chondroitin-sulfates and Pain

Osteoarthritis is one of the leading causes of a chronic pain in elderly people. Old and very old age in itself is a risk factor of a comorbidity, which often limits the therapy specified in clinical recommendations. First of all, it concerns NSAID. In such situations, priority is given to chondroitin sulfate (CS) and glucosamine sulfate (GS) having the anti-inflammatory properties comparable with effects of NSAID. CS and GS also promote the delay in progression of degenerative processes and restoration of the structure of cartilaginous tissue. The drugs of CS and GS groups are Chondroguard and Sustaguard Artro having the considerable evidence-based efficacy and safety and also a polymodality of effects in patients with a combination of osteoarthritis and socially important diseases (atherosclerosis, diabetes mellitus type 2, oncological diseases) and also geriatric syndromes (sarcopenia) and aging in general.. Остеоартрит - одна из ведущих причин хронического болевого синдрома у лиц пожилого возраста. Пожилой и старческий возраст сам по себе является фактором риска развития полиморбидности, которая зачастую ограничивает лекарственную терапию, указанную в клинических рекомендациях. Это прежде всего справедливо в отношении нестероидных противовоспалительных препаратов (НПВП). В таких ситуациях приоритетными становятся хондроитин сульфат (ХС) и глюкозамин сульфат (ГС), обладающие противовоспалительными свойствами, сравнимыми с эффектами НПВП. ХС и ГС также способствуют замедлению прогрессирования дегенеративных процессов и способствуют восстановлению структуры хрящевой ткани. Одними из препаратов ХС и ГС являются Хондрогард и Сустагард Артро, имеющие значительную доказательную базу в отношении эффективности и безопасности, а также полимодальности эффектов у пациентов с сочетанием остеоартрита и социально значимых заболеваний (атеросклероз, сахарный диабет 2-го типа, онкологические заболевания), а также гериатрических синдромов (саркопения) и старения в целом.

Topics: Aged; Chondroitin Sulfates; Evidence-Based Medicine; Glucosamine; Humans; Osteoarthritis; Pain; Pain Management

Osteoarthritis (OA) is the most prevalent musculoskeletal disease and a major cause of negative relevant outcomes, associated with an ever-increasing societal burden. Pharmaceutical-grade chondroitin sulfate (CS) was repeatedly reported to reduce pain and improve function in patients with knee OA. This treatment was also shown to be cost-effective, compared to placebo, up to 24 months. However, controversies still persist regarding the usefulness of CS for patients with knee OA, mainly due to inconsistent reports from various clinical trials. In this literature review, we aimed to summarize the main most recent findings on the efficacy and safety of CS in OA. Based on the results of studies presenting a low risk of bias, the most recent meta-analysis shows that only the pharmaceutical-grade CS may be considered as an appropriate background treatment for the management of knee OA. Evidence from another recent meta-analysis, using data from full safety reports, confirms the good safety profile of CS in OA. This new evidence on efficacy and safety suggests that recommendations for the use of CS in patients with knee OA cannot be extrapolated to other low-grade preparations as generics, nutraceutical-grade or over-the-counter preparations.

Topics: Chondroitin Sulfates; Humans; Osteoarthritis, Knee; Pain; Treatment Outcome

Osteoarthritis is the most prevalent chronic articular disease, in which pain is one of the main symptoms and the major determinant of functional loss. Several therapeutic options have been proposed, including chondroitin sulfate, but its actual usefulness has not yet been established. To answer this question we searched in Epistemonikos database, which is maintained by screening multiple information sources. We identified 13 systematic reviews including 50 randomized trials overall. We extracted data, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded it is not clear whether the use of chondroitin sulfate leads to an improvement in pain or functionality in osteoarthritis because the certainty of the evidence is very low.. La artrosis es la enfermedad articular crónica que presenta mayor prevalencia, en la cual el dolor es uno de los principales síntomas y el mayor determinante de la pérdida de funcionalidad. Se han planteado múltiples opciones terapéuticas, entre ellas el condroitín sulfato, pero su real utilidad aún no ha sido claramente demostrada. Para aclarar esta interrogante utilizamos la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples fuentes de información. Identificamos 13 revisiones sistemáticas que en conjunto incluyen 50 estudios aleatorizados que responden la pregunta de este resumen. Extrajimos la información relevante, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Concluimos que no está claro si el uso de condroitín sulfato produce una mejoría en el dolor o la funcionalidad en la artrosis porque la certeza de la evidencia es muy baja.

Topics: Chondroitin Sulfates; Databases, Factual; Humans; Osteoarthritis; Pain; Randomized Controlled Trials as Topic

Osteoarthritis (OA) is the most common form of arthritis and the leading cause of disability in the United States, especially among older adults. Treatment options have primarily focused on alleviating the pain often associated with this condition. Acetaminophen and nonsteroidal anti inflammatory drugs (NSAIDs) are often employed for relief of mild-to moderate pain associated with OA. NSAIDs are typically more effective than acetaminophen; however, because of adverse effects associated with long-term use of NSAIDS, acetaminophen is considered first-line therapy. Safety concerns of traditional pharmacotherapeutic agents used in the management of OA, such as NSAIDs and opioids, have led healthcare professionals to seek other options. Trials of disease modulating agents that focus on preventing further damage to the joints have the potential to change how this disease state is managed. This article reviews nonpharmacologic and pharmacologic approaches to management of OA of the knee and hip.

Topics: Acetaminophen; Aged; Aged, 80 and over; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Cyclooxygenase Inhibitors; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Evidence-Based Medicine; Glucosamine; Humans; Osteoarthritis; Pain; Patient Education as Topic; Risk Factors; United States

Previous meta-analyses described moderate to large benefits of chondroitin in patients with osteoarthritis. However, recent large-scale trials did not find evidence of an effect.. To determine the effects of chondroitin on pain in patients with osteoarthritis.. The authors searched the Cochrane Central Register of Controlled Trials (1970 to 2006), MEDLINE (1966 to 2006), EMBASE (1980 to 2006), CINAHL (1970 to 2006), and conference proceedings; checked reference lists; and contacted authors. The last update of searches was performed on 30 November 2006.. Studies were included if they were randomized or quasi-randomized, controlled trials that compared chondroitin with placebo or with no treatment in patients with osteoarthritis of the knee or hip. There were no language restrictions.. The authors extracted data in duplicate. Effect sizes were calculated from the differences in means of pain-related outcomes between treatment and control groups at the end of the trial, divided by the pooled SD. Trials were combined by using random-effects meta-analysis.. 20 trials (3846 patients) contributed to the meta-analysis, which revealed a high degree of heterogeneity among the trials (I2 = 92%). Small trials, trials with unclear concealment of allocation, and trials that were not analyzed according to the intention-to-treat principle showed larger effects in favor of chondroitin than did the remaining trials. When the authors restricted the analysis to the 3 trials with large sample sizes and an intention-to-treat analysis, 40% of patients were included. This resulted in an effect size of -0.03 (95% CI, -0.13 to 0.07; I2 = 0%) and corresponded to a difference of 0.6 mm on a 10-cm visual analogue scale. A meta-analysis of 12 trials showed a pooled relative risk of 0.99 (CI, 0.76 to 1.31) for any adverse event.. For 9 trials, the authors had to use approximations to calculate effect sizes. Trial quality was generally low, heterogeneity among the trials made initial interpretation of results difficult, and exploring sources of heterogeneity in meta-regression and stratified analyses may be unreliable.. Large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged.

