Chondroitin Slows Joint Destruction in Knee Osteoarthritis

Chondroitin sulfate slows the progression of knee osteoarthritis, according to findings from a pilot study that used magnetic resonance imaging to assess joint structural changes.

“It's reassuring to see that the four major x-ray studies are now confirmed by high technology in the assessment of disease progression,” said the study's lead author, Dr. Jean-Pierre Pelletier, in an interview (Osteoarthr. Cartil. 1998;6:39-46; Osteoarthr. Cartil. 2004;12:269-76; Arthritis Rheum. 2005;52:779-86; Arthritis Rheum. 2009;60:524-33).

The randomized, double-blind, placebo-controlled study showed that chondroitin sulfate reduced the cartilage loss volume in 69 patients with knee osteoarthritis in as early as 6 months. (Ann. Rheum. Dis. 2011 March 1).

The findings show that magnetic resonance imaging (MRI) “is a good quantitative technique to find answers in a shorter period of time with a smaller number of patients,” said Dr. Roy D. Altman, professor of medicine at the University of California, Los Angeles, who is not involved with the study.

The effect of the disease-modifying drug chondroitin sulfate on cartilage volume loss, bone marrow lesions (BML), and disease symptoms has been controversial (BMJ 2010;341:c4675). However, the authors of this study said that the MRI findings provided additional evidence regarding the joint structure protective effect of chondroitin sulfate.

Several studies have also shown that MRI can quantitatively and reliably assess the volume and cartilage thickness in addition to joint structural changes in subchondral bone, menisci, and synovium, according to the authors.

“MRI provides you with direct visualization of the cartilage,” said Dr. Pelletier, director of the osteoarthritis research unit at the University of Montreal Hospital Research Centre. “And the beauty of MRI is that it provides assessment of progression of change not only in cartilage, but also in many other tissues of the joint, like the subchondral bone and the synovium.

“In addition, the pronounced reduction in OA cartilage loss found in patients treated with chondroitin sulfate was also associated with a reduction in the size of BML. This finding is most interesting as BML are believed to be associated with the progression of OA cartilage lesions,” according to a number of studies, said Dr. Pelletier.

The study also showed that patients being treated with nonsteroidal anti-inflammatory drugs in addition to chondroitin sulfate showed a significant reduction in synovial membrane thickness (1.3 plus or minus 0.3 mm in 6 months vs. 1.6 plus or minus 0.3 mm with placebo), and a lower incidence of joint swelling, compared with the placebo group (0% in chondroitin sulfate vs. 11.4% in placebo). The finding “is interesting with practical clinical impact, and definitely needs future exploration,” the authors wrote.

Dr. Pelletier and his colleagues recruited 69 patients of both sexes between 40 and 80 years of age from rheumatology clinics in Quebec province. All patients had clinical signs of synovitis.

The study had two phases. For the double-blind phase, the patients were randomly assigned to once-daily placebo or 800 mg of chondroitin sulfate for 6 months. During the following 6 months, or the open-label phase, both study groups received 800 mg of chondroitin sulfate daily.

Cartilage volume and BML were assessed by MRI at baseline, 6 months, and 12 months. Synovial membrane thickness was assessed at baseline and 6 months.

Patients who took a daily oral dose of chondroitin sulfate had a significant reduction in cartilage volume loss at 6 months (–2.87%) and 12 months (–3.71%) in the global knee, compared with the placebo group (–4.67% at 6 months and –6.12% at 12 months).

There were no differences in BML during the first 6 months of the study. But at 12 months, reductions in BML were observed in the chondroitin sulfate group (–0.57%), especially in the lateral compartment (–0.13%) and the lateral condyle (–0.43). The additional 6 months needed to see the difference in BML between the groupsccould suggest that “BML are consequential to cartilage degradation and thus reducing cartilage lesions could lead to fewer BML. Alternatively, BML were shown to be involved in an inflammatory/catabolic process on which chondroitin sulfate could act directly, leading to structural repair,” according to the study authors.

