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Glucosamine in the treatment of osteoarthritis

Arthrosis is a degenerative disease of the articular cartilage that affects almost 50% of those over 65 years of age 1 . Of the total affected, approximately 20% will develop symptoms such as joint stiffness, pain and functional impotence. This disease is responsible for 30% of visits to the general practitioner in older adults and the second cause of disability in the elderly after cardiovascular disease. It also represents an important cause of work absenteeism.



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The key site of the damage is the articular cartilage, where a progressive degeneration associated with a chronic inflammation that causes stiffness and pain occurs. The cause of joint deterioration is not known but certain predisposing factors such as advanced age and obesity have been identified.

The classic treatment has been aimed at improving symptoms, generally using anti-inflammatory drugs such as NSAIDs and other important measures: weight control, exercise, kinesiotherapy and local treatments with capsaicin and infiltrations with corticosteroids. These measures are effective in controlling pain in the medium term but chronic therapy with NSAIDs can cause gastrointestinal and renal adverse effects that limit their use.

In recent years, drugs have appeared that act at the level of cartilage, interacting with components such as proteoglycans and interfering with the oxidative mechanisms dependent on free radicals, which are thought to be related to the state of inflammation and chronic degeneration. Among them is Glucosamine Sulfate, a compound derived from glucosamine which is a normal component of cartilage and joint fluid. This drug is postulated as a disease modifier, since it interferes with the aforementioned degenerative mechanisms and could alter the long-term prognosis in addition to alleviating the symptoms.

The evidence on this compound has been increasing, and there are currently three published systematic reviews and a three-year follow-up clinical trial that provide data in favor of the efficacy of 1500 mg daily of this drug. These four works are summarized in the following table.

• RCT = Controlled and randomized clinical trial ; NS = Not significant; IC = Confidence interval; RA = Absolute risk; RR = Relative risk; RRA = Absolute risk reduction; NNT = Number needed to treat
• 1 Evaluated by validated scales; 2 The results were reported in this paper as a difference in effectiveness between interventions.
• 0 = no difference 0.5 = mild efficacy 1 = moderate efficiency 1.5 = important efficacy
• 3 Effectiveness is reported as effect size
• 0 = effect equal to placebo 0.2 = mild effect 0.5 = moderate effect 0.8 = important effect

Both meta-analyzes found methodological difficulties in the studies that evaluated chondroitin, so it is difficult to interpret the results related to this drug (they are not included in the table)

4 It was used as a measure of joint structural change. The cutoff point for a significant reduction was 0.3 mm.

In the three meta-analyzes 2-3-4 , similar results were obtained regarding the efficacy of glucosamine; it was mild or at best moderately better than Aines or placebo to control pain, joint stiffness and improve overall function. It is convenient to consider, however, that rescue studies were allowed in most studies, so the efficacy to reduce pain and improve joint function is difficult to evaluate. It should also be noted that the studies that evaluated chondroitin (another compound frequently used and that comes from the articular cartilage) included few patients and in the majority significant methodological flaws were detected that prevent valid conclusions.

In 2001, a clinical trial was published in the Lancet 5 that evaluated 212 patients over 50 years of age with osteoarthritis of the knee randomized to receive glucosamine sulphate versus placebo, with three years of follow-up. This study is important because until then there was only data from a few weeks of follow-up. The primary end point was the average width of the joint space in the medial compartment of the knee, which they used as a measure of structural change in the joint. The limit of 0.3 mm was taken as a limit of significant reduction of the joint space. Another final point was the change in scales of pain, rigidity and functional limitation, items evaluated at the beginning of the study, the year and the three years.

At the end of the study, the average decrease in joint space of the glucosamine group was not significant, while those assigned to placebo showed an average decrease at three years of 0.31 mm (CI -0.48 to -0.13). .

Treating 1500 mg of glucosamine daily for three years resulted in an absolute risk reduction of joint space narrowing of 16% and it would be necessary to treat 6 patients for three years to prevent a significant decrease in joint space (NNT). 6).

The patients assigned to glucosamine had a mild to moderate improvement in the symptoms at three years and those who received placebo did not present changes in relation to the basal scales. There were no differences in the stiffness scales and the two groups consumed the same amount of rescue Aines. There were also no differences in relation to the adverse effects and these were mild and not clearly related to the treatment. The authors concluded that long-term glucosamine treatment can prevent structural changes related to osteoarthritis of the knee and significantly improve symptoms.

The most recent meta-analysis 4 was published in July of this year and included 15 studies that evaluated the efficacy in controlling symptoms and modifying the joint structure of both glucosamine and chondroitin. This review found that glucosamine treatment had a significant effect on the articular cartilage modifier compared to placebo, but not chondroitin. Also those treated with glucosamine improved the symptoms in relation to the placebo (see table).

According to the information provided by these four studies, glucosamine can be considered a valid and safe option for the symptomatic treatment of patients with osteoarthritis, and there would also be a modifying effect of the joint architecture, although there is still no clear the utility of this parameter in the evaluation of the effectiveness of the treatment. It is not possible to say the same about chondroitin; Studies with more patients are required, longer follow-up and better methodological quality to draw conclusions about this drug.

While these studies show that glucosamine improved symptom scores, the changes were at best moderate and it is not clear yet what the actual clinical translation of this difference is.

In addition, we must bear in mind that glucosamine treatment is more expensive than using some NSAIDs; the approximate monthly cost of a treatment with 1500 mg daily of glucosamine is $ 57, four times more expensive than paracetamol and almost twice as much as ibuprofen at adequate doses. Another point to consider is that glucosamine takes a little more than a month to start acting, so it is not recommended as rescue medication, and the actual amount of glucosamine that exists in commercial preparations is not completely clear. that it comes in the form of salt and there is a lot of variability between the different preparations.

For these reasons, the US NIH study that is already in the patient recruitment phase will be very welcome; this work will compare glucosamine sulphate with placebo and other long-term Aines and hopefully clarify these unresolved points.

