A prescription-grade formulation of chondroitin sulfate (Condrosulf) helped improve pain and function in patients with osteoarthritis (OA) of the hand, a single-center randomized study found.  Hand pain decreased significantly in patients receiving chondroitin compared with those receiving placebo after six months, with a between-group difference of −8.7 mm on a 100-mm visual analog scale (P=0.016), according to Cem Gabay, MD, of University Hospitals of Geneva in Switzerland, and colleagues.  In addition, there was a −2.14-point difference between the groups in hand function (P=0.008), as measured on the 30-point Functional Index for Hand OA scale, the researchers reported online in Arthritis & Rheumatism. "This was the first study with chondroitin sulfate in hand OA. It will be important to reproduce these data in other patient populations, and to determine whether chondroitin sulfate exerts protective effects on structural damage in hand OA," Gabay told MedPage Today in an email. The growing recognition of potential gastrointestinal and cardiac hazards associated with the use of nonsteroidal anti-inflammatory drugs has prompted researchers to further explore alternatives for painful conditions, particularly those that afflict vulnerable older patients. Hand OA is thought to affect more than half of people 60 and older and the condition can markedly interfere with activities of daily living. Yet few therapeutic options exist, and clinical trials have been few and mostly short-term. Chondroitin sulfate -- sold as a dietary supplement often combined with glucosamine in the United States -- is regulated as a drug in Europe, although the European League Against Rheumatism has rated the evidence for its efficacy in OA of the hands as low. Therefore, to help clarify a potential role for chondroitin, Gabay and colleagues enrolled 162 patients with symptomatic hand OA affecting at least two joints of one hand. Patients had to have pain of at least 40 mm on the 100-point scale and a score of at least six on the functional index. The average age was 63, and the majority of patients were women. Symptom duration was more than six years, with mean baseline pain scores of 43 and functional index scores of 11. They were randomized to receive 800 mg oral chondroitin or placebo once daily for six months, with rescue acetaminophen allowed in doses up to 4 g/day. Aside from pain and function scores, chondroitin also was associated with a shorter duration of morning stiffness (−4.8 versus −0.3 minutes, P=0.031). Mean grip strength also improved, though not significantly, with an effect size for chondroitin versus placebo of +1.9 kg/cm2 (P=0.27). Both active treatment and placebo patients took an average of two 500-mg acetaminophen tablets each week. At six months, 44% of patients receiving chondroitin were rated as slightly or markedly improved by their treating physician, compared with 33% of those receiving placebo (P=0.043). The most common adverse events in both groups were diarrhea, dyspepsia, and nausea. Among the three patients in the chondroitin group who withdrew because of adverse events, two gastrointestinal events were classified as possibly or probably related to the study drug. Treating physicians rated the overall tolerability as good or excellent in 96.3% of the chondroitin group and in 90.8% of the placebo group. The investigators noted that in earlier short-term trials evaluating drugs such as ibuprofen for hand OA, the change in pain scores ranged from −8.7 mm to −10.7 mm, while the change in function score was −2.76 points -- similar to what was seen for chondroitin in this study. However, they conceded that the changes were not dramatic. "Although the difference in change in global hand pain was significantly more pronounced in patients treated with chondroitin sulfate as compared to placebo, the magnitude of the difference was relatively modest. Thus, whether this statistically significant difference has a clinical impact remains to be shown," Gabay and colleagues noted. They also pointed out that the effects of chondroitin seemed to be greater on function than pain, although they doubted that this resulted from the drug's potential to protect against structural damage, as has been seen in trials for knee OA. Markers of cartilage degradation, such as serum cartilage oligomeric matrix protein, did not change over the course of the trial, likely because the effect of treatment was too small for these changes to be detected. "Further studies using more sensitive biomarkers and imaging techniques may provide informative results on the potential chondroprotective effects of chondroitin sulfate in hand OA," the authors stated. They noted that a limitation of the study was its inadequate power to identify effects on secondary outcomes or in patient subgroups.

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