Arthritis
Glucosamine no better than placebo for Arthritis
GLUCOSAMINE is no better than placebo for osteoarthritis, according to a leading Australian rheumatologist.
Professor David Hunter, from the Royal North Shore Hospital and University of Sydney, told the Australian Rheumatology Association annual scientific meeting this week one of the main problems of managing the condition was that much of what was done relied on a placebo effect.
“There have been lots and lots of studies done with glucosamine and they are quite variable in terms of their methods,” Professor Hunter told MO.
“The best evidence currently available would suggest they are no better than a placebo.”
He cited a recent systematic review (Zhang et al) demonstrating there was no benefit above placebo in well-designed studies.
Professor Hunter advised that patients already established on glucosamine should continue taking it.
“It’s relatively cheap, it’s pretty safe and the placebo effect in osteoarthritis is pretty large,” he said.
“So in general, if a patient comes along and they are on glucosamine and they swear by it, I don’t discourage them from taking it.
“If they aren’t already on it, I don’t encourage them and I actually actively discourage them.”
The conference also heard this week that an international survey showed that half of Australians experienced musculoskeletal conditions, such as arthritis and backache.
Professor Lyn March, a senior staff specialist in rheumatology and clinical epidemiology at the Royal North Shore Hospital and an author of the study, said the results were “staggering”.
“Osteoarthritis, low back and neck pain are the most common, affecting more than five million Australians,” she said.
“Knee osteoarthritis has been increasing at the greatest rate over the past decade, particularly in men.”
A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain.
Source
Department of Psychology, York University, Toronto, ON, Canada.
Abstract
Between 40% and 60% of Americans use complementary and alternative medicine to manage medical conditions, prevent disease, and promote health and well-being. Omega-3 polyunsaturated fatty acids (omega-3 PUFAs) have been used to treat joint pain associated with several inflammatory conditions. We conducted a meta-analysis of 17 randomized, controlled trials assessing the pain relieving effects of omega-3 PUFAs in patients with rheumatoid arthritis or joint pain secondary to inflammatory bowel disease and dysmenorrhea. Meta-analysis was conducted with Cochrane Review Manager 4.2.8. for six separate outcomes using standardized mean differences (SMDs) as a measure of effect size: (1) patient assessed pain, (2) physician assessed pain, (3) duration of morning stiffness, (4) number of painful and/or tender joints, (5) Ritchie articular index, and (6) nonselective nonsteroidal anti-inflammatory drug consumption. Supplementation with omega-3 PUFAs for 3-4 months reduces patient reported joint pain intensity (SMD: -0.26; 95% CI: -0.49 to -0.03, p=0.03), minutes of morning stiffness (SMD: -0.43; 95% CI: -0.72 to -0.15, p=0.003), number of painful and/or tender joints (SMD: -0.29; 95% CI: -0.48 to -0.10, p=0.003), and NSAID consumption (SMD: -0.40; 95% CI: -0.72 to -0.08, p=0.01). Significant effects were not detected for physician assessed pain (SMD: -0.14; 95% CI: -0.49 to 0.22, p=0.45) or Ritchie articular index (SMD: 0.15; 95% CI: -0.19 to 0.49, p=0.40) at 3-4 months. The results suggest that omega-3 PUFAs are an attractive adjunctive treatment for joint pain associated with rheumatoid arthritis, inflammatory bowel disease, and dysmenorrhea.
Dr Colin Holloway 
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