chondroitin

Glucosamine and Chondroitin for Osteoarthritis

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Glucosamine and chondroitin are structural components of cartilage, the tissue that cushions the joints. Both are produced naturally in the body. They are also available as dietary supplements. Researchers have studied the effects of these supplements, individually or in combination, on osteoarthritis, a common type of arthritis that destroys cartilage in the joints.

Cartilage is the connective tissue that cushions the ends of bones within the joints. In osteoarthritis, the surface layer of cartilage between the bones of a joint wears down. This allows the bones to rub together, which can cause pain and swelling and make it difficult to move the joint. The knees, hips, spine, and hands are the parts of the body most likely to be affected by osteoarthritis.

How much do we know about Glucosamine and Chondroitin Supplements?

  • We have some information about the safety and usefulness of glucosamine and chondroitin from large, high-quality studies in people.

What do we Know About the Effectiveness of Glucosamine and Chondroitin Supplements?

  • Research results suggest that chondroitin isn’t helpful for pain from osteoarthritis of the knee or hip.
  • It’s unclear whether glucosamine helps with osteoarthritis knee pain or whether either supplement lessens osteoarthritis pain in other joints.

What do we Know About the Safety of Glucosamine and Chondroitin Supplements?

  • Studies have found that glucosamine and chondroitin supplements may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin). Overall, studies have not shown any other serious side effects.
  • If you take glucosamine or chondroitin supplements, tell your health care providers. They can do a better job caring for you if they know what dietary supplements you use.

Glucosamine

Major studies of glucosamine for osteoarthritis of the knee have had conflicting results.

  • A large National Institutes of Health (NIH) study, called the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), compared glucosamine hydrochloride, chondroitin, both supplements together, celecoxib (a prescription drug used to manage osteoarthritis pain), or a placebo (an inactive substance) in patients with knee osteoarthritis. Most participants in the study had mild knee pain.
    • Those who received the prescription drug had better short-term pain relief (at 6 months) than those who received a placebo.
    • Overall, those who received the supplements had no significant improvement in knee pain or function, although the investigators saw evidence of improvement in a small subgroup of patients with moderate-to-severe pain who took glucosamine and chondroitin together.
    • For more information on the trial, see the NCCIH Web page.
  • In several European studies, participants reported that their knees felt and functioned better after taking glucosamine. The study participants took a large, once-a-day dose of a preparation of glucosamine sulfate sold as a prescription drug in Europe.
  • Researchers don’t know why the results of these large, well-done studies differ. It may be because of differences in the types of glucosamine used (glucosamine hydrochloride in the NIH study vs. glucosamine sulfate in the European studies), differences in the way they were administered (one large daily dose in the European studies vs. three smaller ones in the NIH study), other differences in the way the studies were done, or chance.
  • More than 20 studies have looked at the effect of chondroitin on pain from knee or hip osteoarthritis. The quality of the studies varied and so did the results. However, the largest and best studies (including the NIH study discussed under the heading “Glucosamine” above) showed that chondroitin doesn’t lessen osteoarthritis pain.

In general, research on chondroitin has not shown it to be helpful for pain from knee or hip osteoarthritis.A few studies have looked at whether glucosamine or chondroitin can have beneficial effects on joint structure. Some but not all studies found evidence that chondroitin might help, but the improvements may be too small to make a difference to patients. There is little evidence that glucosamine has beneficial effects on joint structure.

Experts’ Recommendations

Experts disagree on whether glucosamine and chondroitin may help knee and hip osteoarthritis. The American College of Rheumatology (ACR) has recommended that people with knee or hip osteoarthritis not use glucosamine or chondroitin. But the recommendation was not a strong one, and the ACR acknowledged that it was controversial.

For Other Parts of the Body

Only a small amount of research has been done on glucosamine and chondroitin for osteoarthritis of joints other than the knee and hip. Because there have been only a few relatively small studies, no definite conclusions can be reached.

What the Science Says About Safety and Side Effects

  • No serious side effects have been reported in large, well-conducted studies of people taking glucosamine, chondroitin, or both for up to 3 years.
  • However, glucosamine or chondroitin may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin).
  • A study in rats showed that long-term use of moderately large doses of glucosamine might damage the kidneys. Although results from animal studies don’t always apply to people, this study does raise concern.
  • Glucosamine might affect the way your body handles sugar, especially if you have diabetes or other blood sugar problems, such as insulin resistance or impaired glucose tolerance.

More to Consider

  • If your joints hurt, see your health care provider. It’s important to find out what’s causing your joint pain. Some diseases that cause joint pain—such as rheumatoid arthritis—may need immediate treatment.
  • If you take warfarin or have blood sugar problems, make sure you talk to your doctor about potential side effects if you are considering or taking glucosamine or chondroitin supplements.
  • If you’re pregnant or nursing a child, it’s especially important to see your health care provider before taking any medication or supplement, including glucosamine or chondroitin.
  • Help your health care providers give you better coordinated and safe care by telling them about all the health approaches you use. Give them a full picture of what you do to manage your health.

Popular Arthritis Supplement Offers Unexpected Health Benefits

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Popular Arthritis Supplement Offers Unexpected Health Benefits

Heart disease remains the leading killer in the United States, claiming over 655,000 lives a year. In addition, 54 million people—almost a quarter of all American adults live with the painful, potentially debilitating disease of arthritis, the leading cause of work disability in the nation. Now, in a stroke of medical serendipity, it appears that a popular supplement may benefit both conditions at once.

An encouraging new study shows that glucosamine and chondroitin, commonly used to treat the pain and inflammation of arthritis, can also do “double duty” in reducing the risk of heart disease and the risk of death from cardiovascular disease conditions. Let’s take a closer look at the promising research.

