The rate of decline of joint space width in patients with osteoarthritis of the knee: a systematic review and meta-analysis of randomized placebo-controlled trials of chondroitin sulfate

ABSTRACT

Background: Chondroitin sulfate has been shown to relieve pain and improve functional limitation in patients with osteoarthritis (OA) of the knee in numerous clinical trials and meta-analyses. Its role as a potential structure-modifying drug for knee OA, however, remains controversial.

Objective: To perform a meta-analysis of randomized double-blind placebo-controlled clinical trials to assess the efficacy of chondroitin sulfate as a structure-modifying drug for knee OA.

Research design and methods: A Medline search was conducted from 1996 through 2007 and five articles that reported results from three trials were identified; one additional trial was identified through review of presentations at annual rheumatology meetings. There was no evidence of heterogeneity across the trials and results were pooled using a fixed effects meta-analysis.

Results: Pooled results demonstrated a small significant effect of chondroitin sulfate on the reduction in rate of decline in minimum joint space width of 0.07 mm/year (95% CI 0.03, 0.10) that corresponded to an effect size of 0.26 (95% CI 0.14, 0.38) (p < 0.0001). This result was robust in sensitivity analyses.

Limitations: The individual studies included in the meta-analysis varied in the number of patients enrolled and the techniques used to acquire knee radiographs and to measure joint space width.

Conclusion: These results demonstrate that chondroitin sulfate is effective for reducing the rate of decline in minimum joint space width in patients with OA of the knee. Chondroitin sulfate may have a role as a structure-modifying agent in the management of patients with knee OA.

Key words: :

• Chondroitin
• Glucosamine
• Joint space narrowing
• Nutritional supplements
• Osteoarthritis
• Structure modification

Acknowledgements

Declaration of interest: This work was supported by a grant from Bioiberica S.A. to the University of Maryland Baltimore. M.C.H. serves as a consultant to the following companies that have products related to the treatment of pain in patients with osteoarthritis: Allergan, Bayer Healthcare LLC, CombinatoRx, Genzyme Corporation, Merck & Co., Inc., NicOx S.A., Novartis Pharma A.G., and Pozen Inc. M.Z. and P.L. have no competing interests to disclose. No editorial assistance was provided during the preparation of this manuscript.

Notes

* These data were presented in part at a scientific symposium sponsored by Bioiberica S.A. held during the 2008 annual congress of the European League of Associations of Rheumatology, Paris, France, June 11–14, 2008