As a practical conclusion, we have good quality evidence to indicate 1500 mg daily of glucosamine to a patient who has contraindicated Aines or in whom these drugs have not been effective, although the role of glucosamine as the first line of Treatment is not yet clear, especially due to the lack of long-term efficacy and safety studies and their high cost.

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Alternative treatments for arthritis: What works and what does not

According to the latest estimates , more than 91 million adults in the United States may suffer from arthritis, mainly osteoarthritis, which can cause pain and damage the joints. If you are one of them, you may have considered alternative treatments for arthritis.



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According to the Centers for Disease Control and Prevention (CDC) almost 40% of those suffering from arthritis have tried an alternative or complementary therapy such as acupuncture or yoga.

"When conventional medicine fails to relieve pain, many seek alternative methods," says Marvin M. Lipman, MD, chief medical consultant for Consumer Reports. "But not only is there very little evidence to support many of these treatments, some are not even regulated."

Do any of them work? "These really do not cause a radical change," says Richard Panush, MD, a professor at the Keck School of Medicine at the University of Southern California. "For some people, at best, these alternatives may have a slight effect under certain circumstances."

Below you will find what the investigations showed.

4 Alternative treatments for arthritis that can help you

Massage. A review of studies published in the Mayo Clinic Proceedings journal indicates that massage therapy can help relieve the pain and stiffness of knee osteoarthritis. In one study, the researchers recommended a 60-minute session per week with an accredited massage therapist. (Find one in American Massage Therapy Association ).

Tai Chi. A review of 215 out of 54 studies indicated that this Chinese exercise , which is slow and with rhythmic movements, slightly decreases the pain caused by arthritis. But, it was less effective than aerobic and strength exercise (For more information visit the American Tai Chi and Qigong Association ).

Yoga. A review of 17 studies published in the Musculoskeletal Care journal indicated that yoga decreases the pain of osteoarthritis. But our experts recommend avoiding Bikram (hot yoga) if you have joint problems. The heat can make you feel that you can stretch more than you should, which could cause damage later in the joints.

Acupuncture. Research suggests that for some people, this traditional Chinese therapy that involves inserting fine needles into certain points of the body, decreases the discomfort of osteoarthritis . One theory is that it can trigger the release of hormones called endorphins that inhibit pain. Or it can simply cause a placebo effect, making you feel better without any medical reason. If testing, be sure to be treated by an accredited professional. (Find one in the National Certification Commission for Acupuncture and Oriental Medicine ).

3 therapies you should avoid

Chiropractic manipulation. Some research suggests that the "realignment" of the spine by a chiropractor can improve some neck and back pain . But, in a 2012 review published in the journal Rheumatology we found no evidence that the therapy effectively decreases the pain of osteoarthritis.

Dietary supplements. Some people take supplements such as glucosamine and chondroitin (often together) or fish oil for joint pain. So far, studies have shown that glucosamine and chondroitin are not more effective than a placebo. Some research suggests that high doses of fish oil can help improve the joint pain of rheumatoid arthritis, an autoimmune condition. But the effects on osteoarthritis are not very clear. In addition, fish oil supplements can cause side effects, such as diarrhea and stomach pain. And dietary supplements are not well regulated by the Food and Drug Administration (FDA), so you can not be sure if what you take is what the label says. (See our report " Supplements can make you sick ").

Homeopathy. The underlying principle of homeopathy is that certain very dilute substances can cure diseases. For example, rhus toxicodendron, made from poison ivy, is marketed as a treatment against osteoarthritis. But Lipman says there is no evidence to support the use of homeopathic remedies for arthritis or any other condition.

3 Smart strategies

Before taking any alternative treatment for arthritis, Lipman recommends that you try to combat the known factors that contribute to the pain and aches of the musculoskeletal system.

Lose weight if you need it. Excess weight adds pressure on the ankles, hips and knees, which increases the intensity and pain of arthritis.

Do the right kind of exercise. The activities that strengthen the muscles and improve your range of movement and stimulate your cardiovascular activity can help you. In addition to taichi and possibly yoga, consider walking regularly or a swimming program. To learn more about the exercises that help with arthritis, click here .

Check with your doctor. If you decide to try an alternative therapy, tell your doctor before you start. You can refer to a reliable professional. Your doctor can also tell you about the potential dangers or if the therapy can interact with your usual medications.

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Glucosamine and chondroitin to treat osteoarthritis

Glucosamine and chondroitin sulfate are found naturally in the connective tissues of the human body, such as those that cover the ends of bones in the joints. But while glucosamine is extracted from animal tissues such as crabs, lobsters, or shrimp shells, chondroitin sulfate is found in animal cartilage such as tracheae or shark cartilage. Both commonly taken as dietary supplements (also known as nutritional supplements).



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It is believed that glucosamine sulfate can aid in the formation and repair of cartilage in people with arthritis . In fact, some laboratory tests show how this substance protects articular cartilage by limiting its decomposition and helping to build new parts of it. Glucosamine hydrochloride, another form of glucosamine, is considered equally effective as in the sulfate form. However, it is more easily absorbed by the body and can be taken in lower doses and with the same efficacy as glucosamine sulfate.

On the other hand, chondroitin sulfate is part of a protein molecule that helps give the cartilage its elastic properties and is believed to also have anti-inflammatory effects, which can help reduce painful swelling in the joints, which occurs when the bones, exposed by the wear of the cartilage, rub against each other. In addition, chondroitin sulfate can also help delay the disintegration of the cartilage and restore its growth, which is a better mattress for the joints.

Conventional medicine does not yet have a proven treatment to stop or slow the progression of osteoarthritis , so the nutritional supplements of glucosamine and chondroitin sulfate have become an alternative treatment for some patients suffering from this disease.

Perhaps the most important aspect of glucosamine and chondroitin supplements is that they are believed to help decrease or prevent the degeneration of joint cartilage, the underlying cause that causes the pain of osteoarthritis, therefore, these dietary supplements can also help relieve existing joint pain It is currently believed that, unlike many other medications available to treat the pain of arthritis and inflammation, glucosamine and chondroitin supplements have very few side effects.

