Supplements for Degenerative Joint Disease
February 2000; Volume 3: 23-24
Source: Leffler CT, et al. Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: A randomized, double-blind, placebo-controlled pilot study. Mil Med 1999; 164:85-91.
We conducted a 16-week randomized, double-blind, placebo-controlled crossover trial of a combination of glucosamine HCl (1,500 mg/d), chondroitin sulfate (1,200 mg/d), and manganese ascorbate (228 mg/d) in degenerative joint disease (DJD) of the knee or low back. Thirty-four males (mean age 43.5 +/-1.7 years, average BMI 27.2 kg/m2) from the U.S. Navy diving and special warfare community with chronic pain and radiographic DJD of the knee or low back were randomized. A summary disease score incorporated results of pain and functional questionnaires, physical examination scores, and running times. Changes were presented as a percentage of the patient’s average score. Acetaminophen, but not NSAIDS, was permitted for pain. Outcomes were assessed by averaging data from two clinic visits after weeks 2 and 3 of the baseline period, and after weeks 7 and 8 of both eight-week treatment periods.
Knee osteoarthritis symptoms were relieved as demonstrated by the summary disease score (-16.3%; P = 0.05), patient assessment of treatment effect (P = 0.02), visual analog scale for pain recorded at clinic visits (-26.6%; P = 0.05) and in a diary (-28.6%; P = 0.02), and physical examination score (-43.3%; P = 0.01). Running times (100-yd dash, and up and down a tower with 80 stairs) did not change.
Symptoms of spinal DJD were not affected. Side effect frequency was similar to that at baseline. There were no hematologic effects. Short-term combination therapy appears safe in this setting.
Comment
DJD hurts 21 million Americans, and in 1998 one billion capsules of glucosamine tried to soothe that hurt. The evidence for glucosamine’s effectiveness as an analgesic equivalent to ibuprofen for DJD is reasonably strong (Alternative Medicine Alert, November 1998, pp. 121-124), and with many fewer side effects. But what of combination therapy in an overweight population with high activity levels?
Dr. Philippi and colleagues endeavored to find out. Twenty-one men with knee DJD (three withdrawals) and 23 with low back DJD (seven withdrawals) were randomized: Of the 10 withdrawals, four did so to take NSAIDS, five had military orders to leave the area, and one did not have time to comply. Those who remained in the study reported using between 15% and 22% less acetaminophen than they had at baseline. No changes in hematologic evaluations or prothrombin times were reported.
The role of manganese in these results is unclear; the 30 mg given here is well above the 2.5-5 mg range deemed safe. Signs of toxicity (tremor, weakness, hypertension) were not reported. Chondroitin’s role is also unclear: Although synthesized in the body and found in cartilage, there is little evidence for its role as an effective analgesic.
This is a small study conducted for a short period, though larger analyses have had some of the same methodological problems. The NIH has invested $6.6 million at nine medical centers nationwide over the next several years to find out whether glucosamine and chondroitin help knee DJD.
Recent Belgian reports of a placebo-controlled three-year study of joint space narrowing and DJD knee symptoms suggest that glucosamine may control narrowing and pain. The concept of repairing cartilage with agents that stimulate proteoglycan production is appealing (see The Arthritis Cure, still a steady seller), but not proven.
Recommendation
Recommend weight management first to patients with DJD of the knee and back. For those who do not want to rely on NSAIDs, or are wary of their effects, try another popular commercial glucosamine preparation, perhaps without manganese, to alleviate symptoms of knee DJD. Give the trial a full eight weeks.
February 2000; Volume 3: 23-24
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