Glucosamine and Chondroitin

Is Glucosamine (with or without Chondroitin) an effective
Arthritis Treatment or is it just powerful marketing? 

Two separate clinical trials have conducted research into the benefits of Glucosamine and Chondroitin, and have come to opposite conclusions. The first trial, organised in the USA in 2008, "provided statistically significant pain relief compared with placebo.." but the second survey, in Switzerland in 2010, found no "clinically relevant effect" of glucosamine or chondroitin, or a combination of the two, on perceived joint pain.

These two studies, both by respected medical researchers, throw the whole question of this medication into further confusion. This is a billion dollar industry and many joint pain sufferers, on both sides of the Atlantic, take these pills almost on a daily basis and swear by their beneficial effect. In the USA there are an estimated 27 million sufferers from osteoarthritis and a further seven or eight million in the UK. The American study cost just over twelve million dollars.

Many senior golfers are regular, faithful users of this product. One golfing friend says he can hear his knee clicking as he walks, if he doesn't take his glucosamine. In eighteen holes of golf, that's a lot of clicks!  

The First Trial, in 2008,
was conducted by 16 universities and hospitals and was co-ordinated by The University of Utah, School of Medicine, Salt Lake City. The tested group numbered 1,583, suffering from osteoarthritis of the knee, of whom almost two-thirds were women. They were examined as two separate groups, those with mild joint pain (1,229 participants) and those with moderate-to-severe pain (354). This is an important factor to consider, because the two groups are widely different in size, the bigger group comprising 78% of the total test.

Not surprisingly, the results for the two groups were markedly different. In the larger group, with only mild pain, the treatment with glucosamine and/or chondroitin did not provide statistically significant pain relief. Of those with moderate-to-severe pain, 79% experienced a significant reduction in pain but 54% of those dosed with placebo also felt the same relief.

You can access the full report at www.nccam.nih.gov/research/results/gait/qa.htm

The Second Trial, in 2010
was a larger study, with 3,803 patients, suffering from osteoarthritis of the hip or knee. Professor Peter Jüni and his team at the University of Bern found no "clinically relevant effect" of glucosamine and/or chondroitin on perceived joint pain. They also said that it had no effect on the cartilage or narrowing of the joint space.

They also recommended that "Health authorities and health insurers should be discouraged from funding glucosamine and chondroitin treatment." Because many people have strong belief in the effectiveness of these products and because the placebo effect can be so strong, they do not suggest that sufferers should stop taking them, merely that they should pay for them themselves and not be funded by the taxpayer.

The report in The British Medical Journal was reviewed in The Daily Telegraph by Andrew M Brown on September 17, 2010.

CONCLUSIONS

• It is necessary to look further into the two trials, to judge the apparent diversity in the results and the difference in the impact of the headlines.
• While the US trial says "provided statistically significant pain relief compared with placebo.." on further examination, this only applies to 79% of those patients in the moderate-to-severe group, -  which is 280 patients out of a total of 1,583 or only 17.6% in the US trial.
• The Swiss trial is unequivocal in its conclusion that Glucosamine/Chondroitin has no scientifically proven benefit.
• Each group of researchers concluded that these products "do no harm", so there is no negative aspect to taking these supplements, except for the cost.
• The US researchers made x-ray examinations of some of the joints, after the trials were completed and concluded that, "..after assessing the x-ray data, the researchers concluded that glucosamine and chondroitin sulfate, together or alone, appeared to fare no better than placebo in slowing loss of cartilage in osteoarthritis of the knee."
• There have been various responses to the Swiss report, possibly from vested interests, challenging these findings and stating such claims as,  "glucosamine sulphate is effective on knee OA symptoms when administered as a well regulated, quality-controlled, prescription product.."
• There appears to be only minimal evidence of benefit, in a relatively small number of cases, but if you believe that these supplements help you, then take them anyway, because they won't do you any harm.