Arthritis refers to inflammatory process involving articulating surfaces of bones. Arthritis is one of the leading causes of morbidity in middle-aged to elderly patients that interfere with normal day to day activities by limiting physical independence. According to the research report published in the Journal of American Medical Association (1) joint diseases like osteoarthritis are highly prevalent and are reported in individuals as young as 25 years. Report also suggested that approximately 12% of the entire US population suffers from moderate to severe osteoarthritis (the most common form of arthritis).
What are some common types or causes of arthritis?
Etiology and patho-physiology of joint disease and resulting damage determine the type of therapy to be performed in order to relieve joint inflammation and disease symptoms. As discussed previously, the most common type of joint inflammation is osteoarthritis that is reported in middle aged individuals, with worsening of symptoms as the time progresses.
Other common varieties include rheumatoid arthritis that has autoimmune origin, septic arthritis (that is associated with open trauma and invasion of micro-organisms into the blood stream) and other similar variants. Most infectious and inflammatory types of arthritis present with temporary symptoms that responds to antibiotics therapies. If treated well, these are not associated with residual joint damage or destruction.
The primary patho-physiology in the development of osteoarthritis and rheumatoid arthritis is the resulting bone damage due to wear and tear changes in joints as a result of inflammation. The loss of cartilage limits range of motion when two bones glide directly on each other. In addition, bone spurs or osteophytes are formed.
These spurs not only make movement painful but also become a source of inflammation, bone destruction, swelling and redness. Consequently, most variants of arthritis responds very well to pain relieving medications but the joint damage or destruction is progressive for which other helpful remedies are needed.
What Is Glucosamine And Chondroitin?
Cartilage that cushion articulating surface of bones is made up of glucosamine and chondroitin. In normal joint tissues, specialized connective tissue cells like chondrocytes and synoviocytes synthesize chondroitin sulfate with the help of normal substrates glucosamine (an amino-sugar). When released from the specialized cells, chondroitin aggregates into complex structures within the connective tissue to form proteoglycan aggregates.
The presence of these connective tissue molecules is responsible for the structural and functional properties of joints (like flexibility, resiliency, strength and stability). Supplemental form of glucosamine and chondroitin helps in cartilage remodeling and repair to decrease the influence of degenerative processes as suggested by a number of experimental and research studies.
How Glucosamine And Chondroitin Work For Arthritis Pain?
Allen D. Sawitzke (2) conducted a study on 572 individuals with well-established knee osteoarthritis (with radiographs showing grade 2 and 3 joint degenerative changes) at 9 centers across United States. The study design was kept double-blind and placebo-controlled to limit the risk of bias. Sawitzke and his associates prescribed the study participants with chondroitin sulfate in a dose of 400 mg 3 times daily and glucosamine 500 mg (3 times daily) for a period of 24 months. The control sample was prescribed placebo (celecoxib 200 mg daily). Researchers monitored joint changes or response to therapy at periodic intervals.
After the completion of trial, also known as Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), researchers concluded that knee osteoarthritis with grade 2 and 3 changes respond fairly well to glucosamine and chondroitin therapy that is marked by reversal of bone or joint changes when compared to the placebo group. Researchers also identified that besides joint remodeling, the two investigational agents are also helpful in relieving arthritis pain and swelling of the joint.
The primary mechanism of actions of glucosamine and chondroitin suggested by Andrew A. Brief (5) include:
- Moderate decrease in the symptoms of joint pain, swelling and inflammation.
- Improvement in overall mobility and range of motion of joints.
- Unlike NSAIDs and other remedies, the positive effects of glucosamine and chondroitin persist even after the withdrawal or cessation of drug therapy.
- Lack of any reported toxicity or side effects with moderate to prolonged consumption.
Another study conducted by Joel Baren (6) suggested that chondroitin and glucosamine are also helpful in the management of rheumatoid arthritis. The series of experiments that were conducted on laboratory rats indicated a 56% reduction in the severity of joint damage with nutritional supplementation with chondroitin and glucosamine.
Baren also suggested that chondroitin sulfate exerts its action by modulating the synthesis of hyaluronan and glycosaminoglycan (that are important connective tissue elements required for strength, stability and flexibility of joints). In addition, chondroitin sulfate also decreases the activity of lysosomal enzymes that destroy the cartilage and leads to joint pain and discomfort.
What are other treatment options available to manage arthritis pain?
Currently, arthritis pain relieving medications (that are available as over the counter non-steroidal anti-inflammatory drugs) form the mainstay of therapy. In addition to over the counter pills, more potent analgesics like steroid injections and opoid analgesics are also used in refractory cases. However, the potential side effects limit the efficacy in elderly population who readily develops ulcer and bleeding disorders with prolonged consumption of NSAIDs.
