Side effect of glucosamine

Glucosamine Hydrochloride

  1. Tsuruta A, Horiike T, Yoshimura M, Nagaoka I. Evaluation of the effect of the administration of a glucosamine containing supplement on biomarkers for cartilage metabolism in soccer players: A randomized double blind placebo controlled study. Mol Med Rep. 2018 Oct;18:3941-3948. Epub 2018 Aug 17. View abstract.
  2. Ma H, Li X, Sun D, et al. Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank. BMJ. 2019 May 14;365:l1628. View abstract.
  3. Kanzaki N, Ono Y, Shibata H, Moritani T. Glucosamine-containing supplement improves locomotor functions in subjects with knee pain: a randomized, double-blind, placebo-controlled study. Clin Interv Aging. 2015;10:1743-53. View abstract.
  4. Esfandiari H, Pakravan M, Zakeri Z, et al. Effect of glucosamine on intraocular pressure: a randomized clinical trial. Eye. 2017;31:389-394.
  5. Murphy RK, Jaccoma EH, Rice RD, Ketzler L. Glucosamine as a Possible Risk Factor for Glaucoma. Invest Ophthalmol Vis Sci 2009;50:5850.
  6. Murphy RK, Ketzler L, Rice RD, Johnson SM, Doss MS, Jaccoma EH. Oral glucosamine supplements as a possible ocular hypertensive agent. JAMA Ophthalmol 2013;131:955-7. View abstract.
  7. Levin RM, Krieger NN, and Winzler RJ. Glucosamine and acetylglucosamine tolerance in man. J Lab Clin Med 1961;58:927-932.
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  9. Wu H, Liu M, Wang S, Zhao H, Yao W, Feng W, Yan M, Tang Y, Wei M. Comparative fasting bioavailability and pharmacokinetic properties of 2 formulations of glucosamine hydrochloride in healthy Chinese adult male volunteers. Arzneimittelforschung. 2012 Aug;62:367-71. View abstract.
  10. Liang CM, Tai MC, Chang YH, Chen YH, Chen CL, Chien MW, Chen JT. Glucosamine inhibits epidermal growth factor-induced proliferation and cell-cycle progression in retinal pigment epithelial cells. Mol Vis 2010;16:2559-71. View abstract.
  11. Raciti GA, Iadicicco C, Ulianich L, Vind BF, Gaster M, Andreozzi F, Longo M, Teperino R, Ungaro P, Di Jeso B, Formisano P, Beguinot F, Miele C. Glucosamine-induced endoplasmic reticulum stress affects GLUT4 expression via activating transcription factor 6 in rat and human skeletal muscle cells. Diabetologia 2010;53:955-65. View abstract.
  12. Kang ES, Han D, Park J, Kwak TK, Oh MA, Lee SA, Choi S, Park ZY, Kim Y, Lee JW. O-GlcNAc modulation at Akt1 Ser473 correlates with apoptosis of murine pancreatic beta cells. Exp Cell Res 2008;314(11-12):2238-48. View abstract.
  13. Yomogida S, Hua J, Sakamoto K, Nagaoka I. Glucosamine suppresses interleukin-8 production and ICAM-1 expression by TNF-alpha-stimulated human colonic epithelial HT-29 cells. Int J Mol Med 2008;22:205-11. View abstract.
  14. Ju Y, Hua J, Sakamoto K, Ogawa H, Nagaoka I. Glucosamine, a naturally occurring amino monosaccharide modulates LL-37-induced endothelial cell activation. Int J Mol Med 2008;22:657-62. View abstract.
  15. Qiu W, Su Q, Rutledge AC, Zhang J, Adeli K. Glucosamine-induced endoplasmic reticulum stress attenuates apolipoprotein B100 synthesis via PERK signaling. J Lipid Res 2009;50:1814-23. View abstract.
  16. Ju Y, Hua J, Sakamoto K, Ogawa H, Nagaoka I. Modulation of TNF-alpha-induced endothelial cell activation by glucosamine, a naturally occurring amino monosaccharide. Int J Mol Med 2008;22:809-15. View abstract.
  17. Ilic MZ, Martinac B, Samiric T, Handley CJ. Effects of glucosamine on proteoglycan loss by tendon, ligament and joint capsule explant cultures. Osteoarthritis Cartilage 2008;16:1501-8. View abstract.
