Glucosamine therapy for treating osteoarthritis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 7 OCT 2009
Assessed as up-to-date: 11 NOV 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Towheed T, Maxwell L, Anastassiades TP, Shea B, Houpt JB, Welch V, Hochberg MC, Wells GA. Glucosamine therapy for treating osteoarthritis. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002946. DOI: 10.1002/14651858.CD002946.pub2.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 7 OCT 2009
Osteoarthritis (OA) is a common form of arthritis and is often associated with significant disability and impaired quality of life. This is an update of a Cochrane review first published in 2001 and previously updated in 2005.
To review randomized controlled trials (RCTs) evaluating the effectiveness and toxicity of glucosamine in OA.
We searched CENTRAL and the Cochrane Database of Systematic Reviews (The Cochrane Library), MEDLINE, PREMEDLINE, EMBASE, AMED, ACP Journal Club, DARE (to January 2008); contacted content experts, and handsearched reference lists and pertinent review articles.
RCTs evaluating the effectiveness and safety of glucosamine in OA.
Data collection and analysis
Data abstraction was performed independently by two review authors and investigators were contacted for missing data.
This update includes 25 studies with 4963 patients. Analysis restricted to studies with adequate allocation concealment failed to show any benefit of glucosamine for pain (based on a pooled measure of different pain scales) and WOMAC pain, function and stiffness subscales; however, it was found to be better than placebo using the Lequesne index (standardized mean difference (SMD) -0.54; 95% confidence interval (CI) -0.96 to -0.12). Collectively, the 25 RCTs favoured glucosamine with a 22% (change from baseline) improvement in pain (SMD -0.47; 95% CI -0.72 to -0.23) and a 11% (change from baseline) improvement in function using the Lequesne index (SMD -0.47; 95% CI -0.82 to -0.12). However, the results were not uniformly positive and the reasons for this remain unexplained. WOMAC pain, function and stiffness outcomes did not reach statistical significance.
RCTs in which the Rotta preparation of glucosamine was compared to placebo found glucosamine superior for pain (SMD -1.11; 95% CI -1.66 to -0.57) and function (Lequesne index SMD -0.47; 95% CI -0.82 to -0.12). Pooled results for pain (SMD -0.05; 95% CI -0.15 to 0.05) and function using the WOMAC index (SMD -0.01; 95% CI -0.13 to 0.10) in those RCTs using a non-Rotta preparation of glucosamine did not reach statistical significance. Two RCTs using the Rotta preparation showed that glucosamine was able to slow radiological progression of OA of the knee over a three-year period (mean difference (MD) 0.32; 95% CI 0.05 to 0.58).
Glucosamine was as safe as placebo in terms of the number of participants reporting adverse reactions (relative risk ratio 0.99; 95% CI 0.91 to 1.07).
Pooled results from studies using a non-Rotta preparation or adequate allocation concealment failed to show benefit in pain and WOMAC function while those studies evaluating the Rotta preparation showed that glucosamine was superior to placebo in the treatment of pain and functional impairment resulting from symptomatic OA.
Plain language summary
Glucosamine for osteoarthritis
This summary of a Cochrane review presents what we know from research about the effect of glucosamine on osteoarthritis.
People with osteoarthritis who take glucosamine:
- may reduce their pain
- may improve their physical function
- will probably not have side effects
What is osteoarthritis and glucosamine?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. Drug and non-drug treatments are used to relieve pain and/or swelling.
Glucosamine can be found naturally in the body and is used by the body as one of the building blocks of cartilage. Glucosamine can also be taken as a pill as a supplement to the diet, or sometimes as an injection. It can come in combination with other supplements (such as chondroitin), or by itself in the form of glucosamine hydrochloride or sulphate. The usual dose recommended on packages is 1500 mg per day or 500 mg three times a day.
In Europe, glucosamine is prescribed by health care providers. But in North America, people can buy glucosamine supplements without a prescription. This means that, in North America, glucosamine is not regulated and the pills may or may not truly contain the amount described on the label.
Best estimate of what happens after about 6 months
Pain: The high quality studies showed that pain improved about the same whether people took glucosamine or fake pills. If all of the studies are examined (including low quality and old studies), then glucosamine improved pain more than fake pills.
People who took fake pills had a pain score of 7 points on a 0 to 100 scale. Pain may improve by 10 more points with glucosamine than with fake pills.
Studies testing only the Rotta brand of glucosamine (including low quality and older studies) showed that glucosamine improved pain more than fake pills. People who took fake pills had a pain score of 6 points on a 0 to 20 scale. People who took the Rotta brand of glucosamine rated their pain 3 points lower than people who did not take glucosamine.
Function: The high quality studies show that glucosamine improved function more than fake pills when measured by one type of scale, but improved the same amount as fake pills when measured by another scale.
Studies testing only the Rotta brand of glucosamine (including low quality and older studies) showed that glucosamine improved function more than fake pills. People who took fake pills had a function score of 22 points on a 0 to 68 scale. People who took the Rotta brand of glucosamine had their ability to function improve by 2 points compared to people who did not take glucosamine.