However, glucosamine and chondroitin nutritional supplements do not offer the same relief results for all patients with osteoarthritis. At the time of writing, the benefits and risks of taking glucosamine and chondroitin sulfate had not been definitively tested, since long-term studies are needed to better understand their effects.

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Glucosamine and chondroitin to treat arthritis

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:

1.     The first step in seeking care for arthritis symptoms should be to obtain a diagnosis by a competent doctor.
2.     The next step is to discuss with the doctor the pros and cons of the different treatment options.
3.     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.
4.     Consider that chondroitin could represent a useless expense.
5.     Ignore any doctor or salesperson who tells you that you have a "miracle cure" for arthritis.
6.     Never buy a dietary supplement just because you saw a radio or television ad.
7.     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).

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Glucosamine treatment osteoarthritis

General description

Glucosamine is a natural compound found in cartilage, the tough tissue that cushions the joints.

In the form of a supplement, glucosamine is obtained from the shell of shellfish or manufactured in a laboratory. There are several forms of glucosamine, for example, glucosamine sulfate, glucosamine hydrochloride and N-acetylglucosamine. These supplements are not considered interchangeable.

Oral glucosamine sulfate is used to treat a painful condition caused by inflammation, breakdown and, ultimately, loss of cartilage (osteoarthritis).



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Evidence

Research on the use of glucosamine for specific conditions demonstrates the following:

•     Osteoarthritis. The use of oral glucosamine sulfate could produce pain relief in people with osteoarthritis of the knee, or with osteoarthritis of the hip or spine.
•     Rheumatoid arthritis. Early research suggests that the use of oral glucosamine hydrochloride could reduce pain related to rheumatoid arthritis when compared to placebo, an inactive substance. However, the researchers did not see improvements in inflammation or in the number of painful or swollen joints.

When choosing glucosamine, read the product labels carefully to make sure you choose the correct form. Although the use of glucosamine sulfate for the treatment of arthritis has been studied, there is no clinical evidence to support the use of N-acetylglucosamine to treat this disease.
Our recommendation
Green light: Generally safe
Generally safe

Glucosamine sulfate may produce pain relief in people with osteoarthritis. The supplement appears to be safe and could be a useful option for people who can not take nonsteroidal anti-inflammatory drugs. While the results of the studies are contradictory, it may be worthwhile to try glucosamine sulfate.

Safety and side effects

When taken in adequate amounts, glucosamine sulfate appears to be safe. The use of glucosamine sulfate by mouth can cause the following:

•     Sickness
•     Heartburn
•     Diarrhea
•     Constipation
•     Drowsiness
•     Skin reactions
•     Headache

Because glucosamine products could derive from the shell of shellfish, there is concern that the supplement may cause an allergic reaction to people allergic to shellfish.

Glucosamine may make asthma worse.

Glucosamine sulfate may affect blood sugar levels, which could interfere with blood sugar control during and after surgery. Stop taking glucosamine sulfate two weeks before undergoing elective surgery.

Interactions

Some of the possible interactions are the following:

•     Acetaminophen / acetaminophen (Tylenol, others). Taking glucosamine sulfate in combination with paracetamol (acetaminophen) may reduce the effectiveness of the supplement and the medication.
•     Warfarin (Coumadin, Jantoven). Taking glucosamine alone or in combination with the chondroitin supplement may increase the effects of warfarin anticoagulant. This can increase the risk of bleeding.

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Glucosamine therapy for the treatment of osteoarthritis

To answer this question, the scientists found and analyzed 20 research studies. The studies evaluated more than 2,500 people with osteoarthritis of the knee or hip. Most studies lasted two to three months. People received glucosamine (in tablets or injection) or were part of another group receiving a pill or a fake injection or a nonsteroidal anti-inflammatory drug (NSAID) to assess which was more effective. This Cochrane Review offers the best evidence that exists today.



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What is osteoarthritis and glucosamine?
Osteoarthritis (OA) is one of the most common forms of arthritis and can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the end of the bones is broken, causing pain and inflammation. Pharmacological and non-pharmacological treatments are used to relieve pain and inflammation. Glucosamine can be found naturally in the body and is one of the fundamental substances of cartilage. It is believed that glucosamine supplementation decreases destruction and increases cartilage synthesis and reduces inflammation. But there is a discussion about its effects.

How well does glucosamine work?
Pain: High-quality studies showed that the pain improved to the same extent when people received glucosamine or fake tablets. If all studies are analyzed (including low-quality studies and previous studies), then glucosamine improves pain to a greater extent than fake tablets.
The pain improved 13 more points on a scale of 0 to 100 with glucosamine than with the fake tablets.

Function: High-quality studies showed that glucosamine improved pain to a greater extent than fake tablets when measured by one type of scale, but improved to the same extent as fake tablets when measured with another scale. This result is the same when all the studies are analyzed (including the low quality studies and the previous ones).

Studies evaluating only the Rotta brand of glucosamine (including low-quality and previous studies) showed that glucosamine improved pain to a greater extent than fake tablets. Glucosamine improved function to a greater extent than fake tablets when measured by one type of scale but improved to the same extent as fake tablets when measured by another type of scale.

What security do you have?
The number of people who received glucosamine and had side effects was almost equal to the number of people who received fake tablets. Side effects included mainly upset stomach and other joint pains.

What conclusion can be established?
In a previous Cochrane review it was shown that glucosamine administered for six weeks reduces pain and improves function (physical capacity) in people with osteoarthritis.

Compared to the previous review, this review that analyzes the newer studies and more high-quality studies shows that there is "platinum" level evidence that pain does not improve greatly when glucosamine is administered for two to three months . According to the scale used to measure the function (physical capacity), the function may not improve completely or to a large extent.

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Glucosamine therapy for the treatment of osteoarthritis

Background
Osteoarthritis (OA) is the most common form of arthritis and is often associated with significant disability and a deterioration in quality of life.



