GLUCOSAMINE The Chiropractic Resource Organization
Glucosamine
This section is compiled by Frank M. Painter, D.C. Send all comments or additions to:
Frankp@chiro.org
If there are terms in these articles you don't understand, you
can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this topic.
The Effect of Nutritional Supplements on Osteoarthritis
Alternative Medicine Review 2004 (Sep); 9 (3): 275–296 ~ FULL TEXT
Osteoarthritis (OA) is the most common form of joint disease and cause of musculoskeletal disability in the elderly. Conventional management of OA primarily focuses on the relief of symptoms, using agents such as analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). These drugs, however, are associated with significant side effects and fail to slow the progression of OA. Several nutritional supplements have been shown to be at least as effective as NSAIDs at relieving the symptoms of OA, and preliminary evidence suggests several of these supplements may have a role in influencing the course of OA. The purpose of this article is to review the available literature on the effectiveness and safety of nutritional supplements for the treatment of OA.
Glucosamine Tops Ibuprofen in Treatment of TMJ Osteoarthritis WESTPORT, CT (Reuters Health) Jun 20, 2001 –– Glucosamine sulfate proved to be more effective than ibuprofen in reducing pain in patients with osteoarthritis of the temporomandibular joint (TMJ), according to the results of a study conducted by Canadian investigators. Glucosamine also exhibited a carryover effect that was absent from ibuprofen treatment.
Glucosamine Sulfate Monograph
Alternative Medicine Review 1999 (Jun); 4 (3): 193–195 ~ FULL TEXT
Glucosamine sulfate's role in halting or reversing joint degeneration appears to be directly due to its ability to act as an essential substrate for, and to stimulate the biosynthesis of, the glycosaminoglycans and the hyaluronic acid backbone needed for the formation of the proteoglycans found in the structural matrix of joints. Successful treatment of osteoarthritis must effectively control pain and should slow down or reverse the progression of the degeneration. Biochemical and pharmacological data combined with animal and human studies demonstrate that glucosamine sulfate is capable of satisfying both of these criteria.
Natural Treatments for Osteoarthritis
Alternative Medicine Review 1999 (Oct); 4 (5): 330–341 ~ FULL TEXT
Osteoarthritis (OA) is the most common form of joint disease. Although OA was previously thought to be a progressive, degenerative disorder, it is now known that spontaneous arrest or reversal of the disease can occur. Conventional medications are often effective for symptom relief, but they can also cause significant side effects and do not slow the progression of the disease. Several natural substances have been shown to be at least as effective as nonsteroidal anti-inflammatory drugs at relieving the symptoms of OA, and preliminary evidence suggests some of these compounds may exert a favorable influence on the course of the disease.
The Role of Glucosamine Sulfate and Chondroitin Sulfates in the Treatment of Degenerative Joint Disease
Alternative Medicine Review 1998 (Feb); 3 (1): 27–39
Successful treatment of osteoarthritis must effectively control pain, and should slow down or reverse progression of the disease. Biochemical and pharmacological data combined with animal and human studies demonstrate glucosamine sulfate is capable of satisfying these criteria. Glucosamine sulfate's primary biological role in halting or reversing joint degeneration appears to be directly due to its ability to act as an essential substrate for, and to stimulate the biosynthesis of, the glycosaminoglycans and the hyaluronic acid backbone needed for the formation of proteoglycans found in the structural matrix of joints.
Reversal of Osteoarthritis by Nutritional Intervention
ACA Journal of Chiropractic November 1990 ~ FULL TEXT
Research from rheumatology and orthopedic clinics from Europe on the ability to reverse osteoarthritis has been accumulating for the last 25 years. Based on these results, this article will describe a nutritional program, that in conjunction with standard therapies used for osteoarthritis, can actually reverse the course of osteoarthritis.
Chronic Joint Pain
Pain is a unique biological process that is perceived differently by each person. Although the experience may vary, one thing is certain—the pain associated with osteoarthritis and rheumatoid arthritis has no simple antidote. People with chronic joint pain typically learn to live with the discomfort. Unlike aspirin and other nonsteroidal, anti-inflammatory drugs commonly recommended for arthritis, natural remedies do more than mask painful symptoms. Antioxidants, fatty acids and enzymes target arthritis where it hurts—by protecting and repairing cartilage and reducing inflammation.
