Glucosamine – Heart Disease and Osteoarthritis

Glucosamine associated with chondroitin Sulfate is a supplement taken for joint health and to relieve joint pain. Several studies have shown unclear results regarding its efficacy in arthritis, but it has been shown to be safe.

A study in the Annals of Rheumatologic Disease suggested it reduced the symptoms of knee pain from osteoarthritis by modifying the inflammatory response not suppressing the symptoms as non-steroidal anti-inflammatory drugs do.  In the MOVES trial, glucosamine was compared with Celebrex (celecoxib) for relief of knee pain in osteoarthritis. At six months the two were noted to be equivalent in reducing pain. Glucosamine did not produce the gastrointestinal side effects that Celebrex and other NSAIDs can while reducing pain.

In an editorial, written in the online journal Primary Care, Dr. David Rakel looked at 466,000 patients entered into the United Kingdom Biobank database who took glucosamine products for arthritis. They were followed for seven years.  Over that period, the glucosamine users had a 15% lower incidence of cardiac events than non-users. Smokers showed a higher reduction in cardiac events – almost 37%.  They attribute this to a reduction in systemic inflammation as evidenced by a decrease in the inflammatory marker levels of C Reactive Protein in glucosamine users.

In general, glucosamine is usually taken at a dose of 750 mg twice a day.  It is combined with chondroitin which increases the viscosity of the synovial (joint) fluid. Glucosamine helps retain fluid in the joint. It usually takes about six to eight weeks to see a positive effect.   For reasons that are not entirely clear, it works best in lean individuals rather than obese ones.

Glucosamine is made from Crustacean shells so those people with a shellfish allergy should avoid it.

Advertisements

Exercise Induced Muscle Soreness May Not Benefit from Regular Use of NSAID’s

The June 11, 2012 issue of MedPage carries coverage of the meeting of the European League Against Rheumatism where work by Matthias Rother, MD, PhD suggested that taking Ketoprofen or even Celecoxib (Celebrex) for exercise induced muscle soreness may not be a great idea.

The study looked at 64 healthy volunteers who were asked to walk down stairs totaling 400 vertical meters – similar to walking all the way down from the top of a 100-story building.  Forty of the volunteers were randomized to take 200 mg of Celebrex or a placebo twice a day. Twenty-four of the participants were randomized to take Ketoprofen or a placebo.

The patients in the Ketoprofen reported no improvement in pain.  In fact, their pain lasted longer (122 hours) than the placebo groups pain (105 hours).  Patients taking the Celecoxib had a mild pain improvement – so mild that it was not felt to be statistically significant.  This led the researchers to conclude that NSAID’s did not provide significant pain relief to justify their use in post-exercise muscle soreness. They went on to say that muscle inflammation and soreness are part of the inflammatory reaction following exercise that is “essential for recovery.”

This was a small study and it is hard to conclude anything. I will still recommend RICE therapy (Rest, Ice, Compression, Elevation) immediately following post injury or exercise.  Celecoxib (Celebrex) did reduce pain by 12- 13%, so, possibly the dosage and frequency of administration of the NSAID needs to be looked at as well. If my patients do not have a medical reason to avoid NSAIDs, they will still be advised to try them for work and exercise related aches and pains.