There was no difference in the number of people who had side effects. Side effects mainly included stomach upset and other joint pain.
搜尋包括MEDLINE, PREMEDLINE, EMBASE, AMED, ACP Journal Club, DARE, CDSR, and CENTRAL，同時搜尋所選文章之參考文獻及聯絡專家 (直到2005年1月)。
兩位作者獨立進行資料摘錄。兩位作者獨立進行資料摘錄，並以Gotzsche's方法及Jadad分數評估摘錄資料的品質。針對二元性的結果，計算相對風險(relative risk, RR)。針對連續性的結果，則計算標準化平均差異(standardized mean difference, SMD)。
如限於8個分配隱密的臨床試驗，在疼痛及WOMAC功能，並無顯著差異。20個隨機臨床試驗(2570位患者)顯示葡萄糖胺治療，由基礎值改善疼痛28% (SMD −0.61, 95% CI −0.95, −0.28) 及由基礎值改善功能Lequesne index 21% (SMD −0.51 95% C 0.96, −0.05)。但結果並不一致。WOMAC 疼痛，功能，及僵硬未達顯著差異。10個用Rotta產品比上安慰劑之隨機臨床試驗偏向葡萄糖胺治療，對於疼痛 (SM 1.31, 95% CI −1.99, −0.64)及Lequesne index功能有效 (SMD −0.51, 95% CI −0.96, −0.05)。但非Rotta產品之隨機臨床試驗，則未達顯著差異：疼痛(SMD −0.15, 95% CI −0.35, 0.05)，WOMAC 功能指標 (SM .03, 95% CI −0.18, 0.25)。4個比上非類固醇消炎止痛藥之隨機臨床試驗，葡萄糖胺在2個研究較佳，2個研究相當。2個用Rotta葡萄糖胺產品研究顯示3年時能減少X光退化變化(SMD 0.24, 95% CI 0.04, 0.43)。葡萄糖胺與安慰劑之副作用相當(RR = 0.97, 95% CI, 0.88, 1.08)。
20個隨機臨床試驗(2570位患者)。非Rotta產品及適當分配隱密性之隨機臨床試驗無法顯示療效﹝疼痛及WOMAC功能﹞。但Rotta產品比安慰劑在疼痛及功能上有改善 。在WOMAC 結果之疼痛、僵硬及功能上，不論Rotta產品及非Rotta產品與安慰劑相比皆無顯著差異。葡萄糖胺與安慰劑之安全性相當。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
是否葡萄糖胺可治療退化性關節炎？這次 Cochrane review看著迄今為止對葡萄糖胺最好的研究。 20個研究與試驗超過 2500人的膝蓋或髖部退化性關節炎。大部分的研究是2至3個月之久。為了測試葡萄糖胺有多有效，研究人員比較了葡萄糖胺(藥丸或注射)，假藥丸或注射，或者非類固醇抗發炎劑(NSAID)。什麼是退化性關節炎和葡萄糖胺？退化性關節炎(OA)是最常見形式的關節炎會影響手，髖部，肩膀和膝蓋。在OA，保護骨頭兩端的軟骨破裂，導致疼痛和腫脹。藥物和非藥物治療可以緩解疼痛和/或腫脹。葡萄糖胺可在體內自然存在，且是軟骨其中一個組成部分。據認為，服用葡萄糖胺補充劑可以幫助阻止軟骨破裂，幫助軟骨生成，減少腫脹。但是其影響效果仍有爭論。葡萄糖胺有多有效？ 疼痛：高品質的研究表明，人們使用葡萄糖胺或假藥丸其疼痛改善是相同的。如果所有的研究都被檢驗(包括低品質和舊的研究)，葡萄糖胺改善疼痛效果超過假藥丸。葡萄糖胺比假藥丸可改善疼痛13% (0到100分數量表)。研究測試只有Rotta牌葡萄糖胺(包括低品質，舊的研究)顯示葡萄糖胺改善疼痛勝過假藥丸。 功能：高品質的研究顯示，當衡量一種類型的量表時，葡萄糖胺改善疼痛勝過假藥丸，但用另一種量表時其表現和假藥丸一樣。所有的研究(包括低品質，舊的研究)或是否使用Rotta牌葡萄糖胺進行分析，這結果是一樣的。安全性如何呢？服用了葡萄糖胺的副作用與服用假藥丸的副作用人數是相等的。副作用主要有胃部不適和其他關節疼痛。什麼是底線？在先前採取的Cochranere view結果表明使用葡萄糖胺6週可減少退化性關節炎病患疼痛和改善功能(體能)。 相比於上一次review，這次review的分析研究是更新更優質的研究報告，顯示有“白金”級的證據，認為服用葡萄糖胺2至3個月對於疼痛是沒有改善的。根據不同的尺度來測量功能(體能)，並非所有功能可能都有改善。葡萄糖胺似乎是安全的。