No significant differences in disease symptoms were measured by visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. “The main aim of the study was not the symptoms. The main goal was to find out whether chondroitin sulfate can reduce progression of knee OA,” said Dr. Pelletier.

The study had a number of limitations, including its small sample size. In addition, the system used did not allow the detection of the cartilage in the patella, the researchers reported. They added that long-term studies are needed to find the impact of chondroitin sulfate in disease symptoms.

Whether the quantitative MRI technique will eventually replace x-ray technology in such studies is unclear, said Dr. Pelletier. “That's for regulatory bodies to decide,” he said.

“But it's quite clear that MRI is the technology of the future. It's very helpful, because you can truly speed up drug development in the field of OA and with less expense, using a smaller number of patients and in a shorter period of time.”

Dr. Jean-Pierre Pelletier and Dr. Johanne Martel-Pelletier are consultants for and shareholders in ArthroLab and ArthroVision. Jean-Pierre Raynauld is a consultant for ArthroVision. Dr. André Beaulieu, Dr. Louis Bassette, and Dr. Frédéric Morin received honoraria from ArthroLab. François Abram is an employee of ArthroVision. Marc Dorais is a consultant for ArthroVision. Dr. Altman had no relevant financial conflicts of interest.

Chondroitin sulfate slows the progression of knee osteoarthritis, according to findings from a pilot study that used magnetic resonance imaging to assess joint structural changes.

“It's reassuring to see that the four major x-ray studies are now confirmed by high technology in the assessment of disease progression,” said the study's lead author, Dr. Jean-Pierre Pelletier, in an interview (Osteoarthr. Cartil. 1998;6:39-46; Osteoarthr. Cartil. 2004;12:269-76; Arthritis Rheum. 2005;52:779-86; Arthritis Rheum. 2009;60:524-33).

The randomized, double-blind, placebo-controlled study showed that chondroitin sulfate reduced the cartilage loss volume in 69 patients with knee osteoarthritis in as early as 6 months. (Ann. Rheum. Dis. 2011 March 1).

The findings show that magnetic resonance imaging (MRI) “is a good quantitative technique to find answers in a shorter period of time with a smaller number of patients,” said Dr. Roy D. Altman, professor of medicine at the University of California, Los Angeles, who is not involved with the study.

The effect of the disease-modifying drug chondroitin sulfate on cartilage volume loss, bone marrow lesions (BML), and disease symptoms has been controversial (BMJ 2010;341:c4675). However, the authors of this study said that the MRI findings provided additional evidence regarding the joint structure protective effect of chondroitin sulfate.

Several studies have also shown that MRI can quantitatively and reliably assess the volume and cartilage thickness in addition to joint structural changes in subchondral bone, menisci, and synovium, according to the authors.

“MRI provides you with direct visualization of the cartilage,” said Dr. Pelletier, director of the osteoarthritis research unit at the University of Montreal Hospital Research Centre. “And the beauty of MRI is that it provides assessment of progression of change not only in cartilage, but also in many other tissues of the joint, like the subchondral bone and the synovium.

“In addition, the pronounced reduction in OA cartilage loss found in patients treated with chondroitin sulfate was also associated with a reduction in the size of BML. This finding is most interesting as BML are believed to be associated with the progression of OA cartilage lesions,” according to a number of studies, said Dr. Pelletier.

The study also showed that patients being treated with nonsteroidal anti-inflammatory drugs in addition to chondroitin sulfate showed a significant reduction in synovial membrane thickness (1.3 plus or minus 0.3 mm in 6 months vs. 1.6 plus or minus 0.3 mm with placebo), and a lower incidence of joint swelling, compared with the placebo group (0% in chondroitin sulfate vs. 11.4% in placebo). The finding “is interesting with practical clinical impact, and definitely needs future exploration,” the authors wrote.