  18. Toegel S, Wu SQ, Piana C, Unger FM, Wirth M, Goldring MB, Gabor F, Viernstein H. Comparison between chondroprotective effects of glucosamine, curcumin, and diacerein in IL-1beta-stimulated C-28/I2 chondrocytes. Osteoarthritis Cartilage 2008;16:1205-12. View abstract.
  19. Lin YC, Liang YC, Sheu MT, Lin YC, Hsieh MS, Chen TF, Chen CH. Chondroprotective effects of glucosamine involving the p38 MAPK and Akt signaling pathways. Rheumatol Int 2008;28:1009-16. View abstract.
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  22. Uitterlinden EJ, Koevoet JL, Verkoelen CF, Bierma-Zeinstra SM, Jahr H, Weinans H, Verhaar JA, van Osch GJ. Glucosamine increases hyaluronic acid production in human osteoarthritic synovium explants. BMC Musculoskelet Disord 2008;9:120. View abstract.
  23. Hong H, Park YK, Choi MS, Ryu NH, Song DK, Suh SI, Nam KY, Park GY, Jang BC. Differential down-regulation of COX-2 and MMP-13 in human skin fibroblasts by glucosamine-hydrochloride. J Dermatol Sci 2009;56:43-50. View abstract.
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  25. Imagawa K, de Andrés MC, Hashimoto K, Pitt D, Itoi E, Goldring MB, Roach HI, Oreffo RO. The epigenetic effect of glucosamine and a nuclear factor-kappa B (NF-kB) inhibitor on primary human chondrocytes–implications for osteoarthritis. Biochem Biophys Res Commun 2011;405:362-7. View abstract.
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  35. Naito K, Watari T, Furuhata A, Yomogida S, Sakamoto K, Kurosawa H, Kaneko K,Nagaoka I. Evaluation of the effect of glucosamine on an experimental rat osteoarthritis model. Life Sci 2010;86(13-14):538-43. View abstract.
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  41. Provenza JR, Shinjo SK, Silva JM, Peron CR, Rocha FA. Combined glucosamine and chondroitin sulfate, once or three times daily, provides clinically relevant analgesia in knee osteoarthritis. Clin Rheumatol 2015;34:1455-62.View abstract.
  42. Kwoh CK, Roemer FW, Hannon MJ, Moore CE, Jakicic JM, Guermazi A, Green SM, Evans RW, Boudreau R. Effect of oral glucosamine on joint structure in individuals with chronic knee pain: a randomized, placebo-controlled clinical trial. Arthritis Rheumatol. 2014 Apr;66:930-9. View abstract.
  43. Hochberg MC, Martel-Pelletier J, Monfort J, Möller I, Castillo JR, Arden N,Berenbaum F, Blanco FJ, Conaghan PG, Doménech G, Henrotin Y, Pap T, Richette P, Sawitzke A, du Souich P, Pelletier JP; on behalf of the MOVES Investigation Group. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis 2016;75:37-44. View abstract.
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  47. Yue, J., Yang, M., Yi, S., Dong, B., Li, W., Yang, Z., Lu, J., Zhang, R., and Yong, J. Chondroitin sulfate and/or glucosamine hydrochloride for Kashin-Beck disease: a cluster-randomized, placebo-controlled study. Osteoarthritis.Cartilage. 2012;20:622-629. View abstract.
  48. Kanzaki, N., Saito, K., Maeda, A., Kitagawa, Y., Kiso, Y., Watanabe, K., Tomonaga, A., Nagaoka, I., and Yamaguchi, H. Effect of a dietary supplement containing glucosamine hydrochloride, chondroitin sulfate and quercetin glycosides on symptomatic knee osteoarthritis: a randomized, double-blind, placebo-controlled study. J.Sci.Food Agric. 3-15-2012;92:862-869. View abstract.
  49. Sawitzke, A. D., Shi, H., Finco, M. F., Dunlop, D. D., Harris, C. L., Singer, N. G., Bradley, J. D., Silver, D., Jackson, C. G., Lane, N. E., Oddis, C. V., Wolfe, F., Lisse, J., Furst, D. E., Bingham, C. O., Reda, D. J., Moskowitz, R. W., Williams, H. J., and Clegg, D. O. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Ann.Rheum.Dis. 2010;69:1459-1464. View abstract.