Topics: Aged; Chondroitin Sulfates; Female; Hip Joint; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain; Radiography; Randomized Controlled Trials as Topic

Mrs A, an active 60-year-old woman, has a history of degenerative osteoarthritis of her knee with pain that has progressed over the past 8 years. She has undergone arthroscopic surgery for a meniscal tear and has taken nonsteroidal anti-inflammatory drugs (NSAIDs), glucosamine, and chondroitin sulfate occasionally, but generally does not like taking medications. She is open to other therapeutic approaches and wants to know if acupuncture can help the pain, improve function, and stop her condition from progressing. The evidence for the effectiveness of acupuncture for knee pain and other common treatments, including exercise, NSAIDs, glucosamine and chondroitin, and intra-articular knee injections are compared, and costs and methods of acupuncture and selecting an acupuncturist are discussed.

Topics: Acetaminophen; Acupuncture Therapy; Adrenal Cortex Hormones; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Female; Glucosamine; Humans; Hyaluronic Acid; Middle Aged; Osteoarthritis, Knee; Pain; Pain Management

Assess the importance of the mid-term placebo effect of symptomatic slow acting drugs given for osteoarthritis.. We analyzed six controlled trials available in the literature. Trial duration ranged from 2 to 6 months. The trials had been conducted to assess the symptomatic effect of diacerhein, avocado/soya unsaponifiable chondrontin sulfate and oxaceprolin given for osteoarthritis of the hip or knee. The main clinical outcomes assessed were functional impairment using the Lequesnes index and a visual analog scale.. Globally, the trials showed decreased function impairment with a 2 to 3 points decrease in the Lequesnes index (15 to 20%) and a 10 to 16 mm fall in the visual analog scale (-20 to -30%) in the placebo groups.. Our findings confirms the importance of the mid-term placebo effect in the clinical course of osteoarthritis in patients given slow-acting drugs. This placebo effect, observed under these circumstances, is an expression of what clinicians will look for in future drugs and should be helpful for calculating the number of patients required in future trials.

Topics: Activities of Daily Living; Aged; Anthraquinones; Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Chondroitin Sulfates; Female; Humans; Hydroxyproline; Male; Middle Aged; Osteoarthritis; Pain; Pain Measurement; Placebo Effect; Randomized Controlled Trials as Topic; Research Design; Time Factors; Treatment Outcome

It is established that intravesical sodium hyaluronate and chondroitin sulfate has high efficacy in patients with bladder pain syndrome/interstitial cystitis (BPS/IC). Currently, an oral form of chondroitin sulfate is also available. The aim of study was to compare the efficacy of intravesical hyaluronic acid monotherapy and long-term oral chondroitin sulfate in combination with intravesical therapy in patients with BPS/IC.. A total of 59 patients with BPS/IC were randomized in two groups. In Group 1, 30 women (mean age 57.1 years) received viscoelastic solution of sodium hyaluronate 50 ml 1 time per week for 12 weeks as intravesical monotherapy. In Group 2 (n=29), patients were prescribed to complex therapy, which included the similar intravesical therapy combined with chondroitin sulfate in a dose 0.39 g, 2 capsules 3 times a day, also for 12 weeks. All patients completed visual analogue scale (VAS), interstitial cystitis symptom index (ISCI), interstitial cystitis problems index (ICPI) and voiding diary before and 1 week after the start of therapy. In all cases a cystoscopy and urodynamic study were performed in order to exclude other bladder pathologies.. At baseline, a mean VAS score in both groups was 7 points, a mean ISCI score was 17 points in Group 1 and 18 points in Group 2 (p>0.1). The mean ICPI score in both groups was 15 points. A frequency of urination in Group 1 and 2 was 11.4 and 11.6 per day, respectively (p>0,1). A mean volume of urination was 138+/-24.6 and 131+/-18.6 , respectively. After 12 weeks of therapy there was significant improvement of VAS, ICSI and ICPI scores in both groups, as well as frequency and volume of urination, but in Group 2 an improvement in almost all parameters studied, except for the volume of urination, was more pronounced.. The combined therapy of BPS/IC with intravesical hyaluronic acid and oral chondroitin sulfate provides significantly better results in comparison with intravesical hyaluronic acid as monotherapy.

Topics: Administration, Intravesical; Chondroitin Sulfates; Cystitis, Interstitial; Female; Humans; Hyaluronic Acid; Middle Aged; Pain; Pain Measurement

Intravesical glucosaminoglycan (GAG) replacement therapies are commonly used in the treatment of bladder pain syndrome (BPS)/interstitial cystitis (IC). Different intravesical glucosaminoglycan products are currently available. In this prospective study, clinical efficacy of chondroitin sulfate and hyaluronic acid are compared in patients with BPS/IC.. Patients were randomized to CS and HA groups. All patients were evaluated for visual analogue pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), voiding diary for frequency/nocturia, and mean urine volume per void at the beginning of the therapy and after 6 months. All patients had a potassium sensitivity test (PST) initially. Wilcoxon and Mann-Whitney U tests were used for statistical analysis.. There were 21 patients in both groups. Mean age of patients in CS and HA groups were 47.10 and 48.90, respectively(P > 0.05). Before treatment, Parson's test was positive in 64.3% of patients (27/42) with no difference between groups. VAS of pain, ICSI, ICPI, frequency at 24 h and nocturia results have improved significantly at both treatment arms. Intravesical CS was also found superior to intravesical HA in terms of 24 h frequency, nocturia and ICPI (P < 0.05). No severe adverse effects were reported.. Data comparing clinical efficiencies of different GAG therapies are very limited. In this study, intravesical CS was found superior to intravesical HA in terms of 24 h frequency, nocturia and ICPI in patients with BPS/IC in short term follow-up. To provide a definitive conclusion on superiority of one GAG therapy to others, further evaluation with long term follow up is required.

Topics: Administration, Intravesical; Adult; Aged; Chondroitin Sulfates; Cystitis, Interstitial; Female; Glycosaminoglycans; Humans; Hyaluronic Acid; Middle Aged; Nocturia; Pain; Pain Management; Pain Measurement; Prospective Studies; Treatment Outcome; Urinary Bladder Diseases; Urodynamics

Maxillary tooth distal movement is a treatment option for Class II malocclusion. This prospective clinical study (split-mouth design) was aimed to compare chondroitin sulphate (CS) levels in gingival crevicular fluid (GCF), the rates of tooth movement, and patient pain and discomfort during segmental maxillary posterior tooth distal movement using either 120 or 180 g of retraction force.. Twenty patients (6 males and 14 females; aged 18.85 ± 4.38 years) with Class II malocclusion were recruited. The force magnitudes were controlled at 120 or 180 g, randomly assigned to either the right or left five-tooth segments. Gingival crevicular fluid samples were collected with Periopaper® strips. Competitive ELISA with monoclonal antibody was used to measure CS levels in GCF. The rates of segmental maxillary posterior tooth distal movement, and the amount of pain and discomfort were evaluated.. The median CS levels during the segmental distal movement period were significantly greater than those before the segmental distal movement period (P < 0.05). At each 1-week period during segmental distal movement, the differences between the median CS levels induced by the two different force magnitudes were not significantly different. The rates of segmental distal movement induced by the two different force magnitudes were not significantly different. The mean visual analog scale scores for pain and discomfort with 180 g of retraction force was significantly greater than that with 120 g (P < 0.05).. One hundred and twenty grams of retraction force was sufficient to cause segmental distal movement, as indicated by biochemically assessed bone remodeling activity and a similar rate of tooth movement to that caused by 180 g of retraction force; it also produced less patient pain and discomfort.. The study has been registered as TCTR20170728001.

