Gallagher Brian, Tjoumakaris Fotios P, Harwood Marc I, Good Robert P, Ciccotti Michael G, Freedman Kevin B
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Am J Sports Med. 2015 Mar;43(3):734-44. doi: 10.1177/0363546514533777. Epub 2014 May 27.
Structure-modifying medications or nutraceuticals may be an effective treatment for osteoarthritis. This study identified 12 treatments that may possess chondroprotective properties: oral glucosamine; chondroitin; nonsteroidal anti-inflammatory drugs (NSAIDs); polyunsaturated fatty acids; S-adenosylmethionine; avocado and soybean unsaponifiable fractions; methylsulfonylmethane; vitamins C, D, and E; intra-articular injections of hyaluronic acid; and platelet-rich plasma (PRP).
To perform a systematic review of randomized controlled trials for the effectiveness of each agent in preserving articular cartilage of the knee and delaying the progression of osteoarthritis.
Systematic review; Level of evidence, 2.
A literature search was performed using PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Searches were performed using "treatment," "osteoarthritis," and "knee" as keywords. Selection criteria included randomized controlled trials of ≥12 months, with a placebo control, measuring radiographic changes in joint space width, cartilage volume, or radiographic progression of osteoarthritis. The primary outcome was changes in joint integrity measures.
A total of 3514 studies were identified from the initial search, 13 of which met inclusion criteria. Treatment with chondroitin sulfate showed a significant reduction in cartilage loss in 3 of 4 studies identified compared with placebo. Two of 3 trials identified for glucosamine also reported significant structural effects relative to placebo. Intra-articular hyaluronic acid was effective in lowering the rate of cartilage loss in only 1 of 3 studies identified versus placebo. Of the 6 studies identified for NSAIDs, vitamin E, and vitamin D, none showed any structural effect compared with placebo. No studies were found that met the inclusion criteria for polyunsaturated fatty acids, S-adenosylmethionine, avocado and soybean unsaponifiable fractions, methylsulfonylmethane, vitamin C, or PRP.
For patients with or at risk for osteoarthritis, the use of glucosamine and chondroitin sulfate may serve as a nonoperative means to protect joint cartilage and delay osteoarthritis progression. Hyaluronic acid injections showed variable efficacy, while NSAIDs and vitamins E and D showed no effect on osteoarthritis progression. The other agents evaluated had no evidence in the literature to support or refute their use for chondroprotection.
结构改善药物或营养保健品可能是骨关节炎的有效治疗方法。本研究确定了12种可能具有软骨保护特性的治疗方法：口服氨基葡萄糖；硫酸软骨素；非甾体抗炎药（NSAIDs）；多不饱和脂肪酸；S-腺苷甲硫氨酸；鳄梨和大豆不皂化物；甲基磺酰甲烷；维生素C、D和E；关节内注射透明质酸；以及富含血小板血浆（PRP）。
对每项药物在保护膝关节软骨和延缓骨关节炎进展方面有效性的随机对照试验进行系统评价。
系统评价；证据等级，2级。
使用PubMed、EMBASE和Cochrane对照试验中央注册库进行文献检索。检索时使用“治疗”“骨关节炎”和“膝关节”作为关键词。选择标准包括≥12个月的随机对照试验，有安慰剂对照，测量关节间隙宽度、软骨体积或骨关节炎的影像学进展的变化。主要结局是关节完整性指标的变化。
初始检索共识别出3514项研究，其中13项符合纳入标准。与安慰剂相比，在识别出的4项研究中有3项显示硫酸软骨素治疗可显著减少软骨损失。识别出的3项氨基葡萄糖试验中有2项也报告了相对于安慰剂的显著结构效应。与安慰剂相比，在识别出的3项研究中只有1项显示关节内透明质酸可有效降低软骨损失率。在识别出的关于NSAIDs、维生素E和维生素D的6项研究中，与安慰剂相比均未显示出任何结构效应。未发现符合多不饱和脂肪酸、S-腺苷甲硫氨酸、鳄梨和大豆不皂化物、甲基磺酰甲烷、维生素C或PRP纳入标准的研究。
对于患有骨关节炎或有骨关节炎风险的患者，使用氨基葡萄糖和硫酸软骨素可作为保护关节软骨和延缓骨关节炎进展的非手术方法。透明质酸注射疗效不一，而NSAIDs以及维生素E和D对骨关节炎进展无影响。评估的其他药物在文献中没有证据支持或反驳其用于软骨保护。
