Chondroitin sulphate for OA

Approximately 40% of Australians are using complementary medicines (CMs) for osteoarthritis (OA).

There are mixed findings from scientific studies about its benefits, which may be due to variations in dosage, the form of chondroitin used, duration of use and research design. Recent systematic reviews found that when restricted to higher quality trials for treatment of OA, there may be no significant beneficial effect of chondroitin.1–3 

Since these reviews, there have been several well designed randomised control trials that suggest CS may play a role in the symptomatic relief of pain and stiffness in OA with a reduction in the need for analgesics. 

A randomised double blind placebo-controlled trial (RDBPCT) of 162 symptomatic patients with x-ray changes of OA of their hands, using either 800mg CS or placebo once daily for six months, found an overall significant reduction in global hand pain, morning stiffness, and use of paracetamol for pain relief and consequent increase in hand function and grip strength.4

Another study assessing the effects of CS on MRI findings in 69 patients suffering OA of the knee, randomised to CS 800mg or placebo for six months, concluded “CS treatment significantly reduced the cartilage volume loss in knee OA starting at six months of treatment, and subchondral bone marrow lesions at 12 months”.5 

This study supports the findings of a two-year RDBPCT that also found pain relief benefits with CS and improved radiological findings, with reduction in joint space width loss on knee OA compared with placebo.6 

Overall, studies suggest CS to be safe, with no significant side-effects at doses of 800–1200mg daily.

Dr Vicki Kotsirilos 

GP and Chair, RACGP-

AIMA joint working party.

References

1. Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, et al. OARSI recommendations for the management of hip and knee osteoarthritis: Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis and Cartilage. 2010;18(4):476-99.
 2. Reichenbach S, Sterchi R, Scherer M, Trelle S, Bürgi E, Bürgi U, Dieppe PA, Jüni P. Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med 2007 Apr 17;146(8):580-90.
 3.Wandel S, Jüni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ 2010;341:c4675 doi: 10.1136/bmj.c4675 (Published 16 September 2010)
 4.Gabay C, Medinger-Sadowski C, Gascon D, Kolo F, Finckh A. Symptomatic effect of chondroitin sulfate 4&6 in hand osteoarthritis the finger osteoarthritis chondroitin treatment study (FACTS). Arthritis & Rheumatism, Sep 6, 2011. DOI: 10.1002/art.30574
 5.Wildi LM, Raynauld JP, Martel-Pelletier J, et al. Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI. Ann Rheum Dis. 2011 Jun;70(6):982-9.
 6.Kahan A, Uebelhart D, De Vathaire F, Delmas PD, Reginster JY. Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: The study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2009 Jan 29;60(2):524-533.