Topics: Adolescent; Adult; Bone Remodeling; Chondroitin Sulfates; Cuspid; Female; Gingival Crevicular Fluid; Humans; Male; Malocclusion, Angle Class II; Maxilla; Mechanical Phenomena; Pain; Pain Measurement; Prospective Studies; Tooth Movement Techniques; Young Adult

Chondroitin Sulfate (CS) is a drug which is available as pharmaceutical-grade and nutriceutical-grade products, with important variations in preparation, composition, purity and therapeutic effects. Previous studies using pharmaceutical-grade CS suggested that the compound improves pain and function and delays structural progression in knee osteoarthritis (OA), whereas discrepant results were observed when lower grade preparations were investigated. Areas covered: The recently published chondroitin versus celecoxib versus Placebo Trial (CONCEPT) assessed the symptomatic effect of pharmaceutical-grade CS 800 mg/day in symptomatic knee OA. Expert opinion: This prospective, randomized, 6-month, 3-arm, double-blind, double-dummy, placebo and celecoxib (200 mg/day) - controlled trial involved 604 patients aged above 50 years with primary knee OA. This study showed that CS is superior to placebo and similar to celecoxib in reducing pain and improving function in Kellgren-Lawrence grade 1-3 patients supporting the role of pharmaceutical-grade CS as a potential first-line treatment for the management of patients with mild to moderate knee OA.

Topics: Administration, Oral; Aged; Celecoxib; Chondroitin Sulfates; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Osteoarthritis, Knee; Pain; Placebo Effect; Treatment Outcome

Gastritis is an inflammation of the gastric mucosa. In this study, we investigated the efficacy of a medical device, Esoxx®, based on hyaluronic acid and chondroitin sulfate on gastritis-related upper abdominal pain/discomfort and endoscopic features. Fifty patients, affected by gastritis, were randomised to receive the medical device or placebo. The primary endpoint was the medical device efficacy on upper abdominal pain/discomfort associated with gastritis and measured by Visual Analogue Scale (VAS). The secondary endpoints were the efficacy of the medical device on gastritis-related mucosal erosions, blood oozing, and hyperemia (redness)/edema, as assessed by endoscopy, and the patients' rating of their compliance with the treatments. A significant reduction in VAS pain was observed in the treatment group after a 5-week treatment, if compared with placebo (p < 0.001). In summary, administration of a medical device, based on hyaluronic acid and chondroitin sulfate, improves gastritis-related upper abdominal pain/discomfort and decreases mucosal erosions, blood oozing, and hyperemia (redness)/edema at 5-week follow-up in patients affected by gastritis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anecdotes as Topic; Child; Chondroitin Sulfates; Double Bind Interaction; Endoscopy, Digestive System; Equipment and Supplies; Female; Gastritis; Humans; Hyaluronic Acid; Male; Middle Aged; Pain; Random Allocation; Retrospective Studies; Treatment Outcome; Young Adult

The goal of this study was to evaluate the effectiveness of an oral joint supplement in working dogs with hip osteoarthritis compared with a positive control group (CG). Fifteen animals were divided in treatment group (TG, n = 10) and CG (n = 5). To TG a commercially available joint supplement, containing glucosamine HCl, chondroitin sulphate, and hyaluronic acid was given for 40 days and a 70-day course of a placebo, to be administered as if it was carprofen. The CG received carprofen for 70 days, and a placebo to be administered as the joint supplement. Response to treatment, measured by the canine brief pain inventory (CBPI) and the Hudson visual analog scale, was evaluated before treatment (T0), after 15 days (T1) and 1 (T2), 2 (T3), 3 (T4), 4 (T5), and 5 (T6) months. With CBPI, no differences were found in pain interference score and pain severity score between TG and CG throughout or when comparing results within groups. Individual results were considered successful in a maximal of three dogs of the TG by T3 (30%) and 1 in CG (25%). With Hudson visual analog scale, improvements where registered with individual results, for 40%-50% of the animals in TG and 60%-80% of cases in CG. The oral joint supplement and carprofen produced some improvements in individual scores but where unable to do so when overall results were considered. Each of these options may not be able, by itself, to fully address the demands of a working dog with joint disease and related pain.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Carbazoles; Chondroitin Sulfates; Dietary Supplements; Dog Diseases; Dogs; Glucosamine; Hyaluronic Acid; Osteoarthritis, Hip; Pain

Intravesical instillation of hyaluronic acid (HA) plus chondroitin sulfate (CS) in women with bladder pain syndrome/interstitial cystitis (BPS/IC) has shown promising results. This study compared the efficacy, safety, and costs of intravesical HA/CS (Ialuril. Randomized, open-label, multicenter study involving 110 women with BPS/IC. The allocation ratio (HA/CS:DMSO) was 2:1. Thirteen weekly instillations of HA (1.6%)/CS (2.0%) or 50% DMSO were given. Patients were evaluated at 3 (end-of-treatment) and 6 months. Primary endpoint was reduction in pain intensity at 6 months by visual analogue scale (VAS) versus baseline. Secondary efficacy measurements were quality of life and economic analyses.. A significant reduction in pain intensity was observed at 6 months in both treatment groups versus baseline (P < 0.0001) in the intention-to-treat population. Treatment with HA/CS resulted in a greater reduction in pain intensity at 6 months compared with DMSO for the per-protocol population (mean VAS reduction 44.77 ± 25.07 vs. 28.89 ± 31.14, respectively; P = 0.0186). There were no significant differences between treatment groups in secondary outcomes. At least one adverse event was reported in 14.86% and 30.56% of patients in the HA/CS and DMSO groups, respectively. There were significantly fewer treatment-related adverse events for HA/CS versus DMSO (1.35% vs. 22.22%; P = 0.001). Considering direct healthcare costs, the incremental cost-effectiveness ratio of HA/CS versus DMSO fell between 3735€/quality-adjusted life years (QALY) and 8003€/QALY.. Treatment with HA/CS appears to be as effective as DMSO with a potentially more favorable safety profile. Both treatments increased health-related quality of life, while HA/CS showed a more acceptable cost-effectiveness profile.

Topics: Administration, Intravesical; Adolescent; Adult; Aged; Aged, 80 and over; Chondroitin Sulfates; Cost-Benefit Analysis; Cystitis, Interstitial; Dimethyl Sulfoxide; Female; Humans; Hyaluronic Acid; Middle Aged; Pain; Pain Measurement; Quality of Life; Treatment Outcome; Urinary Bladder; Urological Agents; Young Adult

We compared the analgesic efficacy and safety of glucosamine sulfate (GS) and chondroitin sulfate (CS) capsules or sachet preparations with glucosamine hydrochloride (GH) and CS capsules in knee osteoarthritis (OA) patients. 1,120 subjects with radiographic knee OA (Kellgren/Lawrence 2-3) were randomized (1:1:1) at 16 centers to receive GS 500 mg/CS 400 mg three times daily capsules (GI) or once daily sachet (GII) or GH 500 mg/CS 400 mg three times daily (GIII) for a 16-week trial. Primary outcome, intention-to-treat (ITT) was change from baseline of patient reported pain intensity (0-100 mm visual analogue scale) in the affected knee and variation of Lequesne's index (LI). Monthly secondary outcomes were changes from baseline in patient reported pain and LI, patient and physician global assessments of disease activity, acetaminophen consumption, and adherence. ITT population comprised 302, 301, and 306 patients in GI, GII, and GIII. Pain significantly decreased (GI = -30.9 ± 1.5; GII = -28.7 ± 1.5; GIII = -29.7 ± 1.5 mm) in all groups (P < 0.001) as well as LI (GI = -3.8 ± 0.2; GII = -3.7 ± 0.2; GIII = -3.9 ± 0.2; P < 0.001). All secondary outcomes improved (P < 0.005) for all groups. Patients that did not complete the study were 77 (44.8 %) for lack of adherence, 16 (9.3 %) consent withdrawal, 11 (6.4 %) adverse events, eight (4.7 %) lost to follow-up, and 17 (9.9 %) for other causes. Non-inferiority analysis found no differences among groups. This is a large study showing that GS/CS and GH/CS provide clinically meaningful and sustained analgesia in knee OA regardless of dose fractionation and capsule or sachet formulations.

