Glucosamine or chondroitin for osteoarthritis

Pain, stiffness and loss of flexibility caused by osteoarthritis is a common condition among older people. To maintain function and manage pain over time, the primary recommendation is physical activity. For treatment of osteoarthritic pain, anti-inflammatory or pain-relieving drugs like ibuprofen or paracetamol are usually prescribed. Glucosamine and chondroitin for pain management and increased function are also widely used.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202207 Registration no: SBU 2021/630

Question

What systematic reviews are there on effects of glucosamine or chondroitin on osteoarthritis?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
CI = Confidence Interval; CS = Chondroitin Sulfate; CrI = Credibility Interaval; MD = Mean difference; NMA = Network Meta-Analysis; NSAID = Non-Steroidal Anti-Inflammatory Drugs; OA = Osteoarthritis; pCGS = Prescription grade Crystalline Glucosamine Sulfate; pCS = Prescription grade Chondroitin Sulfate; RCT = Randomised Controlled Trial; RoB = Risk of Bias; SMD = Standardised Mean Difference
Included studies Population/Intervention Outcome and Results
Jacobsen et al. (Federal Office of Public Health FOPH), 2020, [1]
Chondroitin Sulfate in Osteoarthritis
26 RCTs Population:
Patients with osteoarthritis (OA) in the hip, knee or hand

Intervention:
Oral pharmaceutical-grade Chondroitin Sulfate (CS)

Control:
On-demand analgesics, oral or topical NSAIDs, and other anti-inflammatory treatments		 Chondroitin Sulfate vs placebo (pain):
Knee OA
6 months (n=9):
SMD –0.28
(95% CI, –0.47 to –0.09) ⨁⨁◯◯

12 months (n=7):
Not significant
⨁⨁◯◯

Hip OA
6 months (n=1):
Significant difference, p<0.001
⨁⨁◯◯

Hand OA
6 months (n=1): Significant difference, p<0.016 ⨁⨁⨁◯

Chondroitin Sulfate vs placebo, (function):
Knee OA
6 months (n=2):
Not significant
⨁⨁◯◯

12 months (n=3):
Not significant
⨁⨁◯◯

Chondroitin Sulfate vs placebo (Withdrawal due to adverse events):
Knee OA (n=15):
Not significant
⨁⨁⨁◯

Hand OA (n=2):
Not significant
⨁⨁◯◯

Hip OA (n=1):
Not significant
⨁⨁⨁◯

Chondroitin Sulfate vs NSAID (pain):
Knee OA
6 months (n=3):
Not significant
⨁⨁◯◯

12 months (n=2):
Not significant
⨁⨁⨁◯

Chondroitin Sulfate vs NSAID (function):
Knee OA
6 months (n=2):
Not significant
⨁⨁◯◯

12 months (n=2):
Not significant
⨁⨁⨁◯

Chondroitin Sulfate vs NSAID (withdrawal due to adverse events):
Knee OA (n=3):
Not significant
⨁⨁⨁◯

Chondroitin Sulfate vs paracetamol (pain):
Knee OA
6 months (n=1):
Not significant
⨁⨁◯◯

Chondroitin Sulfate vs paracetamol (withdrawal due to adverse events):

Knee OA (n=1):
Not significant
⨁⨁⨁◯
Authors' conclusion:
“The clinical findings of this report are extracted from a substantial body of evidence of low to moderate quality. Patients treated with CS report slightly greater reductions in osteoarthritic pain up to 6 months compared to placebo, but no difference compared to NSAIDs. The relative benefits are not demonstrated beyond 6 months. The rate of serious adverse events related to CS use is low, noting that this estimate is based on evidence with limited sample sizes and 12 months of follow-up.”
Singh et al. 2016, [2]
Chondroitin for osteoarthritis (Review)
43 RCTs included
- Qualitative analysis: 39 RCTs
- Quantitative analysis: 16 RCTs		 Population:
Adult patients with osteoarthritis (OA) in any joint

Intervention:
Use of oral chondroitin alone or in combination with other oral drugs such as glucosamine

Control:
Placebo or active medications including NSAIDs, analgesics (e.g., acetaminophen), opioid pain-relieving medications, glucosamine or other "herbal" medications, or other comparator oral medications		 Chondroitin vs placebo
Short term (<6 months)
Pain (n=8):
SMD –0.51
(95 % CI, –0.74 to –0.28)
Function (n=8):
Not significant

Long term (>6 months)
Pain (n=6):
SMD –0.39
(95 % CI, –0.78 to 0.00)
Function (n=6):
Not significant