How are glucosamine and chondroitin better than other treatment options?
Most pain killers and injections provide temporary pain relief. In addition, long term use is associated with complications like gastrointestinal discomfort like bleeding, gastric ulcer and dependence (with opoids). According to a latest estimate (3) presented by Department of Health and Human Services, the overall healthcare cost of management of arthritis is over $86 billion.
Glucosamine and chondroitin are far better options due to minimal risk of side effects and complications. Supplemental form of the two agents in the form of over-the-counter pills is now gaining wide acceptance and according to the sales record of 2004, over $730 million per year in the sales of glucosamine and chondroitin for the management of osteoarthritis and other forms of arthritis.
What are the cautions that you must maintain with glucosamine and chondroitin supplementation?
To sum up, although chondroitin sulfate and glucosamine are superior in many respects when compared to NSAIDs, It is recommended to speak to your healthcare provider regarding the supplemental dose and efficacy. Since glucosamine and chondroitin sulfate are considered herbs, FDA does not regulate the dose or strength of formulations very strictly. You should maintain caution if:
- You have a known history of allergy to shellfish, crabs or other sea-foods (since glucosamine and chondroitin are obtained from the shells of marine life).
- Some research studies suggested severe hypersensitivity and anaphylactic responses to glucosamine and chondroitin (resulting in swelling of throat).
- Individuals who have a known history of uncontrolled asthma must avoid glucosamine and chondroitin due to risk of possible exacerbation.
- If you have a history of uncontrolled diabetes or recurrent episodes of hypoglycemia, you should consume glucosamine and chondroitin after speaking to your doctor (8). Research conducted by J.W. Anderson (8) on 3063 human subjects revealed that the risk of mild hypoglycemia and low fasting blood sugar levels is observed only after treatment with glucosamine and chondroitin for period of over 66 weeks.
- If you are pregnant or breast-feeding, it is recommended to avoid until advised otherwise.
What is the recommended dose of glucosamine and chondroitin?
You can start with an initial dose of up to 1000 mg each of glucosamine and chondroitin for a period of 1 month to assess the response to therapy (7). Glucosamine and chondroitin sulfate is generally well-tolerated in individuals for over 3 month continuous therapy.
However, the risk of developing mild side effects like abdominal pain, nausea, vomiting, hypersensitivity to sun, peeling or tearing of nails, diarrhea, constipation, flatulence and alteration in heart rate are also reported. You can reduce the intensity of side effects by consuming glucosamine and chondroitin (7) in divided doses (twice or thrice a day in a maximum daily dose of 1500 mg).
In addition, make sure to follow these recommendations to obtain maximal benefits from these simple yet effective remedies:
- The intake of bone strengthening foods and supplements.
- Perform regular daily physical activity to maintain bone remodeling and joint reconstruction.
1. Towheed, T. E., & Anastassiades, T. P. (2000). Glucosamine and chondroitin for treating symptoms of osteoarthritis. JAMA: The Journal of the American Medical Association, 283(11), 1483-1484.
2. Sawitzke, A. D., Shi, H., Finco, M. F., Dunlop, D. D., Bingham, C. O., Harris, C. L., … & Clegg, D. O. (2008). The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis & Rheumatism,58(10), 3183-3191.
3. United States Senate Committee on Health, Education, Labor and Pensions, Subcommittee on Aging. Center for Disease Control’s role in combating the burden of arthritis. Washington, D.C.: Department of Health and Human Services, 2004.
4. Hochberg MC, Altman RD, Brandt KD, et al. Guidelines for the medical management of osteoarthritis. II. Osteoarthritis of the knee. Arthritis Rheum 1995;38:1541-1546
5. Brief, A. A., Maurer, S. G., & Di Cesare, P. E. (2001). Use of glucosamine and chondroitin sulfate in the management of osteoarthritis. Journal of the American Academy of Orthopaedic Surgeons, 9(2), 71-78.
6. Beren, J., Hill, S. L., Diener-West, M., & Rose, N. R. (2001). Effect of pre-loading oral glucosamine HCl/chondroitin sulfate/manganese ascorbate combination on experimental arthritis in rats. Experimental Biology and Medicine, 226(2), 144-151.
7. Adebowale, A. O., Cox, D. S., Liang, Z., & Eddington, N. D. (2000). Analysis of glucosamine and chondroitin sulfate content in marketed products and the Caco-2 permeability of chondroitin sulfate raw materials. J Am Nutraceutical Assoc, 3(1), 37-44.
8. Anderson, J. W., Nicolosi, R. J., & Borzelleca, J. F. (2005). Glucosamine effects in humans: a review of effects on glucose metabolism, side effects, safety considerations and efficacy. Food and Chemical Toxicology, 43(2), 187-201.