The British Medical Journal has published the results of a meta-analysis that reviews the effect of glucosamine, chondroitin or the two in combination on joint pain and on radiological progression of disease in osteoarthritis of the hip or knee.
The review aimed to identify large randomised controlled trials (more than 200 participants) that assessed the effect of glucosamine, chondroitin or their combination with placebo or head to head in patients with osteoarthritis of the knee or hip. 10 such studies were identified involving 3,803 patients. The studies were reviewed for a primary outcome of pain relief with a secondary outcome of minimal width of joint space.
When comparing the pain efficacy for any active treatment with placebo all of the effect lines crossed the boundary from minimal clinically important difference. When comparing joint space the effect lines crossed the line of no effect. The review also identified that sponsored studies were more likely to report a larger effect compared to studies operated independently.
The authors conclude that active treatment does "not reduce joint pain or have an impact on narrowing of joint space". They further advise that the cost of these treatments should not be covered by health organisations and that new treatment initiations should be avoided.
Action: The National Institute for Health and Clinical Excellence (NICE) guideline on osteoarthritis advises against prescribing glucosamine or chondroitin products. This analysis indicates that this advice is justified.