Chondroitin + Glucosamine vs placebo
Short term (<6 months)
Pain (n=3):
Not significant
Function (n=2):
Not significant

Long term (>6 months)
Pain (n=2):
Not significant
Function (n=2):
Not significant

Chondroitin + Glucosamine vs NSAID
Short term (<6 months)
Pain (n=2):
Not significant
Function (n=1):
Not significant

Long term (>6 months)
Pain (n=3):
Not significant
Function (n=1):
Not significant
Authors' conclusion:
“The improvement in joint pain with chondroitin (alone or in combination with glucosamine) in participants with osteoarthritis was clinically meaningful and statistically significantly better than placebo, based on trials of mostly low quality.”
[…]
“Most evidence for chondroitin comes from small trials. […] Well-designed high-quality RCTs of chondroitin in participants with early and late osteoarthritis are desirable because they can add valuable information to knowledge gaps in this area. Larger samples and appropriate controls (placebo or NSAIDs) are needed, and trials need to provide longer follow-up and closer monitoring so investigators can see long-term effects and detect any safety concerns.”
Gregori et al. 2018, [3]
Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis A Systematic Review and Meta-analysis
Bayesian network meta-analysis (NMA)
47 RCTs (22 037 participants) included in NMA		 Population:
Patients with osteoarthritis (OA) in the knee

Intervention:
Any active pharmacological intervention alone or in combination with another intervention with a follow-up period was at least 1 year

Control:
Active control (another active pharmacological treatment), placebo or no treatment		 Treatment vs placebo
Chondroitin sulfate:
Pain (n=5): Not significant
Function (n=3):
Not significant

Glucosamine sulfate:
Pain (n=2):
SMD −0.29
(95% CrI: −0.49 to −0.09)
Function (n=2):
SMD −0.32
(95% CrI: −0.52 to −0.12)

Glucosamines:
Pain (n=3):
Not significant
Function (n=3):
Not significant

Glucosamines + Chondroitin sulfate:
Pain (n=2):
Not significant
Function (n=2):
Not significant
Authors' conclusion:
“In this systematic review and network meta-analysis of studies of patients with knee osteoarthritis and at least 12 months of follow-up, there was uncertainty around the estimates of effect size for change in pain for all comparisons with placebo. Larger RCTs are needed to resolve the uncertainty around efficacy of medications for knee osteoarthritis.”
Beaudart et al. 2020, [4]
Symptomatic Efficacy of Pharmacological Treatments for Knee Osteoarthritis: A Systematic Review and a Network Meta‑Analysis with a 6‑Month Time Horizon
Bayesian network meta-analysis (NMA)

80 RCTs included in NMA:
- 79 RCTs (15 609 participants) included in NMA of pain outcome
- 55 RCTs (13 655 participants) included in NMA of function outcome		 Population:
Patients with osteoarthritis (OA) in the knee

Intervention:
Any pharmacological treatment, currently prescribed or recommended, administrated during a continuous period of 6 months or more

Control:
Active control (another active pharmacological treatment) or placebo		 Treatment vs placebo
Prescription grade Chondroitin sulfate:
Pain (n=10):
SMD –0.26
(95% CrI: –0.44 to –0.08)
Function (n=5):
Not significant

Chondroitin sulfate:
Pain (n=2):
Not significant
Function (n=4):
Not significant

Prescription grade Crystalline Glucosamine sulfate:
Pain (n=3):
SMD –0.29
(95% CrI: –0.58 to 0.00)
Function (n=3):
SMD –0.44
(95% CrI: –0.66 to –0.21)

Glucosamine sulfate:
Pain (n=5):
Not significant
Function (n=5):
Not significant

Glucosamine sulfate + Chondroitin sulfate
Pain (n=5):
Not significant
Function (n=5):
Not significant
Authors' conclusion:
“Our results support the view that pCS and pCGS are more effective in reducing pain in knee OA than other glucosamine or chondroitin preparations, which do not provide any significant clinical benefit […]. “
Eriksen et al. 2014, [5]
Risk of Bias and Brand Explain the Observed Inconsistency in Trials on Glucosamine for Symptomatic Relief of Osteoarthritis: A Meta-Analysis of Placebo-Controlled Trials
25 Randomized or quasi-randomized controlled trials (3458 participants) Population:
Adult patients with osteoarthritis (OA) in any synovial joint

