AthletePlus - Springdale, Arkansas - Athlete Plus - Physical Therapy - Sports Training - Athlete Plus - Speed Training - AthletesPlus - Core Training
| AthletePlus - Springdale, Arkansas - Athlete Plus - Physical Therapy - Sports Training - Athlete Plus - Speed Training - AthletesPlus - Core Training |
Phone: 479-751-THER (8437) |
      |
 |  |
  |
Important Points  Some studies have shown that glucosamine does reduce pain in individuals with osteoarithritis, but do not decrease joint space. Most studies have shown 1500 mg Gs and 1200 chondroitinsulfate are taken per day. Use of glucosamine for other diagnoses such as back pain has not been studied enough to be proven effective, but reports of decreased joint noises, pain and swelling have sparked an interest. Creams and ointments with glucosamine and chondroitin are useless.By now everyone has probably heard of glucosamine or chondroitin, but are there any studies showing decreased pain for people? Being a physical therapist, some of my patients have taken this supplement with reports of decreased joint pain and tenderness and improved mobility. (7, 17) Some say they do not notice any change while taking the supplement. Critics have stated that some studies do not have enough subjects, may have publication bias, and long-term effects are not known (4,12). But a review of 37 studies (meta analysis) in 2000 showed glucosamine has moderate to large effects in persons. Another review of 13 studies demonstrated large positive effects for glucosamine and chondroitin (10). Effects include less knee pain at rest and at movement and moderate to large positive effects.(12) These studies have shown GS to better tolerated and to be as good or better than ibuprofen for OA of the knee.(4, 10) Persons with osteoarithritis are familiar with the concept of loss of joint space. A recent study of 106 patients took GS once daily for 3 years showed no significant joint space loss. 106 patients on placebo had worsening joint-space narrowing. The authors concluded that the pain relieving and possible structure-modifying affects of GS suggest it could be a disease-modifiying agent in OA. (18) How much do I take? Most studies use 1500 mg GS and 1200 mg CS. How much does it cost? $30 -$45 a month How does it work? The previous view was that GS promotes synthesis of cartilage proteoglycans. One study proposes that GS stimulates the production of hyaluronic acid, which lubricates and provides shock absorption properties of synovial fluid. Synovial fluid is decreased in people with arithritis. Many clinical and veterinary studies have shown that intra-articular injections of high-molecular-weight HA produce rapid pain relief and improved mobility in osteoarthritis. Hyaluronic acid has anti-inflammatory and analgesic properties, and promotes anabolic behavior in chondrocytes. (11) Can I use GS for degenerative arithritis in my back? A study of 34 males in the US Navy with chronic pain and degenerative joint disease in the knee and back showed decreased pain in the knee. More studies with more subjects are needed to see if GS can help with back pain as there was no demonstrated benefit. (14) In conclusion, there is now evidence-based research now that shows positive results with GS. More studies for longer periods will still be beneficial. Advocates of these alternative modalities cite reports of progressive and gradual decline of joint pain and tenderness, improved mobility, sustained improvement after drug withdrawal, and a lack of significant toxicity associated with short-term use of these agents. Critics point out that in the great majority of the relevant clinical trials, sample sizes were small and follow-up was short-term.(1) Most of the glucosamine studies have methodological flaws or used parenteral formulations, making their data difficult to extrapolate into clinical practice. Glucosamine sulfate is shown to be as good as ibuprofen for osteoarthritis of the knee. The better tolerability of GS is explained by its mode of action, because GS specifically curbs the pathogenic mechanisms of osteoarthritis and does not inhibit the cyclo-oxygenases as the non-steroidal anti-inflammatory drugs (NSAIDs) do, with the consequent anti-inflammatory analgesic activities but also with the several adverse reactions due to this not targeted effect. The present study confirms that GS is a selective drug for osteoarthritis, as effective on the symptoms of the disease as NSAIDs but significantly better tolerated. For these properties GS seems particularly indicated in the long-term treatments needed in osteoarthritis.(4) Better designed clinical trials of glucosamine are needed to identify its role in the pharmacotherapy of osteoarthritis.