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Abstract：
BACKGROUND: Structure-modifying medications or nutraceuticals may be an effective treatment for osteoarthritis. This study identified 12 treatments that may possess chondroprotective properties: oral glucosamine; chondroitin; nonsteroidal anti-inflammatory drugs (NSAIDs); polyunsaturated fatty acids; S-adenosylmethionine; avocado and soybean unsaponifiable fractions; methylsulfonylmethane; vitamins C, D, and E; intra-articular injections of hyaluronic acid; and platelet-rich plasma (PRP).
OBJECTIVE: To perform a systematic review of randomized controlled trials for the effectiveness of each agent in preserving articular cartilage of the knee and delaying the progression of osteoarthritis.
METHODS: Systematic review; Level of evidence, 2.
METHODS: A literature search was performed using PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Searches were performed using \"treatment,\" \"osteoarthritis,\" and \"knee\" as keywords. Selection criteria included randomized controlled trials of ≥12 months, with a placebo control, measuring radiographic changes in joint space width, cartilage volume, or radiographic progression of osteoarthritis. The primary outcome was changes in joint integrity measures.
RESULTS: A total of 3514 studies were identified from the initial search, 13 of which met inclusion criteria. Treatment with chondroitin sulfate showed a significant reduction in cartilage loss in 3 of 4 studies identified compared with placebo. Two of 3 trials identified for glucosamine also reported significant structural effects relative to placebo. Intra-articular hyaluronic acid was effective in lowering the rate of cartilage loss in only 1 of 3 studies identified versus placebo. Of the 6 studies identified for NSAIDs, vitamin E, and vitamin D, none showed any structural effect compared with placebo. No studies were found that met the inclusion criteria for polyunsaturated fatty acids, S-adenosylmethionine, avocado and soybean unsaponifiable fractions, methylsulfonylmethane, vitamin C, or PRP.
CONCLUSIONS: For patients with or at risk for osteoarthritis, the use of glucosamine and chondroitin sulfate may serve as a nonoperative means to protect joint cartilage and delay osteoarthritis progression. Hyaluronic acid injections showed variable efficacy, while NSAIDs and vitamins E and D showed no effect on osteoarthritis progression. The other agents evaluated had no evidence in the literature to support or refute their use for chondroprotection.
OBJECTIVE: To perform a systematic review of randomized controlled trials for the effectiveness of each agent in preserving articular cartilage of the knee and delaying the progression of osteoarthritis.
METHODS: Systematic review; Level of evidence, 2.
METHODS: A literature search was performed using PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Searches were performed using \"treatment,\" \"osteoarthritis,\" and \"knee\" as keywords. Selection criteria included randomized controlled trials of ≥12 months, with a placebo control, measuring radiographic changes in joint space width, cartilage volume, or radiographic progression of osteoarthritis. The primary outcome was changes in joint integrity measures.
RESULTS: A total of 3514 studies were identified from the initial search, 13 of which met inclusion criteria. Treatment with chondroitin sulfate showed a significant reduction in cartilage loss in 3 of 4 studies identified compared with placebo. Two of 3 trials identified for glucosamine also reported significant structural effects relative to placebo. Intra-articular hyaluronic acid was effective in lowering the rate of cartilage loss in only 1 of 3 studies identified versus placebo. Of the 6 studies identified for NSAIDs, vitamin E, and vitamin D, none showed any structural effect compared with placebo. No studies were found that met the inclusion criteria for polyunsaturated fatty acids, S-adenosylmethionine, avocado and soybean unsaponifiable fractions, methylsulfonylmethane, vitamin C, or PRP.
CONCLUSIONS: For patients with or at risk for osteoarthritis, the use of glucosamine and chondroitin sulfate may serve as a nonoperative means to protect joint cartilage and delay osteoarthritis progression. Hyaluronic acid injections showed variable efficacy, while NSAIDs and vitamins E and D showed no effect on osteoarthritis progression. The other agents evaluated had no evidence in the literature to support or refute their use for chondroprotection.
