Glucosamine
The Glucosamine/Chondrotin Arthritis Intervention Trial (GAIT) reports that Glucosamine and Chondroitin is effective in treating moderate to severe osteoarthritis knee pain. This study, funded by The National Institute of Health (NIH) confirms nutritional supplements glucosamine and chondroitin are the right combination for effective knee pain relief. The trial rigorously evaluated the efficacy and safety of glucosamine and chondroitin in 1,258 people, concluding in its abstract that the "combination of glucosamine and chondroitin sulfate is effective in treating moderate to severe knee pain due to osteoarthritis."
"GAIT brings good news to adults suffering from the wear and tear of cartilage degeneration, particularly those who cannot tolerate the side effects of taking nonsteroidal anti-inflammatory drugs (NSAIDs)," said C. Thomas Vangsness, Jr., MD, Professor Orthopaedic Surgery, Keck School of Medicine, University of Southern California. "For years glucosamine and chondroitin have been well recognized alternative solutions to pharmaceutical options in treating osteoarthritis patients in Europe, Asia and Russia. In fact, preliminary results reported in the GAIT abstract indicated glucosamine and chondroitin were found to be more effective than Celebrex(R) in treating moderate to severe knee pain. Clearly, the GAIT abstract suggests glucosamine and chondroitin together may be a good non-surgical pain relief choice for arthritis patients," added Dr. Vangsness.
This $14 million GAIT study, funded by the NIH, is the largest placebo controlled, double blind, clinical trial ever conducted to test the effectiveness of glucosamine and chondroitin. All 1,258 patients who completed the study were over the age of 40 with knee pain and randomly assigned placebo; glucosamine 1500 mg; chondroitin 1200mg; glucosamine/chondroitin at above mentioned doses; or celecoxib (Celebrex) 200 mg daily for 6 months. The abstract published each treatment group's response rate to pain. Of note, the group taking the glucosamine/chondroitin combination experienced greater relief for the treatment of moderate to severe knee pain than the Celebrex group.
GAIT was designed to test the safety and efficacy of glucosamine and chondroitin alone and in combination in reducing knee pain associated with osteoarthritis. The study's abstract concluded that when taken together, "glucosamine and chondroitin is effective in treating moderate to severe knee pain due to OA [osteoarthritis]."
Naturally occurring in the body, glucosamine stimulates the production of cartilage, the connective tissue which cushions joints. Chondroitin is also naturally occurring in the body and like glucosamine stimulates the production of cartilage. Previous research indicates glucosamine is just as effective as non-steroidal anti-inflammatory drugs (NSAIDs) in reducing osteoarthritis pain and has fewer gastrointestinal side effects than NSAIDs.
Nearly 1 in 3 Americans (nearly 70 million) live with some form of arthritis, costing the United States $82.5 billion a year in healthcare costs related to treating the illness.(2) For arthritis knee pain sufferers who find relief in taking glucosamine and chondroitin, they will also find the supplements to be great values. Widely used in Europe for years to treat osteoarthritis, glucosamine and chondroitin are safe and effective nutritional supplements, as proven by the GAIT abstract.
http://www.rheumatology.org/annual/abstracts/search.asp
www.prnewswire.com
Two long-awaited clinical trials on glucosamine have found the shellfish-derived substance to significantly reduce the pain of arthritic joints, and it may be better than a commonly used painkiller in Europe.
These first results come from the multi-centered Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) conducted by the US government-funded National Institutes of Health.
GAIT is the first multicenter clinical trial in the United States to test the effects of the dietary supplements glucosamine and chondroitin for treatment of knee osteoarthritis. The study was testing whether glucosamine and chondroitin used separately or in combination are effective in reducing pain and improving functional ability in patients with knee osteoarthritis.
Approximately 1,500 osteoarthritis patients were given a daily dose of either 1,500 mg of glucosamine hydrochloride, 1,200 mg of chondroitin sulphate, a combination of both supplements, 200 mg of the common prescription painkiller celecoxib (Celebrex) or a placebo for 24 weeks. The patients were evaluated at baseline and every four weeks thereafter.
Both celecoxib and the glucosamine-chondroitin combination significantly reduced knee pain compared to placebo.
The authors' abstract says, "Combination glucosamine and chondroitin sulphate is effective in treating moderate to severe knee pain due to osteoarthritis,"
These studies will be presented at the American College of Rheumatology (ACR) meeting in San Diego on 14 November, by Daniel Clegg from the University of Utah.
