Chondroitin sulphate and glucosamine are popular supplements used to treat pain and loss of function associated with osteoarthritis. However, most of the efficacy trials show little improvement over placebo in terms of reducing joint pain or damage.
Chondroitin - what is it?
Chondroitin is the main component of cartilage, it helps to stop water. It is produced naturally by the body. For the production of supplements can be produced from cartilage animals, such as cows, pigs or sharks, or it can be produced in the laboratory. The supplement is sold as chondroitin sulphate. In many European countries it is approved as a prescription drug. In the United States, it is often combined with a glucosamine supplement.
Glucosamine - what is it? When to use and research
Like chondroitin, glucosamine is a natural compound found in healthy cartilage, especially in the fluid around the joints. In the case of dietary supplements, it is collected from crustacean shells or it can be produced in a laboratory. It may occur in several chemical forms, but glucosulfate is the most commonly used in arthritis. In laboratory tests, glucose showed anti-inflammatory properties and even appeared to help regenerate cartilage.
RESEARCH glucose sulphate on the crystalline side resulted in the relief of symptoms in patients with osteoarthritis who had been taking 1500 mg daily for three years.
Chondroitin sulphate in osteoarthritis
Chondroitin may be an additional painkiller in some people with osteoarthritis of the knee and hand. The benefits are usually small (around 8-10% improvement) and work slowly (up to 3 months). A comprehensive natural drug database (NMCD), which assessed and evaluated over 80 000 natural ingredients of drugs and commercial dietary supplements, classified chondroitin as "potentially effective" in the case of knee disease.
A study from 2011r. published in the journal Arthritis and Rheumatism showed that chondroitin sulfate mildly relieves pain and improves function in people with osteoarthritis. The supplement was made from fish and taken daily at a dose of 800 mg for 6 months. Patients reported improvement after 3 months of treatment. A shorter time of morning stiffness was also observed. Chondroitin did not improve the grip strength. In addition, patients treated with chondroitin did not use less painkillers (acetaminophen) than patients taking placebo.
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Since no side effects associated with chondroitin have been reported, it can be tried as an alternative to non-steroidal anti-inflammatory drugs for patients who can not take them and who require long-term treatment. Chondroitin and anti-inflammatory drugs have not been compared directly; however, other studies have shown a similar improvement in hand pain and function as found in chondroitin. Anti-inflammatories relieve pain more quickly than chondroitin sulfate, but may cause more serious side effects (increased risk of gastrointestinal bleeding, heart attack or stroke and interactions with other medications), especially in elderly patients.
Glucosamine in osteoarthritis
Glucosamine can provide modest pain relief in some patients with osteoarthritis of the knee, hip and spine. The Natural Medicines Comprehensive Database classified glucosamine as "probably effective" in osteoarthritis, ranking it higher than chondroitin. Most research performed in patients with knee osteoarthritis.
However, some studies show that glucosamine provides the same pain relief as placebo (a pill that does not contain any medicine). This is called the "placebo effect" in which patients expect that they will feel better. An example is the study published in 2010r. in the journal American Medical Association, which states that glucosamine does not provide additional pain relief compared to placebo in people with chronic low back pain caused by osteoarthritis in the lower back. Half of the participants took glucosamine (1500 milligrams a day) and the other half took a placebo. Both groups claimed that lower back pain improved by around 50 percent during the year. However, due to the small number of people involved in the study, there is a need for more research to confirm these results.
The combination of glucosamine and chondroitin in osteoarthritis
The most comprehensive long-term study of each supplement - an attempt to intervene Glucosamine / Chondroitin Arthritis Intervention (GAIT) - was observed on the combination of chondroitin and glucosamine, both supplements individually, celecoxib (Celebrex) and placebo in patients with osteoarthritis of the knee joints.
The first phase of GAIT showed that the combination of glucosamine and chondroitin sulfate showed significant relief in a smaller subset of study participants with moderate to severe knee pain. But there was no effect in the group with mild pain. These results were published in the New England Journal of Medicine in the 2006 year.
The second phase of the GAIT study, published in the journal Arthritis & Rheumatism in 2008, concerned the prevention of joint damage in the knee. It seems that the combination of glucosamine and chondroitin is not more effective in preventing joint damage caused by osteoarthritis than in the case of placebo. Although the differences between the groups were not statistically significant, participants who lost the smallest amount of joint space within two years were in groups receiving either glucose alone or chondroitin alone. It is possible that taking two supplements together may limit their absorption into the body, explaining the lower effect of a combination of supplements.
In the third phase, in total, over four years, supplements in combination or monotherapy did not bring greater benefits in relieving knee pain than celecoxib or placebo. Although the results were not statistically significant, celecoxib achieved the highest chance of achieving at least 20% pain reduction. These results were published in the 2010 year in the Annals of Rheumatic Disease.
The American College of Rheumatology in its latest recommendations for the treatment of bone and joints published in the 2012 year does not recommend chondroitin or glucosamine for the initial treatment of osteoarthritis. Chondroitin and glucosamine supplements alone or in combination may not work for all people with osteoarthritis. However, patients who take these supplements and who have noticed improvement in them should not stop accepting them. Both supplements are safe to take long-term.
Differences in the effectiveness of chondroitin may also be due to variations in dosage and the quality of supplements. The chondroitin content between different brands can vary widely. Similar concerns related to glucosamine supplements. Talk to your doctor or pharmacist about which brand to choose by trying one of these supplements.
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