Glucosamine arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Osteoarthritis (OA), the most common type of arthritis, is a degenerative disease of the joints.

Although it has an inflammatory component, OA is primarily a "wear-and-tear" disease involving degeneration of joint cartilage and formation of bony spurs within various joints.

Trauma to the joints, repetitive occupational usage, and obesity are risk factors. The main goal of treatment is to relieve pain.

In recent years, glucosamine and chondroitin have been widely promoted as a treatment for OA. Glucosamine, an amino sugar, is thought to help with the formation and repair of cartilage. Chondroitin, a carbohydrate, is a component of cartilage that is thought to promote water retention and elasticity and to inhibit enzymes that break down cartilage. Both compounds are manufactured naturally.

Laboratory studies suggest that glucosamine may stimulate production of cartilage-building proteins. Other research suggests that chondroitin may inhibit production of cartilage-destroying enzymes and combat inflammation as well.

Glucosamine supplements are derived from shellfish shells; chondroitin supplements are generally made from cow cartilage. Human studies have shown that either one may relieve arthritis pain and stiffness with fewer side effects than conventional arthritis drugs. Unfortunately, studies regarding their effectiveness as treatments for OA are contradictory. Another issue is that dietary supplement manufacture is not regulated; therefore, product quality (especially of chondroitin products) is not assured.

Some published studies comparing glucosamine or chondroitin to various standard medications have found that the drugs worked faster than the supplements. But they also found that several months after treatment ended, the analgesic effect of the supplements remained stronger.

In March 2000, a study in the Journal of the American Medical Association concluded:

Trials of glucosamine and chondroitin preparations for OA symptoms demonstrate moderate to large effects, but quality issues and likely publication bias suggest that these effects are exaggerated. Nevertheless, some degree of efficacy appears probable for these preparations [1].

An accompanying editorial cautioned:

As with many nutraceuticals that currently are widely touted as beneficial for common but difficult-to-treat disorders, the promotional enthusiasm often far surpasses the scientific evidence supporting clinical use. [2].

In 2001, the Lancet published the results of a three-year double-blind clinical trial involving 212 people with osteoarthritis who took either glucosamine or a placebo. The researchers found that symptoms improved 20% to 25% in the glucosamine group but worsened slightly in the placebo group. The x-ray examinations showed that serious narrowing of the knee-joint space -- a sign of progression of the disease -- occurred in only half as many patients taking glucosamine as in those receiving the placebo [3].

However, the Medical Letter has reported that the x-rays were questionably standardized; there was little correlation between the joint-space changes and the symptoms; and there was no difference between the glucosamine and placebo groups in the use of standard medication to "rescue" patients [4].

As for chondroitin, a recent analysis of the combined results of seven randomized, controlled trials indicated that the supplement may reduce osteoarthritis symptoms and improve function by an average of some 50%, although the studies had flaws that may exaggerate the benefits.

The results of this trial-GAIT trial funded by the National Institutes of Health- were released in early 2006. While glucosamine/ chnodroitin do not appear to be effective for mild OA, they do seem to be effective for moderate to severe OA. Bottom Line: Keep taking your supplements.)

In the United States, glucosamine and chondroitin products are marketed as "dietary supplements."

No study so far has found any serious side effects from either glucosamine or chondroitin. The most common side effects are increased intestinal gas and softened stools. However, animal research has raised the possibility that glucosamine may worsen insulin resistance, a major cause of diabetes. So far, studies in humans have not substantiated that risk. Nevertheless, people with diabetes should monitor their blood-sugar level particularly carefully when using that supplement. There have been no reports of allergic reactions to glucosamine. But since it's made from shellfish shells, people who are allergic to seafood should use it cautiously, watching for reactions, or avoid it entirely. As for chondroitin, it can cause bleeding in people who have a bleeding disorder or take a blood-thinning drug.

Consumer Reports states:

The long-term safety and efficacy of glucosamine and chondroitin remain unclear. Still, our medical consultants say there's enough evidence to conclude that products containing the amounts of glucosamine, chondroitin, or both that worked in the clinical trials might be worth trying for people with osteoarthritis -- particularly if they've experienced or are likely to experience significant side effects from conventional painkillers. (Those amounts were 1,500 milligrams per day of glucosamine salt -- glucosamine bound to another molecule -- and 1,200 milligrams of chondroitin salt.)

It may take two months to produce any significant improvement. If you see no effect by then, it's probably best to try a different approach [6]

The Medical Letter, which is the medical profession's most respected drug advisory publication, is more conservative:

Glucosamine with or without chondroitin may have some beneficial effect on osteoarthritis, and studies up to 3 years in duration have found no more adverse effects than with placebo, but most Medical Letter consultants are skeptical. Whether glucosamine offers any advantages over better established drugs such as acetaminophen, traditional NSAIDS or selective Cox-2 inhibitors remains to be determined. As with other dietary supplements, the quality and purity of the ingredients may vary [4].

Decisions to use glucosamine or chondroitin must be based on information that is far less complete than is desirable. In addition, product quality control is a significant problem.

In short...
There have been many double blind placebo controlled trials and studies done on glucosamine. In many trials and studies, glucosamine has shown to be very effective at:

• Easing osteoarthritis pain
• Easing articular joint pain
• Rehabilitating damaged cartilage
• Slowing deterioration of cartilage from osteoarthritis
• Improving mobility
• Stimulating the production of proteoglycans, glycosaminoglycans, and synovial fluid

Almost every major nutraceutical or vitamin company puts out a glucosamine product, and today it can be bought in just about every food store, health food store, vitamin store, wellness clinic, and chiropractors office.

However, in the rush to gain market share with their glucosamine product, companies often put out products with little regard to the quality of the product being produced. They use medium or low grade glucosamine products to save money.

All glucosamine products are not the same. There are six main factors some manufacturers claim that you need to analyze when selecting a glucosamine product. These are:

• Amount of glucosamine per daily dose
• Type of Glucosamine
• Quality of Ingredients
• Delivery System
• Synergistic Ingredients
• Price Per Day
If you're not getting the results you should be, it's possible your glucosamine preparation is either not being absorbed properly or it is poor quality.

As with any product, do your homework, ask your physician, and read the label!

1. McAlindon TE and others. Glucosamine and chondroitin for treatment of osteoarthritis: A systematic quality assessment and meta-analysis JAMA 283:1469-1475, 2000. [Full-text version is accessible online for JAMA subscribers.]
2. Tanveer E, Anastassiades TP. Glucosamine and chondroitin for treating symptoms of osteoarthritis: Evidence is widely touted but incomplete. JAMA 283:1483-1484, 2000. [Full-text version is accessible online for JAMA subscribers.]
3. Reginster JY and others. Long-term effects of glucosamine sulfate on osteoarthritis progression: a randomized, placebo-controlled trial. Lancet 357:251-256, 2001.
4. Update on glucosamine for osteoarthritis. Medical Letter 43:111-112, 2001.
5. Product review: GLUCOSAMINE and CHONDROITIN. ConsumerLab Web site, accessed Jan 22, 2002.
6. Joint remedies. Consumer Reports, Jan 2002.
7. Vital Nutrients recalls Joint Ease & Verified Quality Brand Joint Comfort Complex because of adverse health risk associated with aristolochic acid. News release, May 24, 2001.
8. Study of the efficacy of glucosamine and glucosamine/chondroitin sulfate in knee osteoarthritis. NIH Web site, accessed Jan 22, 2002.

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