Supervisor: Dr Marlene Fransen, at The George Institute for International Health.

About Dr Marlene Fransen

Dr Fransen has a background in physiotherapy and a specific research interest in the area of chronic musculoskeletal conditions.. more…

Project Synopsis

This randomised controlled clinical trial will evaluate the effectiveness of glucosamine, with or without chondroitin, among people with symptomatic osteoarthritis of the knee.

There is no known cure for OA and no intervention demonstrated to slow disease progression or delay time to joint replacement surgery. Currently patients are managed symptomatically with paracetamol as ‘the preferred long term oral analgesic’. This recommendation is based on the increased risk of serious gastrointestinal, cardiovascular and renal diseases with long-term NSAIDs use in older people. However, NSAIDs appear to provide better pain relief for patients with more than mild joint pain.

The majority of patients with symptomatic OA will purchase the dietary supplements, glucosamine and chondroitin. Product marketing has led to the belief these dietary supplements are able to slow the rate of joint destruction and cartilage loss and help ease joint pain with, in contrast to NSAIDs, little risk of side effects. However, the few trials conducted to date have been inconclusive.

A total of 940 patients with knee OA will be randomly allocated to glucosamine or matching placebo capsules and chondroitin or matching placebo capsules for two years. Participants will be assessed annually with questionnaires, physical performance measures, radiographs and MRI. The main outcomes will be the rate of joint space narrowing, use of NSAIDs and physical disability. If allocation to either or both of these dietary supplements result in slowing disease progression or in reducing NSAIDs consumption, their widespread use would effectively decrease pain, disability and NSAIDs-related illnesses amongst the increasing number of people with OA.

Additional Information

Possible PhD topics:

• Knee radiography

  • All 940 study participants will have a baseline semi-flexed radiograph of both knees, with follow-up at 1 and 2 years. Radiographs will be taken at about 5 different centres.

  • Validity/reliability/responsiveness of semi-flexed knee radiographs? Association of joint space width with symptoms, compared with standard knee radiographs? Usefulness of radiographs in a multi-centre trial? 1 and 2 year responsiveness of joint space width assessment?

• Knee MRI
  • Baseline and 1 year 3T MRI of the signal knee joint will be conducted in 400 LEGS study participants at 3 different centres.
  • Validity/reliability/responsiveness of cartilage volume or cartilage defect scoring in multi-centre? MRI scores predicting responsiveness to glucosamine/chondroitin?

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