date, there is no ‘cure’ for arthritis. The best that we know
how to do is to treat the symptoms- pain, loss of flexibility,
etc. As a result, arthritis patients have searched for alternatives
to conventional (i.e., medically prescribed) treatments. Some
of these treatments include Chinese herbs, DMSO, ginger, ginkgo,
St. John’s Wort, etc. The sources of many of these therapies
are biological – i.e., plant or animal derived and are, therefore,
frequently labeled as "natural" remedies or treatments.
There is a book published by the Arthritis Foundation that describes
many of these therapies (Horstman, Judith: The Arthritis Foundation’s
guide to Alternative Therapies, 1999). On the one hand, one
must be wary of treatments called "cures" or "miracle
treatments", while on the other hand one needs to evaluate
carefully the criticisms of the "skeptics."
Sulfate and Glucosamine
healthy cartilage covering the ends of bones is called hyaline
or articular cartilage. The cartilage, along with the fluid
in the joint, works to permit movement of long bones next
to each other (e.g. thigh bone vs. shin bone). Cartilage is
made up of cells (called chondrocytes) and the material that
surrounds the cells (called matrix). Cartilage is approximately
95% matrix and 5% cells. The matrix is made up of collagen,
a protein, and glycosaminoglycans, a type of carbohydrate
molecule. Glucosamine and chondroitin sulfate are two molecules
found in articular cartilage. Chondroitin sulfate is the most
abundant glycosaminoglycan (GAG) in cartilage. It binds to
the collagen-giving cartilage its unique characteristics –
strength, flexibility, slipperiness.
studies have been conducted to evaluate the response of cartilage
and, specifically, cartilage cells to treatment with glucosamine
and chondroitin sulfate. Laboratory studies have shown that
glucosamine stimulates cartilage cells and the production
of GAGs in articular cartilage. Likewise, laboratory studies
have shown chondroitin sulfate can act to inhibit many of
the enzymes that work to break down the cartilage and fluid
in the knee joint.
large number of clinical studies have been conducted in Europe
and other countries outside of the United States. Although
the FDA does not require studies to be conducted on nutritional
supplements, a few studies have been completed in the United
States evaluating the effectiveness of a glucosamine and chondroitin
sulfate in the treatment of osteoarthritis. Das et al. reported
on 93 patients with knee osteoarthritis at the Annual Meeting
of the American Academy of Orthopaedic Surgeons in 1999. They
found a significant functional improvement in the treated
patients as compared to placebo-based controls. Leffler et
al. reported similar findings in OA patients with back or
knee involvement (Military Medicine, 164: 85-91, 1999). Currently,
a double-blind, placebo-controlled study is underway at the
Johns Hopkins University School of Medicine to evaluate the
use of the combination therapy. If you live in the Baltimore
area and have arthritis of the knee you can participate in
Concerning Chondroitin Sulfate/Glucosamine Combination Therapy
it matter which product you use?
recent study published by Adebowale, et al. (Journal of
the American Nutraceutical Association, 3: 37-44, 2000)
reported on the analysis of the content of glucosamine and
chondroitin sulfate in 14 products and chondroitin sulfate
in 43 products. They found a significant variation in the
amount of each molecule in the products tested. These amounts
were significantly different from the content listed on
the product label. Furthermore, the less expensive a product
was (i.e., less than or equal to $1.00/1200 mg), the more
deficient the product was.
is this a concern? A patient may try an over-the-counter
product and decide that glucosamine/chondroitin sulfate
does not work for them. However, it may be that the product
that they tried was of poor quality. If a higher quality
(i.e., product containing a product of higher purity and
content) was taken, they might have experienced a favorable
chondroitin sulfate/glucosamine safe?
upon current knowledge, there are no significant side effects
to taking either chondroitin sulfate or glucosamine.
dose should you use?
is recommended by one of the manufacturers (Nutramax Laboratories,
Inc.) that each individual takes 1500-mg glucosamine and
1200-mg chondroitin sulfate/day. They state that this may
be decreased after 60 days. However, additional study is
warranted to evaluate the effect of different doses (concentrations)
and dose regimens (frequency of dose).
I see an immediate effect?
not. Multiple studies have shown a delay from the onset
of treatment to the time of symptom relief. It is possible
that you may not see an effect for three to four months.
individuals with diabetes use this treatment?
has been recent articles suggesting that glucosamine treatment
may increase the risk of diabetes. This study involved only
16 patients. It was widely reported via the internet. Thousands
of patients have been studied. No published study has recorded
any impact on the incidence of diabetes of the course of
is a concern that patients will stop taking OA therapies
known to be effective in favor of yet-to-be proven supplements.
are no known "effective" OA therapies to treat
the skeletal changes that occur- only the symptoms. However,
it is important for each person to visit a physician to
determine that they do have osteoarthritis. "Self
treatment" of osteoarthritis is not nearly as big
a concern as "self diagnosis." If you have symptoms
of recent onset for which a diagnosis has not [yet] been
made, you should see your doctor for the purposes of