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Goals
To review all randomized controlled trials (RCTs) that evaluate the effectiveness and toxicity of glucosamine in OA.

Search methods
We searched MEDLINE, PREMEDLINE, EMBASE, AMED, ACP Journal Club, DARE, CDSR and in the CCTR. Charts were also written to the subject experts and hand searches were made of the reference lists of the identified RCTs and the relevant review articles. All searches were updated in January 2005.

Selection criteria
The relevant studies fulfilled the following criteria: 1) Randomized clinical trials (RCTs) that evaluated the effectiveness and safety of glucosamine in OA, 2) Comparative and placebo-controlled studies were eligible, 3) Single and double studies were eligible blind.

Obtaining and analyzing the data
The summary of the data was carried out independently by two researchers and the results were compared according to the degree of agreement. The Gotzsche method and a validated tool (Jadad 1996) were used to qualify the quality of the RCTs. Continuous outcome measures were combined using standardized mean differences (SMD) as the measure of effect size. The dichotomous outcome measures were combined using the relative risk ratios (RR).

Main results
The analysis limited to eight studies with adequate concealment of allocation failed to demonstrate the benefit of glucosamine for pain and function according to the WOMAC. Overall, the 20 RCTs analyzed found that glucosamine outperformed placebo with an improvement of 28% (change from baseline) in pain (SMD -0.61, 95% CI -0.95, -0). , 28) and 21% (change with respect to the initial value) in the function using the Lequesne index (SMD -0.51, 95% CI -0.96, -0.05). However, the results are not positive in a uniform way and the reasons have not yet been explained. The results of pain, function and rigidity according to the WOMAC did not reach statistical significance.

In the 10 RCTs in which the Rotta preparation of glucosamine was compared with placebo, glucosamine was found to be superior for pain (SMD -1.31, 95% CI -1.99, -0.64) and the function with the Lequesne index (DME -0.51, 95% CI -0.96, -0.05). The combined results for pain (SMD -0.15, 95% CI -0.35, 0.05) and function with the WOMAC index (SMD 0.03, 95% CI -0.18; 0.25) in those RCTs in which a non-Rotta preparation of glucosamine was compared with placebo did not reach statistical significance. In the four RCTs in which the Rotta preparation of glucosamine was compared with an NSAID, glucosamine was superior in two and equivalent in two. Two RCTs using the Rotta preparation showed that glucosamine was able to reduce the radiological progression of knee OA over a period of three years (SMD 0.24, 95% CI 0.04, 0.43).

Glucosamine was as safe as placebo in terms of the number of subjects who reported adverse reactions (RR = 0.97, 95% CI 0.88, 1.08).

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Glucosamine - The natural remedy for joint pain

Arthrosis occurs when the cartilage of the joint is damaged. The function of the cartilage is to act as a buffer between the joints, but when this is impaired one bone rubs against another producing discomfort, inflammation and difficulty of movement. That's where glucosamine comes in.

Until now, the only pain relief was a treatment with anti-inflammatory drugs (for example, Brufen, Orudis) or the injection of steroids (such as cortisone). But this only camouflages the symptoms and temporarily relieves the pain, although the deterioration of connective tissue continues to occur.



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In addition, the dose of the drug should be increased at the same rate that the discomfort increases, leading to a spiral with no exit. This causes more problems since the drugs have harmful side effects. In addition to that they can cause a faster progress of osteoarthritis.

Throughout the years the only solution lies in implanting, through an operation, an artificial joint. But even this does not solve the problem, since they have a limited life and, over time, need to be replaced again.
What is glucosamine?

•     Glucosamine is an amino-sugar that is produced in our own body . The substances needed to produce it are taken by the body through the food we eat.
•     This amino-sugar can be found in synovial fluid, connective tissue and cartilage.
•     It is very important for joint joints to move without pain.
•     It also regulates the structure of cartilage in combination with chondroitin.

How does glucosamine work?

For the cartilaginous tissue to be healthy, three requirements must be met

• Sufficient water for hydration and conservation
• Proteoglycans, to link them with water
• Collagen , to keep the proteoglycans in the correct position

Proteoglycans act like a rope that wraps collagen. They are very important because they can store several times their own weight in water, lubricating the collagen.

If the cartilage is damaged the filaments of the cord weaken and cause "leaks" to the outside. This causes the collagen to lose its strength and the proteoglycans to float and stop being subject, so the cartilaginous tissue can not cushion the blows and cracks completely.

Glucosamine is an important component of proteoglycans, which love water. In addition to its function to favor the synthesis of proteoglycans, its mere presence is an important stimulus for the cells that produce proteoglycans. In fact, glucosamine is a key factor in determining the amount of proteoglycans that cells produce.

It has been shown that glucosamine accelerates the production of proteoglycans and collagen and normalizes the metabolism of cartilage tissue, preventing it from deteriorating.

Due to the effects of glucosamine on cartilage, it can help the body repair damaged cartilage damage and strengthen natural healing mechanisms.

Glucosamine in addition to stimulating the generation of cartilage also helps reduce discomfort and inflammation .

Cases in which glucosamine is recommended

•     When sports activities are carried out regularly
•     Preventive against osteoarthritis
•     When you have low back or chronic back pain
•     When you have persistent discomfort in your joints
•     Preventive in cases of incipient or advanced osteoarthrosis

Sources of glucosamine
Currently there are very few foods that contain glucosamine . The few cases in which the human body can obtain natural glucosamine is eating lobsters, shrimp, crabs or clams, but in most cases the substance is not in the crustacean itself, but in its outer layer. For this reason, taking a glucosamine dietary supplement is the best alternative.
Allergy to seafood

Since most of the glucosamine comes from seafood (some manufacturers offer glucosamine corn), you should consult your doctor before starting the glucosamine treatment. If glucosamine comes from pure shellfish, it is theoretically possible that people who are allergic to shellfish can not take glucosamine.

