Joint Degeneration and Cartilage Deterioration

http://www.fda.gov/ohrms/dockets/ac/04/briefing/4045b1_04_Summary%20GCSOA%20FAC.htm

     Radiographic evidence suggests that glucosamine sulfate and chondroitin sulfate may slow joint degeneration in patients with osteoarthritis. OA patients taking glucosamine sulfate for up to three years had significantly less knee joint degeneration, less joint space narrowing, and significant symptom improvement when compared with placebo (A180/B16, A181/B15). Progression of knee joint space narrowing was reportedly prevented in OA patients taking chondroitin sulfate for one to three years when compared with placebo (A194, A207) or baseline (A193, A205, A206)

     Compared with placebo, consumption of chondroitin sulfate for three years did not prevent development of OA in finger joints that were non-affected at the start of the study, but a significant decrease in the number of patients with new “erosive” OA finger joints was reportedly observed (A198). In a separate two year study,  chondroitin sulfate plus naproxen did not prevent development of OA in finger joints that were non-affected at the start of the study, but compared with naproxen alone, a significant decrease in the number of joints with new erosions was reportedly observed (A215).

     Investigators have reported biochemical evidence from OA patients that chondroitin sulfate may protect against cartilage and bone degradation. Compared with placebo, one year treatment of OA patients with chondroitin sulfate was reported to decrease markers of bone metabolism (serum osteocalcin, urine pyridinoline/deoxypyridinoline) and cartilage metabolism (serum keratin sulfate, cartilage oligometric matrix protein (COMP)) (A193, A205).  Compared with pre-treatment levels, short term treatment (5-10 days) with chondroitin sulfate elevated synovial fluid proteoglycan and hyaluronic acid levels and decreased collagenolytic activity, phospholipase A2 and N-acetylglucosaminidase (A119/B49, A131).