Topics: Aged; Chondroitin Sulfates; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Glucosamine; Humans; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pain Management; Pain Measurement; Treatment Outcome

The aim of this study was to investigate the ability of a glucosamine-containing supplement to improve locomotor functions in subjects with knee pain.. A randomized, double-blind, placebo-controlled, parallel-group comparative study was conducted for 16 weeks in 100 Japanese subjects (age, 51.8±0.8 years) with knee pain. Subjects were randomly assigned to one of the two supplements containing 1) 1,200 mg of glucosamine hydrochloride, 60 mg of chondroitin sulfate, 45 mg of type II collagen peptides, 90 mg of quercetin glycosides, 10 mg of imidazole peptides, and 5 μg of vitamin D per day (GCQID group, n=50) or 2) a placebo (placebo group, n=50). Japanese Knee Osteoarthritis Measure, visual analog scale score, normal walking speed, and knee-extensor strength were measured to evaluate the effects of the supplement on knee-joint functions and locomotor functions.. In subjects eligible for efficacy assessment, there was no significant group × time interaction, and there were improvements in knee-joint functions and locomotor functions in both groups, but there was no significant difference between the groups. In subjects with mild-to-severe knee pain at baseline, knee-extensor strength at week 8 (104.6±5.0% body weight vs 92.3±5.5% body weight, P=0.030) and the change in normal walking speed at week 16 (0.11±0.03 m/s vs 0.05±0.02 m/s, P=0.038) were significantly greater in the GCQID group than in the placebo group. Further subgroup analysis based on Kellgren-Lawrence (K-L) grade showed that normal walking speed at week 16 (1.36±0.05 m/s vs 1.21±0.02 m/s, P<0.05) was significantly greater in the GCQID group than in the placebo group in subjects with K-L grade I. No adverse effect of treatment was identified in the safety assessment.. In subjects with knee pain, GCQID supplementation was effective for relieving knee pain and improving locomotor functions.

Topics: Adult; Aged; Chondroitin Sulfates; Collagen Type II; Dietary Supplements; Double-Blind Method; Female; Glucosamine; Humans; Imidazoles; Japan; Knee; Locomotion; Male; Middle Aged; Pain; Pain Measurement; Quercetin; Range of Motion, Articular; Vitamin D

Osteoarthritis (OA) is a major cause of physical disability and impaired quality of life. Non-steroidal anti-inflammatory drugs are the most used treatment for OA, but they are frequently associated to adverse events. Alternative therapies are under investigation for the treatment of OA. Meriva® is a lecithin delivery form of curcumin, a powerful promoter of anti-oxidant response studied in a number of conditions related to chronic inflammation and pain.. This 4-month observational study, conducted in a 'real-life' scenario, compares the association of Meriva and glucosamine (n=63) with chondroitin sulphate+glucosamine (n=61) in 124 patients with grade 1-2 OA of the knee.. Patients treated with Meriva+glucosamine had significantly higher Karnofsky Index and WOMAC score (both in the physical and emotional domains), compared to those in the chondroitin+glucosamine group. Noteworthy, the walking distance at the treadmill test after 1 month was also significantly higher in the meriva+glucosamine group; this advantage was sustained until the end of the study. Although the need for concomitant drugs and medical attention decreased in both groups, this reduction was more evident for patients treated with Meriva+glucosamine.. Taken together, the results of this study shows that the 4-month administration of the association of Meriva and glucosamine can result in a faster onset of action and improved outcomes than the administration of an association of chondroitin sulphate and glucosamine in patients with OA.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Curcumin; Female; Glucosamine; Humans; Male; Middle Aged; Osteoarthritis, Knee; Pain; Quality of Life; Treatment Outcome

Evaluation of the efficacy and safety of a single oral dose of a 1200 mg sachet of chondroitin 4&6 sulfate (CS 1200) vs three daily capsules of chondroitin 4&6 sulfate 400 mg (CS 3*400) (equivalence study) and vs placebo (superiority study) during 3 months, in patients with knee osteoarthritis (OA).. Comparative, double-blind, randomized, multicenter study, including 353 patients of both genders over 45 years with knee OA. Minimum inclusion criteria were a Lequesne index (LI) ≥ 7 and pain ≥ 40 mm on a visual analogue scale (VAS). LI and VAS were assessed at baseline and after 1-3 months. Equivalence between CS was tested using the per-protocol procedure and superiority of CS vs placebo was tested using an intent-to-treat procedure.. After 3 months of follow-up, no significant difference was demonstrated between the oral daily single dose of CS 1200 formulation and the three daily capsules of CS 400. Patients treated with CS 1200 or CS 3*400 were significantly improved compared to placebo after 3 months of follow-up in terms of LI (<0.001) and VAS (P < 0.01). No significant difference in terms of security and tolerability was observed between the three groups.. This study suggests that a daily administration of an oral sachet of 1200 mg of chondroitin 4&6 sulfate allows a significant clinical improvement compared to a placebo, and a similar improvement when compared to a regimen of three daily capsules of 400 mg of the same active ingredient.

Topics: Administration, Oral; Aged; Chondroitin Sulfates; Double-Blind Method; Female; Humans; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pain Measurement; Treatment Outcome

This pilot open noncontrolled study was designed to assess the efficacy of intra-articular injections of a solution combining hyaluronic acid (HA) and chondroitin sulphate (CS) in the treatment of outpatients affected by knee osteoarthrosis.. Thirty patients with knee OA have been included. The primary objective was to assess clinical efficacy as measured by pain and Lequesne's index. Secondary objectives were to assess potential effect of the treatment on ultrasound parameters, safety and biomarkers of cartilage metabolism and joint inflammation. After a selection visit (V1), the study treatment was administered 3 times on a weekly basis (V2, V3, V4). Follow-up was planned 6 (V5) and 12 weeks (V6) after the first intra-articular injection. Efficacy results showed a reduction in mean pain at V3 and V6 and in functional impairment, the most marked changes being measured at the two follow-up visits (V5 and V6). Although statistical significance was not achieved due to small sample size, a clear tendency towards improvement was detectable for ultrasound assessments as well as biomarkers. Except for a mild injection site hematoma for which the drug causal relationship could not be excluded, no adverse effect of clinical relevance was recorded during the study.. Although this pilot study was performed according to an open design only, the ultrasound as well as biomarkers changes strongly suggest a non-placebo effect. These preliminary results call now for a randomized controlled study to confirm the clinical relevance of the observed results.. #ISRCTN91883031.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Chondroitin Sulfates; Drug Administration Schedule; Drug Combinations; Female; Humans; Hyaluronic Acid; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pilot Projects; Placebos; Severity of Illness Index; Treatment Outcome; Ultrasonography; Viscosupplements

To evaluate the symptomatic effects of highly purified chondroitin 4 and chondroitin 6 sulfate (CS) therapy in patients with osteoarthritis (OA) of the hand.. This investigator-initiated, single-center, randomized, double-blind, placebo-controlled clinical trial included 162 symptomatic patients with radiographic evidence of hand OA (American College of Rheumatology criteria). Inclusion criteria included patient's assessment of global spontaneous hand pain of at least 40 mm on a 0-100-mm visual analog scale (VAS) and functional impairment of at least 6 (0-30 scale) on the Functional Index for Hand OA (FIHOA) in the most symptomatic hand. Patients received either 800 mg of CS (n = 80 patients) or placebo (n = 82 patients) once daily for 6 months and were analyzed in an intent-to-treat approach. The two primary outcomes were the change in the patient's assessment of global spontaneous hand pain and in hand function (by FIHOA score) from baseline to month 6. Secondary outcomes were improvement in grip strength, duration of morning stiffness, acetaminophen consumption, and the investigator's global impression of treatment efficacy.. There was a significantly more pronounced decrease in the patient's global assessment of hand pain in the CS group than in the placebo group (difference VAS scores -8.7 mm; P = 0.016). Hand function improved significantly more in the CS group than in the placebo group (difference in FIHOA scores -2.14; P = 0.008). There was a statistically significant between-group difference in favor of CS for the duration of morning stiffness and for the investigator's global impression of treatment efficacy. Changes in grip strength, acetaminophen consumption, and safety end points were not significantly different between the two groups.. This study demonstrates that CS improves hand pain and function in patients with symptomatic OA of the hand and shows a good safety profile.

