Abstract
Osteoarthritis (OA) treatment is limited by the inability of prescribed medications to alter disease outcome. As a result, patients with OA often take food substances called nutraceuticals in an attempt to affect the structural changes that occur within a degenerating joint. The role of nutraceuticals in OA management can be defined only by an evidence-based approach to support their use. This paper reviews the clinical trials studying glucosamine, chondroitin sulfate, vitamin C, vitamin E, and avocado-soybean unsaponifiables. It highlights the need for additional randomized, placebo-controlled trials to further define the utility of nutraceuticals in OA treatment.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
Lawrence RC, Helmick CG, Arnett FC, et al.: Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998, 41:778–799.
Clegg DO, Reda DJ, Harris CL, et al.: Glucosamine, chondroitin sulfate and the two in combination for painful knee osteoarthritis. N Engl J Med 2006, 354:795–808.
McAlindon TE, Cooper C, Kirwan JR, Dieppe PA: Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis 1993, 52:258–262.
Altman R, Asch E, Bloch D, et al.: Development of criteria for the classification and reporting of OA. Classification of Osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986, 29:1039–1049.
Goldring MB: Anticytokine therapy for osteoarthritis. Expert Opin Biol Ther 2001, 1:817–829.
Aigner T, Kurz B, Fukui N, Sandell L: Roles of chondrocytes in the pathogenesis of osteoarthritis. Curr Opin Rheumatol 2002, 14:578–584.
Goggs R, Vaughan-Thomas A, Clegg P: Nutraceutical Therapies for Degenerative Joint Diseases: A critical review. Crit Rev Food Sci Nutr 2005, 45:145–164.
Laufer S: Role of eicosanoids in structural degradation in osteoarthritis. Curr Opin Rheumatol 2003, 15:623–627.
Henrotin Y, Deby-Dupont G, Deby C, et al.: Production of active oxygen species by isolated human chondrocytes. Br J Rheumatol 1993, 32:562–567.
Sato H, Takahashi T, Ide H, et al.: Antioxidant activity of synovial fluid, hyaluronic acid, and two subcomponents of hyaluronic acid. Synovial fluid scavenging effect is enhanced in rheum atoid arthritis patients. Arthritis Rheum 1998, 31:63–71.
Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum 2000, 43:1905–1915.
Hochberg MC, Altman RD, Brandt KD, et al.: Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. American College of Rheum atology. Arthritis Rheum 1995, 38:1541–1546.
Jordan KM, Arden NK, Doherty M, et al.: EULAR Recommendations 2003: an evidence based approach to the management of knee osteo arthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003, 62:1145–1155.
McAlindon TE, LaValley MP, Gulin JP, Felson DT: Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000, 283:1469–1475.
Towheed TE, Maxwell L, Anastassiades TP, et al.: Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005, 2:CD002946.
Reichelt A, Forster KK, Fischer M, et al.: Efficacy and safety of intramuscular glucosamine sulfate in osteoarthritis of the knee. A randomised, placebo-controlled, double-blind study. Arzneimittelforschung 1994, 44:75–80.
Vajaradul Y: Double-blind clinical evaluation of intra-articular glucosamine in outpatients with gonarthrosis. Clin Ther 1981, 3:336–343.
Pujalte JM, Llavore EP, Ylescupidez FR: Double-blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthrosis. Curr Med Res Opin 1980, 7:110–114.
Houpt JB, McMillan R, Wein C, Paget-Dellio SD: Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J Rheumatol 1999, 26:2423–2430.
Noack W, Fischer M, Forster KK, et al.: Glucosamine sulfate in osteoarthritis of the knee. Osteoarthritis Cartilage 1994, 2:51–59.
Cibere J, Kopec JA, Thorne A, et al.: Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis. Arthritis Rheum 2004, 51:738–745.
Reginster JY, Deroisy R, Rovati LC, et al.: Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001, 357:251–256.
Pavelka K, Gatterova J, Olejarova M, et al.: Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med 2002, 162:2113–2123.
Mazzuca SA, Brandt KD, Lane KA, Katz BP: Knee pain reduces joint space width in conventional standing anteroposterior radiographs of osteoarthritic knees. Arthritis Rheum 2002, 46:1223–1227.
