Is there a role for Glucosamine and Chondroitin in Arthritis?

Glucosamine and Chondroitin have been aggressively promoted
as safe and effective arthritis treatment. The adverts are
everywhere and the Sunday tabloid is likely to have a full
page spread on the benefits of glucosamine and chondroitin
in arthritis. Is it just hype or is there evidence that
these two items are useful treatment for arthritis?

Glucosamine is an amino acid sugar produced by the body and
present in cartilage. There are no serious side effects
with glucosamine. It is extracted from shells of shellfish
so if you are allergic to shellfish be aware of this. If
you are a diabetic, remember that glucosamine is an amino
acid sugar and can impact on your blood sugar level.

Chondroitin is a carbohydrate compound and is present in
cartilage. It gives the cartilage elasticity. Articular
surface of joints are protected by cartilage (articular
cartilage) and this cartilage is a tough smooth gristle
that reduces friction and protects the underlying bone from
wear. Damage and wear of the cartilage is seen on an x-ray
as loss of joint space. Cartilage contains both glucosamine
and chondroitin.

Chondroitin is available as chondroitin sulfate, obtained
from cows' cartilage. There are no serious side effects of
chondroitin. Reported side effects are increased intestinal
gas and loose stools. It should not be given to children or
taken by women considering pregnancy or who are pregnant.
It may potentiate the effects of anti-coagulants.

The rationale for the use of chondroitin and glucosamine as
treatment of arthritis is that these two drugs, according
to some, will improve the health of affected articular
cartilage. Both chondroitin and glucosamine are
manufactured by the body.

Your family doctor is not likely to recommend glucosamine
or chondroitin as an arthritis treatment because there is
no clear evidence that they confer greater benefits over
placebo in arthritis treatment.

Both Chondroitin and glucosamine are considered supplements
and therefore the manufacture is not regulated. When
purchasing these products make sure you purchase from a
reputable company and check the label. The quality of the
product will vary from one manufacturer to another.

A qualitative assessment of various trials was done by T.E.
McAlindon et al. to evaluate the benefits of glucosamine
and chondroitin products for osteoarthritis of the knee
and/or hip. The studies were randomised, double blind,
placebo controlled of four weeks duration. Fifteen studies
reached the criteria and were included in the analysis.
Conclusions: Trials of glucosamine and chondroitin products
for osteoarthritis of the knee and hip showed moderate to
higher effects but there were quality issues and possible
bias suggesting that benefits were exaggerated. They
concluded, however, that some degree of benefits appears
probable.

A trial by H.Muller-Fassbender et al. in 1994 compared
glucosamine sulfate to ibuprofen in osteoarthritis of the
knee. The result showed that glucosamine was as effective
as ibuprofen but without the potential serious side effects.

Although there are no large trials to confirm the real
benefits of Chondroitin and Glucosamine, anecdotally some
arthritis patients swear by them. If you are considering
taking them, use them for three month before making a
decision on their efficacy. They are much safer than NSAIDs
and COX2 inhibitors.


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Dr.Phil Hariram is a retired General Practitioner. He has
spent 27 years treating patients with Arthritis.
Check out his website at
http://www.arthritissage.com
and his blog at
http://www.arthritissage.com/blog