Topics: Aged; Chondroitin Sulfates; Double-Blind Method; Female; Hand Joints; Hand Strength; Humans; Male; Middle Aged; Osteoarthritis; Pain; Pain Measurement; Radiography; Treatment Outcome

The goal of this pilot study was to gather information on differences between intravesical chondroitin sulfate and inactive vehicle control for treatment of interstitial cystitis/painful bladder syndrome (IC/PBS).. This was a prospective, randomized, double-blind, inactive vehicle-controlled, 12-week study (6-week treatment period, followed by a 6-week follow-up period) in patients with IC/PBS. Patients were randomized to weekly intravesical treatment with 2.0% sodium chondroitin sulfate in phosphate-buffered saline or intravesical vehicle control. Primary efficacy analysis compared responders (moderately or markedly improved) according to the 7-point Global Response Assessment. Secondary endpoints include questionnaires focused on symptoms and quality of life.. Sixty-five evaluable patients were randomized. At the primary endpoint analysis (week 7), 22.6% of the vehicle control group were responders compared with 39.4% of the active therapy group (P = .15). There was no statistically significant difference for any of the secondary endpoints. Overall, 76.9% of the patients in the study reported at least 1 adverse event; most were mild or moderate, the majority associated with the vehicle control treatment. Nine nonserious intervention-related adverse events were reported in 3 patients in the vehicle control group compared with 2 in 1 patient in the active treatment group.. The difference in treatment effect in this small underpowered study was not statistically significant, although twice as many patients reported a clinically significant benefit with intravesical chondroitin sulfate treatment compared with vehicle control treatment. This trial provides data required to design a well-powered randomized vehicle-controlled trial to determine the true efficacy of this potentially promising therapy.

Topics: Administration, Intravesical; Adult; Chondroitin Sulfates; Cystitis, Interstitial; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain; Pilot Projects; Prospective Studies; Sample Size; Treatment Outcome

To assess the long-term effects of chondroitins 4 and 6 sulfate (CS) on the radiographic progression of, and symptom changes associated with, knee osteoarthritis (OA).. We performed an international, randomized, double-blind, placebo-controlled trial in which 622 patients with knee OA were randomly assigned to receive either 800 mg CS (n = 309 patients) or placebo (n = 313 patients) once daily for 2 years. Radiographs of the target knee, using the Lyon schuss view, were obtained at the time of enrollment and at 12, 18, and 24 months. The minimum joint space width (JSW) of the medial compartment of the tibiofemoral joint was assessed by digital image analysis. The primary outcome was the loss in minimum JSW over 2 years.. The intent-to-treat analysis demonstrated a significant reduction (P < 0.0001) in minimum JSW loss in the CS group (mean +/- SEM -0.07 +/- 0.03 mm) as compared with the placebo group (-0.31 +/- 0.04 mm). The percentage of patients with radiographic progression > or =0.25 mm was significantly reduced in the CS group compared with the placebo group (28% versus 41% [P < 0.0005]; relative risk reduction 33% [95% confidence interval 16-46%]). The number of patients needed to treat was 8 (95% confidence interval 5-17). Pain improved significantly faster in the CS group than in the placebo group (P < 0.01). There were no differences in safety between groups.. The long-term combined structure-modifying and symptom-modifying effects of CS suggest that it could be a disease-modifying agent in patients with knee OA.

Topics: Aged; Aged, 80 and over; Antirheumatic Agents; Cartilage, Articular; Chondroitin Sulfates; Disease Progression; Double-Blind Method; Female; Humans; Image Processing, Computer-Assisted; Knee Joint; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pain Measurement; Radiography; Recovery of Function; Treatment Outcome

The Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) was a randomized double-blind placebo and active comparator (celecoxib) controlled trial of 1583 persons with symptomatic osteoarthritis (OA) of the knee(1). Patients randomized to celecoxib had significant improvement in knee pain compared to those randomized to placebo. No statistically significant improvement in knee pain compared to placebo was seen among patients randomized to the dietary supplements, although a subset of patients with moderate-to-severe knee pain at entry who were assigned to the combination of glucosamine and chondroitin sulfate did seem to experience some improvement. Additionally, patients taking chondroitin sulfate were noted to have a statistically significant improvement in knee joint swelling. An exploratory post hoc analysis of GAIT patients suggested the effect of chondroitin sulfate on joint swelling occurred more often in patients with milder pain and lower Kellgren-Lawrence Grade at entry.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Celecoxib; Chondroitin Sulfates; Double-Blind Method; Female; Glucosamine; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pyrazoles; Radiography; Sulfonamides; Treatment Outcome

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.. 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.. 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.. 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.).

Topics: Anti-Inflammatory Agents, Non-Steroidal; Celecoxib; Chondroitin Sulfates; Double-Blind Method; Drug Therapy, Combination; Female; Glucosamine; Humans; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pain Measurement; Pyrazoles; Severity of Illness Index; Sulfonamides; Treatment Outcome

Topics: Administration, Topical; Camphor; Cartilage, Articular; Chondroitin Sulfates; Double-Blind Method; Glucosamine; Humans; Mentha piperita; Ointments; Osteoarthritis, Knee; Pain; Plant Oils; Research Design

Topics: Administration, Topical; Camphor; Cartilage, Articular; Chondroitin Sulfates; Double-Blind Method; Glucosamine; Humans; Mentha piperita; Ointments; Osteoarthritis, Knee; Pain; Plant Oils; Research Design

The aim of this study was to evaluate the effect of 800 mg/die of chondroitin sulfate (CHS) per os plus naproxen versus naproxen over 2 years in patients with erosive osteoarthritis (EOA) of the hands. Joint count for erosions, Heberden and Bouchard nodes, Dreiser's algofunctional index and physicians' and patients' global assessment of disease activity were studied. A total of 24 consecutive patients (22 women and 2 men, mean age 53.0 +/- 6) suffering from symptomatic OA with radiographic characteristics of EOA were evaluated. The patients were divided into two groups of 12 patients each. The first group took naproxen 500 mg only. The second group was treated with CHS 800 mg orally plus naproxen 500 mg. Joint counts, radiological hand examinations and assessment of disease activity were performed at baseline, at 12 months and at 24 months. In the second year the treated group showed significant worsening in erosion, Heberden, Bouchard and Dreiser scores was recorded. Physician and patient global assessments of disease activity showed no significant difference from baseline scores. The untreated group showed significant worsening in erosion, Heberden and Bouchard nodes, Dreiser index and physician and patient global assessment scores. This study confirms the partial efficacy of oral CHS in improving some aspects of EOA.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Disease Progression; Drug Therapy, Combination; Female; Finger Joint; Hand Deformities, Acquired; Humans; Male; Middle Aged; Naproxen; Osteoarthritis; Pain; Prospective Studies; Radiography; Severity of Illness Index; Treatment Outcome

To assess the ability of a topical preparation of glucosamine sulfate and chondroitin sulfate to reduce pain related to osteoarthritis (OA) of the knee.. Sixty-three patients were randomized to receive either a topical glucosamine and chondroitin preparation or placebo to be used as required over an 8 week period. Efficacy was assessed using a visual analog scale (VAS) for pain as well as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the SF-36 questionnaire.. VAS scores indicated a greater mean reduction in pain for the glucosamine/chondroitin preparation group (mean change -3.4 cm, SD 2.6 cm) compared to the placebo group (mean change -1.6 cm, SD 2.7 cm) after 8 weeks. After 4 weeks the difference between active and placebo groups in their mean reduction from baseline was 1.2 (95% CI 0.1 to 2.4, p = 0.03) and after 8 weeks was 1.8 (95% CI for difference between groups, 0.6 to 2.9 cm; p = 0.002).. Topical application of glucosamine and chondroitin sulfate is effective in relieving the pain from OA of the knee and improvement is evident within 4 weeks.