People with shellfish allergies react to the proteins contained in this type of food. Glucosamine is obtained from chitin , a carbohydrate of seafood, so it is recommended to supervise a doctor before taking glucosamine in those people with shellfish allergy.
The official recommendation is, however, that people who are allergic to shellfish should avoid glucosamine.
Vegetable Glucosamine suitable for vegans and vegetarians

We have already seen how the natural sources of glucosamine are very scarce and mostly come from bones or exoskeleton of crustaceans. However, food supplements of vegetable glucosamine have been developed, suitable for vegans and vegetarians.
Vegetable glucosamine contains a high concentration of glucosamine hydrochloride. This resulting substance is differentiated from others by the high amount of purity that contains its glucosamine and that contributes to the organism.

This vegetable product comes from or part of the corn, an element that the process converts into dextrose. This is fermented as a step prior to the extraction phase. The result is a hydrolysis process that gives rise to the vegetable glucosamine, which, as we have seen previously, reaches 98% purity.

Glucosamine for osteoarthritis

In principle in conventional medicine there were very few medications for the treatment of osteoarthritis.

Then came the NSAIDs or NSAIDs - non-steroidal anti-inflammatory drugs . These new components became widely used and are currently among the most popular drugs such as aspirin, ibuprofen and naproxen sodium.

•     Although they work very well to treat the pain of osteoarthritis they present, nevertheless, some very serious side effects if they are taken for a period of time longer than necessary.
•     Among these side effects can occur from bleeding from the stomach, collapse of the lower digestive tract or liver failure.
•     At that time it was not known that osteoarthritis could be worsened by the administration of NSAIDs or NSAIDS. NSAIDs acted as the first generation of drugs against COX-2, by blocking an enzyme called COX-1.
•     This was the reason, in part, why the painkiller was used to slow pain receptors like COX-1. But unfortunately, COX-1 is a non-specific molecule.
•     On the other hand, it also affects other body systems, such as blood clotting and digestion. Therefore, those who take aspirin, ibuprofen or naproxen daily are more likely to suffer stomach discomfort, or suffer contusions, due to the diluted degree of blood as the body is being attacked in these aspects, (along with the discomfort or the inflammation).

Drugs

Subsequently, COX-2 inhibitors appeared, the drugs that they supposedly considered "more selective". These are generally drugs that need a prescription (and cost much more than NSAIDs, over-the-counter). Brands such as Vioxx and Celebrex quickly reached "fame" among the most prescribed medications.

However, this has now changed due to the potentially dangerous side effects of COX-2, its high price and the inability to produce other effects than those of masking the pain of arthrosis, without further ado. For this reason, for more than twenty years in the United States and a large part of Europe (Germany, Italy, Portugal and Spain) research is continuing on glucosamine and its effectiveness in the fight against osteoarthritis in humans and animals.

Regeneration

Glucosamine regenerates the cartilaginous tissue, tendons and other connective tissues of the body and acts as a block building these materials and inhibiting enzymes that destroy cartilage, in particular acts against osteoarthritis. When the body is not adequately supplied with glucosamine it can develop osteoarthritis. This degenerative disease that affects millions of people around the world, is characterized by a collapse of "shock" in the joints, especially those where the body weight rests: hip or knee.

It works naturally, preventing the destruction of the cartilage tissue and calming the discomfort of the joints, swelling and loss of mobility. On the other hand, glucosamine has no harmful side effects, such as those produced by NSAIDs or COX-2 drugs. And all this, not to mention the fact that glucosamine is much cheaper (about a dollar per day), and that it has a totally natural origin.

Glucosamine can not cure your osteoarthritis, but it can soothe pain in a very positive way. The effects of glucosamine act from the inside, moisturizing and protecting the joints in a warm way and curing them, instead of camouflaging the discomfort, as occurs with NSAIDs and COX-2, so although the effects of glucosaminesean slower ones are much more effective and positive than those of medications.

On the other hand, in addition to relieving the discomfort, it also protects the joints from further damage, preventing injuries from occurring in the future. It has been proven that many NSAID drugs can actually damage the joints and cause a worsening of osteoarthritis due to the degeneration of the joints, contrary to what happens with glucosamine, which acts by protecting them.
Recommendation
If you need immediate pain relief, you can take glucosamine can along with traditional NSAIDs (aspirin, ibuprofen, etc.) With this the pain temporarily calms down. But glucosamine in addition to reducing discomfort, also strengthens cartilage. Keep in mind that 1000mg of glucosamine per day is sufficient, as has been proven in most clinical trials.

Many people also find that chondroitin and MSM have good effects against the discomfort of arthritis .

When you are ready to use a product, carefully compare its ingredients, to see its actual composition and the percentage of glucosamine used.

Combination of glucosamine and chondroitin

Natural dietary supplements have given excellent results in recent years. To the extent that, in many cases, they can prevent deterioration caused by osteoarthrosis. And even favor a cartilaginous reconstruction .

These natural supplements include a combination of glucosamine with chondroitin sulfate. They are substances that are formed in small amounts naturally in our body through the food we eat .

It is one of the basic constituents of the tendons, cartilages and ligaments, and also guarantees its regeneration and restoration.

In addition, glucosamine regulates the synovial fluid that the body needs so that joint joints move without any limitation. This is why it is especially important for athletes , in whom the tension of the joints is particularly high.

With age the glucosamine production of our body decreases , so it is necessary to take an additional glucosamine supplement to keep the joints healthy.

Recommended dose of glucosamine and administration of the intake

The recommended daily dose of glucosamine is approximately 1000mg.

This dose is achieved by taking a dietary supplement. It can be administered in one shot or in three shots throughout the day. It should be taken before meals with plenty of water.

If glucosamine has been administered for therapeutic purposes you should take it for six months.

If you take a glucosamine supplement for the first time on a daily basis, you may notice its positive effects after one to three months.

Side effects of glucosamine

Glucosamine is a dietary supplement that has no side effects and in which the harmful effects caused by COX-2 and NSAID medications, such as ibuprofen or aspirin, do not occur. What else should you know? Do you have other side effects that you should know about?

Is glucosamine completely safe?