The second study found glucosamine sulphate to be more effective than the over-the-counter painkiller acetaminophen on joint pain. Dr Herrero-Beaumont from the Fundacion Jimenez Diaz in Madrid will disclose the results of this multi-centre European study.
The Glucosamine Unum in Die Efficacy (GUIDE) trial compared a daily dose of 1500 mg of glucosamine sulphate and 3000 mg of the OTC drug to a placebo in 318 patients.
After 24 weeks, the glucosamine supplement showed strong evidence of its effectiveness on various pain and mobility.
The abstract concludes: "Glucosamine sulphate…might be the preferred symptomatic medication in knee osteoarthritis."
In both trials there were no differences among groups in safety.
Andrew Shao, in charge of scientific affairs at the US-based trade association the Council for Responsible Nutrition, noted that each trial can be considered "well-designed, well-conducted, gold-standard".
The glucosamine and chondroitin sulphate used in GAIT were required to meet pharmaceutical standards as it was conducted under an Investigational New Drug application.
Such high standards will be important if glucosamine makers are to attract new consumers that have been alerted to the risks of traditional treatments for arthritis by the makers of Cox-2 inhibitor drugs.
Indeed, the new findings on glucosamine and chondroitin sulphate will prove timely as the withdrawal of Cox-2 inhibitor drugs last year continues to prompt interest in natural substances to relieve joint pain.
This coincides with a high incidence of osteoarthritis quickly rising around the world due both to ageing populations and increasing levels of obesity.
www.nutraingredients/europe
www.nccam.nih.gov
30/09/2005
Randomised, Double-Blind, Parallel, Placebo-Controlled Study of Oral Glucosamine, Methylsulfonylmethane and their Combination in Osteoarthritis
Objective: Glucosamine, classified as a slow-acting drug in osteoarthritis
(SADOA), is an efficacious chondroprotective agent. Methylsulfonylmethane (MSM),
the isoxidised form of dimethyl-sulfoxide (DSMO), is an effective natural analgesic
and anti-inflammatory agent. The aim of this study was to compare the efficacy
and safety of oral glucosamine (Glu), methylsulfonylmethane (MSM), their combination
and placebo in osteoarthritis of the knee.
Patients and design: A total of 118 patients of either sex with mild
to moderate osteoarthritis were included in the study and randomised to receive
either Glu 500mg, MSM 500mg, Glu and MSM or placebo capsules three times daily
for 12 weeks. Patients were evaluated at 0 (before drug administration), 2,
4, 8 and 12 weeks post-treatment for efficacy and safety. The efficacy parameters
studied were the pain index, the swelling index, visual analogue scale pain
intensity, 15m walking time, the Lequesne index, and consumption of rescue medicine.
Results: Glu, MSM and their combination significantly improved signs
and symptoms of osteoarthritis compared with placebo. There was a statistically
significant decrease in mean (± SD) pain index from 1.74 ± 0.47
at baseline to 0.65 ± 0.71 at week 12 with Glu (p < 0.001). MSM significantly
decreased the mean pain index from 1.53 ± 0.51 to 0.74 ± 0.65,
and combination treatment resulted in a more significant decrease in the mean
pain index (1.7 ± 0.47 to 0.36 ± 0.33; p < 0.001). After 12
weeks, the mean swelling index significantly decreased with Glu and MSM, while
the decrease in swelling index with combination therapy was greater (1.43 ±
0.63 to 0.14 ± 0.35; p < 0.05) after 12 weeks. The combination produced
a statistically significant decrease in the Lequesne index. All treatments were
well tolerated.
Conclusion: Glu, MSM and their combination produced an analgesic and
anti-inflammatory effect in osteoarthritis. Combination therapy showed better
efficacy in reducing pain and swelling and in improving the functional ability
of joints than the individual agents. All the treatments were well tolerated.
The onset of analgesic and anti-inflammatory activity was found to be more rapid
with the combination than with Glu. It can be concluded that the combination
of MSM with Glu provides better and more rapid improvement in patients with
osteoarthritis.
Clinical Drug Investigation, 2004, vol. 24, no. 6, pp. 353-363(11)
Usha P.R.1; Naidu M.U.R.1
Combining the sulphur-containing nutrient MSM with well-known joint health supplement glucosamine appears to speed up the anti-inflammatory effect and further reduce pain in patients with osteoarthritis, report Indian researchers.
Glucosamine, derived largely from shrimp shells, is widely used by arthritis
patients but it is less commonly found in combination with MSM, or methylsulfonylmethane,
which is the isoxidised form of dimethyl-sulfoxide (DSMO).
It is however often taken along with chondroitin sulphate.
