For Arthritis of the Knee, Glucosamine and Chondroitin Sulfate is the Best Medicine to Control Long Term Symptoms of Joint Change

A paper presented at the recent American College of Rheumatology annual meeting reviewed all the research results on use of medications to control joint changes and pain in arthritic knees caused by osteoarthritis. Lucio C, Rovati, MD, of the Clinical Research Department of Rottpharm Biotech, Monza, Italy and the University of Milano Vicocca, Milano, Italy and colleagues presented the first systematic review and meta-analysis to investigate the effects of available medication used for at least a year to treat knee osteoarthritis. Their findings were published in the online journal MedPage Today. They reviewed 5992 articles discussing treatment with acetaminophen, calcitonin, celecoxib (Celebrex), chondroitin sulfate, hyaluronic acid, indomethacin, naproxen, vitamin D and zoledronic acid plus several others. The only medication that had a significant long term beneficial effect on pain and physical function was glucosamine and chondroitin sulfate. This does not mean that Tylenol, Aleve, Advil, Celebrex or other nonsteroidal anti-inflammatory drugs did not provide some immediate short term pain relief. It means that over a year they didn’t maintain the joint integrity and consistently maintain or improve function.

Glucosamine Study: “It Doesn’t Work”

C. Kent Kwoh, M.D., of the University of Arizona in Tucson reported results of a study to examine whether individuals who take glucosamine showed evidence of structural benefits in the treatment of their knee arthritis on MRI scans and in biochemical markers of cartilage deterioration. The study appeared in the online version of Arthritis & Rheumatology.

GlucosamineThere is a big retail market for glucosamine with more than one in ten U.S. adults using it for relief of arthritic pain. Many studies have been done but most were sponsored by manufacturers of glucosamine so the results are felt to be reliable. Worldwide sales of glucosamine top $2 billion dollars per year.

To evaluate the substance, Dr. Kwoh found 201 volunteers from his community with chronic knee pain. The patient’s mean age was 52 years old. More than 50% were women. Their body mass index averaged 29kg/m2 indicating they were not grossly overweight. They were randomized and blinded into two groups one receiving 1500mg of glucosamine hydrochloride (Reganasure) or a placebo in a 16 ounce bottle of a diet beverage. They then followed the patients for six months recording their pain evaluations, their changes on MRI images of their knees and noting any difference in the levels of C-terminal telopeptide of type II collagen – a marker of collagen deterioration. The results showed no differences between the glucosamine and placebo group.

Joanne Jordan, M.D., Chief of Rheumatology University of North Carolina noted that the study showed that glucosamine at this dose and for this length of time does not alter or help arthritis sufferers. “Nobody wishes it worked more than me.” said Nancy E Lane, M.D., director of the Center for Musculoskeletal Health at the University of California Davis in Sacramento. “It doesn’t work. There’s a group of patients who get a reduction in pain when they take glucosamine because glucosamine is a sugar and sugars can be analgesic to some people.”

No one has shown that glucosamine is harmful to anyone. It would be helpful if the study ran for more than six months since arthritis is a long term episodic disease. The investigation of supplements and alternative treatments is long overdue so this scientific study is welcome. It just needs to be continued for a longer period of time to satisfy those who use the product and have gotten relief.