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Chondroprotection and the prevention of osteoarthritis progression of the knee: a systematic review of treatment agents.
Am J Sports Med 2015; 43(3):734-44AJ

Abstract

BACKGROUND

Structure-modifying medications or nutraceuticals may be an effective treatment for osteoarthritis. This study identified 12 treatments that may possess chondroprotective properties: oral glucosamine; chondroitin; nonsteroidal anti-inflammatory drugs (NSAIDs); polyunsaturated fatty acids; S-adenosylmethionine; avocado and soybean unsaponifiable fractions; methylsulfonylmethane; vitamins C, D, and E; intra-articular injections of hyaluronic acid; and platelet-rich plasma (PRP).

PURPOSE

To perform a systematic review of randomized controlled trials for the effectiveness of each agent in preserving articular cartilage of the knee and delaying the progression of osteoarthritis.

STUDY DESIGN

Systematic review; Level of evidence, 2.

METHODS

A literature search was performed using PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Searches were performed using "treatment," "osteoarthritis," and "knee" as keywords. Selection criteria included randomized controlled trials of ≥12 months, with a placebo control, measuring radiographic changes in joint space width, cartilage volume, or radiographic progression of osteoarthritis. The primary outcome was changes in joint integrity measures.

RESULTS

A total of 3514 studies were identified from the initial search, 13 of which met inclusion criteria. Treatment with chondroitin sulfate showed a significant reduction in cartilage loss in 3 of 4 studies identified compared with placebo. Two of 3 trials identified for glucosamine also reported significant structural effects relative to placebo. Intra-articular hyaluronic acid was effective in lowering the rate of cartilage loss in only 1 of 3 studies identified versus placebo. Of the 6 studies identified for NSAIDs, vitamin E, and vitamin D, none showed any structural effect compared with placebo. No studies were found that met the inclusion criteria for polyunsaturated fatty acids, S-adenosylmethionine, avocado and soybean unsaponifiable fractions, methylsulfonylmethane, vitamin C, or PRP.

CONCLUSION

For patients with or at risk for osteoarthritis, the use of glucosamine and chondroitin sulfate may serve as a nonoperative means to protect joint cartilage and delay osteoarthritis progression. Hyaluronic acid injections showed variable efficacy, while NSAIDs and vitamins E and D showed no effect on osteoarthritis progression. The other agents evaluated had no evidence in the literature to support or refute their use for chondroprotection.

Authors+Show Affiliations

Jefferson Medical College, Philadelphia, Pennsylvania, USA.Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA kevin.freedman@rothmaninstitute.com.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

24866892

Citation

Gallagher, Brian, et al. "Chondroprotection and the Prevention of Osteoarthritis Progression of the Knee: a Systematic Review of Treatment Agents." The American Journal of Sports Medicine, vol. 43, no. 3, 2015, pp. 734-44.
Gallagher B, Tjoumakaris FP, Harwood MI, et al. Chondroprotection and the prevention of osteoarthritis progression of the knee: a systematic review of treatment agents. Am J Sports Med. 2015;43(3):734-44.
Gallagher, B., Tjoumakaris, F. P., Harwood, M. I., Good, R. P., Ciccotti, M. G., & Freedman, K. B. (2015). Chondroprotection and the prevention of osteoarthritis progression of the knee: a systematic review of treatment agents. The American Journal of Sports Medicine, 43(3), pp. 734-44. doi:10.1177/0363546514533777.
Gallagher B, et al. Chondroprotection and the Prevention of Osteoarthritis Progression of the Knee: a Systematic Review of Treatment Agents. Am J Sports Med. 2015;43(3):734-44. PubMed PMID: 24866892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chondroprotection and the prevention of osteoarthritis progression of the knee: a systematic review of treatment agents. AU - Gallagher,Brian, AU - Tjoumakaris,Fotios P, AU - Harwood,Marc I, AU - Good,Robert P, AU - Ciccotti,Michael G, AU - Freedman,Kevin B, Y1 - 2014/05/27/ PY - 2014/5/29/entrez PY - 2014/5/29/pubmed PY - 2015/9/4/medline KW - articular cartilage KW - chondroprotection KW - knee KW - nutraceutical SP - 734 EP - 44 JF - The American journal of sports medicine JO - Am J Sports Med VL - 43 IS - 3 N2 - BACKGROUND: Structure-modifying medications or nutraceuticals may be an effective treatment for osteoarthritis. This study identified 12 treatments that may possess chondroprotective properties: oral glucosamine; chondroitin; nonsteroidal anti-inflammatory drugs (NSAIDs); polyunsaturated fatty acids; S-adenosylmethionine; avocado and soybean unsaponifiable fractions; methylsulfonylmethane; vitamins C, D, and E; intra-articular injections of hyaluronic acid; and platelet-rich plasma (PRP). PURPOSE: To perform a systematic review of randomized controlled trials for the effectiveness of each agent in preserving articular cartilage of the knee and delaying the progression of osteoarthritis. STUDY DESIGN: Systematic review; Level of evidence, 2. METHODS: A literature search was performed using PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Searches were performed using "treatment," "osteoarthritis," and "knee" as keywords. Selection criteria included randomized controlled trials of ≥12 months, with a placebo control, measuring radiographic changes in joint space width, cartilage volume, or radiographic progression of osteoarthritis. The primary outcome was changes in joint integrity measures. RESULTS: A total of 3514 studies were identified from the initial search, 13 of which met inclusion criteria. Treatment with chondroitin sulfate showed a significant reduction in cartilage loss in 3 of 4 studies identified compared with placebo. Two of 3 trials identified for glucosamine also reported significant structural effects relative to placebo. Intra-articular hyaluronic acid was effective in lowering the rate of cartilage loss in only 1 of 3 studies identified versus placebo. Of the 6 studies identified for NSAIDs, vitamin E, and vitamin D, none showed any structural effect compared with placebo. No studies were found that met the inclusion criteria for polyunsaturated fatty acids, S-adenosylmethionine, avocado and soybean unsaponifiable fractions, methylsulfonylmethane, vitamin C, or PRP. CONCLUSION: For patients with or at risk for osteoarthritis, the use of glucosamine and chondroitin sulfate may serve as a nonoperative means to protect joint cartilage and delay osteoarthritis progression. Hyaluronic acid injections showed variable efficacy, while NSAIDs and vitamins E and D showed no effect on osteoarthritis progression. The other agents evaluated had no evidence in the literature to support or refute their use for chondroprotection. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/24866892/full_citation L2 - http://journals.sagepub.com/doi/full/10.1177/0363546514533777?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -