PMID 25629804 Chondroitin for osteoarthritis 코크란 리뷰 · Cochrane Database Syst Rev, 2015 무작위 시험 43개 - 6개월 미만 통증 10%p 감소(근거 수준 낮음), 제약사 지원 없는 시험만 남기면 이득이 불확실해짐.
핵심요약
골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA).에 쓰는 경구 콘드로이친의 이득과 해를 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다.·다른 약과 비교한 코크란치료·예방의 근거를 엄격히 검토·종합하는 국제 연구 네트워크(Cochrane). 체계적 문헌고찰. 7개 데이터베이스를 2013년 11월까지 검색해 무작위·준무작위 시험 43개(콘드로이친 4,962명, 대조 4,148명)를 포함했고 대부분 무릎 골관절염이었다. 6개월 미만 시험에서 통증(0~100점) 절대위험차는 10%p 낮았고(NNT 5) 이질성이 컸으며(I²=70%) 근거 수준은 낮음, 비뚤림 위험은 높음이었다. WOMAC무릎·고관절 골관절염의 통증·뻣뻣함·기능을 점수화하는 대표적 평가 척도. 최소임상중요개선에서는 콘드로이친 53/100명 대 위약 47/100명(절대차 6%p, 근거 수준 높음)이었고, 최소 관절 간격 손실은 콘드로이친 군이 4.7% 상대적으로 적었다(시험 2건, 근거 수준 높음). 중대한 이상반응은 위약보다 적었다(Peto 오즈비 0.40). 저자들은 통증 8점(0~100), Lequesne 지수 2점(0~24) 개선을 임상적으로 의미 있다고 보면서도, 배정 은폐가 적절한 시험, 200명 초과 대규모 시험, 제약사 지원이 없는 시험으로 좁히면 이 이득이 불확실해진다고 명시했다.
원문 초록 보기
BACKGROUND: Osteoarthritis, a common joint disorder, is one of the leading causes of disability. Chondroitin has emerged as a new treatment. Previous meta-analyses have shown contradictory results on the efficacy of chondroitin. This, in addition to the publication of more trials, necessitates a systematic review. OBJECTIVES: To evaluate the benefit and harm of oral chondroitin for treating osteoarthritis compared with placebo or a comparator oral medication including, but not limited to, nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, opioids, and glucosamine or other "herbal" medications. SEARCH METHODS: We searched seven databases up to November 2013, including the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, CINAHL, EMBASE, Science Citation Index (Web of Science) and Current Controlled Trials. We searched the US Food and Drug Administration (FDA) and European Medicines Agency (EMEA) websites for adverse effects. Trial registers were not searched. SELECTION CRITERIA: All randomized or quasi-randomized clinical trials lasting longer than two weeks, studying adults with osteoarthritis in any joint, and comparing chondroitin with placebo, an active control such as NSAIDs, or other "herbal" supplements such as glucosamine. DATA COLLECTION AND ANALYSIS: Two review authors independently performed all title assessments, data extractions, and risk of bias assessments. MAIN RESULTS: Forty-three randomized controlled trials including 4,962 participants treated with chondroitin and 4,148 participants given placebo or another control were included. The majority of trials were in knee OA, with few in hip and hand OA. Trial duration varied from 1 month to 3 years. Participants treated with chondroitin achieved statistically significantly and clinically meaningful better pain scores (0-100) in studies less than 6 months than those given placebo with an absolute risk difference of 10% lower (95% confidence interval (CI), 15% to 6% lower; number needed to treat (NNT) = 5 (95% CI, 3 to 8; n = 8 trials) (level of evidence, low; risk of bias, high); but there was high heterogeneity between the trials (T(2) = 0.07; I(2) = 70%, which was not easily explained by differences in risk of bias or study sample size). In studies longer than 6 months, the absolute risk difference for pain was 9% lower (95% CI 18% lower to 0%); n = 6 trials; T(2) = 0.18; I(2) = 83% ), again with low level of evidence.For the Western Ontario and McMaster Universities Osteoarthritis Index Minimal Clinically Important Improvement (WOMAC MCII Pain subscale) outcome, a reduction in knee pain by 20% was achieved by 53/100 in the chondroitin group versus 47/100 in the placebo group, an absolute risk difference of 6% (95% CI 1% to 11%), (RR 1.12, 95% CI 1.01 to 1.24; T(2) = 0.00; I(2) = 0%) (n = 2 trials, 1253 participants; level of evidence, high; risk of bias, low).Differences in Lequesne's index (composite of pain,function and disability) statistically significantly favoured chondroitin as compared with placebo in studies under six months, with an absolute risk difference of 8% lower (95% CI 12% to 5% lower; T(2)= 0.78; n = 7 trials) (level of evidence, moderate; risk of bias, unclear), also clinically meaningful. Loss of minimum joint space width in the chondroitin group was statistically significantly less than in the placebo group, with a relative risk difference of 4.7% less (95% CI 1.6% to 7.8% less; n = 2 trials) (level of evidence, high; risk of bias, low). Chondroitin was associated with statistically significantly lower odds of serious adverse events compared with placebo with Peto odds ratio of 0.40 (95% CI 0.19 to 0.82; n = 6 trials) (level of evidence, moderate). Chondroitin did not result in statistically significant numbers of adverse events or withdrawals due to adverse events compared with placebo or another drug. Adverse events were reported in a limited fashion, with some studies providing data and others not.Comparisons of chondroitin taken alone or in combination with glucosamine or another supplement showed a statistically significant reduction in pain (0-100) when compared with placebo or an active control, with an absolute risk difference of 10% lower (95% CI 14% to 5% lower); NNT = 4 (95% CI 3 to 6); T(2) = 0.33; I(2) = 91%; n = 17 trials) (level of evidence, low). For physical function, chondroitin in combination with glucosamine or another supplement showed no statistically significant difference from placebo or an active control, with an absolute risk difference of 1% lower (95% CI 6% lower to 3% higher with T(2) = 0.04; n = 5 trials) (level of evidence, moderate). Differences in Lequesne's index statistically significantly favoured chondroitin as compared with placebo, with an absolute risk difference of 8% lower (95% CI, 12% to 4% lower; T(2) = 0.12; n = 10 trials) (level of evidence, moderate). Chondroitin in combination with glucosamine did not result in statistically significant differences in the numbers of adverse events, withdrawals due to adverse events, or in the numbers of serious adverse events compared with placebo or with an active control.The beneficial effects of chondroitin in pain and Lequesne's index persisted when evidence was limited to studies with adequate blinding or studies that used appropriate intention to treat (ITT) analyses. These beneficial effects were uncertain when we limited data to studies with appropriate allocation concealment or a large study sample (> 200) or to studies without pharmaceutical funding. AUTHORS' CONCLUSIONS: A review of randomized trials of mostly low quality reveals that chondroitin (alone or in combination with glucosamine) was better than placebo in improving pain in participants with osteoarthritis in short-term studies. The benefit was small to moderate with an 8 point greater improvement in pain (range 0 to 100) and a 2 point greater improvement in Lequesne's index (range 0 to 24), both seeming clinically meaningful. These differences persisted in some sensitivity analyses and not others. Chondroitin had a lower risk of serious adverse events compared with control. More high-quality studies are needed to explore the role of chondroitin in the treatment of osteoarthritis. The combination of some efficacy and low risk associated with chondroitin may explain its popularity among patients as an over-the-counter supplement. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 30859538 Effects of Oral Chondroitin Sulfate on Osteoarthritis-Related Pain and Joint Structural Changes: Systematic Review and Meta-Analysis 메타분석 · J Spec Oper Med, 2019 통증 SMD -0.41(시험 18건), 관절강관절에서 뼈와 뼈 사이의 간격. 좁아질수록 연골 손실이 진행됐음을 뜻한다. 협착 -0.30(6건), 연골 부피 -0.11(2건, 신뢰구간이 0 포함) - 연골 부피에는 효과 없음.
핵심요약
경구 콘드로이친 황산이 골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA). 통증과 관절 구조 변화에 미치는 영향을 본 체계적 문헌고찰·메타분석여러 개별 연구의 결과를 통계적으로 합쳐 하나의 종합 결론을 내는 분석.. 무작위 이중맹검 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다.대조 시험만 대상으로 PubMed·Ovid Embase 등을 검색했다. 통증을 본 시험 18건에서 표준화 평균차는 -0.41(95% CI -0.57~-0.25)로 콘드로이친에 유리했고, 관절강관절에서 뼈와 뼈 사이의 간격. 좁아질수록 연골 손실이 진행됐음을 뜻한다. 협착을 본 6건은 -0.30(95% CI -0.61~+0.00), 연골 부피를 본 2건은 -0.11(95% CI -0.48~+0.26)이었다. 하루 1,200 mg 용량이 1,000 mg 이하보다 통증 감소 효과가 컸다. 저자들은 콘드로이친이 통증에는 작거나 중간 정도로 효과적이지만 관절강 협착에는 최소한의 영향만, 연골 부피에는 효과가 없다고 결론지었고, 콘드로이친이 들어 있다고 표시된 보충제의 실제 함량이 들쭉날쭉하므로 의약품 등급 제품을 권해야 한다고 덧붙였다.
원문 초록 보기
Osteoarthritis (OA) is a disorder involving the deterioration of articular cartilage and underlying bone and is associated with symptoms of pain and disability. In military personnel, the incidence of OA has increased between 2000 and 2012 and was the first or second leading cause of medical separations in this period. It has been suggested that consumption of chondroitin sulfate (CS) may reduce the pain and joint deterioration associated with OA. This article reports on a systematic review and meta-analysis of the effectiveness of CS on reducing OA-related pain and joint deterioration. PubMed and Ovid Embase databases and other sources were searched to find randomized, double-blind, placebo-controlled trials on the effects of orally consumed CS on pain and/or joint structure. The outcome measure was the standardized mean difference (SMD) which was the improvement in the placebo groups minus the improvement in the CS groups divided by the pooled standard deviation. There were 18 trials meeting the review criteria for pain with SMD -0.41, 95% confidence interval (95% CI) -0.57 to -0.25 (negative SMD favors CS). Six studies met the review criteria for joint space narrowing with SMD -0.30, 95% CI -0.61 to +0.00. Two studies meet the review criteria for cartilage volume with SMD -0.11, 95% CI -0.48 to +0.26. Larger dosages (1200mg/d) had greater pain reduction efficacy than lower dosages (≤ 1000mg/d). These data suggest that CS has small to moderate effectiveness in reducing OA-related pain but minimal effects on joint space narrowing and no effect on cartilage volume. It is important that clinicians recommend pharmaceutical-grade CS to their patients due to the variability in the amount of CS in dietary supplements purporting to contain CS. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 16495392 Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis 무작위 대조시험(GAIT) · N Engl J Med, 2006 1,583명 - 콘드로이친 1,200 mg 단독 반응률은 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다.보다 5.3%p 높았을 뿐 유의하지 않았다(P=0.17).
핵심요약
미국 국립보건원이 지원한 다기관 이중맹검 시험(GAIT). 증상이 있는 무릎 골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA). 환자 1,583명을 글루코사민 1,500 mg, 콘드로이친 황산 1,200 mg, 두 성분 병용, 세레콕시브 200 mg, 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다. 군으로 무작위 배정해 24주간 관찰했다. 1차 결과는 무릎 통증 20% 감소였다. 위약 반응률 60.1%를 기준으로 콘드로이친 단독은 5.3%p 높았지만 유의하지 않았고(P=0.17), 글루코사민은 3.9%p(P=0.30), 병용은 6.5%p(P=0.09)였다. 대조약인 세레콕시브만 10.0%p로 유의했다(P=0.008). 다만 시작 시점에 통증이 중등도~중증이던 하위군에서는 병용 요법의 반응률이 79.2% 대 54.3%로 위약보다 유의하게 높았다(P=0.002). 이상반응은 경미했고 군 간에 고르게 분포했다.
원문 초록 보기
BACKGROUND: Glucosamine and chondroitin sulfate are used to treat osteoarthritis. The multicenter, double-blind, placebo- and celecoxib-controlled Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) evaluated their efficacy and safety as a treatment for knee pain from osteoarthritis. METHODS: We randomly assigned 1583 patients with symptomatic knee osteoarthritis to receive 1500 mg of glucosamine daily, 1200 mg of chondroitin sulfate daily, both glucosamine and chondroitin sulfate, 200 mg of celecoxib daily, or placebo for 24 weeks. Up to 4000 mg of acetaminophen daily was allowed as rescue analgesia. Assignment was stratified according to the severity of knee pain (mild [N=1229] vs. moderate to severe [N=354]). The primary outcome measure was a 20 percent decrease in knee pain from baseline to week 24. RESULTS: The mean age of the patients was 59 years, and 64 percent were women. Overall, glucosamine and chondroitin sulfate were not significantly better than placebo in reducing knee pain by 20 percent. As compared with the rate of response to placebo (60.1 percent), the rate of response to glucosamine was 3.9 percentage points higher (P=0.30), the rate of response to chondroitin sulfate was 5.3 percentage points higher (P=0.17), and the rate of response to combined treatment was 6.5 percentage points higher (P=0.09). The rate of response in the celecoxib control group was 10.0 percentage points higher than that in the placebo control group (P=0.008). For patients with moderate-to-severe pain at baseline, the rate of response was significantly higher with combined therapy than with placebo (79.2 percent vs. 54.3 percent, P=0.002). Adverse events were mild, infrequent, and evenly distributed among the groups. CONCLUSIONS: Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee. Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain. (ClinicalTrials.gov number, NCT00032890.). ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 20847017 Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis 네트워크 메타분석 · BMJ, 2010 시험 10건 3,803명 - 콘드로이친의 통증 차이는 10 cm 척도에서 -0.3 cm로 임상적 최소 의미 차이에 못 미쳤다.
핵심요약
고관절·무릎 골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA).에서 글루코사민·콘드로이친·병용이 관절 통증과 방사선학적 진행에 미치는 영향을 본 네트워크 메타분석여러 치료법을 간접 비교까지 포함해 한꺼번에 순위 매기는 메타분석.. 시험 10건 3,803명을 포함했다. 10 cm 시각통증척도에서 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다. 대비 통증 차이는 글루코사민 -0.4 cm, 콘드로이친 -0.3 cm, 병용 -0.5 cm였고, 어느 추정치도 95% 신뢰구간이 임상적으로 의미 있는 최소 차이 경계를 넘지 못했다. 업계와 무관한 독립 시험은 상업적 지원 시험보다 효과가 더 작게 나왔다(상호작용 P=0.02). 최소 관절 간격 변화의 차이는 모두 미미했고 95% 신뢰구간이 0을 포함했다. 저자들은 보건당국과 보험자가 이 제제들의 비용을 부담해서는 안 되며 새 처방을 권장하지 말아야 한다고까지 적었다.
원문 초록 보기
OBJECTIVE: To determine the effect of glucosamine, chondroitin, or the two in combination on joint pain and on radiological progression of disease in osteoarthritis of the hip or knee. Design Network meta-analysis. Direct comparisons within trials were combined with indirect evidence from other trials by using a Bayesian model that allowed the synthesis of multiple time points. MAIN OUTCOME MEASURE: Pain intensity. Secondary outcome was change in minimal width of joint space. The minimal clinically important difference between preparations and placebo was prespecified at -0.9 cm on a 10 cm visual analogue scale. DATA SOURCES: Electronic databases and conference proceedings from inception to June 2009, expert contact, relevant websites. Eligibility criteria for selecting studies Large scale randomised controlled trials in more than 200 patients with osteoarthritis of the knee or hip that compared glucosamine, chondroitin, or their combination with placebo or head to head. Results 10 trials in 3803 patients were included. On a 10 cm visual analogue scale the overall difference in pain intensity compared with placebo was -0.4 cm (95% credible interval -0.7 to -0.1 cm) for glucosamine, -0.3 cm (-0.7 to 0.0 cm) for chondroitin, and -0.5 cm (-0.9 to 0.0 cm) for the combination. For none of the estimates did the 95% credible intervals cross the boundary of the minimal clinically important difference. Industry independent trials showed smaller effects than commercially funded trials (P=0.02 for interaction). The differences in changes in minimal width of joint space were all minute, with 95% credible intervals overlapping zero. Conclusions Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 28533290 Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT) 무작위 대조시험(CONCEPT) · Ann Rheum Dis, 2017 604명 6개월 - 의약품 등급 800 mg/일은 통증 -42.6 mm로 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다. -33.3 mm보다 낫고 세레콕시브와 대등했다.
핵심요약
유럽 5개국에서 증상이 있는 무릎 골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA). 환자 604명을 182일간 추적한 전향적 무작위 이중맹검 3군 시험. 의약품 등급 콘드로이친 황산 800 mg/일, 세레콕시브 200 mg/일, 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다.을 비교했고 시각통증척도와 Lequesne 지수를 공동 1차 결과로 삼았다. 치료의향 분석에서 182일째 통증 감소는 콘드로이친 -42.6 mm, 세레콕시브 -39.5 mm로 위약 -33.3 mm보다 유의하게 컸고(콘드로이친 P=0.001), 두 실약 간에는 차이가 없었다. Lequesne 지수도 콘드로이친 -4.7, 세레콕시브 -4.6으로 위약 -3.7보다 유의하게 컸다(P=0.023). 최소임상중요개선과 환자수용가능증상상태 모두 두 실약군에서 유의하게 좋아졌고, 모든 군의 안전성 프로파일이 양호했다. 저자들은 이 제형을 무릎 골관절염 관리의 1차 선택지로 고려해야 한다고 결론지었다.
원문 초록 보기
OBJECTIVES: Chondroitin sulfate 800 mg/day (CS) pharmaceutical-grade in the management of symptomatic knee osteoarthritis consistent with the European Medicines Agency guideline. METHODS: A prospective, randomised, 6-month, 3-arm, double-blind, double-dummy, placebo and celecoxib (200 mg/day)-controlled trial assessing changes in pain on a Visual Analogue Scale (VAS) and in the Lequesne Index (LI) as coprimary endpoints. Minimal-Clinically Important Improvement (MCII), Patient-Acceptable Symptoms State (PASS) were used as secondary endpoints. RESULTS: 604 patients (knee osteoarthritis) diagnosed according to American College of Rheumalogy (ACR) criteria, recruited in five European countries and followed for 182 days. CS and celecoxib showed a greater significant reduction in pain and LI than placebo. In the intention-to-treat (ITT) population, pain reduction in VAS at day 182 in the CS group (-42.6 mm) and in celecoxib group (-39.5 mm) was significantly greater than the placebo group (-33.3 mm) (p=0.001 for CS and p=0.009 for celecoxib), while no difference observed between CS and celecoxib. Similar trend for the LI, as reduction in this metric in the CS group (-4.7) and celecoxib group (-4.6) was significantly greater than the placebo group (-3.7) (p=0.023 for CS and p=0.015 for celecoxib), no difference was observed between CS and celecoxib. Both secondary endpoints (MCII and PASS) at day 182 improved significantly in the CS and celecoxib groups. All treatments demonstrated excellent safety profiles. CONCLUSION: A 800 mg/day pharmaceutical-grade CS is superior to placebo and similar to celecoxib in reducing pain and improving function over 6 months in symptomatic knee osteoarthritis (OA) patients. This formulation of CS should be considered a first-line treatment in the medical management of knee OA. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 19180484 Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: the study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo-controlled trial 무작위 대조시험(STOPP) · Arthritis Rheum, 2009 622명 2년 - 최소 관절 간격 손실 0.07 mm 대 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다. 0.31 mm, 0.25 mm 이상 진행 28% 대 41%(NNT 8).
핵심요약
무릎 골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA). 환자 622명을 콘드로이틴 4·6 황산 800 mg 1일 1회 군(309명)과 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다.군(313명)으로 무작위 배정해 2년간 추적한 국제 이중맹검 시험. 등록 시점과 12·18·24개월에 Lyon schuss 촬영으로 무릎 엑스레이를 찍고 대퇴경골 관절 내측의 최소 관절 간격을 디지털 영상 분석으로 측정했다. 치료의향 분석에서 최소 관절 간격 손실은 콘드로이친 군 0.07 mm, 위약군 0.31 mm로 유의하게 적었다(P<0.0001). 0.25 mm 이상 방사선학적 진행을 보인 비율도 28% 대 41%로 낮았고(P<0.0005) 상대위험 감소 33%, 필요치료수 8이었다. 통증도 콘드로이친 군에서 더 빨리 좋아졌으며(P<0.01) 두 군의 안전성 차이는 없었다. 저자들은 구조 변화와 증상 양쪽을 함께 늦추는 효과를 근거로 질병 조절 약제 가능성을 제기했다.
원문 초록 보기
OBJECTIVE: To assess the long-term effects of chondroitins 4 and 6 sulfate (CS) on the radiographic progression of, and symptom changes associated with, knee osteoarthritis (OA). METHODS: We performed an international, randomized, double-blind, placebo-controlled trial in which 622 patients with knee OA were randomly assigned to receive either 800 mg CS (n = 309 patients) or placebo (n = 313 patients) once daily for 2 years. Radiographs of the target knee, using the Lyon schuss view, were obtained at the time of enrollment and at 12, 18, and 24 months. The minimum joint space width (JSW) of the medial compartment of the tibiofemoral joint was assessed by digital image analysis. The primary outcome was the loss in minimum JSW over 2 years. RESULTS: The intent-to-treat analysis demonstrated a significant reduction (P < 0.0001) in minimum JSW loss in the CS group (mean +/- SEM -0.07 +/- 0.03 mm) as compared with the placebo group (-0.31 +/- 0.04 mm). The percentage of patients with radiographic progression > or =0.25 mm was significantly reduced in the CS group compared with the placebo group (28% versus 41% [P < 0.0005]; relative risk reduction 33% [95% confidence interval 16-46%]). The number of patients needed to treat was 8 (95% confidence interval 5-17). Pain improved significantly faster in the CS group than in the placebo group (P < 0.01). There were no differences in safety between groups. CONCLUSION: The long-term combined structure-modifying and symptom-modifying effects of CS suggest that it could be a disease-modifying agent in patients with knee OA. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 30575881 Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis 네트워크 메타분석 · JAMA, 2018 12개월 이상 시험 47건 22,037명 - 콘드로이친은 관절강관절에서 뼈와 뼈 사이의 간격. 좁아질수록 연골 손실이 진행됐음을 뜻한다. 협착에서만 SMD -0.20, 통증 추정치는 불확실했다.
