Effectiveness of a Combination of Glucosamine–Chondroitin, Chitosan, and Phytoestrogen with Paracetamol on Synovial Biomarkers and Clinical Parameters in Postmenopausal Women with Knee Osteoarthritis: A Pre–Post Experimental Study

Kermawan, Putu; Calisto, Kadek Egadia; Wijaya, Nyoman Satria Nakayoshi; Yogananda, Ketut Shri Satya; Wiwekananda, Ketut Shri Satya

doi:10.22038/abjs.2026.92605.4197

Effectiveness of a Combination of Glucosamine–Chondroitin, Chitosan, and Phytoestrogen with Paracetamol on Synovial Biomarkers and Clinical Parameters in Postmenopausal Women with Knee Osteoarthritis: A Pre–Post Experimental Study

Articles in Press

Document Type : RESEARCH PAPER

Authors

Putu Kermawan ¹

Kadek Egadia Calisto ²

Nyoman Satria Nakayoshi Wijaya ³

Ketut Shri Satya Yogananda ²

Ketut Shri Satya Wiwekananda ²

¹ Department of Orthopedic Surgeon, Faculty of Medicine, Universitas Pendidikan Ganesha, Bali, Indonesia

² Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

³ Faculty of Medicine, Udayana University, Bali, Indonesia

10.22038/abjs.2026.92605.4197

Abstract

Objectives: This study aimed to evaluate the effectiveness of a combination of glucosamine–chondroitin, chitosan, and phytoestrogen with paracetamol on biochemical (sIL-6R, IL-10, COMP) and clinical (VAS, WOMAC) outcomes in postmenopausal women with knee osteoarthritis.

Methods: This was an uncontrolled, single-arm pre-post study that assessed the effects of two weeks of administration of a combination of glucosamine-chondroitin, chitosan, and phytoestrogen with paracetamol on biochemical and clinical outcomes in 30 postmenopausal women with knee OA. The synovial fluid biomarkers measured were sIL-6R, IL-10, and COMP. Assessment of pain and function used the VAS and WOMAC. Nonparametric analysis and parametric analysis were used accordingly as per the distribution of data.

Results: The COMP level showed a significant reduction after intervention, from 124.13 ± 59.33 ng/mL to 87.20 ± 30.98 (P < 0.01), reflecting a decline in the rate of cartilage degradation. sIL-6R decreased from 66.33 (69.17) to 46.33 (68.33) ng/mL (P = 0.36), while IL-10 increased from 20.4 (41.50) to 34.4 (39.00) ng/mL (P = 0.07), indicating anti-inflammatory behavior. Clinically, VAS pain scores improved from 6.65 ± 0.69 to 6.38 ± 0.66 (P < 0.01), and WOMAC scores improved from 56.07 ± 3.43 to 52.17 ± 2.99 (P < 0.01).

Conclusion: Glucosamine-chondroitin, chitosan, and phytoestrogen in combination with paracetamol was associated with significant improvement in pain and function, and favorable biomarker modulation, in postmenopausal women with knee OA. This combination may provide complementary biochemical and clinical benefits.

Keywords

knee osteoarthritis

postmenopausal

glucosamine-chondroitin

chitosan

phytoestrogen

Subjects