[NPInfo] CHONDROITIN REVIEW ARTICLE

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Osteoarthritis and Cartilage
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doi:10.1016/j.joca.2008.06.006
Copyright © 2008 Osteoarthritis Research Society International  
Published by Elsevier Ltd.
Clinical review of chondroitin sulfate in osteoarthritis

D. Uebelhart M.D., a,
aDepartment of Rheumatology and Institute of Physical Medicine,  
University Hospital Zurich, Switzerland

Received 17 June 2008.  Available online 31 July 2008.

Summary

Symptomatic slow-acting drugs for the treatment of osteoarthritis  
(SYSADOA; OA) are compounds which are prescribed as drugs in European  
countries since many years, whereas they are sold as nutraceuticals in  
USA. In Europe, the publication of the EULAR Recommendations for the  
Treatment of Knee OA in 2003 has listed oral chondroitin sulfate (CS)  
as evidence 1A and strength of recommendation A which represents the  
highest level for a therapeutic strategy.

Symptomatic slow-acting drugs are intended to be used as ground  
therapy for OA; these compounds are not rapidly acting agents such as  
Non Steroidal Anti-Inflammatory Drugs (NSAIDs), and their clinical  
efficacy on algo-functional symptoms can only be demonstrated after a  
couple of weeks of regular intake. Interestingly, once the  
administration is stopped, they do show carry-over effects of various  
durations, from about 3 months with the oral formulations to 6–9  
months with intra-articular formulations. The main rationale behind  
the use of the SYSADOA therapeutic class is the reduction of NSAIDs in  
the overall drug management of OA disease and therefore consequently  
to limit the very significant risks of upper Gastro-intestinal (GI)  
tract erosions, ulcers with bleeding and/or deleterious renal effects  
in elderly patients.

The evidence for clinical efficacy of oral CS as a drug able to  
significantly improve the algo-functional symptoms of OA disease does  
come from a set of randomized clinical studies published a couple of  
years ago. Indeed, it was demonstrated that the drug was effective in  
knee and finger OA, whereas previous data suggested that hip OA  
patients could also benefit from it. In addition, oral CS supported  
the comparison with NSAIDs such as diclofenac sodium in a medium/long- 
term clinical study in patients with knee OA. A dose-finding study in  
patients with knee OA did provide strong data supporting the  
administration of 800 mg of CS orally which had nearly the same  
effects as 1200 mg/day, whereas the use of a sequential 3 months  
administration mode, twice a year was also shown to provide the same  
results as a continuous treatment. The good tolerability and safety  
aspects of oral CS were largely documented in these CTs. Taking these  
important points into account, we definitively have enough clinical  
data available supporting the view that oral CS is a valuable and safe  
symptomatic treatment for OA disease.

More recent data based on a couple of previous trials and two pivotal  
studies do provide further evidence that oral CS does also have  
structure-modifying effects in knee OA patients.

A couple of other compounds such as hyaluronan, diacerein, avocado and  
soya unsaponifiables, doxycycline have also been tested with respect  
to their potential disease-modifying effects. Additional compounds  
including receptor activator of NF-κB (RANK) ligand inhibitors,  
cathepsin K inhibitors, bisphosphonates are further assessed regarding  
their potential structure-modifying effect.

Key words: Chondroitin sulfate; osteoarthritis; SYSADOA; DMOADS

Article Outline

Introduction
Oral CS as a SYSADOA
Oral CS as a disease or structure-modifying drug in osteoarthritis  
(SMOAD)
SMOAD effect of CS in knee OA
SMOAD effect of CS in finger joint OA
Meta-analyses on CS in OA
Conclusion
Conflict of interest
References

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