핵심요약
무릎 골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA). 약제의 장기(12개월 이상) 결과만 모은 베이지안 네트워크 메타분석여러 치료법을 간접 비교까지 포함해 한꺼번에 순위 매기는 메타분석.. 5개 데이터베이스를 2018년 6월까지 검색해 무작위 시험 47건(22,037명)을 포함했고, 진통제·항산화제·뼈 작용 약제·소염진통제·관절강관절에서 뼈와 뼈 사이의 간격. 좁아질수록 연골 손실이 진행됐음을 뜻한다. 내 주사·글루코사민과 콘드로이친 같은 서방성 증상완화 성분·질병조절 후보 약제를 함께 비교했다. 통증 감소와 연관을 보인 것은 세레콕시브(SMD -0.18)와 글루코사민 황산(SMD -0.29)뿐이었고 모든 추정치의 불확실성이 컸다. 관절강 협착 개선과 연관을 보인 것은 글루코사민 황산(SMD -0.42), 콘드로이친 황산(SMD -0.20, 95% CrI -0.31~-0.07), 스트론튬 라넬레이트(SMD -0.20)였다. 저자들은 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다.과 비교한 모든 통증 효과 크기 추정치에 불확실성이 있으며 더 큰 무작위 시험이 필요하다고 결론지었다. 공저자 다수가 골관절염 신약을 개발하는 Rottapharm Biotech 소속이다.
원문 초록 보기
IMPORTANCE: Even though osteoarthritis is a chronic and progressive disease, pharmacological agents are mainly studied over short-term periods, resulting in unclear recommendations for long-term disease management. OBJECTIVE: To search, review, and analyze long-term (≥12 months) outcomes (symptoms, joint structure) from randomized clinical trials (RCTs) of medications for knee osteoarthritis. DATA SOURCES AND STUDY SELECTION: The databases of MEDLINE, Scopus, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched until June 30, 2018 (MEDLINE alerts through August 31, 2018) for RCTs of patients with knee osteoarthritis that had treatment and follow-up lasting 1 year or longer. DATA EXTRACTION AND SYNTHESIS: Data at baseline and at the longest available treatment and follow-up of 12 months' duration or longer (or the change from baseline) were extracted. A Bayesian random-effects network meta-analysis was performed. MAIN OUTCOMES AND MEASURES: The primary outcome was the mean change from baseline in knee pain. Secondary outcomes were physical function and joint structure (the latter was measured radiologically as joint space narrowing). Standardized mean differences (SMDs) and mean differences with 95% credibility intervals (95% CrIs) were calculated. Findings were interpreted as associations when the 95% CrIs excluded the null value. RESULTS: Forty-seven RCTs (22 037 patients; mean age range, mostly 55-70 years; and a higher mean proportion of women than men, around 70%) included the following medication categories: analgesics; antioxidants; bone-acting agents such as bisphosphonates and strontium ranelate; nonsteroidal anti-inflammatory drugs; intra-articular injection medications such as hyaluronic acid and corticosteroids; symptomatic slow-acting drugs in osteoarthritis such as glucosamine and chondroitin sulfate; and putative disease-modifying agents such as cindunistat and sprifermin. Thirty-one interventions were studied for pain, 13 for physical function, and 16 for joint structure. Trial duration ranged from 1 to 4 years. Associations with decreases in pain were found for the nonsteroidal anti-inflammatory drug celecoxib (SMD, -0.18 [95% CrI, -0.35 to -0.01]) and the symptomatic slow-acting drug in osteoarthritis glucosamine sulfate (SMD, -0.29 [95% CrI, -0.49 to -0.09]), but there was large uncertainty for all estimates vs placebo. The association with pain improvement remained significant only for glucosamine sulfate when data were analyzed using the mean difference on a scale from 0 to 100 and when trials at high risk of bias were excluded. Associations with improvement in joint space narrowing were found for glucosamine sulfate (SMD, -0.42 [95% CrI, -0.65 to -0.19]), chondroitin sulfate (SMD, -0.20 [95% CrI, -0.31 to -0.07]), and strontium ranelate (SMD, -0.20 [95% CrI, -0.36 to -0.05]). CONCLUSIONS AND RELEVANCE: In this systematic review and network meta-analysis of studies of patients with knee osteoarthritis and at least 12 months of follow-up, there was uncertainty around the estimates of effect size for change in pain for all comparisons with placebo. Larger RCTs are needed to resolve the uncertainty around efficacy of medications for knee osteoarthritis. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 12359162 Oral bioavailability of chondroitin sulfate (Condrosulf) and its constituents in healthy male volunteers 약동학 연구 · Osteoarthritis Cartilage, 2002 건강한 남성 20명에게 소 유래 4 g 투여 - 혈중 농도가 전원에서 200% 넘게 올랐고 2시간째 정점.
