Study under review: Chondroitin sulfate efficacy versus celecoxib on knee osteoarthritis structural changes using magnetic resonance imaging: a 2-year multicentre exploratory study
Osteoarthritis of the knee is a painful condition that affects a lot of people. Almost 4% of the global population has it. Guidelines from the American College of Rheumatology recommend managing the associated pain in part by starting with acetaminophen and escalating to non-steroidal anti-inflammatory drugs (NSAIDs) if the former is ineffective. However, these drugs have several safety concerns. Acetaminophen’s liver toxicity is well known, and there are also concerns that it may negatively affect the gastrointestinal tract and kidneys. NSAIDs also have a host of safety concerns. In addition, these treatments are unlikely to affect the progress of osteoarthritis of the knee.
Chondroitin sulfate, an important component of cartilage that provides much of its resistance to compression, may be able to overcome these problems. Orally supplementing with chondroitin is relatively safe and has also shown promise for improving pain and function in knee osteoarthritis. There is also a host of mechanistic evidence that suggests it could slow the progress of osteoarthritis. However, chondroitin’s efficacy is not a settled matter. Some of the researchers who participated in the study under review suggested that the question of efficacy may be, in part, due to poor quality control. Some formulations of chondroitin sulfate could have dosing variations, contaminants, or composition differences. Using pharmaceutical-grade chondroitin, whose purity and dose is vetted, may provide a better test of its effectiveness. Combining this treatment with an objective measure of its effect on the joint, such as MRI, would be even better.
The study under review did both. Its goal was to explore whether pharmaceutical-grade chondroitin sulfate could slow the progression of knee osteoarthritis.
There are safety concerns about current pharmacological treatments for knee osteoarthritis. In addition, these treatments may not actually slow the progression of the disease. Chondroitin sulfate is relatively safe, but its track record for efficacy is mixed, which could be due to variable composition and purity.
Other Articles in Issue #32 (June 2017)
Another look at the diet-heart hypothesis
When you replace saturated fat with polyunsaturated fat, some studies suggest that good things should happen. But there’s more than one way to interpret the available studies.
Protein, fast and slow
Fast-digesting whey helps with post-workout muscle protein synthesis, and some studies suggest slower-digesting casein reduces muscle protein breakdown. This opens the possibility that their combination could be better than either alone
Timing protein before bed for gains
Sleep is one big fast, which could put muscles’ protein balance into the red. Could taking slow-acting casein before bed put the balance back into the black overnight?
Interview: Matthew Dalby, PhD
Dr. Dalby’s research explores the links between diet, obesity, and the microbiome. In this interview, we discuss fecal transplants, the role of animal models in research, and more.
Should 1000 IU be the new RDA for vitamin D?
Since it was set in 2010, the 600 IU vitamin D RDA has been widely circulated. But a close look at individual patient data may give a more accurate estimate of vitamin D needs.
Better performance with nitrate supplementation?
Nitrates are one of the few supplements that consistently show promise for athletic performance. But should you take them acutely or chronically for best effect?
Interview: Kenneth Brown, MD
Dr. Brown is an accomplished gastroenterologist who has conducted clinical trials on supplements and drugs for GI conditions. We pick his brain here