Bruyere Olivier, Reginster Jean-Yves
WHO Collaborating Center for Public Health Aspect of Osteoarticular Disorders, University of Liège, Liege, Belgium.
Drugs Aging. 2007;24(7):573-80. doi: 10.2165/00002512-200724070-00005.
Osteoarthritis (OA), the most common form of arthritis, is a public health problem throughout the world. Several entities have been carefully investigated for the symptomatic and structural management of OA. This review evaluates published studies of the effect of glucosamine salts and chondroitin sulfate preparations on the progression of knee or hip OA. Despite multiple double-blind, controlled clinical trials of the use of glucosamine and chondroitin sulfate in OA, controversy regarding the efficacy of these agents with respect to symptomatic improvement remains. Several potential confounders, including placebo response, use of prescription medicines versus over-the-counter pills or food supplements, or use of glucosamine sulfate versus glucosamine hydrochloride, may have relevance when attempting to interpret the seemingly contradictory results of different clinical trials. The National Institutes of Health-sponsored GAIT (Glucosamine/chondroitin Arthritis Intervention Trial) compared placebo, glucosamine hydrochloride, chondroitin sulfate, a combination of glucosamine and chondroitin sulfate and celecoxib in a parallel, blinded 6-month multicentre study of patients with knee OA. This trial showed that glucosamine hydrochloride and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with OA of the knee. However, exploratory analyses suggest that the combination of glucosamine hydrochloride and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain. For decades, the traditional pharmacological management of OA has been mainly symptomatic. However, in recent years, several randomised controlled studies have assessed the structure-modifying effect of glucosamine sulfate and chondroitin sulfate using plain radiography to measure joint space narrowing over years. There is some evidence to suggest a structure-modifying effect of glucosamine sulfate and chondroitin sulfate. On the basis of the results of recent randomised controlled trials and meta-analyses, we can conclude that glucosamine sulfate (but not glucosamine hydrochloride) and chondroitin sulfate have small-to-moderate symptomatic efficacy in OA, although this is still debated. With respect to the structure-modifying effect, there is compelling evidence that glucosamine sulfate and chondroitin sulfate may interfere with progression of OA.
骨关节炎（OA）是最常见的关节炎形式，是一个全球性的公共卫生问题。为了对OA进行症状和结构管理，已经对多种药物进行了仔细研究。本综述评估了关于氨基葡萄糖盐和硫酸软骨素制剂对膝或髋OA进展影响的已发表研究。尽管有多项关于在OA中使用氨基葡萄糖和硫酸软骨素的双盲对照临床试验，但这些药物在症状改善方面的疗效仍存在争议。在试图解释不同临床试验中看似矛盾的结果时，几个潜在的混杂因素可能具有相关性，包括安慰剂反应、处方药与非处方药或食品补充剂的使用，或硫酸氨基葡萄糖与盐酸氨基葡萄糖的使用。美国国立卫生研究院资助的GAIT（氨基葡萄糖/硫酸软骨素关节炎干预试验）在一项针对膝OA患者的平行、双盲、为期6个月的多中心研究中，比较了安慰剂、盐酸氨基葡萄糖、硫酸软骨素、氨基葡萄糖和硫酸软骨素的组合以及塞来昔布。该试验表明，单独使用盐酸氨基葡萄糖和硫酸软骨素或两者联合使用，在总体膝OA患者组中并不能有效减轻疼痛。然而，探索性分析表明，盐酸氨基葡萄糖和硫酸软骨素的组合可能对中度至重度膝痛患者亚组有效。几十年来，OA的传统药物治疗主要是对症治疗。然而，近年来，一些随机对照研究使用普通X线摄影来测量多年来关节间隙变窄情况，评估了硫酸氨基葡萄糖和硫酸软骨素的结构改善作用。有一些证据表明硫酸氨基葡萄糖和硫酸软骨素具有结构改善作用。根据最近的随机对照试验和荟萃分析结果，我们可以得出结论，硫酸氨基葡萄糖（而非盐酸氨基葡萄糖）和硫酸软骨素在OA中具有小到中度的症状改善疗效，尽管这仍存在争议。关于结构改善作用，有令人信服的证据表明硫酸氨基葡萄糖和硫酸软骨素可能会干扰OA的进展。
