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.

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Glucosamine and Chondroitin Sulfate Preserves Knee Cartilage in Osteoarthritis

My brother in law is a well-respected researcher and biochemist. Thirty years ago he treated his post exercise aching knees with glucosamine and chondroitin sulfate and felt better. Since then he is a fan. Although he is a firm believer in the scientific method and double blind controlled research studies, we could not find any research to support his observations.   The discussion then turned to, “it helps me and it doesn’t hurt me so why not?”

In a double blind study sponsored by the National Institute of Health known as GAIT, 1500 or more patients with osteoarthritis and a painful knee were randomized to either receive glucosamine and chondroitin sulfate, each substance individually, Celebrex or placebo for six months. The results showed neither led to reduced pain.

Several other studies were as non-conclusive. In the few studies where pain was reduced the study methods and design were criticized and the results were felt to be questionable as were the conclusions of the researchers.   There was nothing positive to say about glucosamine and chondroitin sulfate until a recent study by Martel- Pellitier, Canadian researchers published in Arthritis Care and Research those individuals who took the combination for six years or greater tended to preserve their knee cartilage better than those who did not.  While the knee cartilage was maintained there was no difference in pain or complaints of symptoms between the treated and non- treated group. They believe that by preserving knee cartilage over time there may be less necessity for that joint to be replaced eventually.

I am sure over time this will be studied as well. In the meantime glucosamine and chondroitin sulfate seems to have little toxicity and ultimately my brother in law may be on to something positive.

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.