  50. Jackson, C. G., Plaas, A. H., Sandy, J. D., Hua, C., Kim-Rolands, S., Barnhill, J. G., Harris, C. L., and Clegg, D. O. The human pharmacokinetics of oral ingestion of glucosamine and chondroitin sulfate taken separately or in combination. Osteoarthritis Cartilage 2010;18:297-302. View abstract.
  51. Dudics, V., Kunstar, A., Kovacs, J., Lakatos, T., Geher, P., Gomor, B., Monostori, E., and Uher, F. Chondrogenic potential of mesenchymal stem cells from patients with rheumatoid arthritis and osteoarthritis: measurements in a microculture system. Cells Tissues.Organs 2009;189:307-316. View abstract.
  52. Nandhakumar J. Efficacy, tolerability, and safety of a multicomponent antiinflammatory with glucosamine hydrochloride vs glucosamine sulfate vs an NSAID in the treatment of knee osteoarthritis–a randomized, prospective, double-blind, comparative study. Integr Med Clin J 2009;8:32-38.
  53. Kawasaki T, Kurosawa H, Ikeda H, et al. Additive effects of glucosamine or risedronate for the treatment of osteoarthritis of the knee combined with home exercise: a prospective randomized 18-month trial. J Bone Miner Metab 2008;26:279-87. View abstract.
  54. Nelson BA, Robinson KA, Buse MG. High glucose and glucosamine induce insulin resistance via different mechanisms in 3T3-L1 adipocytes. Diabetes 2000;49:981-91. View abstract.
  55. Baron AD, Zhu JS, Zhu JH, et al. Glucosamine induces insulin resistance in vivo by affecting GLUT 4 translocation in skeletal muscle. Implications for glucose toxicity. J Clin Invest 1995;96:2792-801. View abstract.
  56. Eggertsen R, Andreasson A, Andren L. No changes of cholesterol levels with a commercially available glucosamine product in patients treated with lipid lowering drugs: a controlled, randomised, open cross-over trial. BMCPharmacol Toxicol 2012;13:10. View abstract.
  57. Shankland WE. The effects of glucosamine and chondroitin sulfate on osteoarthritis of the TMJ: a preliminary report of 50 patients. Cranio 1998;16:230-5. View abstract.
  58. Liu W, Liu G, Pei F, et al. Kashin-Beck disease in Sichuan, China: report of a pilot open therapeutic trial. J Clin Rheumatol 2012;18:8-14. View abstract.
  59. Nakamura H, Masuko K, Yudoh K, et al. Effects of glucosamine administration on patients with rheumatoid arthritis. Rheumatol Int 2007;27:213-8. View abstract.
  60. Yue QY, Strandell J, Myrberg O. Concomitant use of glucosamine may potential the effect of warfarin. The Uppsala Monitoring Centre. Available at: www.who-umc.org/graphics/9722.pdf (Accessed 28 April 2008).
  61. Knudsen J, Sokol GH. Potential glucosamine-warfarin interaction resulting in increased international normalized ratio: Case report and review of the literature and MedWatch database. Pharmacotherapy 2008;28:540-8. View abstract.
  62. Muniyappa R, Karne RJ, Hall G, et al. Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects. Diabetes 2006;55:3142-50. View abstract.
  63. Tannock LR, Kirk EA, King VL, et al. Glucosamine supplementation accelerates early but not late atherosclerosis in LDL receptor-deficient mice. J Nutr 2006;136:2856-61. View abstract.
  64. Pham T, Cornea A, Blick KE, et al. Oral glucosamine in doses used to treat osteoarthritis worsens insulin resistance. Am J Med Sci 2007;333:333-9. View abstract.
  65. Messier SP, Mihalko S, Loeser RF, et al. Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study. Osteoarthritis Cartilage 2007;15:1256-66. View abstract.
  66. Stumpf JL, Lin SW. Effect of glucosamine on glucose control. Ann Pharmacother 2006;40:694-8. View abstract.
  67. Qiu GX, Weng XS, Zhang K, et al. . Zhonghua Yi Xue Za Zhi 2005;85:3067-70. View abstract.
  68. 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;354:795-808. View abstract.
