Osteoarthritis (OA), the most common form of arthritis, is a public health problem throughout the world. Several entities have been carefully investigated for the symptomatic and structural management of OA. This review evaluates published studies of the effect of glucosamine salts and chondroitin sulfate preparations on the progression of knee or hip OA. Despite multiple double-blind, controlled clinical trials of the use of glucosamine and chondroitin sulfate in OA, controversy regarding the efficacy of these agents with respect to symptomatic improvement remains. Several potential confounders, including placebo response, use of prescription medicines versus over-the-counter pills or food supplements, or use of glucosamine sulfate versus glucosamine hydrochloride, may have relevance when attempting to interpret the seemingly contradictory results of different clinical trials. The National Institutes of Health-sponsored GAIT (Glucosamine/chondroitin Arthritis Intervention Trial) compared placebo, glucosamine hydrochloride, chondroitin sulfate, a combination of glucosamine and chondroitin sulfate and celecoxib in a parallel, blinded 6-month multicentre study of patients with knee OA. This trial showed that glucosamine hydrochloride and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with OA of the knee. However, exploratory analyses suggest that the combination of glucosamine hydrochloride and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain. For decades, the traditional pharmacological management of OA has been mainly symptomatic. However, in recent years, several randomised controlled studies have assessed the structure-modifying effect of glucosamine sulfate and chondroitin sulfate using plain radiography to measure joint space narrowing over years. There is some evidence to suggest a structure-modifying effect of glucosamine sulfate and chondroitin sulfate. On the basis of the results of recent randomised controlled trials and meta-analyses, we can conclude that glucosamine sulfate (but not glucosamine hydrochloride) and chondroitin sulfate have small-to-moderate symptomatic efficacy in OA, although this is still debated. With respect to the structure-modifying effect, there is compelling evidence that glucosamine sulfate and chondroitin sulfate may interfere with progression of OA.
中文翻译:
氨基葡萄糖和硫酸软骨素可治疗膝盖和髋部骨关节炎。
骨关节炎(OA)是最常见的关节炎形式,是全世界的公共卫生问题。对于OA的症状和结构管理,已经仔细研究了几个实体。该评价评估了氨基葡萄糖盐和硫酸软骨素制剂对膝或髋关节炎进展的影响的已发表研究。尽管在OA中使用了氨基葡萄糖和硫酸软骨素进行了多次双盲,对照临床试验,但关于这些药物在症状改善方面的功效仍存在争议。几种潜在的混杂因素,包括安慰剂反应,处方药与非处方药或食品补充剂的使用,或硫酸葡萄糖胺与盐酸葡萄糖胺的使用,试图解释不同临床试验看似矛盾的结果时可能具有相关性。美国国立卫生研究院(National Institutes of Health)赞助的GAIT(葡萄糖胺/软骨素关节炎干预试验)比较了安慰剂,氨基葡萄糖盐酸盐,硫酸软骨素,葡萄糖胺与硫酸软骨素和硫酸Celcoxib的组合,在一项为期6个月的对OA盲患者进行的平行,双盲的多盲平行研究中。该试验表明,单独或联合使用盐酸氨基葡萄糖和硫酸软骨素不能有效缓解整个膝关节炎患者的疼痛。然而,探索性分析表明,将葡萄糖胺盐酸盐和硫酸软骨素联合使用可能对中度至重度膝关节疼痛患者亚组有效。几十年来 OA的传统药理管理主要是对症治疗。但是,近年来,几项随机对照研究已经使用普通放射线照相技术测量了硫酸氨基葡萄糖和硫酸软骨素的结构修饰效果,以测量多年来关节间隙变窄的情况。有证据表明硫酸葡萄糖胺和硫酸软骨素具有结构修饰作用。根据最近的随机对照试验和荟萃分析的结果,我们可以得出结论,尽管仍存在争议,但硫酸葡萄糖胺(而不是盐酸葡萄糖胺)和硫酸软骨素在OA中的症状功效很小至中等。关于结构修饰作用,有令人信服的证据表明硫酸葡萄糖胺和硫酸软骨素可能会干扰OA的发展。
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