Glucosamine Knee Pain Clinical Studies

Knee pain clinical studies

Knee pain clinical studies

Both glucosamine and chondroitin are found naturally in the joints, where they help keep the cartilage healthy and moist. In supplement form, they help relieve the pain of osteoarthritis and may also help the body repair damaged cartilage. In addition, a number of studies have indicated that people with osteoarthritis need less of their standard medicines while on glucosamine and chondroitin, and that the relief they enjoy continues even after they stop taking the supplements. To date, the evidence indicates that glucosamine and chondroitin can relieve pain and improve joint function in certain people, and that the two substances may help the body build, protect and repair cartilage.

Glucosamine and Chondroitin Knee Pain Studies and References:

Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT).

Kahan A. STOPP (Study on Osteoarthritis Progression Prevention).

The European GUIDE (Glucosamine Unum In Die Efficacy).

The Mayo Clinic

The American Academy of Orthopedic Surgeons.

Archives of Internal Medicine.

Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT).

The National Institutes of Health funded a large-scale, 4-year study that looked at the ability of glucosamine and chondroitin to reduce the pain of osteoarthritis: the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT).1 “Among the participants in the moderate-to-severe pain group, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared to placebo”. Continued analysis of the GAIT study found that the volunteers who were receiving chondroitin had “a statistically significant improvement in knee joint swelling,” and that this seemed to occur more often in those who began the study with milder pain.

Kahan A. STOPP (Study on Osteoarthritis Progression Prevention).

New Study Shows that Chondroitins 4 and 6 Sulfate Retard Progression of Disease and Alleviates Pain in Patients with Knee Osteoarthritis
PARIS, February 20, 2009— Top-level experts of musculoskeletal rheumatic diseases commented on results of the Study on Osteoarthritis Progression Prevention (STOPP) showing marked benefits of treatment with chondroitins 4 and 6 sulfate (CS) in patients suffering from knee osteoarthritis (OA). The study provided compelling evidence that CS significantly retard join structure degradation while providing symptomatic relief to treated patients. This international, randomized, double-blind, placebo-controlled study was conducted in 622 patients aged 45 to 80 years with knee OA. Patients received either an 800-mg sachet of highly purified CS (Genévrier Laboratories, Sophia Antipolis, France, and IBSA, Pambio Noranco, Switzerland) (n = 309 patients) or placebo (n = 313 patients) once daily for 2 years.

“Both ITT and per protocol analyses show that CS significantly retard joint structure degradation”

The intent-to-treat analysis demonstrated:

  • A significant reduction (P < 0.0001) in minimum JSW loss in the CS group (0.07±0.03 mm versus 0.31±0.04 mm) (Figure 1). Of note, the effect of treatment significantly increased with time.
  • A significant reduction (P < 0.0005) of the percentage of patients with radiographic
    progression >0.25 mm in the CS group (28% versus 41%; relative risk reduction 33% [95% confidence interval 16-46%]). A significant reduction of JSW loss was observed with any threshold between 0.05 mm and 0.7 mm. For example, fewer patients experienced JSW loss of at least 0.5 mm with CS as compared to placebo (13% versus 27%, respectively; P<0.0001).

“Rapid and long-lasting improvement of pain”

The ITT analysis (VAS and WOMAC) demonstrated significantly faster improvement in pain in the CS group than in the placebo group (P < 0.01 for the interaction between time and treatment effect). For the decrease in pain scores (VAS), the differences between the 2 groups in favor of CS were already significant after one month of treatment and still significant at 3, 6, 9 months.

No significant differences were observed between the two groups in terms of consumption of acetaminophen, while a trend toward a decrease in the consumption of NSAIDs was observed in the CS group during the study.

“A significant advance in the management of knee osteoarthritis”

Prof. André KAHAN (University of Paris Descartes and Cochin Hospital, Paris, France), lead investigator of the study, underlined the high quality of radiologic assessment. “The study provides clear evidence that the highly purified CS preparation used is not only a symptomatic slow-acting drug for osteoarthritis (SYSADOA), but also, and most importantly , a disease modifying osteoarthritis drug (DMOAD).

See http://www.ibsa.ch/050409stopp_pressrelease.pdf for full press release.

The European GUIDE (Glucosamine Unum In Die Efficacy).