  69. McAlindon T. Why are clinical trials of glucosamine no longer uniformly positive? Rheum Dis Clin North Am 2003;29:789-801. View abstract.
  70. Gray HC, Hutcheson PS, Slavin RG. Is glucosamine safe in patients with seafood allergy (letter)? J Allergy Clin Immunol 2004;114:459-60. View abstract.
  71. Tannis AJ, Barban J, Conquer JA. Effect of glucosamine supplementation on fasting and non-fasting plasma glucose and serum insulin concentrations in healthy individuals. Osteoarthritis Cartilage 2004;12:506-11. View abstract.
  72. Weimann G, Lubenow N, Selleng K, et al. Glucosamine sulfate does not crossreact with the antibodies of patients with heparin-induced thrombocytopenia. Eur J Haematol 2001;66:195-9. View abstract.
  73. Rozenfeld V, Crain JL, Callahan AK. Possible augmentation of warfarin effect by glucosamine-chondroitin. Am J Health Syst Pharm 2004;61:306-307. View abstract.
  74. Guillaume MP, Peretz A. Possible association between glucosamine treatment and renal toxicity: comment on the letter by Danao-Camara. Arthritis Rheum 2001;44:2943-4. View abstract.
  75. Danao-Camara T. Potential side effects of treatment with glucosamine and chondroitin. Arthritis Rheum 2000;43:2853. View abstract.
  76. Yu JG, Boies SM, Olefsky JM. The effect of oral glucosamine sulfate on insulin sensitivity in human subjects. Diabetes Care 2003;26:1941-2. View abstract.
  77. Hoffer LJ, Kaplan LN, Hamadeh MJ, et al. Sulfate could mediate the therapeutic effect of glucosamine sulfate. Metabolism 2001;50:767-70.. View abstract.
  78. Braham R, Dawson B, Goodman C. The effect of glucosamine supplementation on people experiencing regular knee pain. Br J Sports Med 2003;37:45-9. View abstract.
  79. Scroggie DA, Albright A, Harris MD. The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Arch Intern Med 2003;163:1587-90. View abstract.
  80. Tallia AF, Cardone DA. Asthma exacerbation associated with glucosamine-chondroitin supplement. J Am Board Fam Pract 2002;15:481-4.. View abstract.
  81. Du XL, Edelstein D, Dimmeler S, et al. Hyperglycemia inhibits endothelial nitric oxide synthase activity by post-translational modification at the Akt site. J Clin Invest 2001;108:1341-8. View abstract.
  82. Pavelka K, Gatterova J, Olejarova M, et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: A 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med 2002;162:2113-23. View abstract.
  83. Adebowale AO, Cox DS, Liang Z, et al. Analysis of glucosamine and chondroitin sulfate content in marketed products and the Caco-2 permeability of chondroitin sulfate raw materials. JANA 2000;3:37-44.
  84. Nowak A, Szczesniak L, Rychlewski T, et al. Glucosamine levels in people with ischaemic heart disease with and without type II diabetes. Pol Arch Med Wewn 1998;100:419-25. View abstract.
  85. Olszewski AJ, Szostak WB, McCully KS. Plasma glucosamine and galactosamine in ischemic heart disease. Atherosclerosis 1990;82:75-83. View abstract.
  86. Yun J, Tomida A, Nagata K, Tsuruo T. Glucose-regulated stresses confer resistance to VP-16 in human cancer cells through a decreased expression of DNA topoisomerase II. Oncol Res 1995;7:583-90. View abstract.
  87. Pouwels MJ, Jacobs JR, Span PN, et al. Short-term glucosamine infusion does not affect insulin sensitivity in humans. J Clin Endocrinol Metab 2001;86:2099-103. View abstract.
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  89. Das A Jr, Hammad TA. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage 2000;8:343-50. View abstract.
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Glucosamine and Chondroitin