In general, glucosamine is a very safe substance . It has been studied clinically since the 80s, so people take it with full security for more than twenty years. If you are taking glucosamine you should have some information in mind.

Glucosamine and diabetes

The levels of insulin can fluctuate with glucosamine (hydrochloric acid or sulfate), especially in the case of diabetics. Glucosamine is technically a carbohydrate (a sugar), but the body can not convert glucosamine to glucose . Therefore, glucosamine does not provide any additional direct source of glucose.

In diabetic patients there are many factors that can lead to a change in the blood values ​​and, therefore, it is very important to consult the doctor before starting the glucosamine treatment. You must be very careful in monitoring your blood glucose levels while you are taking glucosamine. Try to read the latest information about glucosamine for diabetics.

Glucosamine in pregnant and lactating women

Glucosamine overdose

Extremely high amounts of glucosamine (a multiple of the daily dose) can cause digestive problems that result in loose stools, diarrhea or nausea. Glucosamine should not be taken with food , however it is convenient to mix it with a drink .

Glucosamine, a success story

With the exception of the previous warnings, glucosamine has a long history and is considered very safe, unlike what happens with NSAIDs or COX-2 drugs, which have a long history of long-term toxicity, known to researchers.

You should keep in mind that each aspirin leaflet contains a warning that it only provides temporary (not permanent) relief of osteoarthritis pain. Also, COX-2 inhibitors, such as Celebrex, Vioxx, NSAIDs and COX-2 have harmful side effects and only disguise the damage. On the contrary, glucosamine is not a foreign substance to the organism, but totally natural and as such it is found in the joints.

When you stop taking NSAIDs or COX-2 inhibitors, the pain returns quickly. The explanation is that the discomfort has always been there, but your brain does not perceive it because of the effects of the medication.

In contrast, glucosamine provides persistent effects. Even if you stop taking it, you will remain protected for a certain period of time. Taking a daily dose of glucosamine is the best way to reduce, as much as possible, joint problems and keep them protected. Glucosamine is much more effective if you take it continuously for a long period of time.

Be sure to read the glucosamine product guide, where you can find a review of the glucosamine products available in the market, divided into 9 different categories regarding their price, quality and format. You can see which are the best available products and how each one is classified.

Clinical research on glucosamine

The results of the most recent clinical trials have concluded that glucosamine and chondroitin are better than analgesics.

There is growing interest in finding out how to overcome the limitations caused by living with osteoarthritis, especially as two of the most important medications prescribed for treatment (Vioxx and Bextra) were withdrawn from the market. Two important clinical studies have shown that glucosamine and chondroitin sulfate are more effective than conventional analgesics.


Expert opinion on glucosamine

1. Glucosamine relieves the pain of osteoarthritis

Researchers at the University of Creighton, Nebraska, used glucosamine to calm symptoms in osteoarthritis. In their studies they also found that glucosamine has an inhibitory effect on the development of this disease.

2. Glucosamine stops cartilage destruction

A long-term study by Belgian professor Jean-Yves Regnister confirmed that consumption of glucosamine blocks the damage of cartilage cells. At the same time, the study verified the effects it has on the regeneration of new cartilage.

3. Glucosamine inhibits inflammation

Laut Sven-David Mueller Nortmann proved that one of the effects of glucosamine is that it acts to prevent the release of enzymes that destroy cartilage, it also calms joint inflammation.

4. Remedy for joint pain and back

Other studies have shown that glucosamine has a calming effect on joint pain and back pain. This amino-sugar was found especially useful as prevention in athletes or in overweight people to avoid increasing the tension of their joints.


Glucosamine data

•     It has been used alone or in combination with chondroitin for the treatment of osteoarthrosis. Osteoarthrosis is the leading cause of disability among the elderly. Osteoarthrosis is associated with joint cartilage disease, which causes a change in the structure of the joints.
•     It is an amino acid, which is derived from glucose and glutamine and is produced in the body naturally.
•     It is one of the main components of glycosaminoglycans, hyaluronic acid and proteoglycans. This is essential for the formation of cartilaginous tissue.
•     Dietary supplement used for the treatment of osteoarthrosis, back and joint discomfort and glaucoma. Most studies on glucosamine have been performed on patients with osteoarthrosis of the knee.
•     Fish and seafood are the main source of glucosamine, although elaborated glucosamine is also available.

Benefits of taking glucosamine

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•     It is used for the synthesis of glycoproteins, glycolipids and glycosaminoglycans (also called mucopolysaccharides.) These compounds, which contain carbohydrates, are found in tendons, ligaments, cartilage, synovial fluid, mucous membranes; as well as in the structures of the eye, blood vessels and heart valves.
•     It can reduce catabolic activity by inhibiting the synthesis of proteolytic enzymes and other substances that contribute to damaging the interior of cartilage tissue.
•     Inhibits collagenase enzymes that destroy cartilage. It can have a positive effect on the cartilage cells. It can prevent the degradation of the structure of the cartilaginous tissue
•     Glucosamine also has slightly anti-inflammatory effects.

Contraindications of glucosamine?

•     It is very well tolerated. In a study conducted over three years with a daily intake of 1000 mg of glucosamine, no serious side effects were observed.
•     Glucosamine hydrochloride was used safely in studies conducted for 24 weeks, in which the most common side effect were mild digestive problems.
•     People with allergies to shellfish should avoid taking glucosamine supplements derived from seafood, and instead should take vegetarian supplements of glucosamine.
•     There was concern about the effect on insulin levels and blood sugar levels. The tests that were carried out in healthy people, obese with type 2 diabetes, showed that there was no effect on the levels of hemoglobin A1C or glucose after taking nutritional supplements of glucosamine for 3 months.
•     There was concern that glucosamine could increase cholesterol levels and blood pressure. However, no adverse effect on cholesterol levels or blood pressure has been detected in those who have been taking glucosamine dietary supplements for three years.

