Clinical trials on glucosamine and chondroitin

A significant amount of research has been performed on glycosaminoglycans, especially glucosamine and chondroitin, for the treatment of arthritis. These compounds are commonly marketed as nutritional supplements and numerous 'soft therapeutic claims' are made about their health benefits - especially in aging populations.[1] Since glucosamine is a precursor for glycosaminoglycans, and glycosaminoglycans are major components of cartilage, ingesting glucosamine might nourish joints, and thereby alleviate arthritis symptoms. Authoritative opinions on the actual therapeutic value of these compounds have been very mixed.[2]

Some of the evidence for the effectiveness of glucosamine is disputed.[3][4] A 2008–2009 review of all known studies of glucosamine supplements for horses, for example, found that almost all studies had failed to meet usual standards and were fatally compromised by basic errors in their execution, including failure to test whether active ingredients were as stated, lack of adequate (or any) control groups or baseline measurements, very small sample sizes, and ignoring prior research or self-evident omissions.[5][6] The authors highlighted confirmation bias as a significant issue in such studies, in that most studies were undertaken by manufacturers, on products they already produced commercially, and they were usually undertaken to support claims of benefits which could be used to market the product.[5][6] More recently, other reviews found little evidence that glucosamine and chondroitin supplements were any better than a placebo[7][8] or at most only slightly better.[9][10]

Glucosamine sulfate may be efficacious in ways that glucosamine hydrochloride is not.[11] The Osteoarthritis Research Society International advises arthritis sufferers to discontinue glucosamine therapy if they notice no benefit within six months[12] and the National Institute for Clinical Excellence no longer recommends its use.[13] Despite the difficulty in determining the efficacy of glucosamine, it remains a viable treatment option.[14] Similar trials have been done with chondroitin.[15]

  1. ^ "Glucosamine Chondroitin Supplement: Uses & Side Effects". Cleveland Clinic. Retrieved 2023-11-06.
  2. ^ "Glucosamine". Mayo Clinic. Retrieved 2023-11-06.
  3. ^ The effects of Glucosamine Sulphate on OA of the knee joint. BestBets.
  4. ^ Cite error: The named reference pmid22925619 was invoked but never defined (see the help page).
  5. ^ a b Cite error: The named reference pubmed1 was invoked but never defined (see the help page).
  6. ^ a b Cite error: The named reference proceedings1 was invoked but never defined (see the help page).
  7. ^ Wandel S, Jüni P, Tendal B, Nüesch E, Villiger PM, Welton NJ, Reichenbach S, Trelle S (Sep 16, 2010). "Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis". BMJ (Clinical Research Ed.). 341: c4675. doi:10.1136/bmj.c4675. PMC 2941572. PMID 20847017.
  8. ^ Wu D, Huang Y, Gu Y, Fan W (Jun 2013). "Efficacies of different preparations of glucosamine for the treatment of osteoarthritis: a meta-analysis of randomised, double-blind, placebo-controlled trials". International Journal of Clinical Practice. 67 (6): 585–94. doi:10.1111/ijcp.12115. PMID 23679910. S2CID 24251411.
  9. ^ Chou R, McDonagh MS, Nakamoto E, Griffin J (Oct 2011). "Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review [Internet]". Agency for Healthcare Research and Quality (US). PMID 22091473.
  10. ^ Cite error: The named reference pmid21220090 was invoked but never defined (see the help page).
  11. ^ Rovati LC, Girolami F, Persiani S (Jun 2012). "Crystalline glucosamine sulfate in the management of knee osteoarthritis: efficacy, safety, and pharmacokinetic properties". Therapeutic Advances in Musculoskeletal Disease. 4 (3): 167–80. doi:10.1177/1759720X12437753. PMC 3400104. PMID 22850875.
  12. ^ Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (February 2008). "OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines". Osteoarthr. Cartil. 16 (2): 137–62. doi:10.1016/j.joca.2007.12.013. PMID 18279766.
  13. ^ Cite error: The named reference NICE was invoked but never defined (see the help page).
  14. ^ Henrotin Y, Mobasheri A, Marty M (Jan 30, 2012). "Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis?". Arthritis Research & Therapy. 14 (1): 201. doi:10.1186/ar3657. PMC 3392795. PMID 22293240.
  15. ^ Cite error: The named reference pmid16495392 was invoked but never defined (see the help page).