Patients’ Real Life Experience in Using Glucosamine Sulfate for Treatment of Knee Osteoarthritis Under The Comptroller General’s Department (CGD) Reimbursement Protocol: A Preliminary Report
Chavarin Amarase MD1, Aree Tanavalee MD1, Worapol Jumroonwong MD2, Chotetawan Tanavalee MD1, Saran Tantavisut MD1, Srihatach Ngarmukos MD1
Affiliation : 1 Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 2 Department of Orthopedic Surgery, Roi-Et Hospital, Roi-Et, Thailand
Background : Knee osteoarthritis [OA] is one of the most common orthopedic diseases in Thailand. Glucosamine sulfate is
an option for treatment of mild to moderate knee OA; however, this optional treatment has been restricted under the
reimbursement protocol of the Comptroller General’s Department [CGD]. The objective of this preliminary study was to
evaluate both patient-reported and performance-based benefits of glucosamine for the treatment of knee OA when administered
as specified by the CGD reimbursement protocol.
Materials and Methods : We prospectively evaluated 100 knee OA patients who had been prescribed glucosamine sulfate and
met CGD criteria for reimbursement. Outcomes of treatment were evaluated using conventional subjective measurements,
including the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], visual analog scale [VAS] for
pain, and the Short form-12 [SF-12]. In addition, all patients had to complete two functional performance measures, the
Timed Up and Go Test [TUGT] and the 5-time sit to stand [5XSST]. Measurements of all parameters were performed at
pretreatment then again at week 6, 12, and 18.
Results : Patients were divided in to into 3 groups according to Kellgren and Lawrence system: mild OA (KL 1), moderate OA
(KL 2-3), and severe OA (KL 4) in accordance with the CGD reimbursement protocol. At the 18-week follow-up [FU], 57
of the 100 patients (50 females and 7 males) had completed evaluations of all parameters. Fifteen of the 57 patients were in
the mild group (KL 1), 32 were in the moderate group (KL 2-3), and 10 were in the severe group (KL 4). The patients’ mean
age was 68.28 years, and the mean BMI was 26.03 kg/m2. At the 18-week FU, values of all investigated parameters had
significantly improved. However, improvement of the conventional clinical subjective parameters occurred later than those
of objective functional performance, including TUGT improved from week 6; VAS, SF-12 (PCS), and 5XSST from week 12;
and WOMAC and SF-12 (MCS) from week 18.
Conclusion : At the 18-week FU, glucosamine sulfate treatment of knee OA administered following the CGD reimbursement
protocol results in improvement in all evaluated parameters, especially performance-based measurements, which had no
patient or surgeon bias. Whilst significant improvement was detected from week 6, at week 12, most of them were detected.
Therefore, the results of this preliminary study supported the CGD reimbursement protocol, which defines that physicians
have to evaluate the outcomes of treatment after 12 weeks.
Keywords : Glucosamine sulfate, Osteoarthritis, Knee, Real life, Reimbursement
