Osteoarthritis is the most common type of arthritis worldwide. It is a degenerative condition which occurs when the protective cartilage at the ends of your bones wear out over time. Osteoarthritis often presents with symptoms of joint pain, stiffness, tenderness, loss of range of movement, swelling and sometimes swelling.
As mentioned before, osteoarthritis is one of the common orthopedics problems in the world. As one of the common conditions, there are numbers of methods of treatment for osteoarthritis. We can divide the treatments of osteoarthritis to non-pharmaceutical and pharmaceutical treatments. You can reduce the risk of osteoarthritis with frequent non-weight bearing exercise (e.g: swimming and cycling), healthy diet and adequate rest after exercise. If you do not see any efficient non-pharmaceutical treatment, you may try to get some medications for osteoarthritis. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are often used to treat osteoarthritis. But these days, there are a lot of new medications developed to treat this condition. In this article, we will look to a study that did a comparison of some new drugs for osteoarthritis.
LITERATURE SEARCH
- A) Type of study design
The study entitled “Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis” is based on Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), which is done to evaluate the efficacy and safety of the treatment for knee pain from osteoarthritis. It is a randomized controlled trial (RCT) as they were randomly assigned 1583 patients with symptomatic knee osteoarthritis to receive 1500 mg of glucosamine daily, 1200 mg of chondroitin sulfate daily, both glucosamine and chondroitin sulfate, 200 mg of celecoxib daily, or placebo for 24 weeks. Furthermore, prior to the study, the primary outcome was measured; a 20 percent decrease in knee pain from baseline to week 24.
This study was done in the year of 2005.
- B) Overview of literature search
There are few search engines used in finding the most suitable study for proposed general questions which are PubMed and Google Scholar. With the aid of advanced search, I am able to shortlist the studies that are suitable for my general question. “Glucosamine”, “Chondroitin” and “Osteoarthritis” are all the keywords I chose to come across about 2000 related studies. There are few articles that have been reviewed and most of them are discussing the effectiveness, side effects and ability of both supplements in replacing current medications for osteoarthritis symptoms. However, I did a finalization to choose an article entitled “Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis” written in February 2006 as my choice for stated general questions. In my own interpretation, this study is most likely the best study for my PICO question as it is a randomized controlled trial (highest hierarchy of evidence), which is also presented with a result of effectiveness of the supplements on improving the symptoms of osteoarthritis. However, the study is made in the year of 2006, which an outdated source will be my main concern.
- C) Reference:
Clegg DO, Reda DJ, Harris CL, Klein MA, Odell JR, Hooper MM, et al. Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis. New England Journal of Medicine. 2006Feb23;354(8):795–808.
CRITICAL APPRAISAL
- A) Summary of review of the article:
Background
Chondroitin sulfate and glucosamine are used to treat osteoarthritis. The double-blind, multicenter placebo- and celecoxib-controlled Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) evaluated their safety and efficacy as a treatment for knee pain from osteoarthritis.
Method
There are randomly assigned 1583 patients with symptomatic knee osteoarthritis to receive 1200 mg of chondroitin sulfate daily, 1500 mg of glucosamine daily, both chondroitin sulfate and glucosamine, 200 mg of celecoxib daily, or placebo for 24 weeks. On the other hand, the primary outcome measure was a 20 percent decrease in knee pain from baseline to week 24.
Results
In overall, chondroitin sulfate and glucosamine were not significantly better than placebo in reducing knee pain only by 20%. As compared with the rate of response to placebo (60.1 percent), the rate of response to chondroitin sulfate was 5.3 percentage points higher (P=0.17), the rate of response to glucosamine was 3.9 percentage points higher (P=0.30), and the rate of response to combined treatment was 6.5 percentage points higher (P=0.09). The rate of response in the celecoxib control group was 10.0% higher than that in the placebo control group (P=0.008). For patients with moderate-to-severe pain at baseline, the rate of response was significantly higher with combined therapy than with placebo (79.2 percent vs. 54.3 percent, P=0.002). Furthermore, adverse events were mild, infrequent, and evenly distributed among the groups.
Conclusion
Chondroitin sulfate and glucosamine alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee. Exploratory analyses suggest that the combination of chondroitin sulfate and glucosamine may be effective in the subgroup of patients with moderate-to-severe knee pain.
- B) Clinical applicability
This is a study on randomized controlled trial, which is the highest type of study in the hierarchy of evidence. Thus, the results of the study can be reliable compared to other types of study. Furthermore, a total of 1583 subjects of the study can be considered adequate sample size for this kind of study. As mentioned in the article, confidence interval of the study is 98.3 percent (corresponding to the use of criteria in which a P value of less than 0.017) the result stated in the study can be considered as significant.
However, in terms of applicability of the results on this study in Malaysia, it can be brought into further discussion. First of all, the implementation of the supplement in Healthcare in Malaysia can be debatable due to cost effectiveness. The result showed only a slight increase in effectiveness of the supplements on improving the symptoms of osteoarthritis. It will be a high risk investment on the healthcare systems as the current pain management treatment of the osteoarthritis patients already given the similar effectiveness compared to glucosamine sulfate and chondroitin sulfate.
On the other hand, the result showed significant effectiveness specifically on patients with moderate-severe knee pain due to osteoarthritis but not to overall of the patients involved. Thus, these supplements prescription is not effective for all of the patients with osteoarthritis. It is maybe applicable for the sub-group of moderate-severe pain patients to have these additional supplements prescriptions for better improvements on pain management.
Other important factors such as the availability of resources, risk- benefits and expected long-term contribution in our primary healthcare should be analysed further in order to guarantee the best outcomes in the management of the symptoms of osteoarthritis.