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Glucosamine therapy for the treatment of osteoarthritis

glucosamine therapy for the treatment of osteoarthritis
To answer this question, the scientists found and analyzed 20 research studies. The studies evaluated more than 2,500 people with osteoarthritis of the knee or hip. Most studies lasted two to three months. People received glucosamine (in tablets or injection) or were part of another group receiving a pill or a fake injection or a nonsteroidal anti-inflammatory drug (NSAID) to assess which was more effective. This Cochrane Review offers the best evidence that exists today.



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What is osteoarthritis and glucosamine?
Osteoarthritis (OA) is one of the most common forms of arthritis and can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the end of the bones is broken, causing pain and inflammation. Pharmacological and non-pharmacological treatments are used to relieve pain and inflammation. Glucosamine can be found naturally in the body and is one of the fundamental substances of cartilage. It is believed that glucosamine supplementation decreases destruction and increases cartilage synthesis and reduces inflammation. But there is a discussion about its effects.


How well does glucosamine work?
Pain: High-quality studies showed that the pain improved to the same extent when people received glucosamine or fake tablets. If all studies are analyzed (including low-quality studies and previous studies), then glucosamine improves pain to a greater extent than fake tablets.
The pain improved 13 more points on a scale of 0 to 100 with glucosamine than with the fake tablets.


Function: High-quality studies showed that glucosamine improved pain to a greater extent than fake tablets when measured by one type of scale, but improved to the same extent as fake tablets when measured with another scale. This result is the same when all the studies are analyzed (including the low quality studies and the previous ones).

Studies evaluating only the Rotta brand of glucosamine (including low-quality and previous studies) showed that glucosamine improved pain to a greater extent than fake tablets. Glucosamine improved function to a greater extent than fake tablets when measured by one type of scale but improved to the same extent as fake tablets when measured by another type of scale.

What security do you have?
The number of people who received glucosamine and had side effects was almost equal to the number of people who received fake tablets. Side effects included mainly upset stomach and other joint pains.


What conclusion can be established?
In a previous Cochrane review it was shown that glucosamine administered for six weeks reduces pain and improves function (physical capacity) in people with osteoarthritis.


Compared to the previous review, this review that analyzes the newer studies and more high-quality studies shows that there is "platinum" level evidence that pain does not improve greatly when glucosamine is administered for two to three months . According to the scale used to measure the function (physical capacity), the function may not improve completely or to a large extent.

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Glucosamine and chondroitin sulfate

The information contained on this page should not replace the recommendations and indications provided by your doctor. Glucosamine and chondroitin are nutritional supplements and as such are not subject to the same strict regulations required for over-the-counter and nonprescription drugs. Therefore, if you decide to take any supplement, you will do so on your own. Check with your doctor before trying these supplements. Make sure that the cause of the pain is osteoarthritis . Do not interrupt or reduce the dose of prescription medications you are currently taking until you see the doctor.



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What are glucosamine and chondroitin sulfate?

    This supplement may contain glucosamine in the form of N-acetyl glucosamine or sulfate salts or hydrochloride, and chondroitin as chondroitin sulfate. Both are substances that occur naturally in the body, present in the cartilage and that help to maintain their elasticity, lubricating the joints.

Glucosamine:

•     Glucosamine is an aminosaccharide that plays an important role in the formation and repair of cartilage.
•     Glucosamine, as a supplement, is extracted from crustaceans (such as lobsters, shrimp or crabs).

Chondroitin sulfate:

•     Chondroitin sulfate is part of a large protein molecule (proteoglycan) that provides elasticity to cartilage.
•     Chondroitin sulfate is extracted, in most cases, from the cartilage of the cattle trachea, but in Japan it is also extracted from shark cartilage. Like glucosamine, it can be synthesized in the laboratory.

What are these supplements used for?

•     These supplements have been used to treat osteoarthritis (OA) in horses and dogs for many years.
•     In Europe, glucosamine and chondroitin sulfate have been used to treat OA in humans since 1980.
•     It is important to remember that these supplements have not been well studied as treatment for other forms of arthritis or associated diseases, such as rheumatoid arthritis (RA) or gout , or to treat other causes of pain, such as stress fractures.

What studies have been done?

•     A small study conducted in 2012 showed improvement in symptoms when using glucosamine together with an NSAID, and a minor, but significant relief with glucosamine alone.
•     In 2015, a couple of studies were conducted on the use of glucosamine and chondroitin for the management of knee pain associated with OA. In the first, the effectiveness and safety of the supplement was compared with that of celecoxib (medicine marketed as Celebrex ). It was found that the supplement in question showed comparable efficacy to the drug in reducing pain, stiffness, functional limitations and joint inflammation after prolonged use for six months. (ARD Online First, Jan 14, 2015. Ann Rheum Dis doi: 10.1136 / annrheumdis-2014-206792 )
•     The most recent study, published in March 2015, which also analyzed the effectiveness of the supplement in patients with knee OA , gave less encouraging results. According to the researchers, the supplement was not shown to significantly relieve symptoms or modify the progression of OA. ( Effects of Glucosamine and Chondroitin Supplementation on Knee Osteoarthritis, Arthritis and Rheumatology, March 2015 ).

What do these supplements do?

•     In studies conducted mainly in Europe, some people with mild to moderate OA who took glucosamine or chondroitin sulfate showed some relief of pain and a better functioning of the joint. However, the research findings in the US are not consistent, since contradictory results have been observed.

What characteristics should the supplement have?

•     Glucosamine comes in various forms, the most common being glucosamine sulfate and glucosamine hydrochloride. Although both have the same efficacy, most studies used the sulfate salt.
•     Shark cartilage products contain chondroitin sulfate, but the quantity and quality of it is not consistent.
•     Since dietary supplements are not strictly regulated, the quality and content can vary widely.

Some suggestions for choosing quality products are:

•     Select a product manufactured by a large and respectable company that can take responsibility.
•     Read the labels of the products carefully to make sure that the list of ingredients makes sense.
•     Ask for recommendations to your doctor or pharmacist.
•     If you are allergic to shellfish or have an excellent diet of animal products, look for vegetarian / vegan formulas.

