Taking glucosamine and/or chondroitin for arthritis pain? You’re probably wasting your money. That’s the rather disappointing – although not unexpected – conclusion reached by a team of European investigators who carefully analyzed clinical trials of glucosamine and/or chondroitin and osteoarthritis in the hip or knee. Their results were published September 16 in the British Medical Journal.
The research team was led by Peter Jüni, professor and head of the Institute of Social and Preventive Medicine at the University of Bern, Switzerland. The team identified 58 clinical studies of glucosamine and/or chondroitin and osteoarthritis that met strict criteria for quality, size, and methodologies. Out of these 58, they selected the strongest 10, with 3804 total participants. The researchers then used a Bayesian approach to assess the data in the studies. Bayesian approaches allow researchers to analyze data recorded at multiple times in randomized trials in a unified, coherent way.
Their conclusion was unequivocal: “Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space.” They didn’t find any negative effects of the supplements, except for a bit of indigestion in some people. Based on their findings, the researchers recommended that physicians not prescribe the supplements for patients with osteoarthritis and that health-care authorities and insurers not cover the costs of these preparations.
The findings, while not surprising, were not good news for the millions of people who have osteoarthritis. Osteoarthritis, also called degenerative joint disease, is caused by the breakdown of cartilage (the connective tissue that cushions the ends of bones within the joint). People with osteoarthritis experience pain, damage to their joints, and limited motion. Osteoarthritis is the most common form of arthritis, affecting more than 27 million Americans, more than 6 million people in the U.K., and countless others worldwide. Because osteoarthritis is associated with aging – up to 85 percent of Americans aged 65 or older are thought to have some osteoarthritis – it is becoming more prevalent as our societies age.
Glucosamine and chondroitin have been increasingly recommended in guidelines, prescribed by physicians, and swallowed by countless patients over the last ten years. Glucosamine and chondroitin are substances produced by the body and found in and around the cells of cartilage and other connective tissue. Glucosamine is an amino sugar, one of the building blocks of glycosaminoglycans, compounds that make up cartilage. Chondroitin sulfate is a complex carbohydrate that helps cartilage retain water, giving the cartilage its cushioning effect. When ingested, both substances are absorbed through the small intestine, leading physicians to believe that some might be incorporated into cartilage.
Physicians and patients alike had hoped that glucosamine and chondroitin would prove to be the magic mixture that helped to slow disease progression and managed pain. No existing pharmaceutical drugs exist that can slow the progress of the disease. Current treatments for arthritis focus on pain control and usually involve non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin) and naprosyn (Advil). NSAIDS can cause serious heart and gastrointestinal problems, especially if used for extended periods.
But there’s another group that’s saying ouch at the results of the study – the supplement industry. Worldwide, sales of glucosamine supplements increased by about 60 percent from 2003 to 2008, reaching almost $2 billion (£1.3 billion, €0.8 billion) in 2008. Sales are predicted to reach $2.3 billion in 2013.
What’s an arthritis sufferer to do? First, find a knowledgeable physician who’s willing to refer you to other health professionals, such as a physical therapist, physical trainer, orthotist, or a dietitian, when appropriate. Your physician should help you take a whole-body approach to managing arthritis pain. Important first-line interventions include:
- Correcting biomechanics. For instance, use a properly fitted orthotic in your shoe. Such measures can go a long way toward reducing pain and further injury.
- Preventing injuries. Injury prevention is a key component of arthritis prevention, as osteoarthritis often results when joints are injured.
- Maintaining a healthy weight. Too much weight overloads joints, increases the risk of , and . According to the Johns Hopkins Arthritis Center, being 10 pounds overweight increases the force put on the knee with each step by 30-60 pounds. Overweight women are nearly four times as likely to develop osteoarthritis of the knee as are normal weight women; for overweight men the risk is five times greater.
- Eating a nutritious diet. While evidence on the effect of diet on osteoarthritis is mixed, a few clear correlations have been found. Vitamin C is an important component in the formation of normal cartilage, and low levels of vitamin C may lead to weak cartilage. Inadequate Vitamin D intake has been associated with narrowing of joint spaces and disease progression in osteoarthritis. Supplementation of 400 IU of Vitamin D daily may help to decrease the risk – as well as help to prevent osteoporosis, another risk factor for osteoporosis. Along those lines, adequate calcium intake is an essential component of arthritis prevention and management.
- Engaging in low-impact exercise. Low-impact exercise such as cycling, swimming, or yoga, can help to strengthen muscles, taking the load off the joints.
- Consider acupuncture. Acupuncture has been widely studied as an alternative treatment for osteoarthritis. While it doesn’t appear to slow the disease process, it may help with pain and stress management.
And unless you feel like throwing money out the door, leave the glucosamine and chondroitin on the shelf.