Arthritis Information
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| The Use of Glucosamine Sulfate in the Treatment of Osteoarthritis |
| 08/12/10 Kevin R. Stone, MD, Kay Mullin, RD |
It is estimated that one of every six Americans suffers from some type of arthritis. The US Center for Disease control predicts that by 2020, the number will increase to one in five Americans. Osteoarthritis, the most common type of arthritis, is characterized by the degeneration of the cartilage in the joints, and is often caused by physical injuries, repetitive joint stress, or family history of arthritis.
Cartilage acts as the shock absorber of the joints. Visualize a water balloon filled with water and a big sponge inside of it. When you press your hand into the center of the balloon and move the pressure from side to side, the water redistributes in response to the pressure. This is the way the cartilage in a joint responds to jumping, twisting, and excess weight. It distributes the pressure evenly to account for the excess load, thus protecting the bone and joint. With age and use, the cartilage loses this resiliency, much like a sponge in a balloon drying out. The pain and inflammation that results from the degradation of cartilage is referred to as osteoarthritis or osteoarthrosis.
People with osteoarthritis are often told that their condition "will only get worse". This is often not true. Many physicians in the American medical community now agree that the symptoms associated with osteoarthritis can improve slowly with exercise, physical therapy, and a choice of either oral nonsteroidal anti-inflammatories (NSAIDs) or corticosteriods injected into the joint spaces. This treatment approach helps to alleviate the pain and inflammation associated with osteoarthritis resulting in long term pain relief.
Unfortunately there are often side effects such as gastrointestinal problems or local irritation associated with the use of NSAIDs and corticosteriods. These treatments also treat the symptoms of osteoarthritis and not necessarily the root of the problem and in fact they may contribute to a decline in arthritic condition with long term use. Recently, the focus has changed from how do we treat the symptoms to, how do we stop the progression of osteoarthritis. Research is now being done to find a dietary supplement that will halt or slow the progression of cartilage destruction, rather than treating just the pain and inflammation.
Up until recently, "Vitamins for the Joints" or cartilage protective agents, were often overlooked by American doctors. Despite being widely prescribed by European physicians, many American physicians cite the limited clinical evidence supporting glucosamine sulfates use and prematurely dismiss the use of supplements like glucosamine and chondroitin. Since the publication of The Arthritis Cure in 1996, a large group of people began to treat their joint pain with glucosamine and chondroitin, rather than NSAIDs and reported their personal findings to their physicians. Subjectively, 75-80% of people reported drastic improvements in their pain and mobility. But because of limited clinical references, most physicians remained skeptical. In order to understand the theory of how glucosamine sulfate works, you need to have a picture of what cartilage is made of and how it works to protect the joint.
The major components of cartilage are water, glycosaminoglycans, hyaluronic acid, proteoglycans, chondroitin sulfate molecules, collagen and elastin. The elements are then held in a collagen matrix, much like a sponge holds water. These elements together form the cushioning and gliding qualities of the joint. In order to maintain these properties of cartilage health, a person needs a nutrient rich diet and an ample supply of glycosaminoglycans (GAG’s), chondroitin sulfate and proteoglycans, otherwise the cartilage will begin to break down. Arthritis researchers now believe that it is the decay of proteoglycans and glycosaminoglycans that is the central process in the disease process of osteoarthritis and osteoarthrosis. Research focusing on prevention of osteoarthritis seems to point to the use of glucosamine sulfates to help protect and repair the proteoglycans in cartilage.
Most clinical trials on the effectiveness of glucosamine sulfate in treatment of osteoarthritis have compared glucosamine to NSAIDs in subjective measurements by patients. Let’s review the results of these studies. Most of the studies were double blind in design, meaning that neither the doctor nor patient knew whether they were taking glucosamine, NSAID or a placebo.
Glucosamine Sulfate Verses NSAIDs (Ibuprofen): Decrease in the symptoms of osteoarthritis happens during the first week with the use of ibuprofen and not with glucosamine sulfate. By the second week and throughout all the clinical trials, however, the glucosamine group had caught up in terms of pain relief and osteoarthritic symptoms. The remarkable difference comes from side effects; one in three of the ibuprofen users complained of stomach upset, while there were no reported symptoms from the patients taking glucosamine sulfate. Although these studies are limited by length (the longest one was 8 weeks) they certainly show promise in the use of glucosamine in reduction of reported pain levels. Noack W, et al. Osteoarthritis Cartilage 1994;2:51-59.
Oral Glucosamine Sulfate Verses Placebo: Again the glucosamine sulfate group reported a significant decrease in pain and inflammation compared to the placebo group. No adverse reactions were reported by the patients treated with glucosamine sulfate, again making it appear to be an effective treatment for osteoarthritis. Puljate JM, et al. Osteoarthritis Cartilage 1994;2(suppl.1):56.
Glucosamine Sulfate Verses NSAIDs and Placebo: In both the NSAIDs and glucosamine sulfate groups, each symptom of osteoarthritis improved, but to a much faster and greater extent in the group treated with glucosamine. D’Ambrosio E, et al. Pharmatherapeutica 1981;2(8):504-8.
How does glucosamine work? Two questions remain, if glucosamine is so promising why haven't I heard of it, and how does it work? First, the word is getting out, many progressive physicians are currently prescribing glucosamine sulfate for osteoarthritis, however because it is classified as a nutritional supplement, not a drug, it is an out of pocket expense. In addition to subjective clinical studies, animal based clinical trials have been performed to evaluate how glucosamine works. It has been found that in vitro, glucosamine sulfate stimulates cartilage cells to synthesize glycosaminoglycans and proteoglycans. In animal studies, oral glucosamine sulfate has had a beneficial effect on inflammation and arthritis. However, the question still remained, does a glucosamine supplement taken orally, really get to the right place in the joint to stimulate new cartilage growth, as many people claim. In February 2000, an article published in the Journal of the American Medical Association (JAMA), looked at this. In the trial, participants were given glucosamine sulfate tagged with a radioactive dye. This technique allowed the investigators to follow the glucosamine through the body. The results showed that indeed oral glucosamine sulfate became a component of cartilage, supporting all of the subjective results by patients.
How much Glucosamine should I take? The amount of glucosamine sulfate an individual needs should be based on weight. An individual who weighs less than 180 pounds should take 1500 mg per day. An individual who weighs more than 180 pounds should take 2000 mg per day. Most individuals will not notice a drastic improvement until they have taken the right dose for at least 4 weeks.
Are there any side effects? First, as with any supplement, always inform your doctor that you are taking glucosamine. The Arthritis Association cautions the use of glucosamine sulfate during pregnancy or lactation and for use in children. There has been some concern that Glucosamine may also elevate blood glucose in diabetics. Diabetics wishing to take glucosamine should be encouraged to increase their blood glucose monitoring during the first 3 months of taking glucosamine and report any increases in their glucose values to their physicians.
Article provided by The Stone Clinic
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Other References:
The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Altern Med Rev. Feb 1998;3(1):27-39.
Glucosamine. Ann Pharmacotherapy 1998 May;32(5):574-9.
Enhanced synovial production of hyaluronic acid may explain rapid clinical response to high-dose glucosamine in osteoarthritis. Med Hypotheses, 50(6):507-10 1998 Jun
Antiarthritic effects of glucosamine sulfate studied in animal models. Arzeimittelforschung 41:542.
The Arthritis Bible. Weatherby C, Gordin L;Healing Arts Press. 1999.
The author's statements have not been evaluated by the Food and Drug Administration and are not provided to diagnose any disease or to suggest that liquid glucosamine and chondroitin will treat, cure, or prevent any disease.
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