Topics: Administration, Topical; Adult; Antipruritics; Camphor; Chondroitin Sulfates; Double-Blind Method; Female; Glucosamine; Humans; Male; Mentha piperita; Middle Aged; Osteoarthritis, Knee; Pain; Parasympatholytics; Patient Satisfaction; Placebos; Plant Oils

To assess the efficacy and safety of chondroitin sulfate (CS) 1 g/day per os compared to placebo, in a double blind, randomized, parallel group study, with 3 months treatment followed by a 3 month posttreatment period, in patients with femorotibial osteoarthritis (OA).. The main criterion was the functional handicap assessed by Lequesne's algofunctional index (AFI). Secondary efficacy criteria were: self-assessed pain with activity and at rest, self-assessed impact of OA on daily living, patient and physician assessed overall change in patient state since the previous visit, and daily NSAID and analgesic consumption, all evaluated monthly. The main analysis was performed on the intent-to-treat (ITT) population at treatment endpoint compared to baseline (Day 0).. The ITT efficacy data set comprised 130 patients (63 in CS group and 67 in placebo group). At treatment endpoint, the AFI showed greater but nonsignificant improvement in the CS than in the placebo group. Improvement became significant (p = 0.02) in the completer population (n = 114). In the ITT population, all variables tended towards greater improvement in the CS than the placebo group. In the completer population, pain at rest also significantly decreased in the CS group compared to the placebo group (p = 0.03), and, one month after treatment, CS had a significantly higher persistent effect than placebo on the AFI (p = 0.01), pain with activity (p = 0.001), physician assessed patient state (p = 0.05), and most other efficacy criteria. Adverse event rates did not differ significantly.. We observed a trend towards efficacy of CS 1 g/day compared to placebo with good tolerability after 3 month treatment, and persistent efficacy one month posttreatment. Further investigations are required to confirm this trend.

Topics: Administration, Oral; Aged; Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Chondroitin Sulfates; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pain Measurement; Prospective Studies; Severity of Illness Index; Treatment Outcome

A 16-week randomized, double-blind, placebo-controlled crossover trial of a combination of glucosamine HCl (1,500 mg/day), chondroitin sulfate (1,200 mg/day), and manganese ascorbate (228 mg/day) in degenerative joint disease (DJD) of the knee or low back was conducted.. Thirty-four males from the U.S. Navy diving and special warfare community with chronic pain and radiographic DJD of the knee or low back were randomized. A summary disease score incorporated results of pain and functional questionnaires, physical examination scores, and running times. Changes were presented as a percentage of the patient's average score.. Knee osteoarthritis symptoms were relieved as demonstrated by the summary disease score (-16.3%; p = 0.05), patient assessment of treatment effect (p = 0.02), visual analog scale for pain recorded at clinic visits (-26.6%; p = 0.05) and in a diary (-28.6%; p = 0.02), and physical examination score (-43.3%; p = 0.01). Running times did not change. The study neither demonstrated, nor excluded, a benefit for spinal DJD. Side effect frequency was similar to that at baseline. There were no hematologic effects.. The combination therapy relieves symptoms of knee osteoarthritis. A larger data set is needed to determine the value of this therapy for spinal DJD. Short-term combination therapy appears safe in this setting.

Topics: Activities of Daily Living; Adult; Ascorbic Acid; Chondroitin Sulfates; Chronic Disease; Cross-Over Studies; Double-Blind Method; Drug Combinations; Glucosamine; Humans; Lumbar Vertebrae; Male; Manganese Compounds; Middle Aged; Military Personnel; Naval Medicine; Osteoarthritis; Osteoarthritis, Knee; Pain; Pilot Projects; Radiography; Running; Surveys and Questionnaires

The objective of this study was to investigate mechanisms of action of intra-articular hyaluronic acid in osteoarthritis (OA) of the knee. Twelve patients with bilateral knee OA and synovial effusions entered a randomized, single-blind, blind observer study. Hyaluronic acid ("Hyalgan", Fidia SpA, Italy) or placebo were given by intra-articular injection weekly for 5 weeks. Assessments included clinical indices and imaging (magnetic resonance imaging (MRI) and 99m Tc bone scanning) before and after the course of injections. In addition, synovial fluid keratan sulfate (KS), chondroitin sulfate (CS) and C-propeptide of type II collagen (CPII) were measured. MRI and 99m Tc scanning showed no change in either treated or placebo knees over the 6-week study period. A fall in KS levels occurred in treated knees compared with placebo (Wilcoxon paired test, P = 0.1), although this did not reach significance perhaps due to small sample numbers). Ten out of 12 treated knees showed a fall in KS, compared with four out of 12 placebo knees. CS and CPII levels did not change significantly. Intra-articular injection of hyaluronic acid did not result in any improvement in the clinical indices compared to the placebo. In conclusion, assessment of cartilage markers may be of value when studying novel therapies in OA. MRI appearances remain remarkably stable over a 6-week period.

Topics: Adjuvants, Immunologic; Aged; Aged, 80 and over; Biomarkers; Calcium-Binding Proteins; Chondroitin Sulfates; Collagen; Collagen Type II; Female; Humans; Hyaluronic Acid; Injections, Intra-Articular; Keratan Sulfate; Magnetic Resonance Imaging; Middle Aged; Osteoarthritis, Knee; Pain; Patient Satisfaction; Single-Blind Method; Synovial Fluid; Treatment Outcome

Presently, curcuminoid formulations or its combination with conventional therapies has been used for the treatment of knee osteoarthritis (KOA). Nevertheless, evidence is limited due to small-sized clinical trials. This study aims to evaluate the efficacy of curcuminoid formulations or its combination with conventional therapies for KOA.. Randomized controlled trials comparing curcuminoid formulations or its combination with conventional therapies versus conventional therapies, such as non-steroidal antiinflammatory drugs (NSAIDs) and chondroitin sulfate/glucosamine, were searched from databases.. In total, 14 studies involving 1533 patients were included. Curcuminoid formulations were comparative to NSAIDs in reducing Visual Analogue Scale (VAS), total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and WOMAC score for pain/stiffness/physical function. No significant difference was seen between the two groups in terms of patients' satisfaction index, patients' global assessment, reduction of several inflammatory factor, rate of drug compliance, and rescue medication. Notably, curcuminoid formulations combined with NSAIDs significantly reduced VAS and WOMAC/Knee injury and OA Outcome Score (KOOS) pain score more than NSAIDs did. In addition, the curcuminoid formulations were superior to chondroitin sulfate/glucosamine in reducing VAS, total WOMAC score, and WOMAC score for stiffness/difficulty in physical function, while no significant difference was seen in reducing WOMAC pain score and Karnofsky Performance Scale score.. Curcuminoid formulations may be considered a promising alternative for treating KOA. Key points • Curcuminoid formulations are comparative to NSAIDs for KOA. • Curcuminoid formulations are superior to chondroitin sulfate/glucosamine for KOA. • Curcuminoid formulations could provide additional benefits in alleviating pain and some adverse events caused by NSAIDs.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Diarylheptanoids; Glucosamine; Humans; Osteoarthritis, Knee; Pain; Treatment Outcome

We investigated the efficacy of intravesical instillations of combined hyaluronic acid (HA) and chondroitin sulphate (CS) in patients with bacillus Calmette-Guérin (BCG)-induced chemical cystitis unresponsive to first-line therapies.. We retrospectively reviewed the clinical records of patients with grade 2 BCG-induced chemical cystitis unresponsive to first line therapeutic options performed according to the International Bladder Cancer Group guidelines who underwent intravesical instillations of HA/CS. Bladder pain, urinary urgency, voiding volume and number of voids/24 hours recorded prior to treatment, at the end of the treatment, at six months and at one-year follow-up were recorded and analyzed.. The records of 20 patients were identified. All patients underwent eight weekly instillations of HA/CS. Mean baseline visual analogue scale (VAS) scores ± Standard Deviation (SD) for urinary urgency and bladder pain were 7.8 ± 0.5 and 7.2 ± 1.0, respectively. Mean number of voids/24 hours ± SD was 15.4 ± 2.3 and mean urine volume per void ± SD was 85.8 ± 21.0 mL. At the end of the treatment, mean VAS scores ± SD for urgency and pain significantly decreased to 4.7 ± 1.1 and 4.2 ± 0.9, respectively (p < 0.05 in both cases). Mean number of voids/24 hours ± SD decreased to 9.6 ± 1.4 (p < 0.05) and mean urine volume per void ± SD significantly increased to 194.1 ± 59.5 mL (p < 0.05). At six months and one-year followup, all outcome measures remained stable.. Bladder instillations of HA/CS provide significant and durable improvement of bladder pain, urinary urgency, urinary volume per void and urinary frequency in patients with refractory BCG-induced chemical cystitis.

