Wednesday, June 1, 2011

Arthritis supplements (glucosamine and chondroitin). Do they work?

The short answer is: probably only occasionally. What I mean by 'do they work' is essentially do they relieve pain in an arthritic joint. That is after all the bottom line when people are judging any treatment efficacy for this condition. The pain has to be diminished first before function can improve. The data we have so far suggests that these supplements which come in a variety of brand names are not conclusively more effective long term than placebo. What I mean by that is if you decided to wear copper bracelets or drink an extra glass of water every day or put magnets on your knees you would have an equal probability of experiencing pain relief compared to taking supplements. So of course there is a chance they CAN work for you but it is up to you if the cost is worth it. Insurance plans do not cover them as far as I know. When I ask my patients who are taking it what they think, almost all of the time the response I get is "I'm not sure" and often those patients have been taking it for months.
So what are these things anyway? What are they supposed to be doing?
Glucosamine is an aminosaccharide that plays a role in the synthesis of cartilage matrix molecules. It serves as a substrate for the synthesis of chondroitin sulfate, hyaluronic acid and other cartilage matrix substances. Chondroitin sulfate is part of a huge molecule called proteoglycans that is crucial for the load bearing or 'shock-absorbing' properties, if you will,of cartilage. In osteoarthritis, these substances are depleted and the idea behind oral supplementation is that by ingesting these substances, they can be reincorporated into the cartilage matrix, thus restoring cartilage function and reducing pain. The idea is not totally unlike HA injections, as hyaluronic acid is also a cartilage matrix substance important for cartilage function.
Here is a brief comparison between HA injections (see the blog post from May on HA injections) and supplements:

                                   Supplements                                                 HA injections

Evidence based
long term efficacy           NO                                                                YES

Safe to use                    Probably, but no                                               YES
                                     long-term data

Insurance coverage         NO                                                                  YES

AAOS position              NOT RECOMMENDED                      INCONCLUSIVE
(what the American
Academy of
Orthopedic Surgeons

How long before            8 weeks or more                                              3-6 weeks average

There is an excellent review article on these supplements published in the Journal of the American Academy of Orthopedic Surgeons and I will cite a portion of the last paragraph for your review here. If you can get a copy of it I highly recommend it:
" Many unanswered questions remain surrounding their long term effects (whether beneficial or adverse) the most effective dosage and route, and product purity. A well-designed prospective study of glucosamine sulfate and chondroitin sulfate demonstrating that these agents are effective for the prevention and treatrment of osteoarthritis has yet to be conducted"
AA Brief et al J Am Aacad Orthop Surg Vol 9, No 2 March/April 2001 71-78

My advice is to try a more cost-effective treatment. More than likely you can find one. Be sure to read my last blog entry on HA injections and check out our website for more information on arthritis treatment.

Thanks for reading!
Next time a discussion on ACL surgery. Stay tuned!

Dr Doctor

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