"Doc, my knees hurt all the time."
"I can't hardly climb up the stairs my hip bothers me so much."
"I've had a bad back for years."
Even in my profession I encounter the sorrows of OA (osteoarthritis) all the time. Over 20 million Americans suffer from osteoarthritis and the biggest risk factor for the development of this painful condition is aging, followed by obesity. As more and more baby boomers enter their golden years [Don't get personal with me, Bub. -Editor] the effects of years of weight training, organized sports and creeping avoirdupois leave their toll upon the joints. Outside of surgery and pain pills can anything be done to help these poor souls? How about glucosamine/chondroitin (hereafter referred to as G/C) combinations?
Oh, crap. Did they have to publicize this meta-analysis from the Annals of Internal Medicine all over town?
Wait a sec, though - this review looked at clinical trials comparing chondroitin to placebo for the relief of osteoarthritis-associated pain. These conclusions are not surprising to anyone who follows the OA literature, as previous studies have also shown the inefficacy of G/C as pain relievers.
I must confess that I have taken a G/C supplement daily for over two years, but not for relief of the pain of osteoarthritis. I take it on the chance that it might delay or even prevent me from developing the disease. Am I nuts? [Please, oh please, let me answer that. -Ed].
Of course I'm not crazy - I'm a doctor! We doctors in the know are following the literature on OA with interest - especially on studies using G/C as a DMOAD (that's disease-modifying osteoarthritis drug to you novitiates). Taking G/C is worthless for relieving pain, but the jury is still out as to whether or not it can delay the joint deterioration of OA, or even prevent it from harming our aging joints.
Here is one study looking at the effects of taking glucosamine for three years:
Treatment of osteoarthritis is usually limited to short-term symptom control. We assessed the effects of the specific drug glucosamine sulphate on the long-term progression of osteoarthritis joint structure changes and symptoms.
We did a randomised, double-blind placebo controlled trial, in which 212 patients with knee steoarthritis were randomly assigned 1500 mg sulphate oral glucosamine or placebo once daily for 3 years.
The 106 patients on placebo had a progressive joint-space narrowing, with a mean joint-space loss after 3 years of -0.31 mm. There was no significant joint-space loss in the 106 patients on glucosamine sulphate: -0.06 mm.
The long-term combined structure-modifying and symptom-modifying effects of gluosamine sulphate suggest that it could be a disease modifying agent in osteoarthritis.
Interested? This comment from researchers in Belgium may pique you even more:
A similar dose of glucosamine sulfate has also been shown, in two independent studies, to prevent the joint space narrowing observed at the femorotibial compartment in patients with mild to moderate knee osteoarthritis. This effect, which is not affected by the radiographic technique used for the assessment of joint space width, also translated into a 50% reduction in the incidence of osteoarthritis-related surgery of the lower limbs during a 5-year period following the withdrawal of the treatment.
Until I read that long-term studies of G/C show no disease-modifying benefit I am going to take the darn stuff - and try to eat healthy, exercise and keep my weight right where it should be. [Difficile est tenere quae acceperis nisi exerceas! -Ed.]
I eagerly await the day that Adequan (PSGAG) and/or Legend I.V. (intravenous HA) become available for human use. This article explains in more detail what has been scientifically demonstrated in horses, but, on a more subjective scale, I have seen these drugs work wonders in slightly creaky horses, both alone and as an adjunct to IA triamcinolone. (The article also comments on putative chondroprotective effects of triamcinolone not seen with other corticosteroids.) My friend's horse, whom I call my own, has some early OA in his front distal interphalangeal joints -- aka "ringbone" or "coffin joint arthritis". His last "lube job" (IA triamcinolone + IA HA + ESWT) was last summer, and he improved some. I did 3 weekly shots of Adequan IM and 1 Legend IV, and he was moving more freely than I imagined possible.
OK, so there is no such thing as a miracle cure, but I'm a fan of Adequan and Legend, and the side effect profile for both is minimal.
For full disclosure, both of my horses are on oral HA and Cosequin w/MSM. It clearly wasn't enough for my prince and the pea, but my friend's other horse has the tarsus radiographs from hell and has gone almost twice as long as the vets expected since his last hock injections.
I'm with you, I figure, it's my money, maybe I'm flushing it down the toilet, but until someone tells me that I am actually doing harm by using these products, I'll take that bet in hopes of protecting my joints and those of my horses.
Now that you remind me, I have a bottle of Cosamin tablets and my own supply of HA gel that are gathering dust. I guess I treat my horses better than myself. (That would be me on the left, the horses on the right.)
You might want to try GC with MSM. I have osteoarthritis in my neck. There was pain and audible clicking when I turned my head. And when I went to the dentist I had to have them put a pillow under my neck in the dental chair - which only supports the head. I took GC for years with the same hope that you have, that it would slow down the deterioration in my hip and knee. Since I started taking GC/MSM ALL of the symptoms in my neck have disappeared - including the clicking that others could hear. It cannot be "placebo effect" if the results are noticeable to others. I even had my own test case. In January I had a knee replacement. They had me stop the GC/MSM. The symptoms came back. Now that I have been able to go back on the GC/MSM the neck symptoms have again gone away.
I've taken glucosamine sulfate for several years, and I "think" it might help. But I've never been positive. Still, it's pretty cheap at Sam's Club. So I guess I'll go on taking it.
I'm curious...why defend G/C, but downplay "exercise" as simply part of your wellness package when the literature clearly supports exercise in just about every type of OA. Even with this study, the jury is just about split evenly on G/C, but there is rather strong evidence about the benefits of specific exercise in reducing OA pain and delaying surgery. Add some periodic manual therapy to the mix and your doing well. Perhaps exercise is more important to our joints than we give it credit for. Am I nuts? No, I'm a Physical Therapist!
I'd like to second the P/T's comment but this seems pretty consistent with the last lines of Craig's post. I still suggest people with OA take G/C with the advice that it can't hurt and may help based on the some of evidence laid out above. Proper excercise is primary, though. Additionally, excercise takes on so many other problems; if it was a pill, it would be considered a miracle drug. Part of the problem seems to be that people want to believe in pills rather than behavioral modification. It's easier for patients, many times easier for the physician, and pushed by Pharma.
It's quite possible that the G/C does work, but only enough to measure by physical means not by subjective means (subjective studies usually have to have a stronger effect to show up because of the larger variance).
So here's an interesting question for the day: If a treatment shows a real effect measured physically, but no effect subjectively, does it 'work'? Or better, is it useful? This is like a reverse placebo question.
I'm cross posting this comment with a link-back to here at my site (http://angrytoxicologist.com/?p=10) to see what people over there think too.
I still have the bottle I stopped taking when the "not effective" study came out. Think maybe I'll go back to that. Doesn't seem like it can hurt and the possibility of it helping is enough for me.
I've got an elderly relative confined to a wheelchair with bad joint problems and that's not how I want to end up!
Eric and AngryToxicologist,
I heartily concur with your exercise endorsement. In 1996, my osteoarthritis was sufficiently severe to prompt serious consideration of a medical disability request. A physician sent me to a P/T who prescribed what I can only describe as a life-changing exercise program. I have since added a four day per week full-body workout routine, combined with daily 2 to 3 mile walks. That, and a daily dose of Mobic, has allowed me to renew all of my favorite activities, and add a few new ones, including wakeboarding! At age 59, I look forward to an active life that I could not envision eleven years ago.
I have an arthritic guinea pig who we started on glucosomine, and you can really tell the difference. I no longer have a pet who sits fluffed up in a corner trying not to put his toes on the ground.