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Friday, September 17, 2010

The Cost of Cartilage maintenance, via Glucosamine,Chondroitin , better than surgical repair? II

A look at Tweet meme app brought my attention to a product (Chondroitin) that I use regularly for more than 3 years despite never ending debates over efficiency and probably poor medical coverage. (I also intend to use the Chondroitin-Glucosamine mix - as yet 3 months experience only).

From my experience, I cannot let such studies, if that is the proper name in this day and age, go without commented.

The latest very bad news comes from  Researchers at the University of Bern in Switzerland, who conducted a meta-analysis (statistical analysis) of past studies on these popular complementary medicines, which is published in today's edition of British Medical Journal.

QUOTE from BMJ news

"Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee


Compared with placebo, glucosamine and chondroitin - either alone or in combination - do not reduce joint pain or have an impact on narrowing of joint space, according to this meta-analysis. Health authorities and health insurers should not cover the costs of these preparations, and treating new patients with these drugs should be discouraged, say the authors."


I am neither a medical doctor nor a specialised statistician but from my experience of knee-joint-pain  found to be a severe thinning of the cartilage area  on one side*. When I say  thinning of the cartilage area on one side I mean wafer thin, the other side is substantially thicker. The standard X-Ray radiology is insufficient for more highly detailed precision of what wafer thin can mean-much less indeed than we materials scientists involved say in metallurgical research and development would demand. When I talk of  knee-joint-pain I mean enough to fear being force to no longer be able to walk, one of my last sports activities strongly recommended by my general medical practitioner)

[* Main outcome measure Pain intensity. Secondary outcome was change in minimal width of joint space. The minimal clinically important difference between preparations and placebo was prespecified at −0.9 cm on a 10 cm visual analogue scale. (my wafer thin was visually less than .5mm at an uneducated guess!

I have used Chondroitin (sulfate) for more than 3 years. After 1 month I experience less pain, after 3 months practically no pain and was able to resume my 40-45 mn walks with renewed pleasure and great relief - and hope for a continuing maintenance of a certain quality of life.

BONUS
After 3 years, I noticed that I no longer experienced vertebral complaint and could carry weighty items I was forced to avoid for a number of years previously (

Cost here in France where Glucosamine,Chondroitin are very expensive is forcing me to seek other sources.

I shall not pretend to have delved into the published study in-depth, this will come later but have looked at the definition of the complaint supposed to be under examination here, namely osteoarthritis of hip or knee.   As the title says the hip condition appears to be amalgamated with the knee condition, effort subjected to are certainly not equivalent. The definition of Osteoarthritis* is like many medical terms a porridge of number of physico-chemical ills according to wikipedia's list . Herein lies enough basic hotchpotch definition*, of the exact physical (and chemical) , defects as we Metallurgist would call them, to be examined, and corrected.

[*Osteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints,[1] including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A variety of causes—hereditary, developmental, metabolic, and mechanical—may initiate processes leading to loss of cartilage. When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax.[2] ]

Now all this would lead me to feel as I did when I waited three months between the X-ray and requesting my doctors help, that treatment is administered in many cases including mine as being too late. Nothing out of the ordinary was signaled in the "full examination" under radioactive substance intake for whole body radio-isotope scanner detection several years earlier.[REM look-up the dates of the "early bird TBD ]

GOOD and BAD NEWS

"More results needed, [GOOD]


Professor Graeme Jones of Hobart's Menzies Research Institute, and Medical Director of Arthritis Australia, disagrees with some of the findings of the study.

Jones says while is there no evidence that chondroitin is effective in the treatment of osteoarthritis, there's still some debate about the effectiveness of glucosamine. [this refers to the current study and contradicts my experience with chondroitin.- Dubious-Bad?]

"The study concludes that glucosamine doesn't work, however, if you look closely at the study's results, it shows that glucosamine hydrochloride doesn't work, but that glucosamine sulphate does seem to have some benefit," he says.

"We need further large scale studies of glucosamine sulphate to really know."

Jones says the Long Term Evaluation of Glucosamine Sulphate Study (LEGS), currently being conducted by the University of Sydney and funded by the National Health and Medical Council, may provide a clearer answer regarding the effectiveness of glucosamine.

He says many patients with osteoarthritis (of the knee in particular) do report improved symptoms on glucosamine sulphate, although its real mechanism of action remains unknown.

"It's safe, has very few side effects and patients shouldn't be discouraged from trying it," he says.

I am not alone in enjoying the obvious improved quality of life benefits of Chondroitin and am in the process of changing to the mixed Chondroitin-Glucosamine (sulphates) from more cost advantageous sources. 

WHICH BRINGS BACK THE QUESTION OF WHAT IS THE LESS EXPENSIVE TREATMENT, THE LEAST INVASIVE, THE LEAST DANGEROUS.....
 
AND WHEN WILL EARLIER AND MORE PRECISE, MORE DISCERNING DIAGNOSIS TECHNIQUES COME INTO USE? 
 
WHEN WILL THE LABORITORIES REACT TO THE ALTERNATIVE SURGICAL OFFER WHAT APPEERS TO BE MISLEADING STUDIES AND ABUSING THE CLIENTS (both Individuals and government bodies struggling to maintain responsible affordable budgets where France at least this is lagging badly esp behind UK and probably USA) Earlier preventive treatment will mean larger volume at reduced price but over longer periods so it's a good long-term investment.


PS In guise of a personal conclusion: I can also do a bit of running after a 10year stop. I can only atridutte this to my Chondroitin experience. My fairly healthy life style has remained unchanged.
 
REFERENCES:
ABC Science

BMJ-British Medical Journal 17 Sept 2010.

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