Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Glucosamine for Osteoarthritis: Who Knows?

Little evidence glucosamine restores joint integrity.

Osteoarthritis is a chronic degenerative disorder that currently represents one of the main causes of disability within the elderly population, and is a source of inconvenience and chronic pain for many others. The pathophysiologic basis of osteoarthritis entails a complex group of interactions among biochemical and mechanical factors. This has led to an ongoing search for ideal therapeutic management schemes for these patients, as some patients (particularly the elderly) are less tolerant of certain classes of medications used to treat osteoarthritis compared to other demographic groups. It is no surprise that glucosamine has become one of the most frequently used alternative medications worldwide due to its chondroprotective properties, despite the fact that its efficacy has been called into question more than once over the years.

The results of one more glucosamine study were published online last month in the journal “Arthritis & Rheumatology.” The intervention here involved patients (over 200 in this randomized, controlled trial) with mild to moderate knee osteoarthritis drinking 1500 mg of glucosamine hydrochloride dissolved in lemonade each day for six months. The primary outcome was worsening of cartilage damage in all knees assessed using magnetic resonance imaging, according to a validated scoring system.

After 24 weeks of treatment, the researchers found no difference in cartilage worsening between the two groups. Analysis using an adjusted logistic regression model that controlled for clustering by subregions within knees and between knees within an individual likewise showed no association between cartilage deterioration and treatment group.

In other words, there is no evidence glucosamine restores joint integrity. This study did not focus on effectiveness as relates to pain and function.

However, most studies have tended to favor the effectiveness of glucosamine in subjects with osteoarthritis. at least through minimal or indirect evidence. Unfortunately, the many studies have utilized a variety of different glucosamine compounds, leaving an unsettled sense of effectiveness in the minds of many.

In the meantime, patient education, physical activity, physiotherapy, articular protection, postural hygiene, and weight control are essential injury- and pain-limiting tools, which are generally included in all clinical guidelines for the management of osteoarthritis patients, albeit receiving varying degrees of recommendation throughout different regions worldwide.

Tylenol is considered the initial drug for the management of knee osteoarthritis, with anti-inflammatories such as Motrin being broadly recommended if no satisfactory results are observed after first-line management, although their adverse effect profiles should be considered prior to prescription. Lastly, intra-articular glucocorticoids are only implemented in very specific situations where initial treatment has been inefficient. In general, utilization of drugs in this subgroup depends on their safety profile, patient consent, cost-effectiveness, and other factors relevant to the specific clinical evolution of patients.

In other words, just keep on exercising and don't take your eyes off that scale.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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