Dr. Pelletier and his colleagues recruited 69 patients of both sexes between 40 and 80 years of age from rheumatology clinics in Quebec province. All patients had clinical signs of synovitis.

The study had two phases. For the double-blind phase, the patients were randomly assigned to once-daily placebo or 800 mg of chondroitin sulfate for 6 months. During the following 6 months, or the open-label phase, both study groups received 800 mg of chondroitin sulfate daily.

Cartilage volume and BML were assessed by MRI at baseline, 6 months, and 12 months. Synovial membrane thickness was assessed at baseline and 6 months.

Patients who took a daily oral dose of chondroitin sulfate had a significant reduction in cartilage volume loss at 6 months (–2.87%) and 12 months (–3.71%) in the global knee, compared with the placebo group (–4.67% at 6 months and –6.12% at 12 months).

There were no differences in BML during the first 6 months of the study. But at 12 months, reductions in BML were observed in the chondroitin sulfate group (–0.57%), especially in the lateral compartment (–0.13%) and the lateral condyle (–0.43). The additional 6 months needed to see the difference in BML between the groupsccould suggest that “BML are consequential to cartilage degradation and thus reducing cartilage lesions could lead to fewer BML. Alternatively, BML were shown to be involved in an inflammatory/catabolic process on which chondroitin sulfate could act directly, leading to structural repair,” according to the study authors.

No significant differences in disease symptoms were measured by visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. “The main aim of the study was not the symptoms. The main goal was to find out whether chondroitin sulfate can reduce progression of knee OA,” said Dr. Pelletier.

The study had a number of limitations, including its small sample size. In addition, the system used did not allow the detection of the cartilage in the patella, the researchers reported. They added that long-term studies are needed to find the impact of chondroitin sulfate in disease symptoms.

Whether the quantitative MRI technique will eventually replace x-ray technology in such studies is unclear, said Dr. Pelletier. “That's for regulatory bodies to decide,” he said.

“But it's quite clear that MRI is the technology of the future. It's very helpful, because you can truly speed up drug development in the field of OA and with less expense, using a smaller number of patients and in a shorter period of time.”

Dr. Jean-Pierre Pelletier and Dr. Johanne Martel-Pelletier are consultants for and shareholders in ArthroLab and ArthroVision. Jean-Pierre Raynauld is a consultant for ArthroVision. Dr. André Beaulieu, Dr. Louis Bassette, and Dr. Frédéric Morin received honoraria from ArthroLab. François Abram is an employee of ArthroVision. Marc Dorais is a consultant for ArthroVision. Dr. Altman had no relevant financial conflicts of interest.

Chondroitin sulfate slows the progression of knee osteoarthritis, according to findings from a pilot study that used magnetic resonance imaging to assess joint structural changes.

“It's reassuring to see that the four major x-ray studies are now confirmed by high technology in the assessment of disease progression,” said the study's lead author, Dr. Jean-Pierre Pelletier, in an interview (Osteoarthr. Cartil. 1998;6:39-46; Osteoarthr. Cartil. 2004;12:269-76; Arthritis Rheum. 2005;52:779-86; Arthritis Rheum. 2009;60:524-33).

The randomized, double-blind, placebo-controlled study showed that chondroitin sulfate reduced the cartilage loss volume in 69 patients with knee osteoarthritis in as early as 6 months. (Ann. Rheum. Dis. 2011 March 1).

The findings show that magnetic resonance imaging (MRI) “is a good quantitative technique to find answers in a shorter period of time with a smaller number of patients,” said Dr. Roy D. Altman, professor of medicine at the University of California, Los Angeles, who is not involved with the study.

The effect of the disease-modifying drug chondroitin sulfate on cartilage volume loss, bone marrow lesions (BML), and disease symptoms has been controversial (BMJ 2010;341:c4675). However, the authors of this study said that the MRI findings provided additional evidence regarding the joint structure protective effect of chondroitin sulfate.