Glucosamine Hydrochloride Update
The hydrochloride form is more concentrated than the sulfate form, and the hydrochloride form contains substantially less sodium per effective dose than the sulfate form. Glucosamine sulfate is stabilized with sodium chloride (table salt) and can contain as much as 30% sodium. This is a consideration for individuals who want to reduce their dietary intake of sodium.
Glucosamine Sulfate Treats Osteoarthritis
To understand glucosamine's role, it is important to understand joint structure and disease. Cartilage in the joints, called articular cartilage, acts as a shock absorber to cushion the blows of daily wear and tear. Articular cartilage is made of a unique connective tissue that consists of collagen and proteoglycans. Collagen is a strong, fibrous, insoluble protein. Proteoglycans are large, carbohydrate-rich protein chains made up of 95 percent polysaccharides and 5 percent protein called glycosaminoglycans (GAGs).
Glucosamine Sulfate (GS) Comments
Four controlled studies (19, 20, 21, 22) using 750–1500 (3 used the 1500) mg/d oral glucosamine sulfate in patients with osteoarthritic knees, showed significant pain reduction, less analgesic use, improved joint function and, in one study improved histology on biopsy.
Glucosamine Supplements May Raise Diabetes Risk
Use of glucosamine sulfate, a popular anti–arthritis supplement, may contribute to insulin resistance in diabetics or those at risk for the disease, researchers report.
The Glucosamine Series
Glucosamine can be defined two ways depending on your point of view. Oral preparations of glucosamine in the health-food store or doctor's office are classified as a chondroprotective nutraceutical. In the body, glucosamine is an amino monosaccharide produced by chondrocyte cells and used to make glycosaminoglycans and proteoglycans. It is water soluble and well-absorbed in the small intestine. Glucosamine has an affinity for articular cartilage, which is well adapted for its active uptake. Many scientists feel that glucosamine is the most important and rate-limiting substance for the synthesis of healthy cartilage.
Part I: Basic Science
This is first part of a three–part series on glucosamine. Although we have covered glucosamine in this column previously, there continues to be a great deal of interest from both doctors and patients. This month, we will discuss in question and answer form the basic science of glucosamine.
Part II: Forms of Glucosamine
Before we discuss which form of glucosamine to use, we must answer the question, "Does glucosamine work?" Although the answer may seem obvious to those of us in the chiropractic and nutrition communities, many scientists and doctors do not feel glucosamine supplementation is beneficial for arthritis and related connective tissue dysfunction.
Part III: Dosing, Safety and Side Effects
Expert opinions vary on the length of time one should dose glucosamine, from one month[1] to six weeks[2] to eight weeks.[3] Recommendations on the amount of glucosamine generally center around 1,500 mg per day in divided doses, which is the amount utilized in the vast majority of studies on humans.
Glucosamine and Arthritis – A Bandolier Review
Bandolier was surprised to find as many as eight randomised trials. While it is possible to criticise all of the trials to some extent, as a group they are no worse than others used to support commonly–used therapies. There is a consistent thrust of efficacy over placebo, and an inability to distinguish glucosamine from NSAID. But all trials were relatively short–term, and longer–term observations for adverse effects would be welcome. The bottom line is that there is a body of evidence supporting the efficacy of oral and intramuscular glucosamine in arthritis.
Glucosamine Prevents in Vitro Collagen Degradation in Chondrocytes by Inhibiting Advanced Lipoxidation Reactions and Protein Oxidation
Arthritis Res Ther 2007 (Aug 8); 9 (4): R76
Glucosamine hydrochloride, in a dose-dependent manner, inhibited malondialdehyde (TBARS) formation by oxidized lipoproteins. Moreover, we show that glucosamine hydrochloride prevents lipoprotein protein oxidation and inhibits malondialdehyde adduct formation in chondrocyte cell matrix, suggesting that it inhibits advanced lipoxidation reactions. Together, the data suggest that the mechanism of decreasing collagen degradation in this in vitro model system by glucosamine may be mediated by the inhibition of advanced lipoxidation reaction, preventing the oxidation and loss of collagen matrix from labeled chondrocyte matrix. Further studies are needed to relate these in vitro findings to the retardation of cartilage degradation reported in OA trials investigating glucosamine.