Intervention:
Glucosamine

Control:
Placebo		 Treatment vs placebo
Glucosamine, all brands:
All studies (n=25):
SMD –0.58
(95% CI, –0.90 to –0.26)
Low RoB (n=8):
Not significant

Glucosamine, Rottapharm/Madaus:
All studies (n=12):
SMD –1.05
(95% CI, –1.43 to –0.68
Low RoB (n=3):
SMD –0.27
(95% CI, –0.43 to –0.12)

Glucosamine, other brands:
All studies (n=13):
Not significant
Low RoB (n=5):
Not significant
Authors' conclusion:
“We are confident that glucosamine by and large has no clinically important effect. An exception to this statement may be the results repeatedly produced by studies of the product from Rottapharm/Madaus; although the possible biochemical background for this is speculative. […] [Further research] would imply both a confirmatory trial without industry involvement in order to omit industry bias and a basic pharmacologic demonstration of specific properties of the Rottapharm/Madaus crystalline sulfate preparations.”

References

  1. FOPH. Chondroitin sulfate in osteoarthritis. Bern: Federal Office of Public Health (FOPH); 2020. Project number 18.011565. [accessed Mar 24 2022]. Available from: https://www.aramis.admin.ch/Default?DocumentID=65884&Load=true.
  2. Singh JA, Noorbaloochi S, MacDonald R, Maxwell LJ. Chondroitin for osteoarthritis. Cochrane Database Syst Rev. 2015;1(1):CD005614. Available from: https://doi.org/10.1002/14651858.CD005614.pub2.
  3. Gregori D, Giacovelli G, Minto C, Barbetta B, Gualtieri F, Azzolina D, et al. Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. JAMA. 2018;320(24):2564-79. Available from: https://doi.org/10.1001/jama.2018.19319.
  4. Beaudart C, Lengele L, Leclercq V, Geerinck A, Sanchez-Rodriguez D, Bruyere O, et al. Symptomatic Efficacy of Pharmacological Treatments for Knee Osteoarthritis: A Systematic Review and a Network Meta-Analysis with a 6-Month Time Horizon. Drugs. 2020;80(18):1947-59. Available from: https://doi.org/10.1007/s40265-020-01423-8.
  5. Eriksen P, Bartels EM, Altman RD, Bliddal H, Juhl C, Christensen R. Risk of bias and brand explain the observed inconsistency in trials on glucosamine for symptomatic relief of osteoarthritis: a meta-analysis of placebo-controlled trials. Arthritis Care Res (Hoboken). 2014;66(12):1844-55. Available from: https://doi.org/10.1002/acr.22376.

Literature search

CINAHL via EBSCO 14 February 2022

Title: Dietary supplements for treating osteoarthritis
The final search result, usually found at the end of the documentation, forms the list of abstracts.