In the new study, both glucosamine and MSM improved osteoarthritis symptoms
in subjects but when taken together the effect was greater than either alone.
"Combination therapy showed better efficacy in reducing pain and swelling
and in improving the functional ability of joints than the individual agents,"
report the researchers in the June issue of Clinical Drug Investigations
(vol 24, no6, pp 353-363).
More than 7 million adults in the UK - 15 per cent of the population - have
long-term health problems due to arthritis and related conditions, according
to the Arthritis Research Campaign, and 550,000 have moderate to severe osteoarthritis
in their knees.
And across Europe the number of arthritis sufferers will continue to escalate
as the population ages and other major risk factors, such as obesity, also increase.
Dr P Usha and M Naidu from Nizam's Institute of Medical Sciences in Hyderabad,
India randomised 118 people with mild to moderate osteoarthritis to receive
either 500mg glucosamine, 500mg MSM, a combination of both or placebo capsules
three times daily for 12 weeks.
Patients were evaluated at prior to the study and several times during treatment
for efficacy and safety.
After 12 weeks, the average pain score had fallen from 1.74 to 0.65 in those
taking only glucosamine. In MSM-only participants, it fell from 1.53 to 0.74.
However, in the combination group, it fell from 1.7 to 0.36. The researchers
also found that the combination treatment had a faster effect on pain and inflammation
compared to glucosamine alone.
"It can be concluded that the combination of MSM with glucosamine provides
better and more rapid improvement in patients with osteoarthritis," write
the researchers.
nutraingredients.com
7/22/2004
Taking oral glucosamine sulphate and chondroitin sulphate could be a safe and
effective way of treating knee osteoarthritis, report a team of Belgian and
French researchers.
A major review of randomised, placebo-controlled clinical trials published or
performed between January 1980 and March 2002 found that both supplements had
significant effects on joint space narrowing.
The researchers used Medline, Premedline, Embase, Cochrane Database of Systematic
Reviews, Current Contents, BIOSIS Previews, HealthSTAR, EBM Reviews, manual
review of the literature and congressional abstracts, and direct contact with
the authors and manufacturers of glucosamine and chondroitin to perform the
research, published in this month's Archives of Internal Medicine.
There was a "a highly significant efficacy of glucosamine on all outcomes",
said the researchers, including the Lequesne Index, Western Ontario MacMaster
University Osteoarthritis Index (WOMAC) and tests for pain, mobility and safety.
Safety was "excellent" for both compounds.
"Our study demonstrates the structural efficacy of glucosamine and indistinguishable
symptomatic efficacies for both compounds," the researchers concluded.
They added that the data on glucosamine and joint space narrowing is sparse
and there is little data on structural effects of chondroitin, so further studies
are needed to before an accurate dose can be determine for the two supplements.
Nutraingredients.com
7/23/2003
Nutraceutical: Glucosamine
Indication: Knee Pain
Source: British J Sports Med 2003;37:45-49
Research: Twenty-four patients with chronic knee pain were supplemented
with 2000 mg a day of glucosamine and 22 subjects
were given a placebo (lactose). The purpose of this study was to examine the
effects of oral glucosamine supplementation on the
functional ability and degree of pain felt by individuals who had regular knee
pain, most likely due to previous articular cartilage damage,
and possibly osteoarthritis. Over this period, four testing sessions were conducted
with changes in knee pain and function assessed by
clinical and functional tests, (joint line palpation, a 3 meter "duck walk"
and a repeated, walking stair climb), two questionnaires
(the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Knee Pain Scale
(KPS)) and participant subjective evaluations.
Results: The clinical and functional test scores improved with time but
there were no significant differences between the two groups.
The questionnaire results also recorded a significant main effect for time,
but the glucosamine group was found to have significantly
better KOOS quality of life scores at week eight and 12, and lower KPS scores
at week eight than the placebo group. On self-report evaluations of changes
across the 12-week supplementation period, 88% of the glucosamine group reported
some degree of improvement in their knee pain versus only 17% in the placebo
group. The authors concluded that 2000 mg of glucosamine daily can provide some
degree of pain relief and improved mobility in patients with chronic knee pain
as a result of previous cartilage damage or possibly osteoarthritis.
GLUCOSAMINE SULFATE DELAYS OSTEOARTHRITIS
Source: K Pavelka et al., "Glucosamine Sulfate Use and Delay
of Progression of Knee Osteoarthritis," Archives of Internal Medicine
162, no.18 (October 14, 2002): 2113-2123
Long-term treatment with glucosamine sulfate improves
symptoms of knee osteoarthritis and delays progression of the condition, according
to researchers.
