Natural Remedies - Glucosamine and Chondroitin
A Center for Disease Control (CDC) survey finds that more than 50% of American adults aged 65 and above, have been diagnosed with some form of arthritis. Glucosamine and chondroitin are two natural remedies frequently used to treat arthritis and to reduce the resulting pain. Are they any more effective than a placebo? A study published in the New England Journal of Medicine (v 354, p 795, 2006) examines their effectiveness in treating osteoarthritis (arthritis that involves breakdown of the cartilage at the ends of bones with joints).
The study included 1583 patients who had knee osteoarthritis. They were assigned at random to receive one of the following, daily: 1500 mg of glucosamine; 1200 mg chondroitin; both glucosamine and chondroitin; 200 mg of celebrex™; or a placebo. The average age of the patients was 59, and 64% of them were women. After 24 weeks of followup, glucosamine alone, nor chondroitin alone turned out to be any better than a placebo. Their combination may reduce pain slightly more than a placebo, but not enough to be statistically significant. Only celebrex™ was better than a placebo, and then only by 10 percentage points (about 60% of the patients experienced a decrease in pain with a placebo, and about 70% - with celebrex™).
The authors of the study point out some limitations - patients with mild knee pain were included, and consequently there was a large response to the placebo. This might have masked any small additional effects that glucosamine or chondroitin might have had. Treating patients with moderate to severe knee pain had a larger impact, but not enough to be convincingly significant. Once more we are faced with a lack of significant efficacy of these supplements, although they may have minor benefits for a subset of patients. These benefits still need to be substantiated!
An editorial on this topic in the same issue of NEJM examines results from other studies, and suggests the following. First, if patients choose to take glucosamine, they should take glucosamine sulphate, not hydrochloride, because in some studies, this compound seems to be more effective. Patients with severe pain should take chondroitin sulphate together with glucosamine sulphate, since there may be an additive effect. Patients should take three months to evaluate whether there is any noticeable improvement that would justify continuing this therapy.
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Last Modification - March 4, 2006