AB = Abstract; AU = Author; DE = Term from the thesaurus; MH = Exact Subject Heading from CINAHL Subject Headings; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; N = Near Operator (N) finds the words if they are a maximum of x words apart from one another, regardless of the order in which they appear.; W = Within Operator (W) finds the words if they are within x words of one another, in the order in which you entered them.
Search termsItems found
Population: Osteoarthritis
1. TI ( osteoarthritis OR gonarthrosis OR coxarthrosis OR arthrosis OR osteoarthrosis OR osteo-arthritis OR ( degenerative N2 arthritis ) ) OR AB ( osteoarthritis OR gonarthrosis OR coxarthrosis OR arthrosis OR osteoarthrosis OR osteo-arthritis OR ( degenerative N2 arthritis ) ) OR SU ( osteoarthritis OR gonarthrosis OR coxarthrosis OR arthrosis OR osteoarthrosis OR osteo-arthritis OR ( degenerative N2 arthritis ) ) 43,059
Intervention: Dietary supplements
2. TI ( glucosamine OR acetylglucosamine OR "n-acetylglucosamine" OR "n-acetyl-d-glucosamine" OR chondroitin OR nutraceutical* OR pharmaconutraceutical OR pharmaconutrition OR nutrient* OR curcumin OR demethoxycurcumin OR didemethoxycurcumin OR bisdemethoxycurcumin OR turmeric ) OR AB ( glucosamine OR acetylglucosamine OR "n-acetylglucosamine" OR "n-acetyl-d-glucosamine" OR chondroitin OR nutraceutical* OR pharmaconutraceutical OR pharmaconutrition OR nutrient* OR curcumin OR demethoxycurcumin OR didemethoxycurcumin OR bisdemethoxycurcumin OR turmeric ) OR SU ( glucosamine OR acetylglucosamine OR "n-acetylglucosamine" OR "n-acetyl-d-glucosamine" OR chondroitin OR nutraceutical* OR pharmaconutraceutical OR pharmaconutrition OR nutrient* OR curcumin OR demethoxycurcumin OR didemethoxycurcumin OR bisdemethoxycurcumin OR turmeric ) OR TI ( "diet* supplement*" OR "functional food*" OR herb* OR plant OR collagen OR harpagophytum OR "hyaluronic acid" OR vitamin* OR mineral ) OR AB ( "diet* supplement*" OR "functional food*" OR herb* OR plant OR collagen OR harpagophytum OR "hyaluronic acid" OR vitamin* OR mineral ) OR SU ( "diet* supplement*" OR "functional food*" OR herb* OR plant OR collagen OR harpagophytum OR "hyaluronic acid" OR vitamin* OR mineral ) OR TI ( "fish oil*" OR "omega 3" OR "n-3 fatty acid*" OR pufa OR "Green-lipped mussel" OR "Perna canaliculus" OR ( ( rose N1 ( hip OR heb ) ) OR rosehip OR roseheb OR rosehaw ) OR methylsulfonylmethane OR "methyl sulfonmethane" OR "methyl sulfone" OR "dimethyl sulfone" ) OR AB ( "fish oil*" OR "omega 3" OR "n-3 fatty acid*" OR pufa OR "Green-lipped mussel" OR "Perna canaliculus" OR ( ( rose N1 ( hip OR heb ) ) OR rosehip OR roseheb OR rosehaw ) OR methylsulfonylmethane OR "methyl sulfonmethane" OR "methyl sulfone" OR "dimethyl sulfone" ) OR SU ( "fish oil*" OR "omega 3" OR "n-3 fatty acid*" OR pufa OR "Green-lipped mussel" OR "Perna canaliculus" OR ( ( rose N1 ( hip OR heb ) ) OR rosehip OR roseheb OR rosehaw ) OR methylsulfonylmethane OR "methyl sulfonmethane" OR "methyl sulfone" OR "dimethyl sulfone" ) 263,621
Study types: Systematic reviews
3. TI ( (systematic N3 review) OR "meta analys*" OR metaanalys* ) OR AB ( (systematic N3 review) OR "meta analys*" OR metaanalys* ) OR PT ( (systematic N3 review) OR "meta analys*" OR metaanalys* )  
Combined sets:
4. 1 AND 2 4,700
5. 3 AND 4 370
Limits:
6. From 2011 - 294
Final result
  5 AND 6 294

KSR Evidence 10 February 2022

Title: Dietary supplements for treating osteoarthritis
The final search result, usually found at the end of the documentation, forms the list of abstracts.

:au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; Cochrane Protocols = Protocols of systematic reviews registered in Cochrane Library; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”
Search termsItems found
Population: Osteoarthritis
1. osteoarthritis OR gonarthrosis OR coxarthrosis OR arthrosis OR osteoarthrosis OR osteo-arthritis OR ( degenerative NEAR/2 arthritis ) in All text 2,370
Intervention: Dietary supplements
2. glucosamine OR acetylglucosamine OR "n-acetylglucosamine" OR "n-acetyl-d-glucosamine" OR chondroitin OR nutraceutical* OR pharmaconutraceutical OR pharmaconutrition OR nutrient* OR curcumin OR demethoxycurcumin OR didemethoxycurcumin OR bisdemethoxycurcumin OR turmeric OR zingibera*OR "diet* supplement*" OR "functional food*" OR phytotherapy* OR herb* OR plant OR collagen OR harpagophytum OR "hyaluronic acid" OR vitamin* OR mineral OR "fish oil*" OR "omega 3" OR "n-3 fatty acid*" OR pufa OR "Green-lipped mussel" OR "Perna canaliculus" OR ( ( rose NEAR/1 ( hip OR heb ) ) OR rosehip OR roseheb OR rosehaw ) OR methylsulfonylmethane OR "methyl sulfonmethane" OR "methyl sulfone" OR "dimethyl sulfone" in All text 9,430
Combined sets
3. 1 AND 2 343
Limits:
4. From 2011 -  
Final result
  3 AND 4 340

Embase via Elsevier 10 February 2022

Title: Dietary supplements for treating osteoarthritis
The final search result, usually found at the end of the documentation, forms the list of abstracts.

