Although gratifying approaches to the management of osteoarthritis (OA) are available as a result of improved knowledge about disease pathophysiology (see below), responses are limited in many patients by less than optimal responses to available modalities or by intolerance or toxicity to currently available medications. Accordingly, the search continues for agents that are characterized by greater symptomatic relief, less overall toxicity and, optimally, agents that may have a beneficial effect on the basis of disease structural modification. A veritable explosion of new agents considered to have potential efficacy in the treatment of OA has taken place. Carefully performed clinical studies, using designs of sufficient precision and power to avoid errors in conclusions and interpretation, are essential to support the use of these agents in treatment of OA. Current treatment of osteoarthritis includes:
Non-Pharmacologic Therapy
Patient education Programmed exercises Weight loss Joint protection Thermal modalities Pharmacologic Therapy
Nonopioid analgesics (e.g., acetaminophen) Topical analgesics (e.g., capsaicin) Nonsteroidal anti-inflammatory drugs Intra-articular steroids Intra-articular hyaluronate Opioid analgesics Surgical Approaches
Arthroscopic debridement Osteotomy Total joint arthroplasty Glucosamine and chondroitin sulfate, agents marketed as nutritional supplements in the United States, have been purported to be effective in the treatment of OA in various studies over the past 3 to 4 decades. 4,5,6,7,8,9,10,14,15,16,17,19,20,32,33,35,36 Interest relative to their role in the treatment of OA and other arthritides was markedly accentuated in 1997 with the publication of The Arthritis Cure 28 and a subsequent volume, Maximizing the Arthritis Cure, 29 by Jason Theodasakis, MD, who described them as effective drugs for treatment of symptoms of OA and the potential to reduce structural damage in OA cartilage. Subsequently, the intake of these agents in the United States market has increased considerably, and at present, they are widely used by patients. A parallel increase in their use for the treatment of arthritis has been noted in veterinary medicine. A review of the literature reveals that a number of short-term studies, particularly studies in Europe and Asia, suggests that these agents have efficacy equal to that of currently used nonsteroidal anti-inflammatory agents (NSAIDs), although their onset of action is slower. The widespread use of these agents, in addition to short-term trials suggestive of efficacy, has prompted initiation of a larger trial by the Office of Alternative Medicine of the National Institutes of Health comparing their efficacy relative to placebo. This article defines current knowledge of glucosamine, chondroitin sulfate, and collagen hydrolysate to provide a perspective of the current status of these agents in the treatment of osteoarthritis.