Knapik Joseph J, Pope Rodney, Hoedebecke Sally S, Schram Ben, Orr Robin
J Spec Oper Med. 2019 Spring;19(1):113-124. doi: 10.55460/JLSS-PG9B.
Osteoarthritis (OA) is a disorder involving the deterioration of articular cartilage and underlying bone and is associated with symptoms of pain and disability. In military personnel, the incidence of OA has increased between 2000 and 2012 and was the first or second leading cause of medical separations in this period. It has been suggested that consumption of chondroitin sulfate (CS) may reduce the pain and joint deterioration associated with OA. This article reports on a systematic review and meta-analysis of the effectiveness of CS on reducing OA-related pain and joint deterioration. PubMed and Ovid Embase databases and other sources were searched to find randomized, double-blind, placebo-controlled trials on the effects of orally consumed CS on pain and/or joint structure. The outcome measure was the standardized mean difference (SMD) which was the improvement in the placebo groups minus the improvement in the CS groups divided by the pooled standard deviation. There were 18 trials meeting the review criteria for pain with SMD -0.41, 95% confidence interval (95% CI) -0.57 to -0.25 (negative SMD favors CS). Six studies met the review criteria for joint space narrowing with SMD -0.30, 95% CI -0.61 to +0.00. Two studies meet the review criteria for cartilage volume with SMD -0.11, 95% CI -0.48 to +0.26. Larger dosages (1200mg/d) had greater pain reduction efficacy than lower dosages (≤ 1000mg/d). These data suggest that CS has small to moderate effectiveness in reducing OA-related pain but minimal effects on joint space narrowing and no effect on cartilage volume. It is important that clinicians recommend pharmaceutical-grade CS to their patients due to the variability in the amount of CS in dietary supplements purporting to contain CS.
骨关节炎（OA）是一种涉及关节软骨及其下方骨骼退化的疾病，与疼痛和残疾症状相关。在军事人员中，2000年至2012年间OA的发病率有所上升，在此期间它是医疗退役的首要或次要主要原因。有人认为，服用硫酸软骨素（CS）可能会减轻与OA相关的疼痛和关节退化。本文报告了一项关于CS减轻OA相关疼痛和关节退化有效性的系统评价和荟萃分析。检索了PubMed和Ovid Embase数据库以及其他来源，以查找关于口服CS对疼痛和/或关节结构影响的随机、双盲、安慰剂对照试验。结果测量指标是标准化均数差（SMD），即安慰剂组的改善值减去CS组的改善值，再除以合并标准差。有18项试验符合疼痛方面的评价标准，SMD为-0.41，95%置信区间（95%CI）为-0.57至-0.25（负SMD有利于CS）。六项研究符合关节间隙变窄方面的评价标准，SMD为-0.30，95%CI为-0.61至+0.00。两项研究符合软骨体积方面的评价标准，SMD为-0.11，95%CI为-0.48至+0.26。较大剂量（1200mg/天）比较低剂量（≤1000mg/天）具有更强的疼痛减轻效果。这些数据表明，CS在减轻OA相关疼痛方面有小到中等程度的有效性，但对关节间隙变窄影响极小，对软骨体积没有影响。由于声称含有CS的膳食补充剂中CS含量存在差异，临床医生向患者推荐药用级CS非常重要。