(2) Two participants taking glucosamine and 4 taking placebo withdrew from the study due to adverse side effects (P = 0.67). CONCLUSION: Glucosamine was no better than placebo in reducing pain from osteoarthritis of the knee in this group of patients.(3) A double-blind therapeutic investigation was performed on 178 Chinese patients suffering from osteoarthritis of the knee randomized into two groups, one treated for 4 weeks with glucosamine sulfate (GS, CAS 29031-19-4, Viartril-S) at the daily dose of 1,500 mg and the other with ibuprofen (IBU, CAS 15687-27-1) at the daily dose of 1,200 mg. Knee pain at rest, at movement and at pressure, knee swelling, improvement and therapeutic utility as well as adverse events and drop-outs were recorded after 2 and 4 weeks of treatment. GS was significantly better tolerated than IBU, as shown by the adverse drug reactions (6% in the patients of the GS group and 16% in the IBU group--p = 0.02) and by the drug-related drop-outs (0% of the patients in the GS group and 10% in the IBU group--p = 0.0017). The better tolerability of GS is explained by its mode of action, because GS specifically curbs the pathogenic mechanisms of osteoarthritis and does not inhibit the cyclo-oxygenases as the non-steroidal anti-inflammatory drugs (NSAIDs) do, with the consequent anti-inflammatory analgesic activities but also with the several adverse reactions due to this not targeted effect. The present study confirms that GS is a selective drug for osteoarthritis, as effective on the symptoms of the disease as NSAIDs but significantly better tolerated. For these properties GS seems particularly indicated in the long-term treatments needed in osteoarthritis.(4) Other possible uses of GS are in chronic temporomandibular disorders (TMD), specifically, internal derangements with a diagnosis of osteoarthritis. Reports of decreased joint noises, pain and swelling after the administration of therapeutic doses of these supplements have sparked an interest in their possible use in the treatment of osteoarthritis.(13) The current body of evidence currently supports modest efficacy for glucosamine and chondroitin in the treatment of OA symptoms. The products are safe and could play a valuable role in the management of this disorder. Nevertheless, further independent studies are needed to confirm these findings and to determine the clinical applicability of these compounds. Physicians need to become involved in these treatment decisions but are confused by wide variability in the formulation and purity of the numerous preparations available to consumers. The notion that glucosamine and chondroitin might have disease-modifying effects in OA is highly appealing and supported by preliminary data. Research is needed to confirm these findings and to evaluate the impact of glucosamine and chondroitin on all aspects of OA progression.(6) The goals of osteoarthritis therapy are to decrease pain and to maintain or improve joint function. The pharmacologic treatment of this condition has included the use of aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs. More recently, numerous studies have investigated the potential role of chondroprotective agents in repairing articular cartilage and decelerating the degenerative process. Advocates of these alternative modalities cite reports of progressive and gradual decline of joint pain and tenderness, improved mobility, sustained improvement after drug withdrawal, and a lack of significant toxicity associated with short-term use of these agents. T Pooled data demonstrated at least 50% improvement in the study variables in the chondroitin treated group. Discrepancies in some of the study findings reported in the literature may relate to the composition of the nutritional supplements used. Studies in the United States have revealed that a number of preparations claiming to contain certain doses of glucosamine or chondroitin sulfate have significantly less (or none) of the dosages described. Accordingly, it is essential that studies performed with these agents use preparations that are carefully defined in manufacture. The amounts generally administered are glucosamine, 1500 mg, and chondroitin sulfate, 1200 mg, daily. Although glucosamine has been described as effective when used alone, it is probably reasonable to use the combination pending further studies. The average cost is approximately $30 to $45 per month. In the interim, what should physicians tell their patients when they ask whether these agents are effective, or whether they should or should not take them? The authors emphasize that these agents are not FDA-evaluated or recommended for the treatment of OA. They are available as health food supplements, and the number of studies of toxicity, particularly with respect to long-term evaluations, is limited. The pros and cons of these agents and the published data are described so that patients can make a reasonably informed decision as to whether they wish to proceed with use of these agents in therapy. (ABSTRACT TRUNCATED).