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Evidence Results are statistically significant unless indicated. • From 11 systematic reviews1 of GA 1500 mg/day versus placebo (2 to 25 RCTs; 414 to 4963 patients), a meta-analysis (9 RCTs; N = 1643) showed 47% of patients treated with GA and 37% treated with placebo attained meaningful pain reduction after 4 to 156 weeks (number needed to treat of 11).2 -Another meta-analysis had similar findings.3 On a 100-point pain scale (meta-analysis4 rerun by PEER) with baseline pain of 52, placebo reduced pain roughly 13 points. In larger RCTs, pain reduction with GA was the same as placebo. In smaller RCTs, GA reduced pain by roughly 12 points more than placebo. • From 11 systematic reviews1 of CD 800 to 1200 mg/day versus placebo (6 to 18 RCTs; 362 to 4044 patients), a meta-analysis (9 RCTs; N = 2477) showed 57% of patients treated with CD and 45% of patients receiving placebo attained meaningful pain reduction after 12 to 48 weeks (number needed to treat of 9).2 Another meta-analysis found no difference (1 RCT; N = 330).5 On a 100-point pain scale (meta-analysis4 rerun by PEER) with baseline pain of 56, placebo reduced pain roughly 19 points, and CD reduced pain roughly 4 points more than placebo in larger RCTs and roughly 12 points more than placebo in smaller RCTs. • In 6 systematic reviews1 of combined GA and CD versus placebo, only 1 RCT examined meaningful pain reduction and found the combined effect similar to that of the components alone.5 The change on a 100-point pain scale found combined effect not different from placebo.4,6 • Limitations: mostly knee osteoarthritis studies.2 There was no benefit of GA or CD compared with placebo in publicly funded,2 higher-quality, or larger RCTs.3,7,8

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