摘要：
背景：结构调整药物或营养品可能是骨关节炎的有效治疗方法。这项研究确定了12种可能具有软骨保护特性的治疗方法：口服氨基葡萄糖;软骨素;非甾体抗炎药（NSAIDs）;多不饱和脂肪酸;S-腺苷蛋氨酸;鳄梨和大豆不皂化部分;甲磺酰基甲烷;维生素C，D,和E；关节内注射透明质酸；和富含血小板的血浆（PRP）。
目的：对每种药物在保留膝关节软骨和延缓骨关节炎进展方面的有效性的随机对照试验进行系统评价。
方法：系统评价；证据水平，2.
方法：使用PubMed进行了文献检索，EMBASE,和Cochrane中央受控试验登记册。使用“治疗”进行搜索，“\”骨关节炎，\"和\"knee\"作为关键字。选择标准包括≥12个月的随机对照试验，用安慰剂对照，测量关节间隙宽度的射线照相变化，软骨体积,或骨关节炎的影像学进展。主要结果是联合完整性措施的变化。
结果：从最初的搜索中确定了总共3514项研究，其中13项符合纳入标准。与安慰剂相比，在4项研究中的3项，硫酸软骨素治疗显示软骨损失显着减少。针对葡糖胺的3项试验中的两项也报道了相对于安慰剂的显着结构效应。与安慰剂相比，在3项研究中仅有1项，关节内透明质酸可有效降低软骨损失率。在确定的6项NSAIDs研究中，维生素E,还有维生素D,与安慰剂相比，没有显示任何结构效应。没有发现符合多不饱和脂肪酸纳入标准的研究，S-腺苷甲硫氨酸，鳄梨和大豆不皂化部分，甲磺酰基甲烷,维生素C,或PRP。
结论：对于患有骨关节炎或有骨关节炎风险的患者，使用葡糖胺和硫酸软骨素可以作为保护关节软骨和延缓骨关节炎进展的非手术手段。透明质酸注射显示不同的疗效，而NSAIDs和维生素E和D对骨关节炎进展无影响。评估的其他药物在文献中没有证据支持或反驳其用于软骨保护的用途。
目的：对每种药物在保留膝关节软骨和延缓骨关节炎进展方面的有效性的随机对照试验进行系统评价。
方法：系统评价；证据水平，2.
方法：使用PubMed进行了文献检索，EMBASE,和Cochrane中央受控试验登记册。使用“治疗”进行搜索，“\”骨关节炎，\"和\"knee\"作为关键字。选择标准包括≥12个月的随机对照试验，用安慰剂对照，测量关节间隙宽度的射线照相变化，软骨体积,或骨关节炎的影像学进展。主要结果是联合完整性措施的变化。
结果：从最初的搜索中确定了总共3514项研究，其中13项符合纳入标准。与安慰剂相比，在4项研究中的3项，硫酸软骨素治疗显示软骨损失显着减少。针对葡糖胺的3项试验中的两项也报道了相对于安慰剂的显着结构效应。与安慰剂相比，在3项研究中仅有1项，关节内透明质酸可有效降低软骨损失率。在确定的6项NSAIDs研究中，维生素E,还有维生素D,与安慰剂相比，没有显示任何结构效应。没有发现符合多不饱和脂肪酸纳入标准的研究，S-腺苷甲硫氨酸，鳄梨和大豆不皂化部分，甲磺酰基甲烷,维生素C,或PRP。
结论：对于患有骨关节炎或有骨关节炎风险的患者，使用葡糖胺和硫酸软骨素可以作为保护关节软骨和延缓骨关节炎进展的非手术手段。透明质酸注射显示不同的疗效，而NSAIDs和维生素E和D对骨关节炎进展无影响。评估的其他药物在文献中没有证据支持或反驳其用于软骨保护的用途。