(10) OBJECTIVE: A 16-week randomized, double-blind, placebo-controlled crossover trial of a combination of glucosamine HCl (1,500 mg/day), chondroitin sulfate (1,200 mg/day), and manganese ascorbate (228 mg/day) in degenerative joint disease (DJD) of the knee or low back was conducted. METHODS: Thirty-four males from the U.S. Navy diving and special warfare community with chronic pain and radiographic DJD of the knee or low back were randomized. A summary disease score incorporated results of pain and functional questionnaires, physical examination scores, and running times. Changes were presented as a percentage of the patient's average score. RESULTS: Knee osteoarthritis symptoms were relieved as demonstrated by the summary disease score (-16.3%; p = 0.05), patient assessment of treatment effect (p = 0.02), visual analog scale for pain recorded at clinic visits (-26.6%; p = 0.05) and in a diary (-28.6%; p = 0.02), and physical examination score (-43.3%; p = 0.01). Running times did not change. The study neither demonstrated, nor excluded, a benefit for spinal DJD. Side effect frequency was similar to that at baseline. There were no hematologic effects. CONCLUSIONS: The combination therapy relieves symptoms of knee osteoarthritis. A larger data set is needed to determine the value of this therapy for spinal DJD. Short-term combination therapy appears safe in this setting.(14) Glucosamine sulfate and chondroitin sulfate are being used by many patients for the treatment of osteoarthritis. Despite a number of studies supporting efficacy of these agents for palliation of joint pain in patients with osteoarthritis, the American College of Rheumatology Subcommittee on Osteoarthritis believes that it is too early to issue recommendations for use. Currently, the National Institute of Arthritis and Musculoskeletal and Skin Diseases in collaboration with the National Center for Complementary and Alternative Medicine have begun a pivotal study to thoroughly evaluate these agents.(15 The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: A report from the glucosamine/chondroitin arthritis intervention trial.Sawitzke AD, Shi H, Finco MF, Dunlop DD, Bingham CO 3rd, Harris CL, Singer NG, Bradley JD, Silver D, Jackson CG, Lane NE, Oddis CV, Wolfe F, Lisse J, Furst DE, Reda DJ, Moskowitz RW, Williams HJ, Clegg DO. University of Utah School of Medicine, Salt Lake City. The power of the study was diminished by the limited sample size, variance of JSW measurement, and a smaller than expected loss in JSW. CONCLUSION: At 2 years, no treatment achieved a predefined threshold of clinically important difference in JSW loss as compared with placebo. However, knees with K/L grade 2 radiographic OA appeared to have the greatest potential for modification by these treatments. What were the key results of the study?Researchers found that:
How many people participated in the study and who were they?A total of 1,583 people participated in the study. People age 40 or older with knee pain and documented x-ray evidence of osteoarthritis were eligible to participate. Participants could not have used glucosamine for 3 months and chondroitin sulfate for 6 months prior to entering the study. Participants were about 59 years of age, on average, and nearly two-thirds of participants were women. Of the 1,583 study participants, 78 percent (1,229) were in the mild pain subgroup and 22 percent (354) were in the moderate-to-severe pain subgroup. Were there any side effects from the treatments?There were 77 reports of serious adverse effects during the study. Of those 77, only 3 were attributed to study treatments. Most side effects were mild, such as upset stomach, and were spread evenly across the different treatment groups. In addition, although GAIT was not designed to evaluate these risks, no change in glucose tolerance was seen for glucosamine nor was an increased incidence of cardiovascular events seen with celecoxib. Consumer Information and Next StepsShould people with osteoarthritis use glucosamine and chondroitin sulfate?People with osteoarthritis should work with their health care provider to develop a comprehensive plan for managing their arthritis pain: eat right, exercise, lose excess weight, and use proven pain medications. If people have moderate-to-severe pain, they should talk with their health care provider about whether glucosamine plus chondroitin sulfate is an appropriate treatment option. http://nccam.nih.gov/research/results/gait/qa.htm#c1Questions and Answers: NIH Glucosamine/chondroitin Arthritis Intervention Trial Primary Study 1. Sawitzke AD, Shi H, Finco MF, et al. The Effect of Glucosamine and/or Chondroitin Sulfate on the Progression of Knee Osteoarthritis: A Report from the Glucosamine/Chondroitin Arthritis Intervention Trial. Arthritis & Rheumatism, 2008; 58(10):3183–3191. 