Topics: Administration, Intravesical; Aged; BCG Vaccine; Chondroitin Sulfates; Cystitis; Female; Follow-Up Studies; Humans; Hyaluronic Acid; Immunotherapy; Male; Middle Aged; Pain; Pain Measurement; Retrospective Studies; Urinary Bladder Neoplasms; Urodynamics

The analysis of the dynamics of pain and joint function on the background of the 3-month ARTRA.Study was conducted as a multicenter, with the inclusion of 3077 patients, 56.2% of whom received NSAIDs for pain relief. While taking after a month of therapy showed significant compared to the original value of reducing the intensity of pain. The therapeutic effect is increased with duration of dosing. It is shown that the drug reduces the need for arthritis NSAIDs after a month by 6.8%, after 3 months - by 37.3%, ie after the 3-month course of treatment with arthritis, the number of people taking NSAIDs fell by more than 3 times (up 18.9%). A significant reduction in consumption, coupled with the marked dynamics of the pain is regarded by us as a manifestation expressed anesthetic effect of the drug ARTRA.. В статье представлен анализ динамики боли и функции сустава на фоне 3-месячного приема препарата артра. Исследование проводилось как многоцентровое с включением 3077 пациентов, из которых 56,2% получали для купирования боли нестероидные противовоспалительные препараты (НПВП). На фоне приема препарата артра уже через месяц от начала терапии наблюдалось достоверное по сравнению с исходной величиной снижение интенсивности боли. Лечебный эффект увеличивался с длительностью приема препарата. Показано, что прием артры снижает потребность в НПВП спустя 1 мес на 6,8%, через 3 мес на 37,3%, т. е. после завершения 3-месячного курса число лиц, принимающих НПВП, сократилось более чем в 3 раза (до 18,9%). Значительное снижение потребления НПВП в совокупности с отмеченной динамикой боли расценено нами как проявление выраженного обезболивающего эффекта препарата артра.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Drug Therapy, Combination; Female; Glucosamine; Humans; Knee; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pain Management; Pain Measurement; Radiography; Treatment Outcome

Previously, we demonstrated that glucosamine-containing supplementation was effective for improving locomotor functions, especially walking speed. However, the biomechanical mechanism of efficacy has not been elucidated. This study aimed to address this challenge in subjects with knee pain, using a motion capture system.. An open label study was conducted in 30 Japanese subjects with knee pain. The subjects were administered a daily supplement containing 1,200 mg of glucosamine hydrochloride, 60 mg of chondroitin sulfate, 45 mg of type II collagen peptides, 90 mg of quercetin glycosides, 10 mg of imidazole peptides, 1 mg of proteoglycan, and 5 μg of vitamin D (GCQID). The intervention continued for 16 weeks. Efficacy for locomotor functions involving the knee joint was evaluated mainly using the Japanese Knee Osteoarthritis Measure (JKOM) and the 5-question Geriatric Locomotive Function Scale (GLFS-5). To examine the biomechanical mechanism of efficacy for locomotor functions, motions of subjects in a normal walking state were captured. Gait analysis was conducted and efficacy for gait parameters such as normal walking speed, stride length, cadence, and angle of soles was evaluated.. GCQID significantly improved total scores on the JKOM and GLFS-5. In gait analysis, normal walking speed, stride length, and angle of soles at the end of the stance phase were all significantly increased, but cadence did not change significantly during the intervention period. There were significant intercorrelations of changes in normal walking speed, stride length, and angle of soles at the end of the stance phase, and between changes in stride length and total JKOM score.. A GCQID supplement may increase walking speed through increased stride length and angle of kicking from the ground during steps, which might be mainly associated with alleviated knee pain.

Topics: Adult; Aged; Biomechanical Phenomena; Chondroitin Sulfates; Collagen Type II; Dietary Supplements; Female; Gait; Glucosamine; Humans; Japan; Knee Joint; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pain Measurement; Pilot Projects; Vitamin D

Osteoarthritis (OA) is one of the major causes of pain and of outpatient's clinics. 15 years ago, physiopathology of OA and its potential therapeutic targets were announced to be better understood, but the results of therapeutic trials were finally not as convincing as expected. Slow Acting Drugs (SADs) are part of the treatments evaluated in OA. Even if evidence based medicine is low, positive effects of SADs have been observed. We can reasonably propose these treatments for a short test period. It can sometimes enable us to decrease the dosage of others treatment such as NSAIDs. In any case, the physician must properly inform the patient about products available in Switzerland and must be aware of degrees of purity and costs of the products available on the intemet.

Topics: Antirheumatic Agents; Chondroitin Sulfates; Delayed-Action Preparations; Drug Therapy, Combination; Evidence-Based Medicine; Glucosamine; Humans; Hyaluronic Acid; Osteoarthritis; Pain; Treatment Outcome; Viscosupplements

Effectiveness, safety, and tolerability of instillation therapy with chondroitin sulphate (CAS 9082-07-9, Gepan instill) was investigated in a non-interventional study. 286 patients with clinically diagnosed chronic forms of cystitis, such as bladder pain syndromelinterstitial cystitis, radiation cystitis, overactive bladder syndrome and chronically-recurring cystitis were included. The course of symptoms was documented over 8 instillations at maximum, covering a period of approximately three months. All main symptoms of chronic cystitis declined consistently and statistically significantly (p < 0.0001). Both daytime and nighttime micturition frequencies as well as the score levels of urgency and pain declined significantly during the course of treatment. The functional bladder capacity as indicated by the volume of first morning voiding increased from 157.9 ml +/- 7.5 to 186.7 ml +/- 6.9 (mean +/- SE; p < 0.0001). The level of urgency decreased from 6.8 +/- 0.1 to 3.4 +/- 0.2 (mean +/- SE; numerical rating scale (11-point box scale); p < 0.0001) and nocturia decreased from 4.0 +/- 0.2 to 2.1 +/- 0.1 times (mean +/- SE; p < 0.0001). Chondroitin sulphate instillation was effective and well tolerated in the therapy of chronic forms of cystitis associated with a possible GAG layer deficit (GAG layer: mainly composed of the glycosaminoglycans chondroitin sulphate, dermatan sulphate and heparan sulphate), but the results need to be confirmed in a controlled study.