핵심요약
소 유래 콘드로이친 황산을 활성성분으로 하는 경구 제제 4 g을 건강한 남성 20명에게 투여한 뒤 48시간에 걸쳐 혈장에서 콘드로이친 황산 유도체를 추출·정제해 흡수를 측정한 연구. 아가로스 젤 전기영동과 밀도계 주사로 흡수된 다당류 분획을 정량하고 구성 이당류 비율과 전하 밀도를 함께 측정했다. 투여 전에도 모든 피험자의 혈장에서 내인성 콘드로이친 황산이 검출됐고 하루 중 0.3~5.3 μg/mL 사이에서 변동했다. 투여 후에는 전원에서 혈중 농도가 200% 넘게 올라 2시간째 정점에 도달했고 2~6시간 구간에서 유의했다. 혈장 이당류 조성도 바뀌어 비황산화 이당류 비율이 줄고 4-황산화가 최대 60.50%까지, 6-황산화가 최대 17.33%까지 늘었다. 저자들은 외부에서 들어온 콘드로이친 황산이 부분적으로 해중합·탈황산화된 유도체와 함께 고분자량 다당류 형태로 흡수된다고 결론지었다.
원문 초록 보기
OBJECTIVE: Drug treatment of osteoarthritis (OA) includes symptomatic slow-acting drugs (SYSADOA). This class of compounds have a slow onset of action and improve OA symptoms. Among the SYSADOA, Condrosulf) (manufactured by IBSA), whose active ingredient is chondroitin sulfate, has proven to be a valuable therapeutic tool for the symptomatic treatment of OA after oral administration. The aim of this study was to assess the bioavailability of chondroitin sulfate and its constituents after oral administration of Condrosulf) to 20 healthy male volunteers. Pharmacokinetic parameters and the structure and properties of plasma chondroitin sulfate were determined after administration of Condrosulf). The possible physiological regulation of plasma levels of endogenous chondroitin sulfate during the day was also assessed. DESIGN: Condrosulf) (composed of bovine origin chondroitin sulfate, 4 g) was orally administered to 20 healthy human volunteers, and chondroitin sulfate derivatives were extracted and purified from plasma over a 48 h period. Polysaccharide fractions absorbed by oral route were characterized and quantified by agarose-gel electrophoretic technique, and densitometric scanning. In addition, the percentage of constituent disaccharides and charge density were measured in an effort to physico-chemically characterize chondroitin sulfate fractions absorbed per os. RESULTS: Plasma levels of endogenous chondroitin sulfate were detectable in all subjects, and the mean values calculated on six subjects varied during the day from 0.3 to 5.3 microg/ml. After administration of Condrosulf), chondroitin sulfate plasma levels increased (more than 200%) in all subjects with a peak concentration after 2h, with the increase reaching significance from 2 to 6h. Absorption of exogenous chondroitin sulfate was also proved by the change in the composition of disaccharides in plasma after drug administration with respect to baseline. A significant decrease in the relative amount of non-sulfated disaccharide was measured (reaching the minimum relative percentage of 22.96+/-11.68% at 4h). At the same time 4-sulfated disaccharide increased to a maximum of 60.50+/-10.45% after 4h and 6-sulfated disaccharide appeared in blood, reaching a maximum concentration of 17.33+/-6.52% after 2h. Concomitantly the mean charge density increased from 0.40+/-0.09 at pre-dose to a maximum of 0.78+/-0.11 4h after Condrosulf) administration. As for safety, the treatment was well tolerated and did not determine any relevant change in vital signs nor ECG. CONCLUSIONS: From this study and literature data, it appears that exogenous chondroitin sulfate (Condrosulf) is absorbed as a high molecular mass polysaccharide together with derivatives resulting from a partial depolymerization and/or desulfation. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 19814858 Quality of different chondroitin sulfate preparations in relation to their therapeutic activity 리뷰 · J Pharm Pharmacol, 2009 동물 조직에서 추출하는 성분이라 원료 출처·공정·오염물질이 품질을 좌우 - 건강기능식품보다 의약품 등급 권고.
핵심요약
콘드로이친 황산의 품질 관리를 의약품 등급 제제와 건강기능식품으로 나눠 검토한 리뷰. 콘드로이친 황산은 유럽류마티스학회가 무릎·손 골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA).에 서방성 증상완화 성분으로 권고하고 있고 구조 조절 가능성을 보인 시험도 있지만, 동물 유래 원료를 추출·정제해 만들기 때문에 원료 자체와 제조 공정, 오염물질 유무 등 여러 요인이 최종 작용을 좌우한다. 저자는 의약품 등급 제형은 각국 보건당국의 엄격한 규제를 받아 품질·순도·물성이 표준화돼 있는 반면, 여러 건강기능식품의 콘드로이친 품질은 나쁘다는 연구가 다수 나와 있고 원료 출처를 규율하는 명확한 규정도 없다고 지적했다. 결론에서는 원료와 완제품 모두에 대해 순도와 표시 함량을 확인할 구체적이고 정확한 분석 절차가 강제돼야 하며, 그런 규제가 자리 잡기 전까지는 건강기능식품보다 의약품 등급 콘드로이친 황산을 쓰기를 강력히 권한다고 밝혔다.
