BMC Complement Altern Med 2003 (Jun 10); 3 (1): 2 ~ FULL TEXT
van Blitterswijk WJ, van de Nes JC, Wuisman PI
Background: Glucosamine and chondroitin sulfate preparations are widely used as food supplements against osteoarthritis, but critics are skeptical about their efficacy, because of the lack of convincing clinical trials and a reasonable scientific rationale for the use of these nutraceuticals. Most trials were on osteoarthritis of the knee, while virtually no documentation exists on spinal disc degeneration. The purpose of this article is to highlight the potential of these food additives against cartilage degeneration in general, and against symptomatic spinal disc degeneration in particular, as is illustrated by a case report. The water content of the intervertebral disc is a reliable measure of its degeneration/ regeneration status, and can be objectively determined by Magnetic Resonance Imaging (MRI) signals.
Case presentation: Oral intake of glucosamine and chondroitin sulfate for two years associated with disk recovery (brightening of MRI signal) in a case of symptomatic spinal disc degeneration. We provide a biochemical explanation for the possible efficacy of these nutraceuticals. They are bioavailable to cartilage chondrocytes, may stimulate the biosynthesis and inhibit the breakdown of their extracellular matrix proteoglycans.
Results: 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.
Conclusion: The case suggests that long-term glucosamine and chondroitin sulfate intake may counteract symptomatic spinal disc degeneration, particularly at an early stage. However, definite proof requires well-conducted clinical trials with these food supplements, in which disc de-/regeneration can be objectively determined by MRI. A number of biochemical reasons (that mechanistically need to be further resolved) explain why these agents may have cartilage structure- and symptom-modifying effects, suggesting their therapeutic efficacy against osteoarthritis in general.