Topic Overview

What are glucosamine and chondroitin?

Glucosamine and chondroitin are part of normal cartilage. Cartilage acts as a cushion between the bones in a joint.

Glucosamine, also called chitosamine, is a natural substance that is found in the covering of shellfish. It is available in different forms, including glucosamine hydrochloride, N-acetyl-glucosamine (NAG), and glucosamine sulfate, which is a combination of glucosamine and mineral salt. Glucosamine is also available in synthetic forms. The body absorbs glucosamine well.

Chondroitin can come from natural sources, such as shark or bovine cartilage, or it can be made in a lab. Chondroitin is also known as chondroitin sulfate, chondroitin sulfuric acid, and chonsurid. Chondroitin sulfate is a combination of chondroitin and mineral salt.

Glucosamine and chondroitin are available in tablet, capsule, powder, or liquid form and are often taken in combination with each other or in combination with other dietary supplements. Glucosamine may be taken separately as a dietary supplement for joints.

What are glucosamine and chondroitin used for?

Many people take glucosamine and chondroitin, alone or together, for osteoarthritis. Some people believe this helps. But an analysis of studies looking at glucosamine or chondroitin for osteoarthritis in the hip or knee did not show that these supplements slow joint destruction or relieve pain.footnote 1

Are glucosamine and chondroitin safe?

It appears that glucosamine and chondroitin, alone or together, are safe and have few side effects. But they cost money and will not help you more than a placebo. Talk to your doctor if you are thinking about taking glucosamine and chondroitin.

If you are allergic to shellfish, do not take glucosamine unless you have talked to your doctor. Some glucosamine is made from shellfish covering.

The U.S. Food and Drug Administration (FDA) does not regulate dietary supplements in the same way it regulates medicines. A dietary supplement can be sold with limited or no research on how well it works.

Always tell your doctor if you are using a dietary supplement or if you are thinking about combining a dietary supplement with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on a dietary supplement. This is especially important for women who are pregnant or breastfeeding.

When using dietary supplements, keep in mind the following:

  • Like conventional medicines, dietary supplements may cause side effects, trigger allergic reactions, or interact with prescription and nonprescription medicines or other supplements you might be taking. A side effect or interaction with another medicine or supplement may make other health conditions worse.
  • The way dietary supplements are manufactured may not be standardized. Because of this, how well they work or any side effects they cause may differ among brands or even within different lots of the same brand. The form of supplement that you buy in health food or grocery stores may not be the same as the form used in research.
  • Other than for vitamins and minerals, the long-term effects of most dietary supplements are not known.

Effectiveness of Glucosamine and Chondroitin Sulfate for Osteoarthritis

Conventional medicine does not yet have a proven treatment to stop or slow the progression of osteoarthritis.

The nutritional supplements glucosamine and chondroitin sulfate have emerged as a treatment alternative for some patients suffering from osteoarthritis pain.

See Osteoarthritis Complete Treatment Guide

Perhaps the most important aspect of glucosamine and chondroitin sulfate supplements is that they are thought to help slow or prevent the degeneration of joint cartilage, the underlying cause of osteoarthritis pain. Glucosamine and chondroitin sulfate dietary supplements may also help alleviate existing joint pain. Presently, it is thought that unlike many medications available to treat arthritis pain and inflammation, glucosamine and chondroitin sulfate supplements have very few side effects.

However, glucosamine and chondroitin sulfate nutritional supplements do not offer the desired pain relief for all osteoarthritis patients. At the time of this article, the benefits and risks of taking glucosamine and chondroitin sulfate have not been definitively proven, and long term studies are needed to better understand their effects.

Osteoarthritis and Joint Degeneration

Osteoarthritis occurs when the cartilage on the ends of the joints wears down and the exposed bones rub together. This degenerative process causes excess friction in the joints, which leads to loss of motion, stiffness and joint pain. Osteoarthritis is more common among middle-aged and older individuals. Symptoms can range from mild to very severe pain in the back, neck, hands, hips, knees, and/or feet.

When degenerative osteoarthritis occurs in the back, it is usually referred to as facet joint osteoarthritis (because it affects the facet joints in the spine).

See Osteoarthritis of the Spine

When occurring in the neck, it is usually called cervical osteoarthritis.