원문 초록 보기
OBJECTIVES: Chondroitin sulfate is currently recommended by the European League Against Rheumatism (EULAR) as a SYSADOA (symptomatic slow acting drug for osteoarthritis) in Europe in the treatment of knee and hand osteoarthritis based on research evidence and meta-analysis of numerous clinical studies. Furthermore, recent clinical trials demonstrated its possible structure-modifying effects. Chondroitin sulfate, alone or in combination with glucosamine or other ingredients, is also utilized as a nutraceutical in dietary supplements in Europe and the USA. However, it is derived from animal sources by extraction and purification processes. As a consequence, source material, manufacturing processes, the presence of contaminants and many other factors contribute to the overall biological and pharmacological actions of these agents. We aim to review the quality control of chondroitin sulfate in pharmaceutical-grade preparations and nutraceuticals. KEY FINDINGS: Pharmaceutical-grade formulations of chondroitin sulfate are of high and standardized quality, purity and properties, due to the stricter regulations to which this drug is subjected by local national health institutes as regards production and characteristics. On the contrary, as several published studies available in literature indicate, the chondroitin sulfate quality of several nutraceuticals is poor. Additionally, there are no definite regulations governing the origin of the ingredients in these nutraceuticals and the origin of the ingredients in natural products is the most important factor ensuring quality, and thus safety and efficacy, in particular for chondroitin sulfate, due to its extraction from different sources. CONCLUSIONS: Due to the poor chondroitin sulfate quality of some nutraceuticals, we conclude that stricter regulations regarding their quality control should be introduced to guarantee the manufacture of high quality products for nutraceutical utilization and to protect customers from low-quality, ineffective and potentially dangerous products. There is a need for specific and accurate analytical procedures, which should be enforced to confirm purity and label claims both for raw materials and finished chondroitin sulfate products, and also to govern the origin of ingredients. Until these stricter regulations are in place, then it is strongly recommended that pharmaceutical-grade chondroitin sulfate is used rather than food supplements. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 24755394 Environmental neurotoxins β-N-methylamino-l-alanine (BMAA) and mercury in shark cartilage dietary supplements 제품 분석 연구 · Food Chem Toxicol, 2014 시판 상어연골 보충제 16개 중 15개에서 신경독소 BMAA 검출(86~265 μg/g) - 식이 노출의 신경독성 여부는 아직 미지.
핵심요약
상어연골 보충제의 환경 독소 오염을 측정한 연구. 상어는 오래 사는 최상위 포식자여서 먹이를 통해 해양 독소와 메틸수은을 축적하는데, 상어연골에는 콘드로이친과 글루코사민이 섞여 들어 있어 관절용 보충제 원료로 팔린다. 연구진은 시판 상어연골 보충제 16개를 형광검출 고성능액체크로마토그래피와 초고성능액체크로마토그래피-질량분석으로 분석하고, 같은 제품의 총수은을 냉증기 원자형광분광법으로 측정했다. 그 결과 16개 중 15개에서 시아노박테리아 독소 BMAA가 검출됐고 농도는 건조 중량 기준 86~265 μg/g이었다. 상어 지느러미 제품은 모두 낮은 농도의 수은을 함유했다. 저자들은 식이로 섭취한 BMAA의 신경독성 잠재력은 아직 알려져 있지 않다고 전제하면서도, 상어연골 제품이 상승 독성을 갖는 두 가지 환경 신경독소를 함유할 수 있음을 결과가 보여준다고 밝혔다.
원문 초록 보기
Shark cartilage products are marketed as dietary supplements with claimed health benefits for animal and human use. Shark fin and cartilage products sold as extracts, dry powders and in capsules are marketed based on traditional Chinese medicine claims that it nourishes the blood, enhances appetite, and energizes multiple internal organs. Shark cartilage contains a mixture of chondroitin and glucosamine, a popular nutritional supplement ingested to improve cartilage function. Sharks are long-lived apex predators, that bioaccumulate environmental marine toxins and methylmercury from dietary exposures. We recently reported detection of the cyanobacterial toxin β-N-methylamino-l-alanine (BMAA) in the fins of seven different species of sharks from South Florida coastal waters. Since BMAA has been linked to degenerative brain diseases, the consumption of shark products may pose a human risk for BMAA exposures. In this report, we tested sixteen commercial shark cartilage supplements for BMAA by high performance liquid chromatography (HPLC-FD) with fluorescence detection and ultra performance liquid chromatography/mass spectrometry/mass spectrometry (UPLC-MS/MS). Total mercury (Hg) levels were measured in the same shark cartilage products by cold vapor atomic fluorescence spectrometry (CVAFS). We report here that BMAA was detected in fifteen out of sixteen products with concentrations ranging from 86 to 265μg/g (dry weight). All of the shark fin products contained low concentrations of Hg. While Hg contamination is a known risk, the results of the present study demonstrate that shark cartilage products also may contain the neurotoxin BMAA. Although the neurotoxic potential of dietary exposure to BMAA is currently unknown, the results demonstrate that shark cartilage products may contain two environmental neurotoxins that have synergistic toxicities. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 31073924 Safety of Symptomatic Slow-Acting Drugs for Osteoarthritis: Outcomes of a Systematic Review and Meta-Analysis 메타분석 · Drugs Aging, 2019 콘드로이친 황산은 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다. 대비 어떤 종류의 이상반응 위험도 올리지 않았다 - 저자 결론은 '안전하다고 볼 수 있다'.
핵심요약
골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA).에 쓰는 서방성 증상완화 성분들의 안전성을 무작위 위약유효 성분이 없는 가짜 약(플라시보). 효과 비교의 기준으로 쓴다.대조 시험의 전체 안전성 보고서까지 최대한 활용해 재평가한 체계적 문헌고찰·메타분석여러 개별 연구의 결과를 통계적으로 합쳐 하나의 종합 결론을 내는 분석.. MEDLINE·Cochrane CENTRAL·Scopus에서 3,815건을 검색해 25개 연구를 질적 종합에, 13개를 메타분석에 포함했고, 다른 골관절염 약 병용을 허용한 37개 연구는 별도 병렬 분석으로 다뤘다. 1차 결과는 전체 중증·중대 이상반응과 위장관·심장·혈관·신경계·피부·근골격·신장 등 기관계별 이상반응이었다. 글루코사민 황산, 콘드로이친 황산, 아보카도-대두 불검화물은 위약과 비교해 어떤 종류의 이상반응 위험도 올리지 않았다. 반면 디아세레인은 전체 이상반응(오즈비 2.22), 위장관 이상반응(2.85), 신장·요로 이상반응(3.42)이 유의하게 많았다. 저자들은 글루코사민 황산과 콘드로이친 황산을 골관절염 환자에게 안전한 선택지로 볼 수 있다고 결론지었다.
