Purpose
This article discusses current evidence in nutraceuticals and viscosupplementation
uses in osteoarthritis (OA) treatment.
Methods
A search was carried out to identify systematic reviews, randomized controlled trials,
review articles, and original articles (PubMed and Cochrane Database) about nutraceuticals
and viscosupplementation. The keywords used were nutraceuticals, glucosamine, chondroitin,
diacerein, avocado, soybean unsaponifiables, nutraceuticals, and viscosupplementation,
independently or combined with the terms “review” and “randomized.”
Results
Glucosamine hydrochloride has no effect on pain management, although the sulfate formulation
has a moderate effect. Diacerein leads to pain relief, with a superior carryover effect
when compared with placebo. Avocado and soybean unsaponifiables may have positive
effects on knee and hip OA, but long-term results could not be confirmed. Despite
the American Academy of Orthopaedic Surgeons' recommendation against the use of hyaluronic
acid in OA, some systematic reviews found some benefits in the knee.
Conclusions
There is no evidence that nutraceuticals or viscosupplementation influences OA's natural
progression. However, some of these agents seem to reduce pain and improve function.
Level of Evidence
Level IV, systematic review of studies with Level I through Level IV evidence.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Fransen M, Agaliotis M, Nairn L, et al. Glucosamine and chondroitin for knee osteoarthritis: A double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens. Ann Rheum Dis in press, available online 6 January, 2014. doi:10.1136/annrheumdis-2013-203954.
- Nutraceutical—Definition and introduction.AAPS PharmSci. 2003; 5: E25
- Viscosupplementation: A new concept in the treatment of osteoarthritis.J Rheumatol Suppl. 1993; 39: 3-9
- Glucosamine for pain in osteoarthritis: Why do trial results differ?.Arthritis Rheum. 2007; 56: 2267-2277
- Glucosamine therapy for treating osteoarthritis.Cochrane Database Syst Rev. 2005; : CD002946
- Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: Network meta-analysis.BMJ. 2010; 341: c4675
- OARSI guidelines for the non-surgical management of knee osteoarthritis.Osteoarthritis Cartilage. 2014; 22: 363-388
- Treatment of osteoarthritis of the knee (nonarthroplasty).J Am Acad Orthop Surg. 2009; 17: 591-600
- Treatment of osteoarthritis of the knee: Evidence-based guideline, 2nd edition.J Am Acad Orthop Surg. 2013; 21: 571-576
- Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis.N Engl J Med. 2006; 354: 795-808
- Meta-analysis: Chondroitin for osteoarthritis of the knee or hip.Ann Intern Med. 2007; 146: 580-590
- The efficacy and safety of diacerein in the treatment of painful osteoarthritis of the knee: A randomized, multicenter, double-blind, placebo-controlled study with primary end points at two months after the end of a three-month treatment period.Arthritis Rheum. 2007; 56: 4055-4064
- Symptomatic efficacy and safety of diacerein in the treatment of osteoarthritis: A meta-analysis of randomized placebo-controlled trials.Osteoarthritis Cartilage. 2010; 18: 289-296
- An open prospective study on postmarketing evaluation of the efficacy and tolerability of diacerein in osteo-arthritis of the knee (DOK).J Indian Med Assoc. 2008; 106 (58): 54-56
- The efficacy, safety and carry-over effect of diacerein in the treatment of painful knee osteoarthritis: A randomised, double-blind, NSAID-controlled study.Osteoarthritis Cartilage. 2007; 15: 605-614
- Evaluation of the structure-modifying effects of diacerein in hip osteoarthritis: ECHODIAH, a three-year, placebo-controlled trial. Evaluation of the chondromodulating effect of diacerein in OA of the hip.Arthritis Rheum. 2001; 44: 2539-2547
- A meta-analysis of controlled clinical studies with diacerein in the treatment of osteoarthritis.Arch Intern Med. 2006; 166: 1899-1906
- Diacerein for osteoarthritis.Cochrane Database Syst Rev. 2014; 2: CD005117
- Avocado-soybean unsaponifiables (ASU) for osteoarthritis—A systematic review.Clin Rheumatol. 2003; 22: 285-288
