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
Chronic joint problems and arthritis affect 25 per cent of Americans.
Osteoarthritis, the most common type of arthritis, is a degenerative joint disease and affects almost 40 million people Americans. Osteoarthritis is a 'wear-and-tear' disease involving degeneration of joint cartilage and the formation of bony spurs within joints. When cartilage becomes worn, symptoms of osteoarthritis appear in the form of pain and stiffness.
Osteoarthritis usually affects weight-bearing joints. Repetitive occupational usage, trauma to the joints, and obesity are risk factors.
Most people over 60 years of age suffer from osteoarthritis to some extent. Conventional medicines do not stop or slow the progression of osteoarthritis. Traditional medical treatment so far consists of palliative therapies to control the pain associated with osteoarthritis.
NSAIDs, non-steroidal anti-inflammatory drugs, are the traditional drugs used for arthritis. While effective for many, they do have myriad side effects.
Glucosamine is a promising treatment for arthritis and has been shown in numerous double-blind, placebo-controlled studies to have a beneficial effect. In these studies, glucosamine has been shown to slow the progression of osteoarthritis, and decrease pain from arthritis.
Glucosamine is an aminopolysaccharide (a combination of an amino acid - glutamine and a sugar - glucose). Glucosamine is concentrated in joint cartilage where it is incorporated in longer chains known as glycosaminoglycans and finally into very large structures known as proteoglycans. The proteoglycans function to attract water into the joint space for lubrication of the cartilage during movement.
It has been claimed that glucosamine reverses osteoarthritis, protects joints and tendons from injury, and decreases inflammation.
The principle behind glucosamine supplementation is that the glucosamine is incorporated into proteoglycans of joint cartilage to maintain structure and repair damage. Glucosamine may also stimulate chondrocytes (cartilage cells) to begin producing healthy new cartilage matrix (both collagen and proteoglycans). There are numerous European studies showing a benefit of glucosamine supplements for relief of joint pain and stiffness due to arthritis. Many of the studies have been criticized for lack of scientific control, short duration, and small size, but recent meta-analyses of the smaller studies have supported a beneficial role of glucosamine supplements as a safe and effective approach to treating osteoarthritis.
In general 1-3 months of glucosamine supplementation seems to be more effective than a placebo and at least as effective as analgesics and non steroidal anti-inflammatory drugs, in reducing the joint pain of osteoarthritis.
Occasional symptoms of gastrointestinal discomfort and soft stools have been noted, but no significant adverse effects have been noted with glucosamine supplementation. Although there have been no long-term safety studies conducted in humans, animal studies on glucosamine have found it to be non-toxic.
An editorial in the Lancet (Volume 354, Number 9176 July, 31 1999) suggested that glucosamine might contribute to insulin resistance in diabetics or those at risk for diabetes. Insulin resistance - a decrease in the body's response to the blood sugar-regulating hormone insulin - is a condition which is a precursor to type-2 (adult-onset) diabetes. Increasing insulin resistance may result in more difficult to control blood sugar levels.
Therefore, it's important to monitor blood sugar levels in diabetics taking glucosamine.
There have been no reports of allergic reactions to glucosamine. But since glucosamine is made from shellfish shells, people who are allergic to seafood should use it cautiously, watching for reactions. As for chondroitin, it can cause bleeding in people who have a bleeding disorder or take a blood-thinning drug.
Good quality glucosamine supplements are not inexpensive.
No dose-response studies have been conducted with glucosamine supplements. Almost all oral supplementation studies on glucosamine have used 1500mg per day - usually in 3 divided doses of 500mg each. While this level appears to be an effective dose, there is no information to indicate that a higher dose would work better or faster - or that a lower dose would be less effective. What is recommended is to take 1500mg of glucosamine a day for the first 60-90 days, then reduce intake of 250-750mg per day as a "maintenance level."
A 2000 study (1) published in the Journal of the American Medical Association (JAMA) showed that glucosamine and chondroitin appears to help relieve symptoms of osteoarthritis. The authors of the study analyzed 15 previously published studies on the effects of glucosamine and chondroitin on osteoarthritis.
The findings of the study, adjusted for variability and quality in the supplements, showed a significant benefit from glucosamine supplements as well as from chondroitin supplements.
In March 2000, the study in the Journal of the American Medical Association (JAMA) concluded:
"Trials of glucosamine and chondroitin preparations for osteoarthritis 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)
In 2001, the Lancet published the results of a 3-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 50% as many patients taking glucosamine as in those receiving the placebo. (2)
It is important to use high quality products. There is evidence showing that these cartilage precursors are effective for osteoarthritis- but not for rheumatoid arthritis. The quality of the preparation is critical to having good results.
Glucosamine, an amino sugar, has been shown to promote the formation and repair of cartilage. Chondroitin, a carbohydrate, is a cartilage component which promotes water retention and elasticity and inhibits the enzymes which break down cartilage.
Glucosamine supplements are derived from shellfish shells, while 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.
The higher the quality of glucosamine used, the greater the pain relief will be. Since the nutritional supplement industry in the United States is largely unregulated, use caution in purchasing glucosamine. You need to look for the highest quality form of glucosamine, pharmaceutical grade, if you want the best pain relief.
Also crucial to the effectiveness of the glucosamine supplement is the other ingredients which may be included in the product. It is suggested that products which combine glucosamine with s chondroitin may be more effective than either ingredient alone. The synergy between these different compounds makes for a more effective supplement.
It may take up to 2 months for glucosamine to produce any significant improvement.
The GAIT trial published by the National Institutes of Health showed glucosamine to be ineffective for mild disease but possibly effective for moderate to severe disease.
The supplements that is endorsed most is Joint Food- available at the Arthritis Treatment Center (go to their website: www.arthritistreatmentcenter.com). Joint Food is the purest form of glucosamine available, and it is also fully bioabsorbable and bioavailable, meaning it goes to where it's needed- your joints.
(1) McAlindon TE and others. Glucosamine and chondroitin for treatment of osteoarthritis: A systematic quality assessment and meta-analysis JAMA 283:1469-1475, 2000.
(2) Reginster JY and others. Long-term effects of glucosamine sulfate on osteoarthritis progression: a randomized, placebo-controlled trial. Lancet 357:251-256, 2001.
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