원문 초록 보기
BACKGROUND: Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) are an important drug class in the treatment armamentarium for osteoarthritis (OA). OBJECTIVE: We aimed to re-assess the safety of various SYSADOAs in a comprehensive meta-analysis of randomized placebo-controlled trials, using, as much as possible, data from full safety reports. METHODS: We performed a systematic review and random-effects meta-analyses of randomized, double-blind, placebo-controlled trials that assessed adverse events (AEs) with various SYSADOAs in patients with OA. The databases MEDLINE, Cochrane Central Register of Controlled Trials (Ovid CENTRAL) and Scopus were searched. The primary outcomes were overall severe and serious AEs, as well as AEs involving the following Medical Dictionary for Regulatory Activities (MedDRA) system organ classes (SOCs): gastrointestinal, cardiac, vascular, nervous system, skin and subcutaneous tissue, musculoskeletal and connective tissue, renal and urinary system. RESULTS: Database searches initially identified 3815 records. After exclusions according to the selection criteria, 25 studies on various SYSADOAs were included in the qualitative synthesis, and 13 studies with adequate data were included in the meta-analyses. Next, from the studies previously excluded according to the protocol, 37 with mainly oral nonsteroidal anti-inflammatory drugs (NSAIDs) permitted as concomitant medication were included in a parallel qualitative synthesis, from which 18 studies on various SYSADOAs were included in parallel meta-analyses. This post hoc parallel inclusion was conducted because of the high number of studies allowing concomitant anti-OA medications. Indeed, primarily excluding studies with concomitant anti-OA medications was crucial for a meta-analysis on safety. The decision for parallel inclusion was made for the purpose of comparative analyses. Glucosamine sulfate (GS), chondroitin sulfate (CS) and avocado soybean unsaponifiables (ASU; Piascledine®) were not associated with increased odds for any type of AEs compared with placebo. Overall, with/without concomitant OA medication, diacerein was associated with significantly increased odds of total AEs (odds ratio [OR] 2.22; 95% confidence interval [CI] 1.58-3.13; I2 = 52.8%), gastrointestinal disorders (OR 2.85; 95% CI 2.02-4.04; I2 = 62.8%) and renal and urinary disorders (OR 3.42; 95% CI 2.36-4.96; I2 = 17.0%) compared with placebo. In studies that allowed concomitant OA medications, diacerein was associated with significantly more dermatological disorders (OR 2.47; 95% CI 1.42-4.31; I2 = 0%) and more dropouts due to AEs (OR 3.18; 95% CI 1.85-5.47; I2 = 13.4%) than was placebo. No significant increase in serious or severe AEs was found with diacerein versus placebo. CONCLUSIONS: GS and CS can be considered safe treatments for patients with OA. All eligible studies on ASU included in our analysis used the proprietary product Piascledine® and allowed other anti-OA medications; thus, the safety of ASU must be confirmed in future studies without concomitant anti-OA medications. Given the safety concerns with diacerein, its usefulness in patients with OA should be assessed, taking into account individual patient characteristics. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ PMID 31908149 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee 진료지침 · Arthritis Care Res, 2020 미국 류마티스학회 지침에서 콘드로이친 황산은 '손 골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA).'에 한해 조건부 권고 항목으로 들어갔다.
핵심요약
미국 류마티스학회와 관절염재단이 2012년 권고를 갱신해 만든 손·고관절·무릎 골관절염관절 연골이 닳아 통증·뻣뻣함이 생기는 가장 흔한 퇴행성 관절 질환(OA). 관리 지침. 임상적으로 중요한 PICO 질문과 핵심 결과를 정하고 문헌검토팀이 교육·행동·심리사회·물리·심신·약물 요법의 이득과 해를 체계적으로 정리한 뒤, GRADE근거의 확실성을 높음~매우낮음으로 평가하는 국제 표준 등급 체계. 방법으로 근거 수준을 매기고 류마티스내과 의사·내과 의사·물리치료사·작업치료사·환자로 구성된 투표 패널이 합의했다. 운동, 과체중·비만인 무릎/고관절 골관절염 환자의 체중 감량, 자기효능·자기관리 프로그램, 태극권, 지팡이 사용, 무릎 국소 소염진통제, 경구 소염진통제, 무릎 관절강관절에서 뼈와 뼈 사이의 간격. 좁아질수록 연골 손실이 진행됐음을 뜻한다. 내 스테로이드 주사 등이 강한 권고를 받았다. 조건부 권고 목록에는 균형 운동, 요가, 인지행동요법, 침, 온열 요법 등과 함께 '손 골관절염에 대한 콘드로이친 황산'이 포함됐다.
원문 초록 보기
OBJECTIVE: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. METHODS: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. RESULTS: Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. CONCLUSION: This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies. ※ 파이프라인이 API로 수집·저장한 초록 원문 그대로. 한국어 핵심요약은 이 텍스트만을 근거로 작성됩니다.
원문 보기 ↗ 