Herrero-Beaumont G, Roman JA, Trabado MC, et al.: Effects of glucosamine sulfate on 6-month control of knee osteoarthritis symptoms vs placebo and acetaminophen: results from the Glucosamine Unum in Die Efficacy (GUIDE) trial. Arthritis Rheum 2005, 52:S460.
Lequesne MG, Mery C, Samson M, Gerard P: Indexes of severity for osteoarthritis of the hip and knee. Validation—value in comparison with other assessment tests. Scand J Rheumatol Suppl 1987, 65:85–89.
Mazieres B, Loyau G, Menkes CJ, et al.: Chondroitin sulfate in the treatment of gonarthrosis and coxarthrosis. 5-months result of a multicenter double-blind controlled prospective study using placebo [in French]. Rev Rhum Mal Osteoartic 1992, 59:466–472.
L’Hirondel JL: Double-blind clinical study with oral administration of chondroitin sulphate versus placebo for tibio femoral gonarthrosis (125 patients) [in German]. Litera Rheumatol 1992, 14:77–84.
Bucsi L, Poor G: Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of knee osteoarthritis. Osteoarthritis Cartilage 1998, 6(Suppl A):31–36.
Conrozier T: Anti-arthrosis treatments: efficacy and tolerance of chondroitin sulfates (CS 4&6) [in French]. Presse Med 1998, 27:1862–1865.
Bourgeois P, Chales G, Dehais J, et al.: Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3 × 400 mg/day vs placebo. Osteoarthritis Cartilage 1998, 6(Suppl A):25–30.
Pavelka K, Bucsi L, Manopulo R: Double-blind, dose effect study of oral CS 4&6 1200mg, 800mg, 200mg against placebo in the treatment of femorotibial osteoarthritis. Eular Rheumatol Litera 1998, (Suppl 2):63.
Uebelhart D, Thonar EJ, Delmas PD, et al.: Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study. Osteoarthritis Cartilage 1998, 6(Suppl A):39–46.
Mazieres B, Combe B, Phan Van A, et al.: Chondroitin sulfate in osteoarthritis of the knee: a prospective, double blind, placebo controlled multicenter clinical study. J Rheumatol 2001, 28:173–181.
McAlindon TE, LaValley MP, Felson DT: Efficacy of glucosamine and chondroitin for treatment of osteoarthritis. JAMA 2000, 284:1241.
Richy F, Bruyere O, Ethgen O, et al.: Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med 2003, 163:1514–1522.
Michel BA, Stucki G, Frey D, et al.: Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: a randomized, controlled trial. Arthritis Rheum 2005, 52:779–786.
Morreale P, Manopulo R, Galati M, et al.: Comparison of the antiinflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol 1996, 23:1385–1391.
Leffler CT, Philippi AF, Leffler SG, et al.: Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med 1999, 164:85–91.
Cohen M, Wolfe R, Mai T, et al.: A randomized, double blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate and camphor for osteoarthritis of the knee. J Rheumatol 2003, 30:523–528.
Pham T, van der Heijde D, Altman RD, et al.: OMER-ACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartilage 2004, 12:389–399.
Clegg DO, Reda DJ, Shi H, et al.: Chondroitin sulfate may have differential effects on OA symptoms related to degree of radiographic involvement. Osteoarthritis Cartilage 2005, 13(Suppl 1):S76–S77.
McAlindon TE, Jaques P, Zhang T, et al.: Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum 1996, 39:648–656.
Baker K, Niu J, Goggins J, et al.: The effects of vitamin C intake on pain in knee osteoarthritis (OA). Arthritis Rheum 2003, 48:S422.
Wluka AE, Stuckey S, Brand C, Cicuttini FM: Supplementary Vitamin E does not affect the loss of cartilage volume in knee osteoarthritis: a 2 year double blind placebo controlled study. J Rheumatol 2002, 29:2585–2591.
Ernst E: Avocado-soybean unsaponifiables (ASU) for osteoarthritis—a systematic review. Clin Rheumatol 2003, 22:285–288.
Lequesne M, Maheu E, Cadet C, et al.: Structural effect of avocado/soybean unsaponifiables on joint space loss in osteoarthritis of the hip. Arthritis Care Res 2002, 47:50–58.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Frech, T.M., Clegg, D.O. The utility of nutraceuticals in the treatment of osteoarthritis. Curr Rheumatol Rep 9, 25–30 (2007). https://doi.org/10.1007/s11926-007-0018-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11926-007-0018-x