Clinical Support for Glucosamine Sulfate

Glucosamine

Claims, Benefits: Halts, reverses, or cures arthritis.
Bottom Line: Taken with chondroitin sulfate, this is a popular "cure" for osteoarthritis. A new study showed that glucosamine helped slow deterioration of cartilage and relieved pain. A large study on these supplements is underway, with results expected in two or three years. Meanwhile, if you want to try glucosamine, it may help and seems safe. If you take it, tell your doctor.
Wellness Letter, May 2001:

Good News on Glucosamine

   Cartilage cushions human joints, and when it wears down over time and the body's ability to replace it slows or ceases, the result is osteoarthritis, the most common form of arthritis. This painful and potentially disabling condition often goes along with aging.
Pain relievers, over-the-counter and prescription, are the chief medical treatment. But nearly all of these drugs increase the risk of gastrointestinal bleeding. And they do nothing to halt the advance of arthritis. Indeed, some researchers believe that these drugs can make it worse.
In European countries medicinal glucosamine has been prescribed for arthritis for many years, and more recently it has appeared on the American market as a dietary supplement. It is often taken with chondroitin sulfate. Both substances occur naturally in the body and contribute to the formation of cartilage.

A new era for arthritis?

But a new study may be good news for glucosamine. Published in the Lancet, the study was well designed, lasted three years, and included more than 100 people. It found that people with mild-to-moderate knee arthritis who took 1,500 milligrams of purified, standardized glucosamine once a day for three years had, on average, 20 to 25% less pain and disability than those taking a placebo (dummy pill). X-ray exams showed that in those taking glucosamine, arthritis progressed slowly or not at all, while the placebo group continued to lose cartilage at the expected rate. Moreover, glucosamine produced no adverse side effects. And it did not affect blood glucose over the three-year period.
Nevertheless, the study showed that glucosamine helped slow deterioration of cartilage and relieved pain.
UC Berkeley Wellness Letter, May 2001

Study #1
Osteoarthritis: Glucosamine Sulfate vs. Placebo

Italian researchers found that people taking glucosamine sulfate improved twice as much and twice as quickly, compared to those taking placebo, in a randomized, double-blind, placebo-controlled study of 80 people with established osteoarthritis. During the 30 day trial, participants were assigned to take either 250 mg of glucosamine sulfate three times daily or placebo. Researchers measured the degree of articular pain, joint tenderness and swelling, and restriction of active and passive movements on a scale of zero to four, before treatment and after seven, 14, 21, and 30 days. After one month, the glucosamine group experienced a 73% reduction in overall symptoms, compared to 41% in the placebo group. Improvement was visible in the glucosamine group within 20 days, compared to 36 days in the placebo group. During electron microscopy testing, researchers found that cartilage samples taken from the placebo group showed a typical picture of osetoarthritis, while samples from the glucosamine group were more similar to healthy cartilage. Reports of minor side effects were similar in both treatment groups. Researchers concluded that glucosamine improves osteoarthritis by rebuilding damaged cartilage. It has minimal side effects and no known contraindications or drug interactions, making it suitable for long-term treatment [Drovanti, 1980].

Study #2
Osteoarthritis of the Knee: Glucosamine Sulfate vs. Ibuprofen

Researchers found that glucosamine sulfate was just as effective and better tolerated than ibuprofen, in a randomized, double-blind study of 200 people with painful, active osteoarthritis of the knee. During the four-week trial, participants were assigned to take either 1500 mg of glucosamine or 1200 mg of ibuprofen daily in two divided doses. Researchers measured improvement on a weekly basis, as a reduction of the Lequesne's Index (a standard scale for measuring pain, maximum walking distance, and limitation of motion in daily activities) and through an overall physical assessment. Although patients taking the drug therapy initially improved more quickly, the two therapies had a similar success rate from the second week until the end of the study (52% for ibuprofen compared to 48% for glucosamine). There was a significant difference in the number of side effects and drop-outs between the two groups. In the glucosamine group, there were six reports of side effects and one drop out, compared to 35 reports of side effects and seven drop-outs in the ibuprofen group. Researchers concluded that glucosamine is a safer, albeit slightly slower, alternative to drug therapies for osteoarthritis [Muller-Fassbender, 1994].

Study #3
Osteoarthritis of the Knee: Glucosamine Sulfate vs. Placebo

Researchers found that glucosamine sulfate was significantly more effective than placebo, in a randomized, double-blind study of 252 people with osteoarthritis of the knee. During the four week trial, participants were given either 500 mg of glucosamine or placebo three times daily. Researchers measured improvement using the Lequesne's Index (a standard scale for measuring pain, maximum walking distance, and limitation of motion in daily activities) and general assessment by the investigator. At the end of the study, index scores had decreased by an average of 3.2 points in the glucosamine group, compared to only 2.2 points in the placebo group. The overall response rate was 52% among those taking glucosamine and 38% for placebo. Both treatments were well tolerated throughout the study with no difference in the number of reported side effects [Noack, 1994].

Study #4
Osteoarthritis of the Knee: Glucosamine Sulfate vs. Ibuprofen

In a study of 40 people with osteoarthritis of the knee, Portuguese researchers found that ibuprofen reduced pain more quickly during the first two weeks, but that glucosamine offered more sustained, long-term benefits. During the eight week study, participants were randomly assigned to take either 1.5 g of glucosamine or 1.2 g of ibuprofen daily in three divided doses. Researchers measured the degree of articular pain on a zero to three rating scale before the treatment and after one, two, four, and eight weeks. The rate of side effects was 11% in the glucosamine group, compared to 25% in those taking ibuprofen. Although the difference in side effects did not reach statistical significance in this study, researchers believe that it may be more important in long-term treatment. Researchers concluded that ibuprofen may be useful for managing pain during the first two weeks of treatment, but that glucosamine is more appropriate for long-term treatment of osteoarthritis [Vaz, 1982].

References:

DrovantiA, Bignamini AA, Rovati AL. Therapeutic activity of oral glucosamine sulfate in osteoarthritis: a placebo-controlled double-blind investigation. Clinical Therapeutics 1980; 3(4): 260-272.

Muller-Fassbender H, Bach GL, Haase W, et al. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis and Cartilage 1994; 2: 61-69.

Noack W, Fischer M, Forster KK, et al. Glucosamine sulfate in osteoarthritis of the knee. Osteoarthritis and Cartilage 1994; 2: 51-59.

Vaz AL. Double-blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulphate in the management of osteoarthritis of the knee in out-patients. Current Medical Research and Opinion 1982; 8(3): 145-149.

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