The Unum in Die Efficacy Trial found that glucosamine sulfate taken once a day may have more ability to control pain due to knee osteoarthritis than acetaminophen. In the Unum in Die study of 318 patients with symptomatic knee osteoarthritis, patients took either oral glucosamine sulfate soluble powder (1500 mg once a day), acetaminophen (1000 mg three times a day), or placebo over a 6-month period. All groups were also allowed ibuprofen as needed.  Both glucosamine sulfate and acetaminophen showed greater efficacy than placebo in reducing pain, according to the study. Importantly, patients taking glucosamine sulfate appeared to experience more relief than did those on acetaminophen, according to the investigators. Once-daily 1500 mg oral doses of glucosamine sulfate might be the preferred treatment for symptoms of knee osteoarthritis,” reports GUIDE study author Gabriel Herrero-Beaumont, MD, director of the rheumatology department at the Jiménez Díaz Foundation – CAPIO, in Madrid, Spain. He also pointed out that “Based on these results, physicians who typically recommended acetaminophen may well find their patients gain more comfort taking glucosamine sulfate.” Note that glucosamine as either glucosamine sulfate or glucosamine hydrochloride (HCI) are effectively the same except for the carrier molecule that delivers the glucosamine. Both salts, in the pure form, deliver equally effective amounts of the desired glucosamine to joint cartilage. If there is a preference, it should be based on relative purity and economics.

The Mayo Clinic

“The consensus of expert and industry opinion supports the use of chondroitin and its common partner agent, glucosamine, for improving symptoms and stopping (or possibly reversing) the degenerative process of osteoarthritis.”

“Chondroitin Sulfate.” MayoClinic.com. Accessible at http://www.mayoclinic.com/health/chondroitin-sulfate/NS_patient-chondroitin. Viewed July 1, 2009.

The Mayo Clinic gives chondroitin sulfate an “A” for Osteoarthritis.
“Multiple controlled clinical trials since the 1980s have examined the use of oral chondroitin in patients with osteoarthritis of the knee and other locations (spine, hips, finger joints). Most of these studies have reported significant benefits in terms of symptoms (such as pain), function (such as mobility), and reduced medication requirements (such as anti-inflammatories). However, most studies have been brief (six month duration) with methodological weaknesses. Despite these weaknesses and potential for bias in the available results, the weight of scientific evidence points to a beneficial effect when chondroitin is used for 6-24 months. Longer-term effects are not clear. Early studies of chondroitin applied to the skin have also been conducted. Chondroitin is frequently used with glucosamine. Glucosamine has independently been demonstrated to benefit patients with osteoarthritis (particularly of the knee). It remains unclear if there is added benefit of using these two agents together compared to using either alone”. See http://www.mayoclinic.com/health/chondroitin-sulfate/NS_patient-chondroitin/DSECTION=evidence

The Mayo Clinic gives glucosamine an “A for Osteoarthritis of the Knee and a “B” for Osteoarthritis generally. Knee osteoarthritis (mild-to-moderate) “A”
“Based on human research, there is good evidence to support the use of glucosamine sulfate in the treatment of mild-to-moderate knee osteoarthritis. Most studies have used glucosamine sulfate supplied by one European manufacturer (Rotta Research Laboratorium), and it is not known if glucosamine preparations made by other manufacturers are equally effective. Although some studies of glucosamine have not found benefits, these have either included patients with severe osteoarthritis or used products other than glucosamine sulfate . The evidence for the effect of glycosaminoglycan polysulphate is conflicting and merits further investigation. More well-designed clinical trials are needed to confirm safety and effectiveness, and to test different formulations of glucosamine”.

Osteoarthritis (general) “B”
“Several human studies and animal experiments report benefits of glucosamine in treating osteoarthritis of various joints of the body, although the evidence is less plentiful than that for knee osteoarthritis. Some of these benefits include pain relief, possibly due to an anti-inflammatory effect of glucosamine, and improved joint function. Overall, these studies have not been well designed. Although there is some promising research, more study is needed in this area before a firm conclusion can be made.”See: http://www.mayoclinic.com/health/glucosamine/NS_patient-glucosamine/DSECTION=evidence

The American Academy of Orthopedic Surgeons.

The American Academy of Orthopedic Surgeons notes that recent studies appear to support the idea that glucosamine and chondroitin relieve osteoarthritis pain.

“Glucosamine and Chondroitin Sulfate.” American Academy of Orthopedic Surgeons. Last updated July 2007. Accessible at http://orthoinfo.aaos.org/topic.cfm?topic=a00189. Viewed July 1, 2009.

“…you may need to take the supplements (referring to glucosamine and chondroitin) for a couple of months before you see any results…”
[See: http://orthoinfo.aaos.org/topic.cfm?topic=A00189 Viewed 23 October 2009]

Archives of Internal Medicine.

In 2003, a paper published in the Archives of Internal Medicine statistically merged and analyzed the results of several studies on glucosamine and chondroitin for osteoarthritis of the knee. The authors of this study found that both of these substances effectively reduced pain and improved mobility.

1 Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 2006;354(8):795-808.

2 Hocklberg MC, Clegg DO. Potential effects of chondroitin sulfate on joint swelling: a GAIT report. Osteoarthritis Cartilage, 2008;16(Suppl 3):S22-24.

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