Evidenced-Based Medicine Orthopaedic Department TSMH

Clinical Scenario

A 62 Y/O female, suffering from bilateral knee joints pain off and on for years. The S/S exacerbated recently, she called at our OPD seeking for treatment. P.E. and X-ray examination revealed a typical O.A. of bilateral knee joints.

NSAIDs were prescribed in the first place. However, the patient requested adding the “Glucosamine” as an alternative treatment.

Patient Intervention Control Outcome PICO

P: a 62 Y/O female with OA knee I: is Glucosamine effective in treating OA knee C: as opposed to not use Glucosamine O: reduce the knee pain of patients with OA knee

Databases and Resources

PubMed Cochrane library UpToDate

Search Strategy

PubMed Search and resources strategy: Why I used what I used. Search Engine: Clinical Queries in PubMed. MeSH: Glucosamine AND osteoarthritis AND knee joint Clinical Study Category: Therapy

Cochrane library/UpToDate Key words: Glucosamine osteoarthritis

PubMed: 18 articles Cochrane library: 1 article UpToDate: 5 articles

Critical Appraisal

Conclusions

Glucosamine did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee. Heterogeneity among trials of glucosamine is larger than would be expected. Potential explanations include different glucosamine preparations, inadequate allocation concealment, and industry bias.

Implementation and Evaluation

Current pharmacologic therapy of osteoarthritis (OA) consists of analgesics, nonsteroidal antiinflammatory drugs, intraarticular glucocorticoids)..etc. As Glucosamine is a complementary therapy, and the effectiveness not obvious, we here suggest our hospital discontinue using it and evaluate the outcome.

Thank You Chih-Yu Eric Tu MD, MPH