2. Clegg D, Reda DJ, Harris CL, et al. Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis. New England Journal of Medicine, 2006;354:795–808. The dietary supplements glucosamine and chondroitin sulfate, together or alone, appeared to fare no better than placebo in slowing loss of cartilage in osteoarthritis of the knee, researchers from the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) team report in the October issue of Arthritis & Rheumatism.1 Interpreting the study results is complicated, however, because participants taking placebo had a smaller loss of cartilage, or joint space width, than predicted. Loss of cartilage, the slippery material that cushions the joints, is a hallmark of osteoarthritis and its loss is typically measured as a reduction in joint space width—the distance between the ends of bones in a joint as seen on an X-ray. Dietary Supplements Glucosamine and/or Chondroitin Fare No Better than Placebo in Slowing Structural Damage of Knee Osteoarthritis For Immediate Release: Monday, September 29, 2008 |
| So what should you do? Brief AA, Maurer SG, Di Cesare PE Use of glucosamine and chondroitin sulfate in the management of osteoarthritis. J Am Acad Orthop Surg (United States), Mar-Apr 2001, 9(2) p71-8. Delafuente JC Glucosamine in the treatment of osteoarthritis. Rheum Dis Clin North Am (United States), Feb 2000, 26(1) p1-11, vii. Rindone JP, Hiller D, Collacott E, et al. Randomized, controlled trial of glucosamine for treating osteoarthritis of the knee. West J Med (United States), Feb 2000, 172(2) p91-4. Qiu GX, Gao SN, Giacovelli G, et al. Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis. Arzneimittelforschung (Germany), May 1998, 48(5) p469-74. Rubin BR, Talent JM, Kongtawelert P, et al. Oral polymeric N-acetyl-D-glucosamine and osteoarthritis. J Am Osteopath Assoc (United States), Jun 2001, 101(6) p339-44. McAlindon T Glucosamine and chondroitin for osteoarthritis? Bull Rheum Dis (United States), Jul 2001, 50(7) p1-4. Brief AA, Maurer SG, Di Cesare PE Use of glucosamine and chondroitin sulfate in the management of osteoarthritis. J Am Acad Orthop Surg (United States), Mar-Apr 2001, 9(2) p71-8. Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet (England), Jan 27 2001, 357(9252) p251-6 ; Deal CL, Moskowitz RW Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am (United States), May 1999, 25(2) p379-95. McCarty MF Enhanced synovial production of hyaluronic acid may explain rapid clinical response to high-dose glucosamine in osteoarthritis. Med Hypotheses (England), Jun 1998, 50(6) p507-10. McAlindon TE, La Valley MP, Gulin JP, et al. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA (United States), Mar 15 2000, 283(11) p1469-75. Shankland WE The effects of glucosamine and chondroitin sulfate on osteoarthritis of the TMJ: a preliminary report of 50 patients. Cranio (United States), Oct 1998, 16(4) p230-5. Leffler CT, Philippi AF, Leffler SG, et al. Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med (United States), Feb 1999, 164(2) p85-91. O'Rourke M Determining the efficacy of glucosamine and chondroitin for osteoarthritis [In Process Citation] Nurse Pract (United States), Jun 2001, 26(6) p44-6, 49-52. Messier SP, Loeser RF, Mitchell MN, et al. Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. J Am Geriatr Soc (United States), Sep 2000, 48(9) p1062-72. Leeb BF, Schweitzer H, Montag K, et al. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol (Canada), Jan 2000, 27(1) p205-11. Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet (England), Jan 27 2001, 357(9252) p251-6 This article is provided for information and entertainment purposes only. The content is provided "as is" for general information and to educate the reader. The article is not intended to serve as medical advice, diagnosis or treatment. The content should not be considered complete and should not be relied on to suggest a course of treatment for a particular individual suffering from a particular problem, issue or medical need. The reader should always consult with a qualified health care provider familiar with the reader's general health, background and conditions and follow the advice given by the health care provider. Always consult with your physician or other qualified health care provider before starting a new diet, treatment or fitness program. Do not delay seeking specific advice or care or disregard the advice of your health care provider based on information contained in this article. |