Efficacy of Glucosamine Sulfate Treatment in Patients with Osteoarthritis
Pol Merkur Lekarski 2007 (Mar); 22 (129): 204–207
We found the significant improvement during treatment in 38 (80.85%) pts. as measured by WOMAC scale and in 36 (70.60%) as measured by Lequesne'a scale. Self assessed pain improved in 35 (74%) of patients. The efficacy of the treatment was characterized as "good" by 60% of patients, and it was similar to physician assessment (Cohen's kappa coefficient of agreement = 0.9359). No clinically significant adverse events were observed.
Glucosamine and Chondroitin Sulfate Supplementation to Treat Symptomatic Disc Degeneration: Biochemical Rationale and Case Report
BMC Complement Altern Med 2003 (Jun 10); 3 (1): 2 ~ FULL TEXT
During the two years time period, improvement of the structural quality of the disc cartilage (associated with increased water content) was clearly visible by brightening of the T2-weighted MRI signal, as shown in Figure I. The L3-4 disc showed an initial protrusion, which decreased in time, while the MRI signal normalized in time. During the two years, L3-4 disc height restored slightly (5–10%). Disc L4-5 showed signs of an advanced state of degeneration, and no improvement but also no worsening of this disc (endplates morphologically unchanged) over the 2 years period. Contrary to NSAIDs, no significant adverse clinical, hematological, hemostatic or other side effects were found in any clinical study using glucosamine and/or CS supplementation.
Efficacy and Safety of Glucosamine Sulfate versus Ibuprofen in Patients with Knee Osteoarthritis
Arzneimittelforschung 1998 (May); 48 (5): 469–474
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.
Chiropractic Use of Glucosamine Sulfate in the Treatment of Osteoarthritis
J Manip Physiol Ther 1997 (Jul-Aug); 20 (6): 400–414
The rationales for using NSAIDs in the treatment of osteoarthritis is controversial and openly contested. Given the detrimental effects of NSAIDs on joints and other organs, their use should be discouraged and their classification as a first choice conservative treatment should be abolished. (emphasis added) A truly effective and conservative approach to the treatment of osteoarthritis should include chiropractic manipulation, essential nutrient supplementation, exogenous administration of glucosamine sulfate and rehabilitative stretches and exercises to maintain joint function.
Efficacy and Safety of Intramuscular Glucosamine Sulfate in Osteoarthritis of the Knee: A Randomised, Placebo–controlled, Double–blind Study
Arzneimittel–Forschung 1994 (Jan); 44 (1): 75–80
Glucosamine sulfate (Dona, CAS 29031-19-4) is a drug used in the treatment of osteoarthritis. When orally given, it is more effective than placebo and at least as effective as non-steroidal anti-inflammatory drugs in relieving osteoarthritis symptoms. The aim of this multicentre, randomised, placebo-controlled, double-blind, parallel-group study was to assess the efficacy and safety of glucosamine sulfate intramuscularly given on the same parameters.
Antiarthritic Effects of Glucosamine Sulfate Studied in Animal Models
Arzneimittel–Forschung/Drug Research 1991 (May); 41 (5): 542–545
Since, however, the toxicity of indometacin in chronic toxicity experiments is 1000-4000 times larger, the therapeutic margin with regard to prolonged treatments of inflammatory disorders results 10-30 times more favourable for GS than for indometacin. GS can therefore be considered as a drug of choice for prolonged oral treatment of rheumatic disorders.
Effect of Non–steroidal Anti–inflammatory Drugs on the Course of Osteoarthritis
Lancet 1989 (Sep 2); 2 (8662): 519–522 This paper explores the hypothesis that non–steroidal anti–inflammatory drugs (NSAIDs) accelerate the progression of osteoarthritis, by reducing synthesis of vasodilator prostaglandins, thereby diminishing joint perfusion of blood. They recommend that "potent inhibitors of prostaglandin synthesis may be inappropriate in the management of osteoarthritis of the hip" since that is the only joint they study. This paper explores the hypothesis that non–steroidal anti–inflammatory drugs (NSAIDs) accelerate the progression of osteoarthritis, by reducing synthesis of vasodilator prostaglandins, thereby diminishing joint perfusion of blood.
