Glucosamine Sulfate for Osteoarthritis
ABSTRACT & COMMENTARY
Synopsis: Although clinical benefit has been shown for these agents, prior studies were frequently flawed and basic scientific evidence for cartilage healing is lacking.
Source: da Camara CC, Dowless GV. Glucosamine sulfate for osteoarthritis. Ann Pharmacother 1998;32:580-587.
This article is an excellent review of the currently available knowledge (up to 1998) on the beneficial therapeutic effects of glucosamine sulfate in patients with osteoarthritis. In their introduction, da Camara and Dowless review current primary and secondary treatment modalities for osteoarthritis, stressing that the precise biochemical cause of osteoarthritis, a disease characterized by a predominance of degradation of cartilage proteoglycans and of subchondral bone, remains unknown.
Da Camara and Dowless include in their primary prevention strategies such tactics as exercise, weight reduction, avoidance of excessive repetitive motion, protecting the joint from further injury, and patient education. Palliation is the goal of secondary prevention strategies, which include nonpharmacologic therapies such as occupational and physical therapy, appropriate use of braces, bandages, canes, crutches, and walkers, as well as the application of heat or cold therapy. Pharmacologic therapies used as a part of secondary prevention strategies include those agents used to minimize painful symptoms of osteoarthritis such as acetaminophen, nonsteroidal anti-inflammatories, topical agents such as methyl salicylate, and capsaicin, as well as corticosteroids. Unfortunately, none of these pharmacologic agents controls or alters the progression of osteoarthritis.
The use of glucosamine sulfate in this country dramatically increased following publication of the book, The Arthritis Cure, a best seller detailing the author’s (J. Theodosakis) personal experience with the success of glucosamine sulfate in repairing, or at least slowing, the degradation of articular cartilage in patients with osteoarthritis.1 Many of the early clinical trials on the efficacy of glucosamine sulfate in the treatment of osteoarthritis were performed in the early 1980s in Italy, Portugal, and the Philippines. Da Camara and Dowless, in their excellent critical review of the most prominent of these studies, report that although there is increasing evidence suggesting that glucosamine sulfate may provide beneficial effects on joints affected by osteoarthritis (pain relief, decreased tenderness, and improved mobility), most of the data prior to 1998 were derived from studies that were often flawed and frequently involved only small numbers of patients. Unfortunately, as da Camara and Dowless conclude in their review, we are lacking long-term trials on the safety, efficacy, and optimal-dose requirements of glucosamine sulfate in the treatment of patients with osteoarthritis. Such studies have not been supported by U.S. pharmaceutical researchers since the natural products cannot be patented. U.S. Nutramax Laboratories Inc., in Baltimore, Maryland, does have on the market a patented combination product of glucosamine sulfate and chondroitin sulfate (Cosamine and Cosamine DS) and is presently conducting human trials in the United States on this product.
Comment by Letha Y. Griffin, MD, PhD
Osteoarthritis is a common disease that affects about 16 million Americans.2 As the baby boomers age, this number is predicted to rise dramatically. Many patients, discouraged by the lack of safe and effective pharmacologic agents available to treat this disease, readily embraced chondroprotective agents such as glucosamine sulfate and chondroitin sulfate, particularly after the positive media exposure given to Dr. Theodosakis’ book, The Arthritis Cure. Glucosamine, an amino sugar extracted from the chitin in crustacean shells, is reported to stimulate the chondrocytes to encourage proteoglycan and collagen production. Chondroitin sulfate is a polysaccharide and is the most abundant glycosaminoglycan.
Da Camara and Dowless are to be commended for publication of a thorough and thoughtful review of current studies (1998) on the effectiveness of glucosamine sulfate in the treatment of osteoarthritis, including several studies comparing the effectiveness of this product to that of ibuprofen in controlling symptoms of osteoarthritis in humans. Although clinical improvement was noted with these agents in many studies, little objective evidence exists for true healing or regeneration of damaged articular cartilage. Because many of these early studies have basic design flaws, further research is needed to verify the efficacy of chondroprotective agents.
References
1. Theodosakis J. The Arthritis Cure. New York: St. Martins Press; 1997.
2. Helmick CG, et al. Arthritis and other rheumatic conditions: Who is affected now, who will be affected later? Arthritis Care Res 1995;8:203-211.
Chondroprotective agents:
a. include glucosamine sulfate chondroitin sulfate, and corticosteroids.
b. have been thoroughly evaluated in controlled studies designed to prove their efficacy.
c. were used extensively in North America before being introduced into the European marketplace.
d. may have a role in the treatment of osteoarthritis.
e. have many harmful side effects and therefore their use should be restricted.
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