/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ' ' = Citation Marks; searches for an exact phrase; NEAR/n = Requests terms that are within 'n' words of each other in either direction; NEXT/n = Requests terms that are within 'n' words of each other in the order specified
Search termsItems found
Population: Osteoarthritis
1. 'osteoarthritis'/exp OR 'arthrosis':ti,ab,kw OR 'osteo-arthritis':ti,ab,kw OR 'osteo-arthrosis':ti,ab,kw OR 'osteoarthritis':ti,ab,kw OR 'osteoarthrosis':ti,ab,kw OR 'gonarthrosis':ti,ab,kw OR 'coxarthrosis':ti,ab,kw 164,542
2. (degenerative NEXT/2 arthritis):ti,ab,kw 1,736
3. 1 OR 2 165,144
Intervention: Dietary supplements
4. 'glucosamine'/exp OR 'chondroitin sulfate'/de 32,234
5. 'glucosamine':ti,ab,kw OR 'acetylglucosamine':ti,ab,kw OR 'n-acetylglucosamine':ti,ab,kw OR 'n-acetyl-d-glucosamine':ti,ab,kw OR 'chondroitin':ti,ab,kw 42,758
6. 'diet supplementation'/de OR 'vitamin supplementation'/de OR 'mineral supplementation'/de OR 'diet* supplement*':ti,ab,kw 149,105
7. 'functional food'/de OR 'functional food':ti,ab,kw 10,161
8. 'nutraceutical*':ti,ab,kw OR 'pharmaconutraceutical':ti,ab,kw OR 'pharmaconutrition':ti,ab,kw OR 'nutrient*':ti,ab,kw OR 'pharmaconutrition'/de 207,647
9. 'herb*':ti,ab,kw OR 'plant':ti,ab,kw OR 'plant extract'/exp 763,069
10. 'curcumin'/exp OR 'curcuma longa'/exp OR 'curcuma longa extract'/exp 449,306
11. 'fish oil'/exp OR 'omega 3 fatty acid'/exp OR 'polyunsaturated fatty acid'/exp OR 'perna canaliculus'/exp 65,817
12. 'fish oil*':ti,ab,kw OR 'omega 3':ti,ab,kw OR 'n-3 fatty acid*':ti,ab,kw OR 'pufa':ti,ab,kw OR 'green-lipped mussel':ti,ab,kw OR 'perna canaliculus':ti,ab,kw 46,527
13. 'rose':ti,ab,kw AND next:ti,ab,kw AND ('hip':ti,ab,kw OR 'heb':ti,ab,kw) OR 'rosehip':ti,ab,kw OR 'roseheb':ti,ab,kw OR 'rosehaw':ti,ab,kw 204
14. 'harpagophytum'/exp OR 'harpagophytum':ti,ab,kw OR 'devil claw':ti,ab,kw OR 'devil`s claw':ti,ab,kw OR 'devils claw':ti,ab,kw 492
15. 'vitamin'/exp OR 'mineral'/de OR 'vitamin*':ti,ab,kw OR 'minerals':ti,ab,kw 852,968
16. 'hyaluronic acid'/de OR 'hyaluronic acid':ti,ab,kw 52,747
17. 'collagen'/de OR 'collagen':ti,ab,kw 298,931
18. 'dimethyl sulfone'/de OR 'dimethyl sulfone' OR 'dimethylsulfone' OR 'methyl sulfone' OR 'methylsulfonylmethane' 956
19. 4 OR 5 OR 6 OR 7 OR 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18 2,348,120
Study types: Systematic reviews
20. 'systematic review'/de OR 'meta analysis'/exp OR 'cochrane database syst rev':ta OR ((systematic NEAR/3 review):ti,ab) OR 'meta analys*':ti,ab OR metaanalys*:ti,ab 63,012
Combined sets
21. 3 AND 19 24,305
22. 21 AND 20 1,243
Limits
23. 22 AND (2011:py OR 2012:py OR 2013:py OR 2014:py OR 2015:py OR 2016:py OR 2017:py OR 2018:py OR 2019:py OR 2020:py OR 2021:py OR 2022:py) 940
Final result
  23 940

Medline via OvidSP 10 February 2022

Title: Dietary supplements for treating osteoarthritis
The final search result, usually found at the end of the documentation, forms the list of abstracts.

.ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp = Text, heading word, subject area node, title; “ “ = Citation Marks; searches for an exact phrase; ADJn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other.
Search termsItems found
Population: Osteoarthritis
1. exp osteoarthritis/ 70,684
2. (Osteoarthritis or Gonarthrosis or Coxarthrosis or Arthrosis or Osteoarthrosis or Osteo-arthritis).tw,kw. 85,517
3. (degenerative adj2 arthritis).tw,kw. 1,482
4. or/1–3 106,384
Intervention: Dietary supplements
5. exp Glucosamine/ or Chondroitin/ 17,836
6. (glucosamine or acetylglucosamine or "n-acetylglucosamine" or "n-acetyl-d-glucosamine" or chondroitin).tw,kw 37,456
7. exp Dietary Supplements/ 90,842
8. diet* supplement*.tw,kw. 32,817
9. Functional Food/ 2,476
10. functional food.tw,kw. 6,149
11. (nutraceutical* or pharmaconutraceutical or pharmaconutrition or nutrient*).tw,kw. 176,748
12. (herb* or plant).tw,kw. 510,626
13. Phytotherapy/ or exp Plant Extracts/ or "Plants, Medicinal"/ or exp Zingiberaceae/ 244,523
14. (curcumin or demethoxycurcumin or didemethoxycurcumin or bisdemethoxycurcumin or turmeric).tw,kw. 19,027
15. (fish oil* or omega 3 or n-3 fatty acid* or PUFA or Green-lipped mussel or Perna canaliculus).tw,kw. 37,140
16. ((rose adj (hip or heb)) or rosehip or roseheb or rosehaw).tw,kw. 200
17. collagen/ or collagen.tw,kw. 227,055
18. Harpagophytum.tw,kw. 190
19. Hyaluronic Acid/ or hyaluronic acid.tw,kw. 32,727
20. vitamins/ or vitamin*.tw,kw. 246,642
21. minerals/ or minerals.tw,kw. 46,356
22. (Methylsulfonylmethane or methyl sulfonmethane or methyl sulfone or dimethyl sulfone).tw,kw. 411
23. or/5–22 1,490,134
Study types: Systematic reviews
24. (Systematic Review or Meta-Analysis).pt. or Cochrane Database Syst Rev.ja. or ((systematic adj3 review) or "meta analys*" or metaanalys*).ti,ab. 374,538
Combined sets
25. 4 and 23 11,259
26. 25 and 24 564
Limits
27 limit 26 to yr="2011 -Current" 459
Final result
  27 459

Scopus via Elsevier 10 February 2022

Title: Dietary supplements for treating osteoarthritis
The final search result, usually found at the end of the documentation, forms the list of abstracts.

TITLE-ABS-KEY = Title or abstract or keywords; ALL = All fields; PRE/n = "precedes by". The first term in the search must precede the second by a specified number of terms (n).; W/n = "Within". The terms in the search must be within a specified number of terms (n) in any order.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; LIMIT-TO (SRCTYPE, "j" = Limit to source type journal; LIMIT-TO (DOCTYPE, "ar" = Limit to document type article; LIMIT-TO (DOCTYPE, "re" = Limit to document type review
Search termsItems found
Population: Osteoarthritis
1. TITLE-ABS-KEY ( ( osteoarthritis OR gonarthrosis OR coxarthrosis OR arthrosis OR osteoarthrosis OR osteo-arthritis ) OR ( degenerative W/2 arthritis ) ) 148,774
Intervention: Dietary supplements
2. TITLE-ABS-KEY ( glucosamine OR acetylglucosamine OR "n-acetylglucosamine" OR "n-acetyl-d-glucosamine" OR chondroitin OR nutraceutical* OR pharmaconutraceutical OR pharmaconutrition OR nutrient* OR curcumin OR demethoxycurcumin OR didemethoxycurcumin OR bisdemethoxycurcumin OR turmeric OR zingibera* OR; "diet* supplement*" OR "functional food*" OR phytotherap* OR herb* OR plant OR collagen OR harpagophytum OR "hyaluronic acid" OR vitamin* OR mineral OR "fish oil*" OR "omega 3" OR "n-3 fatty acid*" OR pufa OR "Green-lipped mussel" OR "Perna canaliculus" OR ( rose W/1 ( hip OR heb ) ) OR rosehip OR roseheb OR rosehaw OR methylsulfonylmethane OR "methyl sulfonmethane" OR "methyl sulfone" OR "dimethyl sulfone" ) 4,895,882
Study types: Systematic reviews
3. TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analys*" OR metaanalys* ) OR ( SRCTITLE ( cochrane ) AND DOCTYPE ( re ) )  
Combined sets
4. 1 AND 2 21,314
5. 4 AND 3 1,308
Limits
6. From 2011 -  
Final result
  5 AND 6 980
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