Difficulties with assessing the benefit of glucosamine sulphate as a treatment for osteoarthritis.

Osteoarthritis is a chronic disease with a major impact on quality of life for a large proportion of the population. It is a disease for which to date there has been no disease-modifying therapy identified. As a result of its physiological role in articular cartilage, glucosamine sulphate has been postulated as a treatment for osteoarthritis. Claims have included symptomatic relief and even reduction in the rate of disease progression. Despite promising in vitro studies, however, the role of glucosamine sulphate in the management of osteoarthritis remains unclear. Studies addressing this issue have generated a wide range of conclusions, and these are discussed here. Methodological issues need to be addressed in order to gauge whether there is true benefit. On current evidence, it would appear that the benefits of dietary supplementation with glucosamine sulphate are limited to mild symptomatic relief, while a disease-modifying agent for this disease remains elusive.

Intra-articular hyaluronic acid preparations for use in the treatment of osteoarthritis.

Intra-articular hyaluronic acid preparations have been available for the treatment of osteoarthritis of the knee for over 15 years. Their use has been limited by cost, difficulties of administration and conflicting evidence of efficacy. Difficulties in conducting adequate clinical trials have resulted in the appearance of multiple meta-analyses whose findings are not congruent. The appearance of a single injection agent and a better understanding of the mechanisms by which this intervention is effective may help to solve this ongoing problem in healthcare research.