Considering the alternatives, harvard Health Latter, Jul 1999, V, Issue 9, p7

Considering the Alternatives;

Harvard Health Letter; Jul 1999, V 24, Issue 9, p 7.

There are new treatment options available for people with arthritis. One of the new treatments is the use to glucosamine and chondroitin sulfate. The combination of the two have been shown in studies to relieve pain of osteoarthritis, with few of the side effects of conventional medicine, and to stop and even reverse the progress of the osteoarthritis. Glucosamine in found
in all tissues and plays a part in repair and maintenance of joint cartilage, stimulation cartilage cells to produce glycosamineglycans and proteoglycans, the building blocks of cartilage.

The article discusses that the research done on the use of glucosamine and chondroitin sulfate is not clear. The European studies looked at mild to moderate osteoarthritis and with the use of the combination of glucosamine and chondroitin sulfate reduced the pain and increased mobility at least as well as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve).

These studies were short in duration, had small samples, or had methodological flaws.In February 1999, a U.S. study was done on glucosamine and chondroitin sulfate with 93 patients given either a placebo or a combination of 2,000 mg of glucosamine and 1,600 mg of chrondroitin sulfate per day. The results at the end of six months showed that 52% of the patients taking the supplement experienced a significant decrease in the pain of their arthritis compared to the 28% of the patients taking a placebo.

The studies have shown that the benefits of glucosamine and chondroitin sulfate may take a few weeks, so the article suggests that conventional medication may need to be continued for the first month. The article also suggests that the only truly natural and proven method for battling osteoarthritis is to shed the excess weight and to exercise.

Glucosamine for osteoarthritis
Medical Letter on Drugs and Therapeutics; 9/26/97, V 39, Issue1010, p 91-92.

Glucosamine supplementation is claiming to treat arthritis. "Dietary supplements" are not regulated by the FDA and must have a disclaimer that the product is not intended to diagnose, treat or prevent any disease. Due to the FDA not regulating glucosamine there is not guideline for purity and amount in different products on the market.

There are claims being made are that glucosamine is a basic constituent of articular cartilage. It stimulates the cartilage cells to create new glycosaminoglycans and proteoglycans which are part of the cartilage structure. When supplementing glucosamine the cells rebuild the damaged area and help reverse the affects of the degeneration of the joint.

In animal studies the intake of oral glucosamine had a beneficial effect on inflammation in mechanical arthritis and immunological-reactive arthritis, but much less than that of indomethacin. The short term controlled trials on humans have shown that glucosamine is effective in relieving pain and increasing the range of motion in patients with osteoarthritis.

One of the four week studies showed that glucosamine is as effective in relieving symptoms as ibuprofen and others. Glucosamine was generally well tolerated in these studies. There was a few incidences of Gastrointestinal discomfort and nausea, but the incidence was no higher than with the placebo.

The article states that glucosamine appears to be safe and might be effective for treatment of osteoarthritis, but the studies have been sort term only lasting four to eight weeks. Longer studies still need to be done for the Medical Letter consultants to become convinced with the treatment of osteoarthritis by glucosamine.

Rindone, et al.; Randomized, controlled trial of glucosamine for treating osteoarthritis of the knee;
Western Journal of Medicine; February 2000, V 172, p 91-95.

The study was designed to determine the effectiveness of glucosamine in pain reduction for osteoarthritis. The patients involved in the study had to have a history of osteoarthritis of the knee and have radiographic findings consistent with the disease. There were 98 patients aged 34 to 81 years old placed in randomized groups. One group was given 500 mg of glucosamine three times per day, the other group was given a placebo. The treatment lasted for 2 months (8 weeks). The patients were to continue taking their other analgesics for the duration of the study.

The study found that the glucosamine had little effect on the intensity of pain in the patients with the osteoarthritis of the knee. Other studies had opposite findings, this is the first study to have negative findings. The authors think that these negative findings could be do to the patients being older, heavier, and having the arthritis longer than the participants in the
other studies. There were more patients in this study having severe diseases than patients in other studies, this suggests that there is more pronounced joint disease in these patients and it may not respond as well to glucosamine. They theorize that glucosamine is a precursor to proteoglycans, which are instrumental in helping cartilage retain water and in promoting
formation of an elastic layer, factors that improve the functional characteristics of cartilage.

Older patients with more severe joint degeneration have more damage to their cartilage and thus are less responsive to the effects of glucosamine. The negative results could be due to the length of the study being insufficient to find clinical improvement in these patients. One reason not discussed as an effect in the outcome of the study is that the patients continued the use of their current pain medications. How can you find a difference in pain if the pain relief is counteracted by the NSAIDS the patients are currently taking.

Kelly, G.; The Role of Glucosamine Sulfate and Chondroitin Sulfates in the Treatment of Degenerative Joint Disease;
Alternative Medicine Review; 1998, V 3, N 1, p 27-39.

