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The Raelian Movement
for those who are not afraid of the future : http://www.rael.org
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NSAID = glucosamine = chondroitin = placebo for knee OA
Clinical question
Is glucosamine or chondroitin, alone or in combination, more effective than an NSAID or a placebo to treat radiographically substantiated osteoarthritis of the knee?
Bottom line
None of the treatments were more effective than placebo in decreasing pain associated with fairly severe and long-standing osteoarthritis of the knee. On the other hand, all treatments, including placebo, produced a substantial and sustained decrease in pain. One nonpharmacologic explanation: Patients with chronic painful illnesses generally prefer more frequent dosing (Am J Hosp Pharm 1985;42(11):2499-501). In this study, patients took a handful of tablets several times a day (both placebo and active drug), with additional tablets of acetaminophen (paracetamol) as needed, and the control associated with this frequent treatment could be responsible in part of the effectiveness of placebo. (LOE = 2b)
Reference
Sawitzke AD, Shi H, Finco MF, et al. Clinical efficacy and safety of glucosamine, chondroitin, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Ann Rheum Dis 2010; 69(8):1459-1464.
Study design
Randomized controlled trial (single-blinded)
Funding
Government
Allocation
N/A
Setting
Outpatient (any)
This study is a 2-year follow-up of a 6-month study that assessed treatments for osteoarthritis of the knee. These investigators enrolled 520 patients with osteoarthritis who completed the initial 6-month study and were game to continue masked treatment for another 18 months. The average patient in the study was 56 years old, had knee osteoarthritis symptoms for 10 years, and had grade 2 or grade 3 changes on x-ray and a joint space width of at least 2 mm. The average Western Ontario McMaster Univerity Osteoarthritis Scale (WOMAC), pain subscale, score was approximately 48 of a possible 80. This scale is usually used to assess osteoarthritis treatment. Over the course of the 18 months, approximately one third of patients dropped out of the study. Continuing their intially assigned treatment, patients took glucosamine HCl 500 mg 3 times daily, chondroitin sodium 400 mg 3 times a day, both glucosamine and chondroitin at these doses, celecoxib 200 mg once daily, or placebo. To assure masking, all patients took something once a day and something 3 times a day (a double-dummy design). In addition, they were also able to use acetaminophen up to 4 g a day. In other words, they took a lot of tablets frequently throughout the day, which, by allowing patients to constantly "treat" their pain, may have increased the placebo response. This placebo response was both profound and sustained. No matter which treatment they received, WOMAC scores dropped to less than 30 within the first several months of the study and stayed there throughout the rest of the 2-year follow-up. The percentage of patients who experienced at least a 20% improvement in pain scores was not different over the 2 years of study. As-needed analgesic use was not different among the groups. In the report of the initial 6 months of treatment, glucosamine/chondroitin in combination was more effective in patients with severe pain; this difference was not sustained in the long term. These results can be seen as a pharmacologic "failure," a placebo "success," or an indicator of the natural history of knee osteoarthritis pain.
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WARNING FROM RAEL: For those who don't use their intelligence at its full
capacity, the label "selected by RAEL" on some articles does not mean that I
agree with their content or support it. "Selected by RAEL" means that I believe
it is important for the people of this planet to know about what people think or
do, even when what they think or do is completely stupid and against our
philosophy. When I selected articles in the past about stupid Christian
fundamentalists in America praying for rain, I am sure no Rael-Science reader
was stupid enough to believe that I was supporting praying to change the
weather. So, when I select articles which are in favor of drugs, anti-semitic,
anti-Jewish, racist, revisionist, or inciting hatred against any group or
religion, or any other stupid article, it does not mean that I support them. It
just means that it is important for all human beings to know about them. Common
sense, which is usually very good among our readers, is good enough to
understand that. When, like in the recent articles on drug decriminalization, it
is necessary to make it clearer, I add a comment, which in this case was very
clear: I support decriminalizing all drugs, as it is stupid to throw depressed
and sad people (as only depressed and sad people use drugs) in prison and ruin
their life with a criminal record. That does not mean that there is any change
to the Message which says clearly that we must not use any drug except for
medical purposes. The same applies to the freedom of expression which must be
absolute. That does not mean again of course that I agree with anti-Jews,
antisemites, racists of any kind or anti-Raelians. But by knowing your enemies
or the enemies of your values, you are better equipped to fight them. With love
and respect of course, and with the wonderful sentence of the French philosopher
Voltaire in mind: "I disapprove of what you say, but I will defend to the death
your right to say it".
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"Ethics" is simply a last-gasp attempt by deist conservatives and
orthodox dogmatics to keep humanity in ignorance and obscurantism,
through the well tried fermentation of fear, the fear of science and
new technologies.
There is nothing glorious about what our ancestors call history,
it is simply a succession of mistakes, intolerances and violations.
On the contrary, let us embrace Science and the new technologies
unfettered, for it is these which will liberate mankind from the
myth of god, and free us from our age old fears, from disease,
death and the sweat of labour.
Rael
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