BEST GLUCOSAMINE CHONDROITIN

Many people with arthritis, especially osteoarthritis use supplements in their diet to ease the pain of arthritis. Glucosamine and chondroitin are the most well-known. It is important to check with your doctor before starting any new treatments. If you’re using any other medication, your doctor can review the other medications and help you decide whether or not these arthritis supplements are right for you. In addition, always follow the instructions on the medication label. Do not take more of the supplements than is recommended.

CHONDROITIN

Chondroitin is a major component of cartilage that helps it retain water. The body makes it naturally. For the production of supplements, it can be manufactured from the cartilage of animals, like cows, pigs or sharks, or it can be made in the laboratory. The supplement is sold as chondroitin sulfate. In many European countries, it is approved as a prescription treatment for OA. In the U.S., it is often combined with a glucosamine supplement.

Efficacy

Chondroitin may provide additional pain relief for some people with knee and hand osteoarthritis. The benefit is usually modest (about 8 to 10 percent improvement) and it works slowly (up to 3 months). Natural Medicines Comprehensive Database (NMCD) has rated and evaluated more than 80,000 natural drug ingredients and commercial dietary supplements. It classified chondroitin as “possibly effective” for knee OA.

A 2011 study published in the journal Arthritis and Rheumatism found chondroitin sulfate to modestly relieve pain and improve function in people with hand OA. (The results of this study were not yet taken into account by the NMCD for their recommendation.) The supplement was made from fish and taken daily at a dose of 800 mg for 6 months. Patients reported some improvement after 3 months of treatment. They also noticed a shorter duration of morning stiffness. Chondroitin did not improve grip strength. In addition, patients treated with chondroitin did not use less pain medication (acetaminophen) than those taking a placebo.

Compared to NSAIDs

Because no side effects due to chondroitin were reported, it can be tried as an alternative to nonsteroidal anti-inflammatory drugs (NSAIDs) for patients who cannot take NSAIDs and who need long-term treatment. Chondroitin and NSAIDs have not been compared head-to-head. However, other studies of NSAIDs in patients with hand OA showed a similar improvement in hand pain and function as found with chondroitin. The NSAIDs relieve pain more rapidly than chondroitin sulfate, but they may cause more serious side effects (increased risk of gastrointestinal bleeding, heart attack or stroke, and interactions with other medications), particularly in elderly patients.

GLUCOSAMINE

Like chondroitin, glucosamine is a natural compound found in healthy cartilage, particularly in the fluid around the joints. For dietary supplements, it is harvested from shells of shellfish or can be made in the laboratory. It can come in several chemical forms, but the one most used in arthritis is glucosamine sulfate. In laboratory tests, glucosamine showed anti-inflammatory properties and even appeared to help cartilage regeneration. Glucosamine may provide modest pain relief for some patients with osteoarthritis of the knee, hip, and spine. Natural Medicines Comprehensive Database classified glucosamine as “likely effective” for osteoarthritis, thus rating it higher than chondroitin. Most of the studies included in the recommendation were done in patients with osteoarthritis of the knee. Glucosamine is very safe. Thus, patients who need long-term treatment and cannot take NSAIDs can try it in place of NSAIDs.

However, some studies show that glucosamine provides the same pain relief as a placebo (a pill that does not contain any medicine). This is called a “placebo effect,” in which the patients expect to feel better, so they do. An example is a study published in 2010 in the Journal of the American Medical Association that found glucosamine did not provide additional pain relief compared to placebo in people with chronic lower back pain due to osteoarthritis in the lower spine. Half of the participants took glucosamine (1,500 milligrams daily) and the other half took a placebo. Both groups said their lower back pain improved by about 50 percent over one year. However, due to a small number of people involved in the study, more research is needed to confirm these results for lower spine OA.

GLUCOSAMINE AND CHONDROITIN SULFATE

Glucosamine Chondroitin Supplement Facts

Glucosamine and chondroitin sulfate are components of normal cartilage. In the body, they are the building blocks for cartilage and appear to stimulate the body to make more cartilage. There are conflicting studies on glucosamine and chondroitin, some demonstrating a beneficial effect on osteoarthritis pain. Chondroitin sulfate and glucosamine are popular supplements used to treat the pain and loss of function associated with osteoarthritis (OA). However, most studies assessing their effectiveness show modest to no improvement compared with placebo in either pain relief or joint damage. Others, including the NIH-sponsored multicenter Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), did not show benefit for the primary outcome of reducing pain. More recently, another study also found that glucosamine did not slow down cartilage damage or reduce knee pain.

