Aging Begins at 30

Lifestyle Changes, Drugs Help Symptoms of Osteoarthritis

"You write a health column, don’t you? What do you know about glucosamine for arthritis?" "Essentially nothing," I had to admit. But, thanks to pharmacist friends, two arthritis specialists, and some literature, I’ve become "educated."

Osteoarthritis (degenerative joint disease) is decreased formation and increased destruction of joint cartilage of unknown cause. Many joints can be affected but, mainly the hips, knees, and hands. Injury aggravates it, including obesity injury. Pressure three times your weight, pounds your leg joints with every step, especially the inner joint surface of knock knees in obese people. Women are affected twice as often as men. Injured cells release digestive enzymes destroying cartilage. Damaged, exposed bone forms spurs that interfere with movement.

About 16 million American adults and almost all persons over 75 have osteoarthritis. It is the principal cause of pain and disability in the elderly and results in 40% of all drug costs.

Interest in glucosamine, a building block for cartilage, was aroused by a best-selling book with the attractive but erroneous title "The Arthritis Cure." Unfortunately there is no proven cure. The typical treatment course includes weight loss, avoiding high impact joint abuse, exercise with full range of joint movement, local heat or cold, physical and occupational therapy, joint protection, anti-pain medicine (aspirin or acetaminophen), or "non-steroidal" anti-inflammation drugs (NSAIDs), such as ibuprofen, are current treatments. NSAIDs cause side effects, sometime serious, in 15% of patients. Different patients respond to NSAIDs differently and choosing can be difficult. Some NSAIDs are suspected of speeding cartilage destruction.

Starting in the 1950s with test-tube and animal experiments, glucosamine (2amino2deoxyglucose) helped cartilage growth and prevented arthritis in animals. In the 1980s human experiments began. Taken by mouth 25% of glucosamine diffuses everywhere but concentrates in the liver, kidney, and cartilage. The experiments were derailed when Congress passed a health act permitting natural food supplements without FDA approval if no claim was made to diagnose, treat, or prevent disease. No purity analysis was required. Natural products cannot be patented so no drug company sponsored efforts to prove effectiveness and safety. Anyone can sell glucosamine, made from chitin in crab shells.

The 20 patient studies in the literature done abroad have serious design flaws. The longest follow up was two months, and 200 was the most patients studied. No strict American FDA controlled tests are available.

When arthritis patients treated with glucosamine were compared in double-blind, placebo-matched patients, about 59% of glucosamine-treated patients improved compared with 32% of placebo-treated patients. When patients were treated with glucosamine, 52% responded compared to 49% taking ibuprofen (Motrin). Improvement was measured on strictly defined scales. No drug interactions were reported. Only 4% of patients taking glucosamine had mild side effects, mainly gastrointestinal.

Glucosamine has some promise. It appears safe but all evaluations indicate doubt. The Arthritis Foundation does not recommend glucosamine. Saying its effectiveness is premature until correct dosage and long term effects have been studied. Taking glucosamine you may be volunteering to be a case of some bizarre toxicity. Remember the miserable persistent disease eosinophilic myalgia from a contaminant in natural tryptophan tablets (for sleep) that went undetected because it lacked FDA control. Glucosamine may work and may be safe, but we certainly don’t know for sure.

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See related Patient Topics Bones, Joints and Muscles, Osteoarthritis or Seniors' Health.

See related Provider Topics Bones, Joints and Muscles, Osteoarthritis or Seniors' Health.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

http://www.vh.org/adult/patient/internalmedicine/aba30/1999/osteoarthritis.html