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Alternative Treatments for Arthritis

ls of glucosamine for OA pain that were reported between 1980 and 2006. Glucosamine is classified as a dietary supplement in the U.S., is widely available, and appears to be safe but its efficacy is uncertain, with some trials reporting little effect and others reporting positive results.

The authors attempted to identify factors that explain these differing results and found that glucosamine hydrochloride, as opposed to glucosamine sulfate, has no effect on pain. Among the 12 glucosamine sulfate trials, only two were not funded by industry, and like trials of glucosamine hydrochloride, both showed no effect on pain. Industry involvement appeared to be the strongest predictor of trial results which suggested that industry bias accounted for the results of these studies and not treatment efficacy.

Trials using preparations by Rottapharm had an especially large effect compared with other studies and this may be due to bias or possibly to unique efficacy of the Rotta formulation. Allocation concealment, (which attempts to prevent selection bias) was the only other factor that had a major impact, with trials that had adequate allocation concealment showing no glucosamine efficacy.

Although trials with industry involvement were more likely to have positive results, they still had varied outcomes (heterogeneity); this may be due to differences in formulations or dosages, although trials using only Rottapharm products also had varying outcomes. Among glucosamine sulfate trials, enough heterogeneity existed such that no definitive conclusion about efficacy is possible, the authors state. However, industry bias remains the most likely explanation for the positive results of some studies whereas others show no efficacy.

In an accompanying editorial in the same issue, Jean-Yves Reginster of the WHO Collaborating Center for Public Health Aspects of Rheumatic Disease in Liege, Belgium, finds the conclusions of the Vlad rep
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