Arthrosetherapie:
Glucosamin und Chondroitin Sulfat konnten die arthrosebedingten
Knieschmerzen nicht überzeugend lindern
Für
die Behandlung von Arthritis-Beschwerden wird derzeit oft die
Einnahme von Glucosamin und Chondroitin-Sulfat als Mono- oder
Kombinationstherapie empfohlen. Die bisher vorliegenden Studien
erbrachten widersprüchliche und wenig überzeugende Resultate.
Daher ist noch längst nicht bewiesen, daß diese Therapie überhaupt
zuverlässig wirkt. Die Nebenwirkungen sind allerdings meist
harmlos, so daß Patienten individuelle entscheiden müssen, ob
sich die Geldausgabe ihrer meinung nach lohnt.
In der hier vorliegenden Studie wurden 1.583 Patienten behandelt,
die über chronische arthrotisch bedingte Knieschmerzen klagten.
Die Probanden erhielten 24 Wochen lang täglich 1.500 mg Glucosamine,
1.200 mg Chondroitin sulfate , beides oder 200 mg des COX-2-Hemmers
Celecoxib, bzw. ein unwirksames Scheinmedikament (Placebo).
Bei der Untersuchung ging es um die Frage, ob die Therapien
in der Lage waren, die Schmerzen im Untersuchungszeitraum um
mindestens 20% zu vermindern.
Es
zeigte sich bei Betrachtung aller Probanden, daß Glucosamin
und Chondroitin Sulfat in Bezug auf die geklagten Arthrose-Schmerzen
nicht besser wirkten als das eingesetzte unwirksame Scheinmedikament.
Selbst durch die Einnahme des COX-2-Hemmers wurden die Knieschmerzen
im Vergleich zum Placebo nur um 10% besser gemildert.
In der Unter-Gruppe der Patienten mit mittelgradigen bis starken
Knieschmerzen lag die Wirkrate bei dem unwirksamen Scheinmedikament
bei 54.3 Prozent und bei der kombinierten Einnahme von Glucosamin
und Chondroitin Sulfat lediglich bei 79.2%. Da es nur um eine
Schmerzlinderung von 20% ging, ist dieser Unterschied zwar vorhanden
aber so niedrig, daß sich der Einsatz der teuren Nahrungsergänzungsmittel
kaum lohnt.
Glucosamine, chondroitin sulfate, and the two in combination
for painful knee osteoarthritis.
Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM,
Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE,
Cush JJ, Moreland LW, Schumacher HR Jr, Oddis CV, Wolfe F, Molitor
JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt
KD, Moskowitz RW, Williams HJ.
Division of Rheumatology, University of Utah School of Medicine,
Salt Lake City, UT 84132, USA. gait.study@hsc.utah.edu
BACKGROUND: Glucosamine and chondroitin sulfate are used
to treat osteoarthritis. The multicenter, double-blind, placebo-
and celecoxib-controlled Glucosamine/chondroitin Arthritis
Intervention Trial (GAIT) evaluated their efficacy and safety
as a treatment for knee pain from osteoarthritis.
METHODS: We randomly assigned 1583 patients with
symptomatic knee osteoarthritis to receive 1500 mg of glucosamine
daily, 1200 mg of chondroitin sulfate daily, both
glucosamine and chondroitin sulfate, 200 mg of celecoxib
daily, or placebo for 24 weeks.
Up to 4000 mg of acetaminophen daily was allowed as rescue
analgesia. Assignment was stratified according to the severity
of knee pain (mild [N=1229] vs. moderate to severe [N=354]).
The primary outcome measure was a 20 percent decrease in
knee pain from baseline to week 24.
RESULTS: The mean age of the patients was 59 years, and
64 percent were women. Overall, glucosamine
and chondroitin sulfate were not significantly better than placebo
in reducing knee pain by 20 percent.
As
compared with the rate of response to placebo (60.1 percent),
the rate of response to glucosamine was 3.9 percentage
points higher (P=0.30), the rate of response to chondroitin
sulfate was 5.3 percentage points higher (P=0.17), and
the rate of response to combined treatment was 6.5 percentage
points higher (P=0.09). The rate of response in the celecoxib
control group was 10.0 percentage points higher than
that in the placebo control group (P=0.008).
For
patients with moderate-to-severe pain at baseline, the rate
of response was significantly higher with combined therapy than
with placebo (79.2 percent vs. 54.3 percent,
P=0.002). Adverse events were mild, infrequent, and evenly distributed
among the groups.
CONCLUSIONS: Glucosamine and chondroitin sulfate alone
or in combination did not reduce pain
effectively in the overall group of patients with osteoarthritis
of the knee. Exploratory analyses suggest that the combination
of glucosamine and chondroitin sulfate may be effective in the
subgroup of patients with moderate-to-severe knee pain.
(ClinicalTrials.gov
number, NCT00032890.). Copyright 2006 Massachusetts Medical
Society.