Several studies have also shown that MRI can quantitatively and reliably assess the volume and cartilage thickness in addition to joint structural changes in subchondral bone, menisci, and synovium, according to the authors.

“MRI provides you with direct visualization of the cartilage,” said Dr. Pelletier, director of the osteoarthritis research unit at the University of Montreal Hospital Research Centre. “And the beauty of MRI is that it provides assessment of progression of change not only in cartilage, but also in many other tissues of the joint, like the subchondral bone and the synovium.

“In addition, the pronounced reduction in OA cartilage loss found in patients treated with chondroitin sulfate was also associated with a reduction in the size of BML. This finding is most interesting as BML are believed to be associated with the progression of OA cartilage lesions,” according to a number of studies, said Dr. Pelletier.

The study also showed that patients being treated with nonsteroidal anti-inflammatory drugs in addition to chondroitin sulfate showed a significant reduction in synovial membrane thickness (1.3 plus or minus 0.3 mm in 6 months vs. 1.6 plus or minus 0.3 mm with placebo), and a lower incidence of joint swelling, compared with the placebo group (0% in chondroitin sulfate vs. 11.4% in placebo). The finding “is interesting with practical clinical impact, and definitely needs future exploration,” the authors wrote.

Dr. Pelletier and his colleagues recruited 69 patients of both sexes between 40 and 80 years of age from rheumatology clinics in Quebec province. All patients had clinical signs of synovitis.

The study had two phases. For the double-blind phase, the patients were randomly assigned to once-daily placebo or 800 mg of chondroitin sulfate for 6 months. During the following 6 months, or the open-label phase, both study groups received 800 mg of chondroitin sulfate daily.

Cartilage volume and BML were assessed by MRI at baseline, 6 months, and 12 months. Synovial membrane thickness was assessed at baseline and 6 months.

Patients who took a daily oral dose of chondroitin sulfate had a significant reduction in cartilage volume loss at 6 months (–2.87%) and 12 months (–3.71%) in the global knee, compared with the placebo group (–4.67% at 6 months and –6.12% at 12 months).

There were no differences in BML during the first 6 months of the study. But at 12 months, reductions in BML were observed in the chondroitin sulfate group (–0.57%), especially in the lateral compartment (–0.13%) and the lateral condyle (–0.43). The additional 6 months needed to see the difference in BML between the groupsccould suggest that “BML are consequential to cartilage degradation and thus reducing cartilage lesions could lead to fewer BML. Alternatively, BML were shown to be involved in an inflammatory/catabolic process on which chondroitin sulfate could act directly, leading to structural repair,” according to the study authors.

No significant differences in disease symptoms were measured by visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. “The main aim of the study was not the symptoms. The main goal was to find out whether chondroitin sulfate can reduce progression of knee OA,” said Dr. Pelletier.

The study had a number of limitations, including its small sample size. In addition, the system used did not allow the detection of the cartilage in the patella, the researchers reported. They added that long-term studies are needed to find the impact of chondroitin sulfate in disease symptoms.

Whether the quantitative MRI technique will eventually replace x-ray technology in such studies is unclear, said Dr. Pelletier. “That's for regulatory bodies to decide,” he said.

“But it's quite clear that MRI is the technology of the future. It's very helpful, because you can truly speed up drug development in the field of OA and with less expense, using a smaller number of patients and in a shorter period of time.”

Dr. Jean-Pierre Pelletier and Dr. Johanne Martel-Pelletier are consultants for and shareholders in ArthroLab and ArthroVision. Jean-Pierre Raynauld is a consultant for ArthroVision. Dr. André Beaulieu, Dr. Louis Bassette, and Dr. Frédéric Morin received honoraria from ArthroLab. François Abram is an employee of ArthroVision. Marc Dorais is a consultant for ArthroVision. Dr. Altman had no relevant financial conflicts of interest.