Comparative effectiveness of S-adenosylmethionine and etoricoxib in newly diagnosed patients of knee osteoarthritis


  • Prashant S. Chaudhary Department of Pharmacology, MGM Medical College, Aurangabad, Maharashtra
  • Shweta V. Deshmukh Department of Community Medicine, MGM Medical College, Aurangabad, Maharashtra
  • Deepali L. Jaybhaye Department of Pharmacology, MGM Medical College, Aurangabad, Maharashtra
  • Sukhmeen K. Johar Department of Pharmacology, MGM Medical College, Aurangabad, Maharashtra
  • Bajrang L. Pandey Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
  • Gagan A. Sharma Medical Services, Akumentis Healthcare Ltd, Thane, Maharashtra, India



Knee injury and osteoarthritis outcome score, Nitric oxide, Nonsteroidal anti-inflammatory drug, Osteoarthritis, S-adenosylmethionine


Background: Knee osteoarthritis is an important cause for morbidity in elderly people. Therapy is largely symptomatic with nonsteroidal anti-inflammatory drugs which pose risk in the elderly. Methionine is natural body constituent with novel property of blunting S-adenosylmethionine (SAMe) inflammatory process and cartilage degradation. The aim of this study was to compare effectiveness of SAMe, with standard etoricoxib therapy in newly diagnosed knee osteoarthritis cases.

Methods: 127 newly diagnosed knee osteoarthritis patients were randomized into two groups. 55 participants received treatment  of etoricoxib 600 mg extended release once daily for 90 days (group 1) and 72 received  etoricoxib 600 mg extended release once daily and SAMe 400 mg twice daily  for initial 15 days followed by SAMe once daily 400 mg as maintenance dose for next 75 days  (group 2). The outcomes were measured by knee injury and osteoarthritis outcome score (KOOS). Pre and post treatment KOOS scores of all cases were separately pooled to define the median for whole as well as components of KOOS parameters. Relative frequencies of cases with values around respective medians were compared by MOODS median test. Patient characteristics, disease characteristics were also examined for bearing on outcomes besides the treatment.

Results: SAMe treatment was associated with significantly greater improvement in symptoms, activities of daily life, spontaneous recreational activities and the quality of life compared to etoricoxib therapy. The therapy was well-tolerated.

Conclusions: The study confirms SAMe as superior therapeutic option in osteoarthritis. SAMe indeed has been reported to have specific anti-arthritic effects and promotive to general well-being.


Ndlovu MN, Denis H, Fuks F. Exposing the DNA methylome iceberg. Trends Biochem Sci. 2011;36(7):381-7.

Laird PW. Principles and challenges of genomewide DNA methylation analysis. Nat Rev Genet. 2010;11(3):191-203.

Eleswarapu SV, Leipzig ND, Athanasiou KA. Gene expression of single articular chondrocytes. Cell Tissue Res. 2007;327(1):43-54.

Burrage PS, Mix KS, Brinckerhoff CE. Matrix metalloproteinases: role in arthritis. Front Biosci. 2006;11:529-43.

Sokolove J, Lepus CM. Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis. 2013;5(2):77-94.

Laine L. Gastrointestinal Effects of NSAIDs and Coxibs. J Pain Symptom Management. 2003;25(2):32-40.

Courtney P, Doherty M. Key questions concerning paracetamol and NSAIDs for osteoarthritis. Ann Rheumatic Dis. 2002;61(9):767-73.

di Padova C. S-adenosylmethionine in the treatment of osteoarthritis. Review of the clinical studies. Am J Med. 1987;83(5):60-5.

Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study. Br J Dermatol. 2007;157(1):68-73.

Harmand MF, Vilamitjana J, Maloche E, Duphil R, Ducassou D. Effects of S-adenosylmethionine on human articular chondrocyte differentiation: an in vitro study. Am J Med. 1987;83(5):48-54.

Konig B. A long term (two years) clinical trial with S-adenosylmethionine for the treatment of osteoarthritis. Ann J Med. 1987;83(5A):89-94.

Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502.

Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64.

Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23(2):137-45.

Bottiglieri T. S-Adenosyl-L-methionine (SAMe): from the bench to the bedside—molecular basis of a pleiotrophic molecule. Am J Clini Nutr. 2002;76(5):1151-7.




How to Cite

Chaudhary, P. S., Deshmukh, S. V., Jaybhaye, D. L., Johar, S. K., Pandey, B. L., & Sharma, G. A. (2020). Comparative effectiveness of S-adenosylmethionine and etoricoxib in newly diagnosed patients of knee osteoarthritis. International Journal of Basic & Clinical Pharmacology, 9(3), 480–486.



Original Research Articles