Topics: Adult; Aged; Aged, 80 and over; Chondroitin Sulfates; Chronic Disease; Cystitis; Cystitis, Interstitial; Female; Glycosaminoglycans; Humans; Injections; Male; Middle Aged; Pain; Pain Measurement; Prospective Studies; Urinary Bladder; Urinary Bladder, Overactive; Urination; Urodynamics

Americans continue to spend millions of dollars annually on glucosamine and chondroitin for symptoms of osteoarthritis. These agents are classified as dietary supplements, not as drugs, per se. Therefore, they do not meet the requirements of the FDA to be classified as drugs. This study was designed to determine if glucosamine and chondroitin are effective for osteoarthritis pain. This report was adapted from an online publication by the National Center for Complimentary and Alternative Medicine of the National Institutes of Health to inform the general public about the GAIT trial and its findings. Participants taking the positive control, celecoxib, experienced statistically significant pain relief versus placebo, about 70% of those taking celecoxib had a 20% or greater reduction in pain versus about 60% for placebo. Overall, there were no significant differences between the other treatments tested and placebo. For a subset of participants with moderate-to-severe pain, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared with placebo, about 79% had a 20% or greater reduction in pain versus about 54% for placebo. According to the researchers, because of the small size of this subgroup these findings should be considered preliminary and need to be confirmed in further studies. For participants in the mild pain subset, glucosamine and chondroitin sulfate together or alone did not provide statistically significant pain relief.

Topics: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Celecoxib; Chondroitin Sulfates; Clinical Trials as Topic; Dietary Supplements; Double-Blind Method; Drug Therapy, Combination; Female; Glucosamine; Humans; Male; Middle Aged; National Institutes of Health (U.S.); Osteoarthritis, Knee; Pain; Pyrazoles; Sulfonamides; Treatment Outcome; United States

Topics: Adult; Chondroitin Sulfates; Humans; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain

Topics: Chondroitin Sulfates; Clinical Trials as Topic; Humans; Meta-Analysis as Topic; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain

Topics: Chondroitin Sulfates; Clinical Trials as Topic; Humans; Meta-Analysis as Topic; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain

Topics: Chondroitin Sulfates; Clinical Trials as Topic; Humans; Meta-Analysis as Topic; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain

Topics: Anti-Inflammatory Agents, Non-Steroidal; Celecoxib; Chondroitin Sulfates; Clinical Trials as Topic; Dietary Supplements; Glucosamine; Humans; Osteoarthritis; Pain; Pyrazoles; Sulfonamides; Treatment Outcome

Topics: Chondroitin Sulfates; Drug Therapy, Combination; Glucosamine; Humans; Osteoarthritis, Knee; Pain; Severity of Illness Index

Topics: Acetaminophen; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Drug Therapy, Combination; Glucosamine; Humans; Osteoarthritis, Knee; Pain; Placebos

Topics: Aged; Chondroitin Sulfates; Complementary Therapies; Dementia; Geriatric Assessment; Humans; Pain; Pain Measurement; Treatment Outcome

Chondroitin sulfate (CS) is a symptomatic slow-acting drug for osteoarthritis (SYSADOA). It should be noted, however, that there is a CS formulation approved as a drug in Europe, with evidenced efficacy and safety demonstrated by clinical trials in osteoarthritic patients. This formulation should therefore be considered as the reference product. This CS is manufactured by Bioibérica (Spain), commercialized in Europe by IBSA (Switzerland) and Bioibérica, and in the United States by Nutramax. Hence, all other CS formulations must demonstrate their bioequivalence with the reference product. Pharmacokinetic studies have shown that oral exogenous CS is absorbed as several metabolites, and the active moiety has not yet been identified. It is thus difficult to establish bioequivalence from plasma concentration against time curves. However, the FDA permits bioequivalence studies comparing the time course of the pharmacological response with two formulations of the same compound. It has been reported that the time course of CS response can be fitted to a modified Hill equation, as follows: E-E0=[(Emax x Ty )/(T50y+Ty)]. Where E is the effect at time T, E0 is the basal effect, Emax is the maximal effect, T50 is the time required to achieve 50% of the maximal effect and y is the sigmoid slope factor. Hence, it is proposed that a generic CS can be compared to the reference product using the Emax, T50, and y values derived by non-linear regression fitting to the modified Hill equation. The reference/test formulation ratio with the 90% confidence intervals (CI) can thus be estimated. If CI for each parameter ratio lies within 0.8-1.2, both CS formulations can be considered as bioequivalent. In the absence of such bioequivalence studies, physicians and patients are advised to use the reference product to obtain the maximal benefit in terms of efficacy and safety.

Topics: Algorithms; Chemistry, Pharmaceutical; Chondroitin Sulfates; Humans; Osteoarthritis; Pain; Pain Measurement; Pilot Projects; Therapeutic Equivalency

The purpose of this study was to analyze the biochemical changes in the joint fluid, and pain relief resulting from isometric quadriceps exercise in patients with osteoarthritis of the knee.. Nineteen osteoarthritic knees in 17 patients with joint effusion were included. The patients performed isometric quadriceps exercise for 3 months. Isometric muscle torque at 30 and 60 degrees flexion, pain as measured using the visual analog scale and biochemical markers in joint fluid were evaluated before and after the exercise.. Pain score decreased from 3.9 to 2.3 after 12 weeks of exercise (P<0.001). Extension torque at 30 and 60 degrees knee flexion significantly increased from 4.7 to 6.9 kgm (47% increase, P<0.001) and from 10.8 to 12.6 kgm (17% increase, P<0.005) after 12 weeks of exercise. The molecular weight of hyaluronan increased from 2.11 to 2.40x10(6)(P<0.05) and the viscosity of joint fluid increased from 45.8 to 59.8 mPas after 12 weeks of exercise (P<0.05). Chondroitin 4-, 6-sulfate concentration in joint fluid decreased from 81.9 to 75.5 nmol/ml (P<0.05).. Isometric quadriceps exercise resulted in significant changes in joint fluid biochemical parameters, and these changes, at least in part, may explain the ameliorative effect of muscle exercise for osteoarthritis of the knee.

Topics: Aged; Albumins; Biomarkers; Chondroitin Sulfates; Exercise Therapy; Female; Humans; Hyaluronic Acid; Hydrogen-Ion Concentration; Isometric Contraction; Knee Joint; Male; Middle Aged; Muscle, Skeletal; Osteoarthritis, Knee; Pain; Proteins; Synovial Fluid; Viscosity

To assess the response to chondroitin sulfate (structum) in low back pain (LBP) due to spinal osteochondrosis.. 30 patients (mean age 51.4 years) with a definite primary LBP took structum in a dose 1 g/day for 24 weeks. The diagnosis was made according to WHO recommendations (2000). The response was assessed with uniform international questionnaires and visual analogue scale.. The treatment reduced pain syndrome and improved spinal function in 73.3% patients with LBP studied.. It would be valid to include long-acting chondroprotective drugs in the program of LBP in spinal osteochondrosis.

Topics: Adult; Aged; Chondroitin Sulfates; Female; Humans; Male; Middle Aged; Osteochondritis; Pain; Spinal Diseases; Surveys and Questionnaires; Treatment Outcome

Pain, stiffness, and indicators of muscle damage occur at different times after eccentric muscle action. After a single bout of maximal resisted lengthening of the elbow flexors, elbow position, pain perception, and indicators of cellular damage were measured. Immediately postexercise, a significant decrease in resting muscle length was observed that continued to 48 h. At this time, an increase in perceived muscle soreness was noted (P less than 0.05), and a biopsy of the biceps brachii revealed mast cell degranulation, separations of the extracellular matrix from myofibers, and increased plasma constituents in the extracellular space. It is proposed that myofiber disruption allows intracellular proteins to escape and extracellular proteins and ions to enter, causing swelling, whereas the disrupted extracellular matrix initiates the inflammatory response, which includes the release of mast cell granules seen at 48 h postexercise. Thus the delayed sensation of pain (soreness) after repeated eccentric muscle actions probably results from inflammation in response to extracellular matrix disruption.

Topics: Adult; Aged; Antibodies, Monoclonal; Biopsy; Chondroitin Sulfates; Exercise; Extracellular Matrix; Female; Humans; Immunohistochemistry; Male; Muscles; Myositis; Pain; Proteoglycans