On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

Are there studies that show glucosamine sulfate decreases pain and inflammation in patients with osteoarthritis?

1     *Glucosamine/    results=257   
2     *Osteoarthritis/    results=3547   
3     1 and 2    results= 26   
4     limit 3 to (local holdings and human and english language)    results= 14   
5     *Inflammation/    results= 3349   
6     4 and 5    results= 0   
7     Randomized Controlled Trials/    results=10797   
8     4 and 7    results= 1   

Reference Librarian comments

Good job. I wish you'd almost always "explode" the medical subject heading, but it worked here even when you didn't. I like the simpler "glucosamine AND arthritis" idea -- and just toss out the inflammation idea. Or: do an entirely separate search, like this: glucosamine and inflammation.

Ovid does not alert us nicely to the fact that getting randomized controlled trials is better done via a LIMIT trick (rather than "anding" to the subject randomized controlled trials). This is a nasty, glitchy, "gotcha" in the system.

I did the search, just like you did, except for the randomized trial trick, and got a few that you might want to see. I'll copy the references here below.

Thank you for participating in the assignment.

<1>
AN 99159469
AU Leffler CT. Philippi AF. Leffler SG. Mosure JC. Kim PD.
IN Medical Department, Naval Special Warfare Group Two, Naval Amphibious Base
Little Creek, Norfolk, VA 23521, USA. occdr@aol.com
TI Glucosamine, chondroitin, and manganese ascorbate for
degenerative joint disease of the knee or low back: a randomized,
double-blind, placebo-controlled pilot study.
SO Military Medicine. 164(2):85-91, 1999 Feb.
LM Dana. Incomplete holdings, check catalog.
AB OBJECTIVE: A 16-week randomized, double-blind, placebo-controlled crossover
trial of a combination of glucosamine HCl (1,500 mg/day),
chondroitin sulfate (1,200 mg/day), and manganese ascorbate (228 mg/day) in
degenerative joint disease (DJD) of the knee or low back was conducted.
METHODS: Thirty-four males from the U.S. Navy diving and special warfare
community with chronic pain and radiographic DJD of the knee or low back were
randomized. A summary disease score incorporated results of pain and
functional questionnaires, physical examination scores, and running times.
Changes were presented as a percentage of the patient's average score.
RESULTS: Knee osteoarthritis symptoms were relieved as
demonstrated by the summary disease score (-16.3%; p = 0.05), patient
assessment of treatment effect (p = 0.02), visual analog scale for pain
recorded at clinic visits (-26.6%; p = 0.05) and in a diary (-28.6%; p =
0.02), and physical examination score (-43.3%; p = 0.01). Running times did
not change. The study neither demonstrated, nor excluded, a benefit for
spinal DJD. Side effect frequency was similar to that at baseline. There were
no hematologic effects. CONCLUSIONS: The combination therapy relieves
symptoms of knee osteoarthritis. A larger data set is needed
to determine the value of this therapy for spinal DJD. Short-term combination
therapy appears safe in this setting.

<2>
AN 98302160
AU Qiu GX. Gao SN. Giacovelli G. Rovati L. Setnikar I.
IN Peking Union Medical College Hospital, The People's Republic of China.
TI Efficacy and safety of glucosamine sulfate versus ibuprofen
in patients with knee osteoarthritis.
SO Arzneimittel-Forschung. 48(5):469-74, 1998 May.
LM Dana Biomedical Library (Dana).
AB A double-blind therapeutic investigation was performed on 178 Chinese
patients suffering from osteoarthritis of the knee
randomized into two groups, one treated for 4 weeks with
glucosamine sulfate (GS, CAS 29031-19-4, Viartril-S) at the
daily dose of 1,500 mg and the other with ibuprofen (IBU, CAS 15687-27-1) at
the daily dose of 1,200 mg. Knee pain at rest, at movement and at pressure,
knee swelling, improvement and therapeutic utility as well as adverse events
and drop-outs were recorded after 2 and 4 weeks of treatment. The variables
were recorded also after 2 weeks of treatment discontinuation in order to
appreciate the remnant therapeutic effect. Both GS and IBU significantly
reduced the symptoms of osteoarthritis with the trend of GS
to be more effective. After 2 weeks of drug discontinuation there was a
remnant therapeutic effect in both groups, with the trend to be more
pronounced in the GS group. GS was significantly better tolerated than IBU,
as shown by the adverse drug reactions (6% in the patients of the GS group
and 16% in the IBU group--p = 0.02) and by the drug-related drop-outs (0% of
the patients in the GS group and 10% in the IBU group--p = 0.0017). The
better tolerability of GS is explained by its mode of action, because GS
specifically curbs the pathogenic mechanisms of
osteoarthritis and does not inhibit the cyclo-oxygenases as
the non-steroidal anti-inflammatory drugs (NSAIDs) do, with the consequent
anti-inflammatory analgesic activities but also with the several adverse
reactions due to this not targeted effect. The present study confirms that GS
is a selective drug for osteoarthritis, as effective on the
symptoms of the disease as NSAIDs but significantly better tolerated. For
these properties GS seems particularly indicated in the long-term treatments
needed in osteoarthritis.

<3>
AN 94183329
AU Reichelt A. Forster KK. Fischer M. Rovati LC. Setnikar I.
IN University Clinic of Orthopedics, Freiburg/Brsg. Fed. Rep. of Germany.
TI Efficacy and safety of intramuscular glucosamine sulfate in
osteoarthritis of the knee. A randomised,
placebo-controlled, double-blind study.
SO Arzneimittel-Forschung. 44(1):75-80, 1994 Jan.
LM Dana Biomedical Library (Dana).
AB Glucosamine sulfate (Dona, CAS 29031-19-4) is a drug used
in the treatment of osteoarthritis. When orally given, it is
more effective than placebo and at least as effective as non-steroidal
anti-inflammatory drugs in relieving osteoarthritis
symptoms. The aim of this multicentre, randomised, placebo-controlled,
double-blind, parallel-group study was to assess the efficacy and safety of
glucosamine sulfate intramuscularly given on the same
parameters. 155 out-patients with knee osteoarthritis
(Lequesne's criteria), radiological stage between I and III, Lequesne's
severity index of at least 4 points and symptoms for at least 6 months, were
treated with i.m. glucosamine sulfate (or placebo) 400 mg
twice a week for 6 weeks. Clinic visits were performed at enrollment, after a
2-week baseline, at weekly intervals during treatment and 2 weeks after drug
discontinuation. Responders to treatment were considered those patients with
a reduction of at least 3 points in the Lequesne index, together with a
positive overall judgement by the investigator. The Lequesne index was
slightly over 10 points in average in both groups at the beginning of
treatment. A significant decrease in the index was observed for
glucosamine compared to placebo (3.3 vs. 2.0 points in
average, respectively; p < 0.05, Student's t-test). The responder rate in the
evaluable patients was 55% with glucosamine (n = 73) and
only 33% (n = 69) with placebo (p = 0.012, Fisher's Exact Test). According to
the intention-to-treat approach, considering also drop-outs, these
proportions were 51% vs. 30% (p = 0.015).(ABSTRACT TRUNCATED AT 250 WORDS)