Chondroitin unlikely to benefit patients with hip or knee OA, says study

Chondroitin is unlikely to benefit patients with hip or knee osteoarthritis and should be "discouraged" according to a recent meta-analysis.Dr. Peter Juni (University of Bern, Switzerland) and colleagues write that previous meta-analyses describe moderate to large benefits of chondroitin in patients with osteoarthritis. However, this finding has not been supported by recent large-scale trials.Therefore the authors undertook the current systematic review and meta-analysis of all available randomised, controlled trials to determine the effects of chondroitin on pain and joint space. This incorporated data from 20 trials involving 3,846 patients, identified through a search of Medline and related sources.Juni's group report a high degree of heterogeneity between the trials, with recent high-quality studies describing chondroitin as having minimal or no effect on joint pain. However, the effects on joint space were "inconclusive".The authors also found that the apparent benefits of chondroitin were largely confined to studies of poor methodological quality, such as those with small patient numbers or ones with unclear concealment of allocation. When the analysis was limited to the three best-designed studies with the largest sample sizes (40% of all patients), chondroitin offered virtually no relief from joint pain."No robust evidence supports the use of chondroitin in osteoarthritis. Large-scale, methodologically sound trials indicate that the symptomatic benefit is minimal to nonexistent," Juni and colleagues comment, adding that the effect of chondroitin on joint space narrowing "is likely to be small, and its clinical significance is uncertain."The authors add, "the use of chondroitin should be restricted to randomized, controlled trials...for patients with advanced osteoarthritis, a clinically relevant benefit is unlikely and the use of chondroitin should be discouraged."In a related editorial Dr David Felson (Boston University) accepts the evidence based approach by Juni and colleagues but adds, "Because no frequent or severe adverse effects have been reported, chondroitin sulfate should not be considered dangerous. If patients say that they benefit from chondroitin, I see no harm in encouraging them to continue taking it as long as they perceive a benefit."Reference...