03164nas a2200277 4500000000100000008004100001260001600042653001100058653001900069653000900088653004200097653002400139653002400163653002000187653002300207100002000230700001700250700001800267700001800285700001700303245009200320300001200412490000700424520244100431022001402872 2018 d c5146547146010aHumans10aOsteoarthritis10aPain10aRandomized Controlled Trials as Topic10aBiological Products10aDietary Supplements10aPain Management10aPlant Preparations1 aMachado Gustavo1 aLiu Xiaoqian1 aEyles Jillian1 aRavi Varshini1 aHunter David00aDietary supplements for treating osteoarthritis: a systematic review and meta-analysis. a167-1750 v523 a

OBJECTIVE: To investigate the efficacy and safety of dietary supplements for patients with osteoarthritis.

DESIGN: An intervention systematic review with random effects meta-analysis and meta-regression.

DATA SOURCES: MEDLINE, EMBASE, Cochrane Register of Controlled Trials, Allied and Complementary Medicine and Cumulative Index to Nursing and Allied Health Literature were searched from inception to April 2017.

STUDY ELIGIBILITY CRITERIA: Randomised controlled trials comparing oral supplements with placebo for hand, hip or knee osteoarthritis.

RESULTS: Of 20 supplements investigated in 69 eligible studies, 7 (collagen hydrolysate, passion fruit peel extract,extract,extract, curcumin, pycnogenol and L-carnitine) demonstrated large (effect size >0.80) and clinically important effects for pain reduction at short term. Another six (undenatured type II collagen, avocado soybean unsaponifiables, methylsulfonylmethane, diacerein, glucosamine and chondroitin) revealed statistically significant improvements on pain, but were of unclear clinical importance. Only green-lipped mussel extract and undenatured type II collagen had clinically important effects on pain at medium term. No supplements were identified with clinically important effects on pain reduction at long term. Similar results were found for physical function. Chondroitin demonstrated statistically significant, but not clinically important structural improvement (effect size -0.30, -0.42 to -0.17). There were no differences between supplements and placebo for safety outcomes, except for diacerein. The Grading of Recommendations Assessment, Development and Evaluation suggested a wide range of quality evidence from very low to high.

CONCLUSIONS: The overall analysis including all trials showed that supplements provided moderate and clinically meaningful treatment effects on pain and function in patients with hand, hip or knee osteoarthritis at short term, although the quality of evidence was very low. Some supplements with a limited number of studies and participants suggested large treatment effects, while widely used supplements such as glucosamine and chondroitin were either ineffective or showed small and arguably clinically unimportant treatment effects. Supplements had no clinically important effects on pain and function at medium-term and long-term follow-ups.

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