It is reasonable to extrapolate that this same inhibition takes place in all joint complexes.
Absorption, Distribution and Excretion of Radioactivity After a Single Intravenous or Oral Administration of [14C] Glucosamine to the Rat
Pharmatherapeutica 1984; 3 (8): 538–550
Blood levels, tissue distribution and excretion patterns of radioactivity were studied in the rat after administration of [14C] glucosamine sulphate by the intravenous or oral route. After intravenous administration, plasma radioactivity declined in the first 30 min, then increased, reaching a peak at the 2nd hour, and disappeared, with a half-disappearance time of 28 hours.
Oral Glucosamine Sulfate in the Management of Arthrosis: Report on a Multi–Centre Open Investigation in Portugal
Pharmatherapeutica 1982; 3 (3): 157–168
Oral glucosamine was fully tolerated by 86% of patients, a significantly larger proportion than that reported with other previous treatments and approached only by injectable glucosamine. The onset of possible side-effects was significantly related to pre-existing gastro-intestinal disorders and related treatments, and to concomitant diuretic treatment.
Double–blind Clinical Evaluation of Oral Glucosamine Sulphate in the Basic Treatment of Osteoarthrosis
Curr Med Res Opin 1980; 7 (2): 110–114
Significant alleviation of symptoms was associated with the use of the active drug at the prescribed dose. Similarly, patients given glucosamine sulphate experienced earlier alleviation of symptoms compared with those who had placebo. The use of glucosamine sulphate also resulted in a significantly larger proportion of patients who experienced lessening or disappearance of symptoms within the trial period.
Conservative Treatment of Spinal Arthroses with Glucosamine Sulfate and Phenylbutazone – A Controlled Study
Therapiewoche 1980; 30: 5922–5928
The use of several objectifiable parameters (Schober test, Lasegue test, distance from finger tips to floor when bending over) showed that combined oral and intramuscular administration of glucosamine sulfate for vertebral syndromes was as effective as a standard therapy with phenylbutazone. However, the average time of treatment required to achieve a clinically relevant result was signifcantly shorter. No side effects were observed.
Therapeutic Activity of Oral Glucosamine Sulfate in Osteoarthrosis: A Placebo-Controlled Double-Blind Investigation
Clinical Therapeutics 1980; 3 (4): 260–272
The patients who had placebo showed a typical picture of established osteoarthrosis. Those who had glucosamine sulfate showed a picture more similar to healthy cartilage. It is concluded that glucosamine sulfate tends to rebuild the damaged cartilage, thus restoring articular function in most chronic arthrosic patients.
Glucosamine Sulphate for the Management of Arthrosis: A Controlled Clinical Investigation
Curr Med Res Opin 1980; 7 (2): 104–109
During the maintenance period, a further significant improvement was recorded in the group receiving glucosamine, whereas with placebo the symptom scores rose to almost the pre-treatment levels. A similar pattern was shown in the measurement of walking speed. Clinical and biological tolerance were excellent with both treatments. No drug-related complaints were recorded, nor signs of interference in other illnesses or interactions with other drug treatments. It is suggested that injectable and/or oral treatment with pure glucosamine sulphate should be considered for the basic therapy of primary or secondary osteoarthrosis, mainly because it restores articular function to a certain extent.
Other Supplements Which Reduce Joint Pain
Gentle Devil's Claw
One would not expect a plant with a diabolically painful name like devil's claw (DC) (Harpagophytum procumbens) to relieve arthritis pain. Yet several clinical studies have shown this herb to exert some pain relief for various musculoskeletal conditions. [1-4] Results of a recent German study involving 197 subjects with low back pain showed a 600 or 1,200 mg daily dose of DC extract (providing 50 or 100 mg of harpagoside, a marker constituent in DC extracts required in the German Commission E monographs) offers better pain relief than placebo.[3] However, subjects in the DC group experienced more frequent gastrointestinal upset.
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