See Cervical (Neck) Arthritis

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Glucosamine and Chondroitin Sulfate Dietary Supplements

Glucosamine and chondroitin sulfate are naturally found in connective tissues in the human body, such as those covering the ends of bones in the joints. Glucosamine is extracted from animal tissues such as crab, lobster, or shrimp shells, while chondroitin sulfate is found in animal cartilage such as tracheas or shark cartilage.1 They are commonly taken as dietary supplements (also known as nutritional supplements).

In This Article:

  • Effectiveness of Glucosamine and Chondroitin Sulfate for Osteoarthritis
  • Research on Glucosamine and Chondroitin Sulfate Supplements
  • Safe Use of Glucosamine and Chondroitin Sulfate Supplements

Glucosamine and chondroitin sulfate are believed to impact the cartilage degeneration process of osteoarthritis in the following ways:

  • Glucosamine sulfate is thought to help with cartilage formation and repair.1 Some laboratory tests show that glucosamine sulfate may help protect joint cartilage by limiting breakdown and helping to build up levels of cartilage.2 Glucosamine hydrochloride, another form of glucosamine, is considered to be equally effective as the sulfate form. It is absorbed more easily by the body and can be taken in lower dosages with the same effectiveness as glucosamine sulfate.
  • Chondroitin sulfate is part of a protein molecule that helps give cartilage its elastic properties and is thought to have an anti-inflammatory effect, which can help to reduce the painful swelling in the joints that occurs when the exposed bones in the joint rub together.3 In addition, chondroitin sulfate may also help slow the breakdown of cartilage and help restore cartilage growth to better cushion the joints.3

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Combining Nutritional Supplements With Other Treatments

Glucosamine and chondroitin sulfate may not provide sufficient pain relief for all osteoarthritis patients. Many patients find it is best to use glucosamine and chondroitin sulfate nutritional supplements in conjunction with other nonsurgical treatments (under the guidance of their treating physician), such as:

  • Pain medication that has anti-inflammatory properties, such as ibuprofen, COX-2 inhibitors, naproxen, and other non-steroidal anti-inflammatory drugs (NSAIDs). Acetaminophen may also be helpful for relief of joint pain associated with osteoarthritis. Taking glucosamine and chondroitin sulfate nutritional supplements may reduce some patients’ need for anti-inflammatory or pain medications, while others may continue to take other medications for pain relief. However, patients taking daily aspirin therapy should avoid taking chondroitin sulfate supplements, as it may contribute to bleeding.
  • Gentle stretching exercises can help maintain flexibility and range of motion as well as reduce stiffness in the muscles and joints. Engaging in gentle physical activity may also help maintain overall back health even after a flare-up of osteoarthritis pain is relieved.

    See Stretching for Back Pain Relief

  • Water therapy (specific exercises performed in a pool) can help patients with severe osteoarthritis pain. Pool therapy allows the joints to be unweighted by the water, which may be less painful than other types of exercise. Another gentle form of exercise is using an elliptical machine or a stationary exercise bike, which provide forms of aerobic exercise that are low-impact on the joints.

    See Pool Therapy to Relieve Osteoarthritis Pain and Low-Impact Aerobic Exercise

  • Traction for cervical osteoarthritis and/or manual manipulations (e.g. chiropractic or osteopathic) can help to control the chronic pain and other symptoms of osteoarthritis, as well as provide relief from severe episodes of pain. Patients considering traction should always work with a physician to ensure correct and safe use of the traction devices, as improper application of traction can be detrimental.

    See Chiropractic Treatments for Lower Back Pain

Additional non-medical approaches (e.g. acupuncture, yoga or Tai Chi, instrument assisted soft tissue techniques such as Active Release Technique (ART), Graston Technique (GT), muscle energy techniques, proprioceptive neuromuscular rehabilitation (PNF), Nimmo method, massage, and others) may also be effective for some patients.

Sometimes rest or weight loss may be recommended for certain patients in order to reduce stress on the joints. Some patients may also require a short period of rest and medication to reduce joint inflammation before they begin to exercise.

The proper course of treatment will differ for each patient and should be supervised by a health professional.

