Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study.

OBJECTIVE: A 16-week randomized, double-blind, placebo-controlled crossover trial of a combination of glucosamine HCl (1,500 mg/day), chondroitin sulfate (1,200 mg/day), and manganese ascorbate (228 mg/day) in degenerative joint disease (DJD) of the knee or low back was conducted. METHODS: Thirty-four males from the U.S. Navy diving and special warfare community with chronic pain and radiographic DJD of the knee or low back were randomized. A summary disease score incorporated results of pain and functional questionnaires, physical examination scores, and running times. Changes were presented as a percentage of the patient's average score. RESULTS: Knee osteoarthritis symptoms were relieved as demonstrated by the summary disease score (-16.3%; p = 0.05), patient assessment of treatment effect (p = 0.02), visual analog scale for pain recorded at clinic visits (-26.6%; p = 0.05) and in a diary (-28.6%; p = 0.02), and physical examination score (-43.3%; p = 0.01). Running times did not change. The study neither demonstrated, nor excluded, a benefit for spinal DJD. Side effect frequency was similar to that at baseline. There were no hematologic effects. CONCLUSIONS: The combination therapy relieves symptoms of knee osteoarthritis. A larger data set is needed to determine the value of this therapy for spinal DJD. Short-term combination therapy appears safe in this setting.

CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic yield and accuracy.

OBJECTIVE: We assessed the positive predictive value of percutaneous biopsy of sclerotic lesions to determine whether the reported success rate of the percutaneous technique could be generalized to sclerotic lesions or whether our diagnostic yield was too low to justify this added step before open surgical confirmation. MATERIALS AND METHODS: We retrospectively studied all sclerotic bone lesions biopsied by the percutaneous CT-guided technique at the Massachusetts General Hospital between 1988 and 1997. The 43 lesions were categorized by location, maximum diameter, density (graded 1-4, relative to cortex), and pattern of density (geographic, vague, or geographic with sclerotic margins). Pathologic and clinical follow-up were used to determine the positive and negative predictive values. RESULTS: Of the 43 patients biopsied, neither the maximum diameter of the lesion nor its density was predictive of benignancy or malignancy. Fine-needle aspiration (FNA) complemented core biopsy results; for example, in one case, FNA showed findings indicating disease when the core biopsy showed none, and in another case the reverse occurred. No complications were reported in these 43 patients. CONCLUSION: Percutaneous CT-guided biopsy of sclerotic bone lesions is a viable alternative to open surgical biopsy. In this study, the positive predictive value of the combined FNA and bone biopsy results was 82% and the negative predictive value was 100%. No complications were reported.