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Can chondroitin save knee cartilage?

Chondroitin’s mixed results for slowing the progression of osteoarthritis may be due to the low-quality or lower-dose chondroitin used in some studies. Looking at the structural effects of higher-dose, pharmaceutical-grade chondroitin could shed more light on its efficacy

Study under review: Chondroitin sulfate efficacy versus celecoxib on knee osteoarthritis structural changes using magnetic resonance imaging: a 2-year multicentre exploratory study

Introduction

Osteoarthritis of the knee is a painful condition that affects a lot of people. Almost 4%[1] of the global population has it. Guidelines[2] 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[3] is well known, and there are also concerns[4] that it may negatively affect the gastrointestinal tract and kidneys. NSAIDs also have a host[5] of safety concerns. In addition, these treatments are unlikely to[6] 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[7] and has also shown promise[8] for improving pain and function in knee osteoarthritis. There is also a host of mechanistic evidence[9][10] 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[11] 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.

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