Surgery for Osteoarthritis

In rare cases, spine fusion surgery may be required to treat severe osteoarthritis pain. However, fusion surgery is generally not optimal, because osteoarthritis usually affects multiple vertebral levels, and multilevel fusions are generally not advisable.

For more in-depth information, see Glucosamine and Chondroitin Sulfate Supplements for Osteoarthritis on Arthritis-health.com.

  • 1.Arthritis Foundation. “Alternative therapies: glucosamine and chondroitin sulfate.” 2004.
  • 2.Deal, C.L.: “Neutraceuticals as Therapeutic Agents in Osteoarthritis.” Rheumatic Disease Clinics of North America. 1999: 379-395.
  • 3.National Institutes of Health. National Center for Complimentary and Alternative Medicine. “Questions and Answers: NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT).” 2004. http://nccam.nih.gov/research/results/gait/qa.htm?nav=gsa.

The Truth About Glucosamine and Chondroitin Sulfate

We, at Orthopedic Associates, pride ourselves in providing our patients the best possible care. As a component to this quality medical attention, we would like to provide you with the information that may assist you in managing your health. A common question we are asked is, “Would it help me to take Glucosamine and Chondroitin Sulfate?” Hopefully, after reading this brochure you will increase your understanding of this particular supplement and its relevance to you.

Glucosamine and chondroitin sulfate are nutritional supplements and are not subject to the same rigorous regulations required for prescription and non-prescription drugs. Therefore, if you decide to take any supplements, you do so at your own risk.

The information provided in this brochure does not replace the advice and guidance given by your doctor. If you have any questions about this supplement, please ask your physician.

What is Glucosamine and Chondroitin Sulfate?

Glucosamine sulfate and chondroitin sulfate are naturally occurring substances found in the connective tissues of the body, including the cartilage that covers the ends of bones in the joints.
Glucosamine sulfate functions are the primary building block for proteoglycans, large molecules in cartilage that give it viscoelastic (buffering) properties. When taken orally, glucosamine sulfate is absorbed readily into the system and can be traced to cartilage as soon as four hours after consumption.

Similar to non-steroidal anti-inflammatory drugs, glucosamine sulfate has been shown to have unique anti-inflammatory effects. Additionally, in some laboratory tests, the glucosamine supplement demonstrated a protective effect on the cartilage as well. These studies suggest that glucosamine sulfate may inhibit the breakdown of cartilage associated with osteoarthritis and may have the potential to help build-up cartilage.

Glucosamine hydrochloride, another form of glucosamine, is available as a nutritional supplement and is considered to be as effective as the sulfate form although there are fewer completed studies to review. This hydrochloride form of glucosamine is more available for absorption into the body; therefore, a smaller dose delivers an equivalent amount in the system.

Chondroitin sulfate is a larger molecule also found in cartilage. Chondroitin sulfate has been studied much less extensively, but early results show that it also seems to work as an anti-inflammatory and reduces pain. Some laboratory studies suggest that chondroitin sulfate may slow cartilage breakdown associated with osteoarthritis and even stimulate cartilage growth.

Who Should Take Glucosamine/Chondroitin Sulfate?

Many patients who suffer from osteoarthritis may benefit from the positive effects of taking this supplement. The painful symptoms of osteoarthritis may appear when cartilage becomes worn, and exposed bones begin to rub together. Conventional medicine does not yet have a proven treatment to stop or slow the progression of osteoarthritis. Traditional medical treatment includes drug therapy to control the pain associated with osteoarthritis. These treatments are sometimes disappointing for physicians and patients because medications may not provide complete relief and can have unwanted side effects. Some of these patients may be candidates for nutritional supplements like glucosamine and chondroitin sulfate.

How Do I Take These Supplements?

  • Typical dosage is 1500mg for glucosamine sulfate and 1200mg for chondroitin sulfate, taken once daily. For body weight less than 100 lbs, the dose is generally reduced to 1000mg for glucosamine sulfate and 800mg for chondroitin sulfate.
  • Duration of treatment has not yet been determined.
  • Reported improvement (e.g. reduction in painful symptoms) varies from three weeks to as much as eight weeks.
  • Some studies have shown continued improvement of symptoms after oral intake was stopped.
  • Generally, if there is no pain reduction after two months, there is little chance of improvement.
  • Patients should keep a diary of their symptoms when treatment begins to better judge any changes in pain level or joint movement, and this information should be shared with their physician.