How are these supplements taken?

•     If you decide to try these supplements, experts recommend taking the amount used in most clinical studies:
•         Glucosamine: capsules, tablets, liquid or powder, 1,500 mg (milligrams) per day.
•         Chondroitin: capsules, tablets and powder, 800 to 1,200 mg per day divided into two to four doses.
•     If this dose relieves the symptoms, you can decrease the amount gradually after the first few months.
•     It may take a month before you notice any improvement.
•     It is generally recommended to ingest glucosamine and chondroitin sulfate together, although it is not known for sure if the combination has a better effect than the individual use of each substance.
•     You should plan your intake of the supplements along with the medications you currently take for 6 to 8 weeks. If the pain goes down, ask your doctor if you should decrease or stop the other medications for a period of time, to check if any changes in pain and stiffness levels are made.
•     If after four to six months you do not notice any change in symptoms, the supplements probably will not provide any relief. Some people may experience partial relief using the supplements, but they may need to continue taking medications for complete relief.

Do these supplements have side effects?

    Both glucosamine and chondroitin sulfate can have the following adverse effects:

•         Increase in intestinal gas
•         Stomach ache
•         Softer stools

    More studies should be done to confirm the safety and efficacy of the supplements. See your doctor if you notice any new or unusual symptoms when taking these supplements.

Precautions

    Children, pregnant women and women who may become pregnant should not take these supplements. These substances were not studied enough to determine the effects they could have on a developing fetus or a child.

People who have the conditions listed below should be cautious with these supplements:

Glucosamine:

•     Diabetes, since glucosamine is an aminosugar, dietetics must control blood sugar levels more frequently when taking these supplements.
•     Individuals on anticoagulants such as warfarin ( Coumadin ) in combination with glucosamine hydrochloride with or without chondroitin should refrain from taking the supplement.
•     Allergy to seafood, if you are allergic, consult your doctor before you start taking glucosamine. In most cases, allergies are caused by the proteins found in seafood, not by chitin, the carbohydrate from which glucosamine is extracted.
•     Glaucoma, a new study suggests that people with this disorder or with intraocular hypertension may worsen eye pressure if they take glucosamine. Other side effects are increased triglycerides and cholesterol.

Chondroitin sulfate:

•     This supplement may include components with structure similar to heparin, an anticoagulant drug, so ingesting it together with an NSAID, such as aspirin, could increase the risk of bleeding. In this case it is advisable to take the prothrombin time and coagulation more frequently.
•     Certain tablets may contain high levels of manganese (Mn), which could cause long-term nervous system poisoning (if it exceeds 11 mg Mn / day). In addition, since chondroitin comes from cattle, there is the remote possibility of contamination associated with mad cow disease.
•     If you are allergic to sulfonamides, avoid it, or start with small doses of chondroitin and be alert for side effects. Other effects are diarrhea or constipation.

Considerations:

•     The American College of Rheumatology, in its most recent recommendations for the initial treatment of OA (2012) does not recommend glucosamine or chondroitin to patients with osteoarthritis. Glucosamine and chondroitin alone or together do not always work for everyone. However, those who decide to try these supplements and benefit from them do not have to suspend them. Taking them for the long term seems to be safe.
•     Note that studies of the supplement have been done in patients with knee pain associated with OA, so it can not assume the validity of its use in other joints of the body or for other types of arthritis.
•     Discrepancies in the effectiveness of chondroitin can also be generated from variations in the doses and quality of the supplements. The content of chondroitin tends to vary quite a lot between different brands. The same can be said about glucosamine supplements. Talk to your doctor or pharmacist about which brand to choose from any of these products, or combination thereof.

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Glucosamine and arthritis

    Clinically fundamental: As a short-term intervention, oral and intramuscular glucosamine is associated with pain relief and symptomatic in patients with arthritis. Glucosamine appears to be similar in efficacy to NSAIDs, but long-term interventions are needed to establish the efficacy and adverse effects.



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Glucosamine is a treatment that does not require a prescription and is available to relieve pain and symptoms related to arthritis.

Systematic review
Moore RA. Glucosamine and arthritis. Bandolier 46; 1998

    Outcome variables: pain, swelling, days elapsed until improvement, response to treatment

The inclusion criteria were controlled and randomized clinical trials of oral or intramuscular glucosamine as a treatment for arthritis; comparisons with placebo or active treatment. We summarized the findings of the original articles, and where possible, we calculated the relative benefits and numbers needed to treat with 95% confidence intervals using the response rates for the active and placebo groups on variables related to pain.

Findings
All included studies evaluated oral and / or intramuscular glucosamine in patients with arthritis for up to eight weeks. Six studies were double blind, and two were not masked. The studies included patients with osteoarthritis or gonarthrosis. Oral doses of glucosamine were 1.5 g / day, and intramuscular doses of 400 mg twice to three times a week.

Dichotomous data were obtained to calculate the relative benefits and numbers needed to treat. The types of variables that could be obtained varied between the studies, and included pain assessment, symptomatic relief, response to treatment. These variables were taken between 3 and 8 weeks
.
Placebo-controlled trials
Five trials demonstrated significant beneficial effects of glucosamine versus placebo. Three of them presented a significant relative benefit, and a global number needed to treat 5.0 (3.5 to 8.9) for short-term pain reduction benefits compared to placebo.

Controlled trials with active treatment

Three studies compared glucosamine with NSAIDs. Two trials compared 1.2 g / day of ibuprofen with oral glucosamine in 239 patients, and found no significant differences. The third study compared intramuscular glucosamine with intramuscular phenylbutazone, but did not show significant results.

Adverse effects
Few adverse effects or dropouts from these studies were found. They tended to occur less frequently in patients with glucosamine than in those in the NSAID group. A large non-masked study with 1208 patients taking oral glucosamine at a dose of 1.5 g / day for 13 to 99 days presented 28 patients who discontinued treatment due to adverse effects. The adverse effects that were found in more than 1% of the patients were epigastric pain / discomfort, heartburn, diarrhea, and nausea.