Osteoarthritis (OA), the most common type of arthritis, is a degenerative disease of the joints. Although it is sometimes able to cause acute inflammation, it is more commonly a "wear and tear" disease that involves the degeneration of articular cartilage and the formation of bone spurs within several joints. Joint trauma, repetitive occupational use and obesity are risk factors. The majority of people over 60 years of age have this condition to a certain extent, with approximately 16 million patients requiring medical attention. The main goal of treatment is to relieve pain.
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Glucosamine and chondroitin have been widely promoted as a treatment for OA. It is believed that glucosamine - an amino sugar - promotes the formation and repair of cartilage. Chondroitin, a carbohydrate, is a cartilaginous component that is believed to promote water retention and elasticity and inhibit the enzymes that break down cartilage. Both compounds are manufactured by the body. Glucosamine supplements are derived from seafood shells; Chondroitin supplements are usually made from cow's cartilage.
Results of the investigation
Laboratory studies suggest that glucosamine can stimulate the production of proteins that form cartilage. Other research suggests that chondroitin could inhibit the production of enzymes that destroy cartilage and also fight inflammation. Some studies in humans have found that either can relieve the pain and stiffness of arthritis with fewer side effects than conventional arthritis medications. Other studies have not shown any benefit. As the research accumulates, the expert review bodies have been cautious because, although the positive reports outnumber the negative ones, the studies with negative reports have been larger and better designed [1]. In addition, it has not been determined whether glucosamine offers any advantage over established medications, such as paracetamol, traditional non-steroidal anti-inflammatory drugs (NSAIDs) or selective Cox-2 inhibitors [2].
The largest and best designed clinical trial is the Arthritis Intervention Trial with Glucosamine / Chondroitin (GAIT), funded by the National Institutes of Health of the United States. So far, the GAIT has produced two sets of negative results. In 2006, the researchers reported on a 24-week study involving 1,583 patients randomly assigned to receive 500 mg of glucosamine hydrochloride three times a day, 400 mg of sodium chondroitin sulfate three times a day, 500 mg of glucosamine plus 400 mg of chondroitin sulfate three times a day, 200 mg of celecoxib (Celebrex) daily, or a placebo. The study found that glucosamine and chondroitin, alone or together, did not reduce knee pain from osteoarthritis more effectively than placebo. These two drugs reported approximately 17% better than the placebo group in the case of moderate pain [3].
The aforementioned report was accompanied by an editorial that concluded:
[Based on this study], it seems prudent to tell our patients with symptomatic osteoarthritis of the knee that neither glucosamine hydrochloride nor chondroitin sulfate alone have been shown to be more effective than placebo for the treatment of knee pain. If patients choose to take food supplements to control their symptoms, they should be advised to take glucosamine sulfate instead of glucosamine hydrochloride and, for those with severe pain, taking chondroitin sulfate with glucosamine sulfate may have an additional effect. Three months of treatment is a sufficient period for the evaluation of effectiveness; if there is no clinically significant decrease in symptoms at this time, the supplements should be discontinued. In addition, there is no evidence that these agents prevent osteoarthritis in healthy people or in people with knee pain but with normal radiographs [4].
In 2007, another well-designed study involved 71 patients with osteoarthritis of the knee who were followed for a year. The study found no significant differences in function and pain between the treatment and placebo groups [5]. Later that year, a meta-analysis concluded: "Methodologically adequate trials on a large scale indicate that the symptomatic benefit of chondroitin is minimal or non-existent.The use of chondroitin in routine clinical practice should, therefore, be discouraged." [6]
To study whether glucosamine or chondroitin could decrease the structural damage of osteoarthritis, GAIT patients were offered the opportunity to continue their original treatment for an additional 18 months, for a total of two years [7]. Approximately 570 patients were enrolled. In 2008, the researchers reported that none of the treatment groups showed a significant structural benefit (slowing of joint space narrowing). The researchers expressed the hope that further research may find that a subset of patients not yet defined may benefit, but I do not share their optimism.
Two studies reported in 2010 that patients with chronic pain experienced no benefit from taking 1,500 mg a day of glucosamine. One study involved 250 adults with chronic low back pain and degenerative osteoarthritis who were followed for one year. Half of the patients took glucosamine and half received a placebo. The group to which glucosamine was administered did not have significant improvements with respect to the group that received placebo [8]. The other study included 662 GAIT participants with moderate to severe knee osteoarthritis, who received glucosamine (500 mg three times a day), chondroitin sulfate (400 mg three times daily), glucosamine, and chondroitin sulfate combined (same doses) , celecoxib (Celebrex, 200 mg once a day) or a placebo. There were no statistically significant differences between the groups [9].
