Does celecoxib triumph of an anti-inflammatory for arthritic knee pain?

A daily supplement of pharmaceutical grade chondroitin is as good as celecoxib (Celebrex) in relieving arthritic pain in the knee and has no dangerous side effects, researchers say.

Dr. Jean-Yves Reginster of the Li├Ęge State University in Belgium and his colleagues recruited 604 people over the age of 50 with knee osteoarthritis of five European countries and randomly assigned to take 800 mg of extra-pure chondroitin sulfate ( Chondrosulf), 200 mg of celecoxib (Celebrex) or a placebo every day for six months.

Those who took chondroitin sulfate or celecoxib had similar levels of pain relief at the end of the study, and in both groups the improvement was greater than for those who took only a placebo, according to the report in Annals of the Rheumatic Diseases.

Reginster told Reuters Health that the findings are in line with previous studies showing that pharmaceutical grade chondroitin sulfate could significantly decrease the progression of osteoarthritis of the knee over a three-year period.

He emphasized that pharmaceutical grade chondroitin is not the same as over-the-counter supplements, which are made differently and can not enter the joint in concentrations high enough to combat the causes of cartilage degradation and pain.

Dr. Michael Shepard of the Hoag Orthopedic Institute in Orange, California, said the study had a relatively low number of participants and that most US studies of this type would have two years instead of six months.

In addition, US-based studies of chondroitin have had mixed results, Shepard said, not participating in the study. Some have found that supplements are as effective as ibuprofen (also an NSAID), and some have found that chondroitin sulfate is no more effective than placebo, he told Reuters Health.

“I tell my patients, ‘buyer be careful,'” Shepard said in an e-mail. “I tell you the mixed results of chondroitin in the literature. I tell you to try chondroitin for a month as a test and if you like it and feel better about it, then continue to take it.”

If chondroitin does not work for them, it suggests taking a NSAID “periodically”, and be aware of the side effects.

“If you are going to stay in an NSAID for an extended period, then you need regular follow-up with your doctor,” Shepard warned.

Dr. Rachel Wolfe of the Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, agreed that chondroitin is “reasonable” for some people, especially those with contraindications for NSAIDs.

“However, it should not be replaced with other treatments such as quadriceps strengthening exercises, and weight loss, which we know will provide benefit. It should be used in conjunction with these measures,” said Wolfe, who was not involved in the study.

“Chondroitin is not a miracle pill, but if it allows people to feel less pain and be more active, it will lose weight and strengthen muscles, so I think it can benefit,” Wolfe told Reuters Health via e-mail. “Studies like this point out that medicine is still an art – we do not have perfect answers, and we have to individualize for each patient.”

The study was sponsored by IBSA Institut Biochimique SA, a pharmaceutical company based in Lugano, Switzerland, which makes the chondroitin sulfate supplements used in the test.