts.showed  joint space

Narrowing.
Michel et al. 2005 38 300 800 mg o.d 2 years Joint space narrowing In CS group no significant joint space loss and significant joint space narrowing in placebo group.

In three included studies 27, 30, 31 improvement in joint space narrowing is observed and conclusion of those articles show that GS is very effective in preventing joint space narrowing.

Two studies 24, 25 show improvement in joint tenderness and swelling. One study 26 concluded decrease in lequence’s index by 3.2 points. One article 28 has outcome measure of worsening osteophytes which is very less in placebo group than in GS group. Among included articles of Chondroitin sulphate outcome measure is joint space width in three articles 33, 37, 38 which showed that chondroitin sulphate is prominently superior to placebo in preventing further joint space narrowing.

Three studies 32, 34, 36 included were conducted to know the effect of chondroitin sulphate in pain reduction and conclusion of that studies showed that chondroitin sulphate effectively decrease the joint pain and was found to be better than placebo.

One study 34 show decrease in lequence’s index and improved walking time in the CS group. Another study 35 concluded that CS may protect against the development of erosive changes in patients with finger joint OA.

CONCLUSIONS: According to conducted review it is concluded that Glucosamine and Chondroitin sulphate are effective in the  treatment of Osteoarthritis because these are found to be better than placebo in reducing pain and more prominently effective in preventing further joint space narrowing already present in patients of OA. Other problems which the patients of this disease have to face like swelling and walking time are also improved by these chondroprotective agents. The two agents are also found to be effective in reducing lequence’s index. So the two agents can be used in osteoarthritis treatment as their safety is already assured as compared to other symptomatic treatment for OA (NSAIDS cause severe damage to gastro protective layer). But these agents can take more time to treat disease than the conventional medicine like NSAIDS.

ACKNOWLEDGEMENTS:

First acknowledgement is to Almighty ALLAH for guiding the intellect along the correct pathway. Then we really want to say very thanks to our Honorable teacher Mr. Fahad Pervaiz, who has provided us a very easy way to understand and complete this project, and he also provided us good guidelines regarding this project by sharing his precious knowledge with us.

 

Finally we must say thanks to our beloved parents who always pray for us and our success is just because of their pray, then we should say thanks to our friends and our group fellows, who has participated in completing this project.

 

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    How to cite this article:

    Batool F, Muhammad S, Ashraf F, Rana B, Mahmood F and Tanveer S: Clinical Effectiveness of Glucosamine and Chondroitin Sulphate in Treatment of Osteoarthritis. Int J Pharm Sci Res 2015; 6(2): 541-45.doi: 10.13040/IJPSR.0975-8232.6 (2).541-45.

     

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Ijpsr

Fakhra Batool , Muhammad Sohail *, Fizah Ashraf , Beenish Rana , Fahad Mahmood and Sana Tanveer

Department of Pharmacy IUB Cosmetics Lab. Department of Pharmacy Khawaja Fareed Campus Islamia University Bahawalpur Pakistan

muhammadsohail39@gmail.com

11 May, 2014

12 August, 2014

13 October, 2014

http://dx.doi.org/10.13040/IJPSR.0975-8232.6(2).541-45

01 February, 2015

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