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Chondroitin Sulfate Shows Efficacy for Hand Osteoarthritis
Nancy A. Melville
September 8, 2011 ? Daily supplementation of chondroitin sulfate has been shown to be safe and effective in reducing hand pain and improving function in patients with hand osteoarthritis, according to a new placebo-controlled study published online September 8 in Arthritis & Rheumatism.
Chondroitin sulfate is currently used in some European countries for the treatment of knee osteoarthritis and has a relatively benign safety profile. Few trials have examined its efficacy in treating osteoarthritis of the hand, however.
In an effort to investigate that application of the therapy, researchers conducted a randomized, placebo-controlled, double-blind trial, the Finger osteoArthritis Chondroitin Treatment Study (FACTS), involving 162 symptomatic patients with radiographic hand osteoarthritis.
"The idea of our study was to determine whether chondroitin sulfate, a drug used in some European countries for the treatment of knee osteoarthritis, was also effective in hand osteoarthritis, thus adding another therapeutic option to this condition," lead author Cem Gabay, MD, a professor of medicine from the University Hospitals of Geneva, Switzerland, told Medscape Medical News.
He said he had no expectations about how the supplementation would affect osteoarthritis of the hand.
"When I started this study I had no preconceived opinion. We used a state-of-the-art approach ? a randomized, placebo controlled study ? to examine this question, and the improvement was significant on both global pain and hand function." At the end of the 6-month study, patients who received 800 mg chondroitin sulfate (n = 80) once daily demonstrated significantly greater decreases in global hand pain compared with placebo, rated on a visual analog scale (−8.7 mm; P = .02).
The chondroitin sulfate group also had improved hand function compared with placebo, according to the Functional Index for Hand Osteoarthritis scale (−2.14; P = .008). In addition, the investigators saw statistically significant differences in favor of chondroitin sulfate, as measured by the duration of morning stiffness and the global impression of treatment efficacy.
There were no significant differences between the 2 groups in terms of the evolution of grip strength or acetaminophen consumption. Safety endpoints also showed no differences.
"The study did not show any potential safety signal," Dr. Gabay said. "This result confirms previous results showing a good safety profile of chondroitin sulfate."
Osteoarthritis of the hand has been shown in some studies to affect 20% to 30% of the more than 27 million osteoarthritis sufferers in the United States alone, and its prevalence increases to greater than 50% after the age of 60 years.
The most commonly affected joints in hand osteoarthritis are the distal interphalangeal, proximal interphalangeal, thumb interphalangeal, and trapeziometacarpal joints, according to the study's authors.
The condition is often managed with oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. However, NSAIDs are associated with an increased occurrence of gastrointestinal adverse events with short-term use and of cardiovascular adverse effects with long-term use.
Although offering a potentially safer alternative to those drugs, a disadvantage of chondroitin sulfate is that it takes several months for improvements to take effect: The study showed that improvement in global hand pain and functional scores began to appear only after 3 months of treatment, whereas relief from NSAIDs is immediate.
The 2 could be taken together, however, until the effects of chondroitin sulfate emerged, which could still allow for reduced reliance on NSAIDs for pain relief.
"There is no contraindication to combine these drugs," Dr. Gabay said. "The only potential problem is the occurrence of side effects with NSAIDs, particularly in elderly patients."
There has previously been only 1 randomized controlled trial comparing chondroitin sulfate to placebo for hand osteoarthritis, involving treatment with chondroitin sulfate and chondroitin polysulfate, and that study showed reduced structural damage in the treatment groups after 3 years, as well as fewer patients with erosive osteoarthritis.
Dr. Joanne M. Jordan
Although chondroitin sulfate has few adverse effects, it is nevertheless more tightly regulated in Europe, and that may be one reason for its wider use there for osteoarthritis, said Joanne M. Jordan, MD, MPH, chief of the Division of Rheumatology, Allergy, and Immunology and director of the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill, in an interview with Medscape Medical News. Dr. Jordan was not involved in the study.
"[Chondroitin sulfate] is pretty well tolerated," Dr. Jordan said. "It is a mild anticoagulant, so people on blood thinners have to be careful, at least in theory.
"It is available as a prescription drug in Europe and a nonprescription supplement in the US, with less regulation and less confidence in the actual content of supplements. This might explain in part why it is not used much in the US," she said.
The next step in the research should be to explore the therapy outside of a regulated environment, and in comparison to current therapies, Dr. Jordan noted.
"The findings suggest that a prescription preparation of chondroitin sulfate is better than placebo in treating hand symptoms in people with hand osteoarthritis," Dr. Jordan said. "Whether this applies to chondroitin as an unregulated supplement is not known.
"This would need to be replicated in a larger study in multiple centers. Additionally, comparison of chondroitin sulfate to known effective drugs for hand symptoms would be a logical next step," she noted.
The study was supported by the Institut Biochimique SA, Pambio-Noranco, Switzerland. Dr. Jordan has disclosed that she has contract support for research with Johnson & Johnson and is a consultant to Interleukin Genetics, Algynomics, Eli Lilly, and Johnson & Johnson.
Arthritis Rheum. Published online September 8, 2011. Abstract
Medscape Medical News ? 2011 WebMD, LLC
Send comments and news tips to [email protected].
