Original article
Nonsteroidal Anti-Inflammatory Drug or Glucosamine Reduced Pain and Improved Muscle Strength With Resistance Training in a Randomized Controlled Trial of Knee Osteoarthritis Patients

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Abstract

Petersen SG, Beyer N, Hansen M, Holm L, Aagaard P, Mackey AL, Kjaer M. Nonsteroidal anti-inflammatory drug or glucosamine reduced pain and improved muscle strength with resistance training in a randomized controlled trial of knee osteoarthritis patients.

Objectives

To investigate the effect of 12 weeks of strength training in combination with a nonsteroidal anti-inflammatory drug (NSAID), glucosamine, or placebo on muscle cross-sectional area (CSA), strength (primary outcome parameters), and function, power, pain, and satellite cell number (secondary outcome parameters) in patients with knee osteoarthritis (OA).

Design

Double-blinded, randomized controlled trial.

Setting

Hospital.

Participants

Patients (N=36; 20 women, 16 men; age range, 50–70y) with bilateral tibiofemoral knee OA. A total of 181 patients were approached, and 145 were excluded.

Interventions

Patients were randomly assigned to treatment with the NSAID ibuprofen (n=12), glucosamine (n=12), or placebo (n=12) during 12 weeks of quadriceps muscle strength training.

Main Outcome Measures

Muscle CSA and strength.

Results

No differences between groups were observed in gains in muscle CSA. Training combined with ibuprofen increased maximal isometric strength by an additional .22Nm/kg (95% confidence interval [CI], .01–.42; P=.04), maximal eccentric muscle strength by .38Nm/kg (95% CI, .05–.70; P=.02), and eccentric muscle work by .27J/kg (95% CI, .01–.53; P=.04) in comparison with placebo. Training combined with glucosamine increased maximal concentric muscle work by an additional .24J/kg versus placebo (95% CI, .06–.42; P=.01).

Conclusions

In patients with knee OA, NSAID or glucosamine administration during a 12-week strength-training program did not improve muscle mass gain, but improved maximal muscle strength gain in comparison with treatment with placebo. However, we do not find that the benefits are large enough to justify taking NSAIDs or glucosamine.

Section snippets

Study Design

The study was designed as a double-blinded, placebo-controlled, randomized intervention study in which individuals with knee OA performed 12 weeks of strength training. The patients were randomly assigned to treatment with placebo, ibuprofen, or glucosamine in combination with training. Staff personnel not involved in the project randomly assigned patients to the 3 groups using a random number table and prepared the medication for each patient. Study personnel and participants were blinded to

Results

In total, 181 persons with clinical OA of the knee were prescreened during the recruitment period. Of these, 122 were disqualified and 23 were not interested in participation (fig 1). The reasons for disqualification were lack of knee OA on radiographs or unilateral OA (28%), severe health problems (22%), previous knee trauma or operation (19%), age less than 50 or over 70 years (10%), other rheumatologic diseases (5%), regular training (8%), previous gastric ulcer (4%), or intolerance/allergy

Discussion

Important observations in the present study were that the gains in muscle mass (CSA) after a 12-week strength-training program in patients with knee OA did not differ between the NSAID, glucosamine, and placebo allocation groups. Gains in muscle mass are of high importance for patients with knee OA because muscle atrophy is a typical observation in patients with OA.1 To our knowledge, the effect of longer-term consumption of NSAIDs combined with physical training has been very sparsely

Conclusions

Clinically, the important question that arises from our study's findings is whether the improvement in muscle strength and reduction of pain seen with glucosamine or ibuprofen administration during physical training justifies treatment of patients with knee OA with these medications during training. The additional gain with medication combined with training found in our study does not seem large enough for the patient, especially when seen in light of the additional cost of the medication and

References (63)

  • K.R. Baker et al.

    Quadriceps weakness and its relationship to tibiofemoral and patellofemoral knee osteoarthritis in Chinese: the Beijing Osteoarthritis Study

    Arthritis Rheum

    (2004)
  • C. Slemenda et al.

    Quadriceps weakness and osteoarthritis of the knee

    Ann Intern Med

    (1997)
  • G. Jamtvedt et al.

    Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews

    Phys Ther

    (2008)
  • E. Roddy et al.

    Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus

    Rheumatology (Oxford)

    (2005)
  • M. Fransen et al.

    Exercise for osteoarthritis of the knee

    Cochrane Database Syst Rev

    (2008)
  • W.H. Ettinger et al.

    A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritisThe Fitness Arthritis and Seniors Trial (FAST)

    JAMA

    (1997)
  • A.E. Mikesky et al.

    Effects of strength training on the incidence and progression of knee osteoarthritis

    Arthritis Rheum

    (2006)
  • H. Lund et al.

    A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis

    J Rehabil Med

    (2008)
  • G.D. Deyle et al.

    Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program

    Phys Ther

    (2005)
  • A.K. Lange et al.

    Strength training for treatment of osteoarthritis of the knee: a systematic review

    Arthritis Rheum

    (2008)
  • K.R. Baker et al.

    The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial

    J Rheumatol

    (2001)
  • E.M. Weinheimer et al.

    Resistance exercise and cyclooxygenase (COX) expression in human skeletal muscle: implications for COX-inhibiting drugs and protein synthesis

    Am J Physiol Regul Integr Comp Physiol

    (2007)
  • T.A. Trappe et al.

    Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis

    Am J Physiol Endocrinol Metab

    (2002)
  • T.A. Trappe et al.

    Skeletal muscle PGF(2)(alpha) and PGE(2) in response to eccentric resistance exercise: influence of ibuprofen acetaminophen

    J Clin Endocrinol Metab

    (2001)
  • U.R. Mikkelsen et al.

    Local NSAID infusion inhibits satellite cell proliferation in human skeletal muscle after eccentric exercise

    J Appl Physiol

    (2009)
  • A.L. Mackey et al.

    The influence of anti-inflammatory medication on exercise-induced myogenic precursor cell responses in humans

    J Appl Physiol

    (2007)
  • Q.A. Soltow et al.

    Ibuprofen inhibits skeletal muscle hypertrophy in rats

    Med Sci Sports Exerc

    (2006)
  • B.A. Bondesen et al.

    The COX-2 pathway regulates growth of atrophied muscle via multiple mechanisms

    Am J Physiol Cell Physiol

    (2006)
  • F. Richy et al.

    Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis

    Arch Intern Med

    (2003)
  • K. Pavelka et al.

    Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study

    Arch Intern Med

    (2002)
  • T.E. Towheed et al.

    Glucosamine therapy for treating osteoarthritis

    Cochrane Database Syst Rev

    (2005)
  • Cited by (0)

    Supported by the Nordea Foundation (Centre for Healthy Aging Grant), MYOAGE (grant no. 223576) funded by the European Commission under the Seventh Framework Programme, Danish Rheumatism Association, Danish Ministry of Health (grant no. 2006-1022-61), IMK Almene Fond (grant no. 30206-158), and Lundbeck Foundation (grant no. A1385).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    Clinical Trial Registration Number: NCT00833157.

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