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The popular dietary supplement glucosamine showed no evidence of structural benefits on MRI among patients with chronic knee pain typical of osteoarthritis, a randomized trial found. In an adjusted model, cartilage deterioration was no less in patients who used the supplement for 6 months than in controls, with an odds ratio of 0.938 for decreased worsening, according to C. Kent Kwoh, MD, of the University of Arizona in Tucson, and colleagues. Moreover, patients receiving glucosamine were no more likely to have improvements in subchondral bone marrow lesions, with an adjusted odds ratio of 0.537 the researchers reported online in Arthritis & Rheumatology. "This paper highlights yet again the difficulties inherent in studying osteoarthritis of the knee," observed Allen Sawitzke, MD, of the University of Utah in Salt Lake City. "It is a variable illness, generally takes years to develop to the point of symptoms and likely does not advance evenly but instead in episodes," explained Sawitzke, who was the lead investigator on a National Institutes of Health-sponsored clinical trial of glucosamine and chondroitin, which also found minimal benefits for the supplements. Because there are currently no proven effective disease-modifying drugs for use in osteoarthritis, many patients rely on complementary and alternative therapies such as glucosamine. More than one in 10 U.S. adults use this supplement, and global sales exceeded $2 billion in 2010. "There's a big market out there," said Nancy E. Lane, MD, director of the Center for Musculoskeletal Health at the University of California Davis in Sacramento, who also was involved in the NIH study. Numerous studies have sought to determine whether or not glucosamine is effective, and results have conflicted and may have been influenced by publication bias in industry-sponsored trials. Most previous studies also have relied on radiographs to evaluate structural changes, rather than the more sensitive MRI, which can directly reveal changes to cartilage and characteristic findings such as subchondral bone marrow lesions that are associated with progression and pain. Therefore, Kwoh and colleagues enrolled 201 individuals from the community with chronic knee pain typical of osteoarthritis, randomizing them to receive 1,500 mg per day of glucosamine hydrochloride (Regenasure) or placebo in a 16-ounce bottle of a diet beverage. The study was funded by the Beverage Institute for Health & Wellness of the Coca-Cola Company and by the National Institute of Arthritis, Musculoskeletal and Skin Diseases. Patients' mean age was 52, body mass index was 29 kg/m2, and slightly more than half were women. Baseline scores on the pain and function subscales of the Western Ontario and McMaster Universities (WOMAC) scales were 46 and 45, respectively (range 25 to 100). During the course of the trial, there was deterioration in cartilage in only 1.41% of knee subregions, which was less than they expected, the investigators reported. "This may have limited in particular our ability to detect the potential short-term and long-term benefits of glucosamine over placebo with regard to structural progression," Kwoh and colleagues wrote.