- Efficacy and safety of piascledine 300 versus chondroitin sulfate in a 6 months treatment plus 2 months observation in patients with osteoarthritis of the knee.Clin Rheumatol. 2010; 29: 659-670
- Randomised, controlled trial of avocado-soybean unsaponifiable (Piascledine) effect on structure modification in hip osteoarthritis: The ERADIAS study.Ann Rheum Dis. 2014; 73: 376-384
- Hyaluronic acid injections for knee osteoarthritis. Systematic review of the literature.Can Fam Physician. 2004; 50: 249-256
- Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis—Meta-analysis.Osteoarthritis Cartilage. 2011; 19: 611-619
- Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials.J Bone Joint Surg Am. 2004; 86: 538-545
- Viscosupplementation for osteoarthritis of the knee: A systematic review and meta-analysis.Ann Intern Med. 2012; 157: 180-191
- US-approved intra-articular hyaluronic acid injections are safe and effective in patients with knee osteoarthritis: Systematic review and meta-analysis of randomized, saline-controlled trials.Clin Med Insights Arthritis Musculoskelet Disord. 2013; 6: 57-63
- Viscosupplementation for the treatment of osteoarthritis of the knee.Cochrane Database Syst Rev. 2006; : CD005321
- Current concepts in the therapeutic management of osteoarthritis with glucosamine.Bull Hosp Jt Dis. 2005; 63: 31-36
- Crystalline glucosamine sulfate in the treatment of osteoarthritis: Evidence of long-term cardiovascular safety from clinical trials.Open Rheumatol J. 2011; 5: 69-77
- The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: A placebo-controlled, double-blinded, randomized clinical trial.Arch Intern Med. 2003; 163: 1587-1590
- A comprehensive review of oral glucosamine use and effects on glucose metabolism in normal and diabetic individuals.Diabetes Metab Res Rev. 2011; 27: 14-27
- The effect of glucosamine on glucose metabolism in humans: A systematic review of the literature.Osteoarthritis Cartilage. 2011; 19: 375-380
- Is glucosamine safe in patients with seafood allergy?.J Allergy Clin Immunol. 2004; 114: 459-460
- Effects of chondroitin and glucosamine sulfate in a dietary bar formulation on inflammation, interleukin-1beta, matrix metalloprotease-9, and cartilage damage in arthritis.Exp Biol Med (Maywood). 2005; 230: 255-262
- Chondroitin and glucosamine in the management of osteoarthritis: An update.Curr Rheumatol Rep. 2013; 15: 361
- Therapeutic efficacy of undenatured type-II collagen (UC-II) in comparison to glucosamine and chondroitin in arthritic horses.J Vet Pharmacol Ther. 2009; 32: 577-584
- Diacerein inhibits the synthesis of resorptive enzymes and reduces osteoclastic differentiation/survival in osteoarthritic subchondral bone: A possible mechanism for a protective effect against subchondral bone remodelling.Arthritis Res Ther. 2008; 10: R71
- Osteoarthritis and nutrition. From nutraceuticals to functional foods: A systematic review of the scientific evidence.Arthritis Res Ther. 2006; 8: R127
- Effects of three avocado/soybean unsaponifiable mixtures on metalloproteinases, cytokines and prostaglandin E2 production by human articular chondrocytes.Clin Rheumatol. 1998; 17: 31-39
- Successful nonoperative management of chronic osteoarthritis pain of the knee: Safety and efficacy of retreatment with intra-articular hyaluronans.Osteoarthritis Cartilage. 2005; 13: 751-761
- Intra-articular injections for osteoarthritis of the knee.Cleve Clin J Med. 2006; 73 (901-904, 906-911): 897-898
- Osteoarthritis: Is viscosupplementation really so unsafe for knee OA?.Nat Rev Rheumatol. 2012; 8: 635-636
- Rate of adverse reactions to more than 1 series of viscosupplementation.Orthopedics. 2012; 35: e514-e519
- OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines.Osteoarthritis Cartilage. 2008; 16: 137-162
Article Info
Publication History
Published online: January 26, 2015
Accepted:
November 13,
2014
Received:
July 12,
2014
Footnotes
See commentary on page 793
The authors report the following potential conflict of interest or source of funding: M.A.P.d.A. receives support from Zimmer (grant CW81571).
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