Another study reported in 2014 found no evidence that glucosamine and chondroitin are effective in relieving knee symptoms or slowing the development of the disease among patients with osteoarthritis. Over a period of 4 years, the researchers followed 1,625 patients, 18% of whom started using glucosamine or chondroitin during the study period. Users had no improvement over patients who did not use it [10].
products
In the United States (and Mexico) glucosamine and chondroitin products are marketed as "food supplements". Glucosamine is available in many forms, including glucosamine sulfate, glucosamine hydrochloride (HCl) and N-acetylglucosamine (NAG), and may also contain potassium chloride or sodium chloride salt. However, there is no conclusive evidence that one presentation is better than another. Chondroitin is typically sold as chondroitin sulfate.
In December 1999 and January 2000, ConsumerLab.com tested 25 brands of glucosamine, chondroitin and combination products and discovered that 10 glucosamine-only products passed the test, but only 2 with only chondroitin and 6 of 13 with combination products did not pass the tests. tests because their chondroitin levels were too low. In January 2001, one of the combined products was eliminated because its manganese level was considered too high [11]. The latest ConsumerLab report indicates that 8 products of 8 tested glucosamine-only, contained the amount shown on the label, but 2 products of 2 analyzed chondroitin-only did not contain the same amount shown on the label [12].
In 2001, Consumer Reports evaluated 19 products and reported:
They were reasonably well standardized, delivering at least 90 percent of the amount of glucosamine or chondroitin promised on the label, thus meeting a new standard for supplements proposed by the US Pharmacopoeia. UU., Which sets standards for medications and proposes them for supplements. However, four products, glucosamine and chondroitin "Double Strength", glucosamine chondroitin "ArthxDS", the glucosamine chondroitin complex "Solgar Extra Strength" and chondroitin sulfate "Now", did not meet this standard. Two products: the glucosamine chondroitin complex "Solgar Extra Strength" and Twinlab CSA (chondroitin sulfate) recommended very few pills per day to supply the dose used in successful clinical trials. Many others listed the recommended amount of pills as a range that allows consumers to take a dose that may be inadequate [13].
Security considerations
So far, no studies have found serious side effects of glucosamine or chondroitin. The most common side effects are increased intestinal gas and loose stools. However, studies in animals have suggested the possibility that glucosamine may worsen insulin resistance, one of the main causes of diabetes. So far, studies in humans have not corroborated this risk. However, people with diabetes who use this nutritional supplement should closely monitor their blood sugar level. No allergic reactions have been reported to glucosamine, but because it is obtained from seafood shells, people who are allergic to shellfish should exercise caution when using it paying attention to the signs of a reaction, or better yet, avoid it altogether . As for chondroitin, it can cause bleeding in people who have a bleeding disorder or who take an anticoagulant medication.
In 2001, Vital Nutrients recalled two products (Vital Nutrients Joint Ease and Verified Quality Joint Comfort) in which they were found to contain aristolochic acid, a substance that can cause kidney toxicity and cancer [14].
In 2008, a Scottish newspaper reported the death of several people due to liver failure within a few weeks of taking glucosamine [15]. Although the cause and effect could not be proven, local doctors issued a warning.
In conclusion
Chondroitin seems to have no effect. Whether glucosamine is useful or not is more complicated, but better designed studies indicate that it is not. This usually means that the negative evidence at the end will be conclusive. Given the scant evidence, the decision to use glucosamine is based on information that is less complete than desirable. In addition, the quality control of the product can be a problem in many cases. This is my advice:
- The first step in seeking care for arthritis symptoms should be to obtain a diagnosis by a competent doctor.
- The next step is to discuss with the doctor the pros and cons of the different treatment options.
- If you decide to try glucosamine, do so taking into account the latest information about it. Consumer Reports, ConsumerLab.com or your doctor can help you choose the right product.
- Consider that chondroitin could represent a useless expense.
- Ignore any doctor or salesperson who tells you that you have a "miracle cure" for arthritis.
- Never buy a dietary supplement just because you saw a radio or television ad.
- Beware of the price. The Puritan's Pride mail order division, which frequently has "5x2" and "3x1" offers, sells products that cost between $ 4 USD and $ 5 USD per month. (Be sure, of course, to ignore the misleading advertising that the company does, you should not rely on any vendor of food supplements, herbs or homeopathic remedies to obtain information about whether they are useful or not).