Nancy A. Melville
September 8, 2011 ? Daily supplementation of chondroitin sulfate has been shown to be safe and effective in reducing hand pain and improving function in patients with hand osteoarthritis, according to a new placebo-controlled study published online September 8 in Arthritis & Rheumatism.
Chondroitin sulfate is currently used in some European countries for the treatment of knee osteoarthritis and has a relatively benign safety profile. Few trials have examined its efficacy in treating osteoarthritis of the hand, however.
In an effort to investigate that application of the therapy, researchers conducted a randomized, placebo-controlled, double-blind trial, the Finger osteoArthritis Chondroitin Treatment Study (FACTS), involving 162 symptomatic patients with radiographic hand osteoarthritis.
"The idea of our study was to determine whether chondroitin sulfate, a drug used in some European countries for the treatment of knee osteoarthritis, was also effective in hand osteoarthritis, thus adding another therapeutic option to this condition," lead author Cem Gabay, MD, a professor of medicine from the University Hospitals of Geneva, Switzerland, told Medscape Medical News.
He said he had no expectations about how the supplementation would affect osteoarthritis of the hand.
"When I started this study I had no preconceived opinion. We used a state-of-the-art approach ? a randomized, placebo controlled study ? to examine this question, and the improvement was significant on both global pain and hand function." At the end of the 6-month study, patients who received 800 mg chondroitin sulfate (n = 80) once daily demonstrated significantly greater decreases in global hand pain compared with placebo, rated on a visual analog scale (−8.7 mm; P = .02).
The chondroitin sulfate group also had improved hand function compared with placebo, according to the Functional Index for Hand Osteoarthritis scale (−2.14; P = .008). In addition, the investigators saw statistically significant differences in favor of chondroitin sulfate, as measured by the duration of morning stiffness and the global impression of treatment efficacy.
There were no significant differences between the 2 groups in terms of the evolution of grip strength or acetaminophen consumption. Safety endpoints also showed no differences.
"The study did not show any potential safety signal," Dr. Gabay said. "This result confirms previous results showing a good safety profile of chondroitin sulfate."
Osteoarthritis of the hand has been shown in some studies to affect 20% to 30% of the more than 27 million osteoarthritis sufferers in the United States alone, and its prevalence increases to greater than 50% after the age of 60 years.
The most commonly affected joints in hand osteoarthritis are the distal interphalangeal, proximal interphalangeal, thumb interphalangeal, and trapeziometacarpal joints, according to the study's authors.
The condition is often managed with oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. However, NSAIDs are associated with an increased occurrence of gastrointestinal adverse events with short-term use and of cardiovascular adverse effects with long-term use.
Although offering a potentially safer alternative to those drugs, a disadvantage of chondroitin sulfate is that it takes several months for improvements to take effect: The study showed that improvement in global hand pain and functional scores began to appear only after 3 months of treatment, whereas relief from NSAIDs is immediate.
The 2 could be taken together, however, until the effects of chondroitin sulfate emerged, which could still allow for reduced reliance on NSAIDs for pain relief.
"There is no contraindication to combine these drugs," Dr. Gabay said. "The only potential problem is the occurrence of side effects with NSAIDs, particularly in elderly patients."
There has previously been only 1 randomized controlled trial comparing chondroitin sulfate to placebo for hand osteoarthritis, involving treatment with chondroitin sulfate and chondroitin polysulfate, and that study showed reduced structural damage in the treatment groups after 3 years, as well as fewer patients with erosive osteoarthritis.
Dr. Joanne M. Jordan
Although chondroitin sulfate has few adverse effects, it is nevertheless more tightly regulated in Europe, and that may be one reason for its wider use there for osteoarthritis, said Joanne M. Jordan, MD, MPH, chief of the Division of Rheumatology, Allergy, and Immunology and director of the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill, in an interview with Medscape Medical News. Dr. Jordan was not involved in the study.
"[Chondroitin sulfate] is pretty well tolerated," Dr. Jordan said. "It is a mild anticoagulant, so people on blood thinners have to be careful, at least in theory.
"It is available as a prescription drug in Europe and a nonprescription supplement in the US, with less regulation and less confidence in the actual content of supplements. This might explain in part why it is not used much in the US," she said.
The next step in the research should be to explore the therapy outside of a regulated environment, and in comparison to current therapies, Dr. Jordan noted.
"The findings suggest that a prescription preparation of chondroitin sulfate is better than placebo in treating hand symptoms in people with hand osteoarthritis," Dr. Jordan said. "Whether this applies to chondroitin as an unregulated supplement is not known.
"This would need to be replicated in a larger study in multiple centers. Additionally, comparison of chondroitin sulfate to known effective drugs for hand symptoms would be a logical next step," she noted.
The study was supported by the Institut Biochimique SA, Pambio-Noranco, Switzerland. Dr. Jordan has disclosed that she has contract support for research with Johnson & Johnson and is a consultant to Interleukin Genetics, Algynomics, Eli Lilly, and Johnson & Johnson.
Arthritis Rheum. Published online September 8, 2011. Abstract
Medscape Medical News ? 2011 WebMD, LLC
Send comments and news tips to [email protected].
