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Randomised controlled trial
In people with hand osteoarthritis, chondroitin sulphate therapy for 6 months improves pain and function compared with placebo
  1. Jean-Yves Reginster
  1. Public Health Sciences, University of Liège, Liège 4000, Belgium
  1. Correspondence to Jean-Yves Reginster
    Public Health Sciences, University of Liège, Liège 4000, Belgium; jyreginster{at}ulg.ac.be

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Context

Osteoarthritis of the finger joints is present in about 10% of individuals aged 40 to 49, rising to 92% in individuals over 70 years of age.1 However, knowledge and research in the field of hand osteoarthritis are limited. Therefore, the Disease Characteristics in Hand OA initiative was founded in 2005 with the aim of addressing key issues and facilitating research into hand osteoarthritis. This group concluded that future research in hand osteoarthritis is warranted.2 Whereas several studies were conducted over the last two decades exploring the ability of chemical entities to induce symptom or structure modifications in osteoarthritis of the lower limbs,3,,5 few studies were conducted with improvement in hand osteoarthritis symptoms, or structure as outcomes.

Methods

Gabay and colleagues conducted a single-centre, randomised, double-blind, placebo-controlled clinical trial of 162 patients with radiographic evidence of hand osteoarthritis and moderate to severe pain (at least 40 mm on a 0–100 mm Visual Analogue Scale (VAS)) to assess if chondroitin sulphate improves hand pain and function. Patients were of either sex, aged 40 years and older and given 800 mg of chondroitin sulphate as a single tablet each day or placebo for a total period of 6 months. The chondroitin preparation contained highly purified chondroitins 4 and 6 sulphate of fish origin. The primary outcome criteria were the change in the patient's assessment of global spontaneous hand pain on a VAS and inhand function on the Functional Index for Hand OA (FIHOA).6

Findings

Of 562 patients screened, 162 met the inclusion criteria and 139 patients completed the trial. Improvement in the patient's assessment of global hand pain on the VAS was significantly more pronounced in the chondroitin sulphate group than in the placebo group. The decrease in the FIHOA score demonstrated similar pattern. The relative benefit of chondroitin sulphate on both primary end points became evident only after 3 months of treatment. No serious adverse reaction occurred in any study patients.

Commentary

The study was well-designed and the tools used to assess the primary end points correspond to the current state of the art in such trials. It would have been of interest, however, to follow patients for another 3 to 6 months after withdrawal of the treatment to assess whether chondroitin sulphate use is accompanied by a carry-over effect on pain and function.

Chondroitin sulphate provided a benefit on symptoms and function of a similar magnitude than what has been previously reported for non-steroidal anti-inflammatory drugs (NSAIDs) in the same type of patients.7 Chondroitin sulphate was associated with minimal side effects, hence generating a risk/benefit ratio which will most likely be better than the one derived from NSAID studies.

Chondroitin 4 and chondroitin 6 sulphate were previously reported to reduce structural progression of knee osteoarthritis.4 The results from the present study that suggest that this medication can also be effective on osteoarthritis at other sites, is another piece of evidence for the consideration of chondroitin sulphate as a first-line treatment of osteoarthritis. However, caution should be exerted that, as it was also demonstrated for glucosamine, results obtained with a highly purified, pharmaceutical grade, preparation cannot be extrapolated to all marketed products, particularly to those sold over-the-counter or as nutriceutical supplements. Further research is now needed to confirm these results and also to evaluate whether chondroitin sulphate might also have significant long-term benefits on the structural progression of hand osteoarthritis.

References

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Footnotes

  • Competing interests None.