What are the side effects of taking Glucosamine and Chondroitin Sulfate?

Preliminary studies show glucosamine sulfate and chondroitin sulfate to be safe and well tolerated. Common side effects may include:

  • Nausea
  • Diarrhea
  • Gastrointestinal upset

These side effects are reported in a small portion of patients. However, even substances that are found naturally in the body can have unpredictable results when taken in higher than normal quantities and in different formulations. This is particularly true with patients who are taking multiple medications or who have other diagnosed illness. For example:

  • Studies suggest that glucosamine sulfate may increase insulin resistance. For this reason, diabetic patients should use glucosamine sulfate with caution and only under medical supervision.
  • Patients on blood thinners (anticoagulants) should use chondroitin sulfate only after discussing and receiving approval from their physician.

What are side effects of glucosamine supplements?

There are not enough long-term studies to tell what, if any, side effects glucosamine supplements may have if they are taken for many years. Preliminary results from a recent three-year study did not show more side effects from glucosamine than from a placebo.
Glucosamine does not raise blood sugar. Adverse effects range from minimal to absent. In one large, nonblinded study, about 2% of patients who used glucosamine sulfate stopped participation because of adverse effects. The most frequently mentioned side effects in study participants who take glucosamine sulfate are stomach pain or tenderness, heartburn, diarrhea, and nausea.
At this time, there are no known interactions with other supplements or medications and no conditions that would prohibit taking glucosamine, with the possible exception of diabetes. Animal studies suggest that glucosamine may reduce the efficiency with which insulin removes blood sugar from the bloodstream. There is no evidence that the same effect occurs in humans, and experts do not agree if there is a risk to diabetic patients.

Do Glucosamine Supplements Work for Arthritis?

Glucosamine is one of the world’s most popular supplements. It’s also among the most controversial.

Here is the research about how it affects the two common types of arthritis.

Osteoarthritis

While many studies conclude that glucosamine has no benefits for osteoarthritis, others indicate that it may relieve joint pain and other symptoms over time.

This especially applies to glucosamine sulfate salts, a formulation patented by the pharmaceutical company Rottapharm.

One controlled study in 318 adults with osteoarthritis found that taking 1,500 mg of the “Rotta formulation” daily for half a year reduced pain and improved function more than a placebo.

The benefits appeared similar to a daily 3 g dose of acetaminophen — a commonly used pain reliever (7).

Another two studies, which included around 200 people, showed that taking 1,500 mg of glucosamine sulfate daily for three years improved their overall symptoms — including pain, stiffness and function — compared to a placebo (8, 9).

However, these studies were possibly industry-influenced since Rottapharm financed all three. Currently, no large, long-term, industry-independent studies on the effectiveness of glucosamine are available.

An independent analysis of several high-quality studies concluded that the “Rotta formulation” improved certain measures of pain and function more than a placebo, whereas other forms didn’t show any significant benefits (10).

That said, the benefits of taking glucosamine sulfate are small and some researchers consider them clinically irrelevant (11).

Summary: The benefits of this supplement are controversial. Some studies suggest that glucosamine sulfate may slightly improve osteoarthritis symptoms when taken for at least half a year.

Rheumatoid Arthritis

Osteoarthritis should not be confused with rheumatoid arthritis, which is much less common.

Rheumatoid arthritis is an autoimmune disease in which the immune system attacks the joints. Unlike osteoarthritis, it is not caused by everyday wear and tear.

Scientists have generally assumed that glucosamine has no benefits for rheumatoid arthritis.

Nevertheless, one study in 51 adults with rheumatoid arthritis suggests otherwise. It found that taking 1,500 mg of glucosamine hydrochloride for three months improved self-assessed symptoms more than a placebo (12).

However, more studies need to confirm these findings before any solid conclusions can be made.

Summary: Limited evidence indicates that glucosamine hydrochloride may improve symptoms in people with rheumatoid arthritis. However, more studies are needed.

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