Glucosamine and Chondroitin Supplements

The supplements, which are available in pharmacies and health food stores without a prescription, are well-tolerated and appear to be safe. However, there are no long-term studies to confirm their long-term safety and effectiveness. Keep in mind that the U.S. Food and Drug Administration (FDA) regulates supplements, but treats them like food rather than drugs. The FDA does not require supplement manufacturers to prove their products are safe or effective before selling them in the marketplace. Many physicians may still recommend a trial of glucosamine at this point. If there is no apparent improvement by three months, it would be reasonable to stop glucosamine. Research is ongoing.

There are many different brands of glucosamine and chondroitin, which are usually sold together as one arthritis supplement. Again, there is no government monitoring to ensure the purity of these products. In order to assure that you get a consistent dose of the supplements, stick with a reputable manufacturer. Choose products that large and well-established companies are selling. If you don’t recognize a brand name, ask about the company’s reputation, how long it has been in business, and how long the store has stocked the brand.

Contraindications

People with diabetes should use caution when taking glucosamine because it may raise blood sugar. People taking blood-thinning medication (anticoagulants) should check with their doctors before taking glucosamine and chondroitin. These arthritis supplements may also have a blood thinning effect. So people taking these supplements in addition to an anticoagulant may have to have their blood tested more often. People who are allergic to shellfish also should consult their doctors before using glucosamine and chondroitin. Glucosamine is extracted from a substance in shellfish. The effects of these supplements on a growing child or developing baby are not yet known. For that reason, glucosamine and chondroitin are not recommended for children, women who are pregnant, women who are nursing, and women who could become pregnant.

GLUCOSAMINE AND CHONDROITIN COMBINATION IN OSTEOARTHRITIS

White capsules of glucosamine chondroitin

The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) is the most comprehensive long-term study of any supplement. This study looked at the combination of chondroitin and glucosamine, both supplements individually, celecoxib (Celebrex) and placebo in patients with knee osteoarthritis.

The first phase of GAIT found that the combination of glucosamine and chondroitin sulfate showed significant relief in a smaller subgroup of study participants with moderate-to-severe knee pain. But there was no effect in the group with mild pain. Those results were published in the New England Journal of Medicine in 2006.

The second phase of the GAIT study was published in the journal Arthritis & Rheumatism in 2008. It looked at preventing joint damage in the knee. The combination of glucosamine and chondroitin appeared to be no more effective at preventing joint damage caused by osteoarthritis than a placebo. While the differences between the groups were not statistically significant, the participants who lost the least amount of joint space over two years were in the groups taking either glucosamine alone or chondroitin alone. It is possible that taking the two supplements together might limit their absorption into the body. This may explain the lower effect of the supplement combination.

In the third phase looking at a total of four years, the supplements in combination or alone had no greater benefit in knee pain relief than celecoxib or placebo. Although the results were not statistically significant, celecoxib achieved the highest odds of attaining at least 20% reduction in pain. These results were published in 2010 in the journal Annals of Rheumatic Disease.

Bottom Line

The American College of Rheumatology in their latest osteoarthritis treatment recommendations published in 2012 does not recommend chondroitin or glucosamine for the initial treatment of osteoarthritis. Chondroitin and glucosamine supplements alone or in combination may not work for everyone with osteoarthritis. However, patients who take these supplements and who have seen improvements with them should not stop taking them. Both supplements are safe to take long-term.

Variations in dosing and quality of the supplements may also have caused the differences in the effectiveness of chondroitin. The chondroitin content between different brands can vary a lot. Similar concerns have been raised over glucosamine supplements. Talk with your doctor or pharmacist about which brand to choose when trying out either of these supplements or a combination product.

SIDE EFFECTS OF GLUCOSAMINE AND CHONDROITIN

These arthritis supplements are generally well-tolerated. However, side effects can occur. The most commonly reported side effects of glucosamine and chondroitin include, but not limited to Nausea, Diarrhea or constipation, Heartburn, and increased intestinal gas.

JOINT SUPPLEMENTS

Glucosamine and chondroitin are structural components of cartilage, the tissue that cushions the joints. Both are produced naturally in the body. They are also available as dietary supplements. Researchers have studied the effects of these supplements, individually or in combination, on osteoarthritis, a common type of arthritis that destroys cartilage in the joints. Cartilage is the connective tissue that cushions the ends of bones within the joints. In osteoarthritis, the surface layer of cartilage between the bones of a joint wears down. This allows the bones to rub together, which can cause pain and swelling and make it difficult to move the joint. The knees, hips, spine, and hands are the parts of the body most likely to be affected by osteoarthritis.