Glucosamine Supplementation Linked to Surprising Health Effects

The study, conducted by researchers at West Virginia University (WVU) and published in the Journal of the American Board of Family Medicine, involved over 16,000 adults over age 40. After adjusting for age, sex, race, education, smoking status, and physical activity, the researchers came to a stunning conclusion.

They found that participants who took glucosamine and chondroitin daily for a year reduced the risk of death from any cause—by an astounding 39 percent. The supplementation also reduced cardiovascular deaths—including death from coronary artery disease, stroke, and other forms of heart disease—by 65 percent. In fact, glucosamine/chondroitin supplementation worked about as well as regular exercise in reducing the risk of death (although the researchers do not recommend that people forego exercising in favor of glucosamine).

“Does this mean … you should skip the gym [after work], take a glucosamine pill and go home instead? That’s not what we suggest,” said study leader Dana King, professor and chair of the Department of Family Medicine at WVU.

Still, Dr. King called the study results “encouraging” and characterized the impact as “pretty significant.”

Beneficial Glucosamine and Chondroitin Protect Against Deadly Heart Disease and Strokes

The researchers’ interest had been piqued by earlier studies, which involved participants taking the supplement for arthritis pain. Scientists conducting the research found that there were substantial associations between intake of glucosamine/chondroitin and mortality.

In one 2019 study published in the British Medical Journal, the scientists noted that glucosamine/chondroitin given for arthritis pain also significantly lowered the risk of heart disease and stroke. Specifically, the supplementation lowered the risk of adverse cardiovascular events by 15 percent, cardiovascular-related deaths by 22 percent, and coronary heart disease by 18 percent. For the WVU study, researchers took things a step further by setting out to further explore the link between regular consumption and mortality from cardiovascular conditions.

Multitasking: Glucosamine and Chondroitin Protect Both the Joints and Cardiovascular System

Glucosamine and chondroitin already exist naturally in the joints and synovial fluid, where they are necessary for the formation, lubrication, and preservation of protective, bone-cushioning cartilage.

With osteoarthritis, this cartilage wears down and causes painful contact between the bones in the joints. Glucosamine and chondroitin have shown the ability to treat the inflammation and cartilage loss of the condition. As a result, they can slow joint degeneration, reduce pain and tenderness, and even help rebuild stronger bones after fracture or injury. (By the way, glucosamine/chondroitin supplementation has also been shown to benefit the gut lining, thereby treating leaky gut and IBD [inflammatory bowel disease] as well).

But what accounts for glucosamine’s ability to protect the heart?

Researchers have found that glucosamine and chondroitin are powerful natural antioxidants and anti-inflammatory agents. They have been shown to reduce both oxidative stress and levels of C-reactive protein (an inflammatory marker associated with heart disease). In addition, they can help suppress pro-inflammatory cytokines, which could otherwise trigger disease-causing systemic inflammation. Supplementation has also been shown to reduce levels of harmful LDL cholesterol, potentially reducing the development of atherosclerosis that leads to heart disease.

For Maximum Benefit, Choose the Right Type of Glucosamine Supplement

Glucosamine and chondroitin supplements are made from chitin, a compound found in shellfish. Natural healers typically recommend supplementation with 1,500 mg a day of glucosamine and 1,200 mg a day of chondroitin (many products conveniently feature these two compounds together). Note: Most experts feel that glucosamine sulfate is superior to other formulations, such as glucosamine hydrochloride and N-acetyl glucosamine. Of course, check first with your integrative doctor before supplementing. And, if you are allergic to shellfish, don’t use glucosamine or chondroitin.

You can also increase your dietary intake of glucosamine and chondroitin with nourishing bone broth.

Remember, long-term, regular use of these supplements seems to yield the most benefits. Be aware that it may take eight to twelve weeks before improvements begin to appear.

Of course, more study is needed to further explore the life-prolonging benefits of glucosamine and chondroitin. And supplementation doesn’t appear to work for all osteoarthritis patients—some studies have shown unimpressive results. However, many people swear by them for their ability to ease pain and stiffness.

As for Dr. King, the lead author of the recent WVU study? The physician not only strongly recommends glucosamine and chondroitin, but goes a step further, acknowledging that he regularly takes the supplement himself.

Now that’s a solid endorsement.

glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee

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To determine the effect of glucosamine, chondroitin, or the two in combination on joint pain and on radiological progression of disease in osteoarthritis of the hip or knee.

Design Network meta-analysis. Direct comparisons within trials were combined with indirect evidence from other trials by using a Bayesian model that allowed the synthesis of multiple time points.

Main outcome measure Pain intensity. Secondary outcome was change in minimal width of joint space. The minimal clinically important difference between preparations and placebo was prespecified at −0.9 cm on a 10 cm visual analogue scale.

Data sources Electronic databases and conference proceedings from inception to June 2009, expert contact, relevant websites.

Eligibility criteria for selecting studies Large scale randomised controlled trials in more than 200 patients with osteoarthritis of the knee or hip that compared glucosamine, chondroitin, or their combination with placebo or head to head.

Results 10 trials in 3803 patients were included. On a 10 cm visual analogue scale the overall difference in pain intensity compared with placebo was −0.4 cm (95% credible interval −0.7 to −0.1 cm) for glucosamine, −0.3 cm (−0.7 to 0.0 cm) for chondroitin, and −0.5 cm (−0.9 to 0.0 cm) for the combination. For none of the estimates did the 95% credible intervals cross the boundary of the minimal clinically important difference. Industry independent trials showed smaller effects than commercially funded trials (P=0.02 for interaction). The differences in changes in minimal width of joint space were all minute, with 95% credible intervals overlapping zero.

Conclusions Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged.

source:BMJ