Glucosamine And Chondroitin - Do They Work For Joint Pain?

Glucosamine is derived from the shells of crabs andosteoarthritis of the knee to three years of
oysters, and is widely promoted as a naturaltreatment with glucosamine or placebo. Placebo
substance for the treatment of arthritis and jointtreated patients had a greater degree of joint space
pain. Glucosamine is felt to be a precursor ofnarrowing as measured by X-ray than glucosamine
proteoglycans. Proteoglycans are thought to be(-.19 mm v +.04 mm). There were statistically
instrumental in helping cartilage retain water and insignificantly greater reductions in glucosamine for
promoting formation of an elastic layer, which maymeasures of pain self ratings (-2 v -1.3) as well as
improve the functional characteristics of cartilage.measures of stiffness and function. One randomized
Chondroitin is a product derived from the cartilage ofplacebo controlled study showed efficacy with a
sharks and cows that is promoted for the preventionglucosamine-chondroitin combination compared to
of arthritis and the treatment of joint pain.placebo (4).
Chondroitin is often combined with glucosamineIn 2006 a large well-controlled study assigned 1583
where it is sold in health food stores. Chondroitinpatients with osteoarthritis of the knee to
stimulates the production of proteoglycans andglucosamine, chondroitin, a glucosamine/chondroitin
hyaluronic acid and inhibits proteolytic enzymes, whichcombination, celecoxib, or placebo for six months of
destroy cartilage. Chondroitin and glucosamine aretreatment. A positive treatment outcome was
often given in combination for osteoarthritis.defined as a 20% change in knee pain severity. Sixty
Most of the earlier studies of glucosamine andpercent of placebo patients responded to treatment
chondroitin were performed by manufacturers andcompared to 67% of glucosamine/chondroitin
were not well controlled (1). A meta-analysispatients, a difference that was not statistically
performed in 2000 of studies of glucosamine andsignificant. Celecoxib had a 70% response that was
chondroitin found that studies funded by supplementstatistically significantly better than placebo. A
manufacturers resulted in more favorable results forsubgroup of patients with moderate to severe pain
the supplement combo than independent studies;at baseline did significantly better with glucosamine
few of the manufacturers' studies were properlychondroitin than placebo (79% response v 54%) (5).
controlled. Overall there was a moderate effect forIn summary the glucosamine and chondroitin
both, and the authors concluded that some degreecombination shows some efficacy for treatment of
of efficacy was probable (1).osteoarthritis.
Only one of the studies reviewed in 2000 reported1. McAlindon, T.E., LaValley, M.P., Gulin, J.P., Felson, D.T.
that patients definitely did not know whether theyGlucosamine and chondroitin for treatment of
were being given a supplement or a placebo. In thatosteoarthritis: A systematic quality assessment and
study, 252 patients with osteoarthritis of the kneemeta-analysis. Journal of the American Medical
were randomly assigned to receive four weeks ofAssociation. 2000;283(11):1469-1475.
glucosamine or placebo. Glucosamine was associated2. Reginster, J.-Y., Deroisy, R., Rovati, L.C., Lee, R.L.,
with a drop in pain ratings from 10.6 to 7.5 versusLejeune, E., Bruyere, O., Giacovelli, G., Henrotin, Y.,
10.6 to 8.4 in placebo; fifty two percent ofDacre, J.E., Gossett, C. Long-term effects of
glucosamine patients had a clinically significant changeglucosamine sulphate on osteoarthritis progression: a
as measure by a three-point drop on an index ofrandomised, placebo-controlled clinical trial. Lancet.
arthritis severity compared to 37% on placebo.2001;357:251-256.
These differences were statistically significant.3. Rindone, J.P., Hiller, D., Collacott, E., Nordhaugen, N.
More recently several randomized placebo controlledRandomized, controlled trial of glucosamine for
trials have been performed.treating osteoarthritis of the knee. Western Journal
In one study 212 patients with osteoarthritis of theof Medicine. 2000;172(2):91-94.
knee were assigned to placebo or glucosamine for4. Lefler, C.T., Philippi, A.F., Leffler, S.G. Glucosamine,
three years of treatment. Patients on placebo had achondroitin, and manganese ascorbate for
greater narrowing of the disk space in the kneedegenerative joint disease of the knee or low back: a
compared to glucosamine as measured on X-ray (-.31randomized, double-blind, placebo-controlled pilot
mm v -.06 mm). Glucosamine patients had astudy. Military Medicine. 1999;164:85-91.
significant improvement in pain ratings compared to5. Clegg, D.O., Reda, D.J., Harris, C.L., Klein, M.A., O'Dell,
placebo. Glucosamine showed no increase in sideJ.R., Hooper, M.M., Bradley, J.D., Bingham, C.O., 3rd,
effects compared to placebo (2).Weisman, M.H., Jackson, C.G., Lane, N.E., Cush, J.J.,
In another study 98 males with osteoarthritis of theMoreland, L.W., Schumacher, H.R., Jr., Oddis, C.V.,
knee were assigned to glucosamine or placebo forWolfe, F., Molitor, J.A., Yocum, D.E., Schnitzer, T.J.,
two months of treatment. There was no differenceFurst, D.E., Sawitzke, A.D., Shi, H., Brandt, K.D.,
in pain ratings between patients treated withMoskowitz, R.W., Williams, H.J. Glucosamine,
glucosamine (3.3) and placebo (3.5) (3). Glucosaminechondroitin sulfate, and the two in combination for
was also associated with more side effects, includingpainful knee osteoarthritis. New England Journal of
loose stools, nausea, heartburn, and headache.Medicine. Feb 23 2006;354(8):795-808.
Another study randomized 202 patients with