How glucosamine help 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.
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Glucosamine – a natural supplements- may or may not help with osteoarthritis. Whether it does or doesn’t depends on the study you are reading.
An estimated 23 million adults in the United States have osteoarthritis, which is a condition caused by wear and tear of cartilage in joints. Some evidence has suggested that glucosamine, a natural substance found in cartilage, helps the body repair itself. Another natural substance, called chondroitin sulfate, has also been considered a possible arthritis reliever. The two are often administered in a combination preparation.
In the January 27, 2001 issue of The Lancet, glucosamine was reported to protect against joint destruction.
The results of this major three-year Belgian study were eye-opening. As in previous trials lasting shorter periods of time, patients taking glucosamine reported far greater pain improvements than those who went without the supplement. But in this study, Belgian researchers at the University of Liege, found an effect that had not been seen with glucosamine before. Glucosamine prevented knee joints from narrowing, a sign that the cartilage that normally cushions the bones remained intact.
"For the first time, we have shown that a compound may be able to at least slow down the progression of osteoarthritis," reported the lead investigator, Dr. Jean-Yves Reginster, when the study results were first calculated.
The investigators followed strict scientific protocol. They recruited 212 people who suffered severe osteoarthritis confirmed by X rays. Next, the patients were asked how much pain and stiffness they had and how well they could get around. Their symptoms were rated on a scale ranging from mild to moderate, the same type of criteria used by U.S. researchers.
In a randomized, controlled fashion, half the volunteers were then given 1,500 mg of glucosamine sulfate a day, and the others received a placebo. Three years later, patients who took glucosamine sulfate reported feeling 20 percent better than before, but the placebo group said they felt about 8 percent worse. X rays taken after three years also showed that the knee joints of glucosamine users had not lost cartilage. In contrast, the knee joints of those who took a placebo had narrowed considerably.
Glucosamine appears to offer certain advantages over such standard arthritis treatments as Tylenol and ibuprofen. These drugs can quickly relieve osteoarthritis pain and stiffness, but they do nothing to stop joint damage. There is at least some evidence that glucosamine does.
The body uses glucosamine to build proteoglycans, compounds that give cartilage its resilience.
In the new U.S. study (GAIT), researchers followed almost 1,600 patients with painful knee osteoarthritis for six months. The patients were randomly assigned to different treatments -- glucosamine hydrochloride, chondroitin sulfate, the painkiller celecoxib (Celebrex), or a placebo. Regardless of what drug or supplement they took, they were allowed to take daily doses of acetaminophen (Tylenol).
Celecoxib relieved pain, but the supplements did not for a majority of the patients, and neither of them did a better job than a placebo.
However, the study indicated that a combination of glucosamine and chondroitin might help patients with moderate or severe osteoarthritis. Those patients made up about 20 percent of participants in the study; the other 80 percent had milder forms of the disease.
Summary of results from GAIT (Glucosamine / Chondroitin Arthritis Intervention Trial)
• Results revealed that the combination of glucosamine and chondroitin is better than placebo but the benefits seem to depend on severity of pain.
• In patients with moderate-to-severe osteoarthritis knee pain, 79.2% taking glucosamine/chondroitin combination experienced pain relief.
• For patients taking celecoxib, 69.4% experienced pain relief. (65.7% experienced relief taking glucosamine alone and 61.4 % taking chondroitin alone. 54.3% taking placebo reported pain relief.
• In patients with mild knee osteoarthritis pain, the glucosamine chondroitin combination was not significantly more effective than placebo.
Information from the Arthritis Foundation
The Arthritis Foundation has said in an accompanying statement that it "believes that, based on the findings from this study and the supplements' safety and cost-effectiveness, the combination of glucosamine and chondroitin should be considered by patients and physicians as part of an overall treatment plan for painful knee OA. Further research is needed to determine exactly how glucosamine and chondroitin work, as well as the possible effectiveness of these supplements on limiting the progression of cartilage damage."
Dr. Jason Theodosakis, who helped propel glucosamine to fame in his best-selling book, The Arthritis Cure (St. Martin’s, 1997), recommends that glucosamine be taken along with the cartilage-building compound chondroitin sulfate.
Although studies are lacking, other supplements may also be worth trying along with glucosamine if that compound alone is not effective. These include the supplement MSM (750 mg, 3 times a day); the B vitamin niacinamide (1,000 mg, 3 times a day; at this high dose, use only under a doctor’s supervision); the herb boswellia (1 pill, standardized to contain 150 mg boswellic acid, 3 times a day); and SAMe (400 mg twice a day for two weeks, then 200 mg twice a day).
In the current Belgian study, glucosamine alone proved to be an effective arthritis fighter. The project used a special patented version of glucosamine sulfate, which can be purchased only by prescription in Europe. In the U.S., glucosamine is widely available in pharmacies and health-food stores. In fact, Americans spend some $400 million on glucosamine products every year. The hard part is to find a reliable brand.
Dr. Theodosakis has found plenty of bad glucosamine products among the 100 or so brands on the market. As with other supplements, some did not contain what was stated on the label. "It's really buyer beware," he says. His findings underline the importance of sticking with brands you trust from reliable manufacturers.
If you’re thinking of trying glucosamine, it may be best to use glucosamine sulfate rather than glucosamine hydrochloride or glucosamine chlorohydrate. The latter forms may also be effective, but the sulfate form of glucosamine has been tested most extensively.
Suggested dose: Take 500 mg of glucosamine sulfate 3 times a day, for a total daily dose of 1,500 mg. The supplement is slow to act, so up to a month may pass before you start to feel better. You can also take Tylenol or another pain reliever for two weeks or so, and then just glucosamine if pain and stiffness subside. Glucosamine can also be combined with other supplements (see above). Consult your doctor before discontinuing prescription drugs.
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