The article describes that glucosamine is found in the body as glucosamine 6-phosphate, which is the building block for glycolipids, glycoproteins, glycosaminoglycans, hyaluronate and proteoglycans (which require amino sugars). "Directly or indirectly, glucosamine plays a role in the formation of articular surfaces, tendons, ligaments, synovial fluid, skin, bone, nails,
heart valves, blood vessels, and mucous secretions of the digestive, respiratory, and urinary tracts." The proteoglycans are essential to providing the framework of collagen and to hold water, which enhances the flexibility and resistance to compression. Glucosamine halts or reverses the joint degeneration by acting as a substrate or stimulating the synthesis of
glycosaminoglycans and hylauronic acid used in the formation of the proteoglycans found in the matrix of the joints.

When humans take an oral dose of glucosamine, 90% in absorbed in the gastrointestinal tract. Glucosamine is more rapidly incorporated into the articular cartilage than into any other structural tissue. The current information shows that glucosamine is ineffective at inhibiting cyclooxygenase and proteolytic enzymes involved in inflammation. Glucosamine is able to protect
against edema induced by carregeenan, dextran, and formalin, but it cannot counteract other edema provoking substances such as bradykinin, serotonin, or histamine.

The article goes on to introduce the current research showing that glucosamine has reduced pain in patients, helped halt the degeneration and even caused regeneration in patient taking it with long term use. Glucosamine seems to be more affective in mild arthritic patients and may take some time for the pain relief to occur (any where from 2-4 weeks). Researchers have found that arthritis in the shoulder or elbow respond the best and polyarticular arthritis and arthritis in the hip have the poorest response rate. When comparing pain relief with glucosamine and ibuprofen, the ibuprofen offered the relief faster in the first two weeks, but after that the patients taking glucosamine had greater relief and the relief lasted longer through out the 8
week study.

Gottlieb, Marc S.; Conservative Management of Spinal Osteoarthritis with Glucosamine Sulfate and Chiropractic Treatment;
Journal of Manipulative and Physiological Therapeutics; July/August 1997, V 20, N 6, p 400-414.

Osteoarthritis is very prevalent in adults aged 25-74 the U.S., with 32.5% of affected in their hands, 22.2% in their feet, 3.8% in their knees, 1.3% in their hips (men only). The term Osteoarthritis means inflammation of a joint, but usually the term is applied to DJD which is a non-inflammatory process where there is a break down of cartilage. To understand ways to treat
the osteoarthritis (OA) or DJD we must understand what form the patient has to find the best option for them.

Most countries treat OA with NSAIDS "there is no justification for this; inflammation is a transient and relatively minor component of OA. Also, there is little evidence to suggest the efficacy of NSAIDs for the treatment of OA; in fact, there is evidence to the contrary, which suggests that the use of NSAIDs may actually increase the progression of the disease" (due to overuse of joints when the pain mechanism is turned off).

The structure of the hyaline cartilage on the joints is 10-30% collagen, 3-10% proteoglycans, and 60-87% water, inorganic salts, proteins, and lipids. The water is essential due to its noncompressible properties (making it able to disperse stress evenly) and its ability to provide nourishment to the avascular tissue.

Glucosamine is one of the new treatment methods for OA. It has been found to be effective in inhibiting the release of proteolytic enzymes and lysosomal enzymes, it does not inhibit prostaglandin biosynthesis. This is the main difference between glucosamine and NSAIDs.

Glucosamine acts as an "anti-reactive" agent rather than an "anti-inflammatory" agent. "Glucosamine has proven to be effective in the treatment of OA in double-blind controlled clinical studies, by improving mobility and relieving pain." Studies have reported that patients feel relief of pain by glucosamine sulfate after 2-3 weeks of treatment. The pain relief seems to be caused by an objective improvement of the articular conditions rather than an analgesic effect. It is possible that long-term use of glucosamine could lead to reversal of some OA conditions.

Di Fabio, Richard; Grappling with the "Miracle" of Glucosamine;
Journal of Orthopaedic & Sports Physical Therapy; August 1999, Vol 29, N. 8, p 442-443.

The editorial discusses the activity of many young men and women who have participated in sports at a young age where they were injured. As they age these injuries in the joints lead to degeneration later in life. "Premature osteoarthritis is a common occurrence in athletes and it is not confined to elderly populations. More than six percent of adults over 30 years of age are estimated to have symptomatic knee osteoarthritis". The new treatment being used by people with degenerative joints is glucosamine sulfate, which has been claimed to reverse or stop the progression of the osteoarthritis. The glucosamine is supposed to rebuild the damages articular surfaces and relieves the pain as well as ibuprofen, but without the serious side effects.

Glucosamine is a dietary supplement and is not regulated by the Food and Drug Administration. This means that there is no regulation regarding the quality or amount in the different brands offering the glucosamine. The author also states that there have been many flaws in the research done on glucosamine. Over all the editorial advises caution regarding the use of
glucosamine.

"Care must be taken to protect the joints from further injury and the long-term consequences of 'accelerated rehabilitation' need to be re-evaluated. As good as some people think that glucosamine is for relief of symptoms, it is not a cure for osteoarthritis."

There is a great deal of conflicting information regarding glucosamine, to understand the benefits you need to look at each study and find out who were helped and the amount they were given. I would not discount the use of glucosamine until further studies are done. Glucosamine is a better option than ibuprofen and if it works I think that people should know about it.