The effect of glucosamine sulphate on structural disease progression in knee osteoarthritis

骨关节炎（OA）是一种关节疾病，其特征是软骨和关节间隙的进行性丧失，导致疼痛增加和日常活动困难。OA是澳大利亚老年人的主要健康问题，也是国家卫生优先领域。目前还没有治愈骨性关节炎的方法，也没有干预措施证明可以减缓疾病进展或延迟关节置换手术的时间。目前，所有临床指南都建议将扑热息痛作为“首选的长期口服镇痛药”，对患者进行症状管理。这一建议是基于老年人长期使用非甾体抗炎药会增加严重胃肠道、心血管和肾脏疾病的风险。然而，非甾体抗炎药似乎能更好地缓解轻度关节疼痛。在OA患者中，对膳食补充剂硫酸氨基葡萄糖的需求很大。产品营销使人们相信，氨基葡萄糖能够减缓关节破坏和软骨损失的速度，并有助于缓解关节疼痛，与非甾体抗炎药相比，副作用的风险很小。然而，迄今为止进行的少数试验尚无定论。如果市场宣传是不合理的，许多老年人正在浪费有限的经济资源，并且由于对氨基葡萄糖的益处不切实际的期望，而不重视已被证明有效的生活方式改变，如定期运动和减肥。总共900名膝关节OA患者将被随机分配到硫酸氨基葡萄糖或匹配的安慰剂胶囊中，为期两年。主要结果将是关节间隙狭窄率，非甾体抗炎药的使用和身体残疾。如果氨基葡萄糖能减缓疾病进展或减少非甾体抗炎药的消耗，那么广泛使用该产品将有效地减少越来越多OA患者的疼痛、残疾和非甾体抗炎药相关疾病。

Osteoarthritis (OA) is a joint disease characterized by a progressive loss of cartilage and joint space resulting in increasing pain and difficulty performing usual daily activities. OA is the leading health problem amongst older Australians and a National Health Priority area. There is no known cure for OA and no intervention demonstrated to slow disease progression or delay time to joint replacement surgery. Currently patients are managed symptomatically with all clinical guidelines recommending paracetamol as 'the preferred long term oral analgesic'. This recommendation is based on the increased risk of serious gastrointestinal, cardiovascular and renal diseases with long-term NSAIDs use in older people. However, NSAIDs appear to provide better pain relief for patients with more than mild joint pain. Amongst patients with OA, there is much demand for the dietary supplement glucosamine sulphate. Product marketing has led to the belief that glucosamine is able to slow the rate of joint destruction and cartilage loss and help ease joint pain with, in contrast to NSAIDs, little risk of side effects. However, the few trials conducted to date have been inconclusive. If the marketing claims are unjustified, many older people are wasting limited financial resources and due to unrealistic expectations of the benefit of glucosamine, placing a lower priority on lifestyle changes of proven effectiveness, such as regular exercise and weight loss. A total of 900 patients with knee OA will be randomly allocated to glucosamine sulphate or matching placebo capsules for two years. The main outcomes will be the rate of joint space narrowing, use of NSAIDs and physical disability. If glucosamine results in slowing disease progression or in reducing NSAIDs consumption, the widespread use of this product would effectively decrease pain, disability and NSAIDs-related illnesses amongst the increasing number of people with OA.