*****
Weitere
Informationen:
Dietary Outcomes in Osteoarthritis Disease Management
Carol
J. Henderson, PhD, RD
Department of Nutrition
Georgia State University
Atlanta, GA
Glucosamine
Sulfate and Chondroitin Sulfate
Glucosamine is an aminomonosaccharide, a component of almost
all human tissues, including cartilage. It is the principle
component of O- and N-linked glycosaminoglycans, which form
the matrix of all connective tissues. Glucosamine sulfate has
a relatively low molecular weight and is the sulfate salt of
the natural aminomonosaccharide, glucosamine. Glucosamine is
commercially available in pharmacies, health food stores, and
retail stores and is sold via the Internet. It is most commonly
available as the sulfate, HCl, N-acetyl or chlorhydrate salt
isomers, which are water-soluble (10).
The sulfate and HCl forms differ in their purity, sodium content,
bioactive glucosamine, and equivalent dosages. Unlike glucosamine
sulfate and HCl forms that are most commonly used in clinical
trials, glucosamine does not have active intestinal transport.
In some preparations, glucosamine is combined with chondroitin
sulfate.
Glucosamine
sulfate provides pain relief and improved function in knee OA
(11).
In a recent 3-year, randomized, placebo-controlled, prospective
study by Bruyere et al, 212 patients with knee OA were evaluated
to determine the effect of glucosamine and chondroitin on symptom
and structure modification in knee OA (12).
In patients who had mild OA and were in the highest quartile
of baseline mean joint space narrowing, glucosamine was associated
with a trend (p=0.10) towards a significant reduction in joint
space narrowing (13).
The authors reported indistinguishable symptomatic efficacies
for both compounds as indicated by two 3-year, double-blinded,
controlled studies (14,15).
Chondroitin
sulfate occurs naturally in human cartilage, bone, cornea, skin
and the arterial wall. Preparations of chondroitin sulfate are
derived form bovine and calf cartilage. Careful selection of
cattle to avoid herds contaminated with bovine spongiform encephalopathy
must be considered. Chondroitin sulfate is a larger and more
poorly absorbed; <10% intestinal absorption compared to 90%
for glucosamine sulfate (10).
Several
small, short-term, 3- to 12-month, randomized placebo controlled
clinical trials to evaluate the effects on chondroitin sulfate/placebo
or NSAID have demonstrated modest reductions in knee OA pain
and improved function (16).
Sustained effects have been reported up to 3 months after discontinuation
of chondroitin sulfate (17).
Few
studies have attempted to evaluate the potential chondroprotective
effects of chondroitin sulfate by observing the progression
of radiographic changes of OA (18,19).
Using a computerized technique to evaluate joint space narrowing,
patients were treated with 800 mg chondroitin sulfate/day or
with placebo (18).
After 1 year, joint space narrowing had decreased significantly
in placebo-treated patients but had not changed from the baseline
value in the chondroitin sulfate treatment group. In a 3-year
trial, hand radiographs of 119 patients with OA were evaluated,
of which 34 received chondroitin sulfate 400 mg/day and 85 patients
received placebo (19).
A significant decrease in the number of patients with new erosive
OA was observed in the chondroitin sulfate group compared to
the placebo group.
Reports
of small, randomized controlled trials have examined the combination
of glucosamine and chondroitin sulfate for knee OA pain and
low back pain have been reported. It is important to note that
these studies treatments were not consistent and included both
oral and intravenous glucosamine, glucosamine HCl, and manganese
ascorbate. In general studies using chondroitin sulfate combined
with other agents (eg, glucosamine sulfate), improved symptoms
of OA compared to placebo (9).
Precautions
and Possible Side Effects:
There are no known contraindications to glucosamine supplementation.
Glucosamine appears safe and has few short-term side effects.
Pregnant women, children, and very elderly people should avoid
glucosamine since no studies among these specific populations
exist. Patients taking blood-thinners should be extremely careful
if they take glucosamine combined with chondroitin. Chondroitin
is chemically similar to blood-thinning drugs such as heparin,
warfarin, and even aspirin, and could cause excessive bleeding.
Possible side effects of glucosamine include nausea, diarrhea,
heartburn, drowsiness, skin rash, and headache. There has been
an unsubstantiated concern that glucosamine derived from the
shellfish exoskeletons may cause reactions in people allergic
to shellfish. One case study reports the exacerbation of an
asthma attack associated with the use of a glucosamine-chondroitin
supplement prescribed for OA pain (20).
A recent 3-month, randomized, placebo-controlled trial did not
demonstrate elevated blood glucose levels associated with glucosamine
use (21).
Insufficient data exist regarding possible interactions between
glucosamine and other dietary supplements.
Recommendations:
Glucosamine sulfate 1500 mg daily in divided doses for
patient with symptomatic OA may be considered. Response
is slower than NSAIDs. Discontinuation is recommended if
there is no documented response after 3 months.
Chondroitin
sulfate may be considered in the treatment of pain from OA and
may be given in the amount of 1,200 mg/day or 400 mg tid. Efficacy
of a single daily dose of 1,200 mg/day does not seem to differ
from that of 400 mg given tid.
Dietary Outcomes in Osteoarthritis Disease Management
Carol
J. Henderson, PhD, RD
Department of Nutrition
Georgia State University
Atlanta, GA
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