In a 3-year, randomized, placebo controlled, double-blind study, researchers
gave 202 patients with knee osteoarthritis either a placebo or 1500 mg of glucosamine
sulfate per day. The researchers measured changes in tibiofemoral joint space
width and assessed joint pain symptoms. While those receiving the placebo experienced
average joint space narrowing of 0.19 mm after three years, average joint space
width did not change in those who received glucosamine sulfate. Moreover, symptoms
improved only modestly among those taking the placebo, while symptoms improved
by 20-25% among those taking the supplement.
"Long term treatment with glucosamine sulfate retarded progression of
knee oseoarthritis, possibly determining disease modification," concluded
the researchers.
Early results from the study, which was funded by the Rotta Research/Rottapharm
Group, were presented in November 2000 at the annual meeting of the American
College of Rheumatology in Philadelphia, and in June 2001 at the annual meeting
of the European Congress of Rheumatology in Prague, Czech Republic.
"The Arthritis Cure" presents evidence to support the use of Glucosamine Sulfate and Chondroitn Sulfate in the rebuilding process of joints and cartilage. It also chronicles how arthritis sufferers have benefited from taking these two components.
Efficacy and Safety of Glucosamine Sulfate Versus Ibuprofen
in Patients With Knee Osteoarthritis.
Qiu GX, Gao SN, Giacovelli G, Rovati L, Setnikar I
Arzneimittel-Forschung 48(5):469-74, 1998 May
A double-blind therapeutic investigation was performed on 178 Chinese patients suffering from osteoarthritis of the knee randomized into two groups, one treated for 4 weeks with glucosamine sulfate(GS, CAS 29301-19-4, Viatril-S) at the daily dose of 1,500 mg and the other with ibuprofen (IBU, CAS 15687-27-1) at the daily dose of 1,200 mg.
Knee pain at rest, at movement and at pressure, knee swelling, improvement and therapeutic utility as well as adverse events and drop-outs were recorded after 2 and 4 weeks of treatment. The variables were recorded also after 2 weeks of treatment discontiuation in order to appreciate the remnant therapeutic effect.
Both GS and IBU significantly reduced the symptoms of osteoarthritis with the trend of GS to be more effective. After 2 weeks of drug discontinuation there was a remnant therapeutic effect in both groups, with the trend to be more pronounced in the GS group.
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 speciifically 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. The present study confirms that GS is a selective drug for osteoarthritis, as effective on the symptons of the disease as NSAIDs but significantly better tolerated.
For these properties GS seems particularly indicated in the long-term treatments in osteoarthritis.
Guarantor: LCDR Alan F. Philippi, MC USNR
Contributors: LT Christopher T. Leffler, MC USNR* LCDR Alan F. Phillippi, MC
USNR* Susan G. Leffler, MD, James C. Mosure, MD Lt Peter D. Kim, USNR
Objective: A 16-week randomized, double-blind, placebo-controlled crossover trial of a combination of glucosamine HCl (1,500 mg/day), chondroitin sulfate (1,200 mg/day), and manganese ascorbate (228 mg/day) in degenerative joint disease (DJD) of the knee or low back was conducted.
Methods: Thirty-four males from the U.S. Navy diving and special warfare community with chronic pain and radiographic DJD of the knee or low back were randomized. A summary disease score incorporated results of pain and functional questionnaires, physical examination scores and running times. Changes were
presented as a percentage of the patient's average score.
Results: Knee osteoarthritis symptoms were relieved as demonstrated by
the summary disease score (-16.3%; p=0.05), patient assessment of treatment
effect (p=0.02), visual analog scale for pain recorded at clinic visits (-26.6%;
p=0.05) and in a diary (-28.6%; p=0.02), and physical examination score (-43.3%;
p=0.01). Running times did not change. The study neither demonstrated, nor excluded,
a benefit for spinal DJD. Side effect frequency was similar to that at baseline.
There were no hematologic effects.
Conclusions: The combination therapy relieves symptoms of knee osteoarthritis.
A larger data set is needed to determine the value of this therapy for spinal
DJD. Short-term combination therapy appears safe in this setting.
"Power für die Gelenke", by Dr. Michaela Döll, presents
evidence
to support the use of Glucosamine and Chondroitn Sulfate for easing
joint pain and symptoms of arthritis.
Anyone who experiences some form
of joint pain will find this book very informative as to possible remedies.
It is the number one selling joint pain book in Germany
and is soon to
be released in other countries.