Glucosamine vs. NSAIDs in the treatment of Osteoarthritis.

• What is Osteoarthritis?
• Standard medical treatment: more harm than good?
• How do NSAIDs accelerate joint destruction?
• Glucosamine - a natural alternative to arthritis medications

The most common form of arthritis is osteoarthritis. Osteoarthritis affects nearly 12% of the US population. Among people older than 70 years, the prevalence is nearly 35%. Osteoarthritis is the leading medical condition for which people use alternative therapies. Americans spend more on natural remedies for osteoarthritis than for any other medical condition. In treating osteoarthritis, glucosamine and chondroitin sulfate are the most commonly used alternative supplements. People often seek alternative therapies after having side effects or gaining incomplete relief of symptoms with conventional medications.

What is Osteoarthritis?

Osteoarthritis (or degenerative joint disease) is a form of arthritis characterized by the breakdown of cartilage within joints. The weight-bearing joints and joints of the hands are those most often affected by degenerative changes associated with osteoarthritis. In affected joints, there is much cartilage destruction followed by hardening and the formation of large bone spurs in the joint margins. Pain, deformity, and limitation of motion in the joint results.

Osteoarthritis is often caused by physical injuries, repetitive joint stress, or family history of arthritis.

Standard medical treatment: more harm than good?

Non-steroidal anti-inflammatory drugs (NSAIDS) are the most commonly used therapy. Research indicats that current drugs being used in osteoarthritis may be producing short-term benefit, but actually accelerating the progression of the joint destruction.

The process contributing to osteoarthritis appears to be able to be stopped and sometimes reversed. Therefore, the major goal of therapy appears to be enhancing repair processes by various connective tissue cells. Unfortunately, the current medications being used actually inhibit repair processes.

The primary drugs used to treat osteoarthritis is aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). This drugs relieve the pain, but do nothing to arrest the degenerative process. There is evidence that although these drugs may produce short-term benefits, they actually cause further joint damage and accelerate the progression of osteoarthritis by inhibiting synthesis of proteoglycans. They merely "hide" the symptoms by numbing the pain or reducing the swelling.

NSAIDs are associated with potentially serious adverse effects, including gastrointestinal upset, headaches, dizziness, tinnitus, and are therefore recommended for only short periods of time. Continued NSAIDs use may lead to the development of stomach ulcers, liver and kidney toxicity.

Medicinal treatment of arthritis is currently directed toward relief of the symptoms rather than treating and preventing its cause. While aspirin, NSAIDs, and COX-2 inhibitors may reduce osteoarthritis pain, they do nothing to stop or slow down cartilage deterioration. In other words, these medications have no effect on the disease itself.

How do NSAIDs accelerate joint destruction?

Aspirin and other NSAIDs actually inhibit cartilage repair and accelerate cartilage destruction.

The way in which these drugs work is to inhibit enzymes involved in the production of inflammatory compounds. Enzymes are molecules involved in speeding up chemical reactions. Enzymes to either join molecules together or split them apart by making or breaking the chemical bonds that join molecules together. With NSAIDs, they not only suppress the enzymes that produce inflammatory compounds, they also inhibit enzymes that manufacture cartilage components. A person may feel free from pain while on the NSAID, but there arthritis is silently getting worse as noted in several clinical studies. So NSAID use is associated with acceleration of osteoarthritis and increased joint destruction. Aspirin and other NSAIDs appear to suppress symptoms but accelerate the progression of osteoarthritis.

What is Glucosamine?

Glucosamine is an amino monosaccharide found in most tissues in the body. Glucosamine is involved in the biosynthesis of glycosaminoglycans and proteoglycans, essential for the extracellular matrix of connective tissues. Glucosamine is synthesized in chondrocytes in the body from glucose and glutamine.

Glucosamine can be synthesized for commercial use from crab, lobster, or shrimp shells. In the making of the supplemental tablets, glucosamine is combined with sulfate or hydrochloride.

How does it work?

The major components of cartilage are water, glycosaminoglycans, hyaluronic acid, proteoglycans, chondroitin sulfate molecules, collagen, and elastin. These elements are held in a collagen matrix, and together form the cushioning and gliding qualities of the joint. Without cartilage, joint junctions would be bone-on-bone, creating a very rough and rigid articulation surface.

Glucosamine stimulates production of glycosaminoglycans and proteoglycans, the two essential building blocks of cartilage. Glucosamine also promotes incorporation of sulfur into cartilage, increasing its strength and durability. Glucosamine exhibits anti-inflammatory properties via the inhibition of proteolytic enzymes.

Glucosamine - a natural alternative to arthritis medications

Glucosamine is responsible for stimulating the manufacture of substances necessary for joint repair. Glucosamine has also been shown to exert a protective effect against joint destruction and, when given orally as glucosamine sulfate, it is selectively taken up by joint tissues to exert a powerful therapeutic effect in osteoarthritis.

Numerous double-blind studies have shown glucosamine sulfate to yield as good as or even better results compared to NSAIDs in relieving the pain and inflammation of osteoarthritis. Glucosamine sulfate exhibits no pain relieving effects. While NSAIDs offer purely symptomatic relief and may actually promote the disease process, glucosamine sulfate addresses the cause of osteoarthritis.

Glucosamine sulfate not only improves the symptoms including pain, it also helps the body repair damaged joints. This is outstanding, but what is even more outstanding is the safety and the lack of side effects associated with oral glucosamine sulfate. In contrast, the side effects and risks associated with NSAIDs currently used in the treatment of osteoarthritis are significant.

In addition, glucosamine sulfate is virtually free of side effects, there are no known contra-indications, it is readily absorbed from the intestines, stays in the blood for several hours and very little is excreted. In contrast, conventional arthritis medications can cause relatively severe side effects. Current medical treatment for osteoarthritis simply suppresses symptoms, and since it does not address the underlying causes, it actually promotes the disease process.

The beneficial results with glucosamine are more obvious the longer it is used. Because glucosamine sulfate is not a pain relieving substance per se, it takes a while longer to produce results. But, once it starts working, it will produce much better results compared to NSAIDs. Pain relief is seen with continued use as damaged tissues are repaired and rebuilt.

Natural substance improves a condition by addressing the underlying cause and supporting the body's ability to heal itself.

Glucosamine has been shown to be well tolerated, with few significant side effects (mainly gastrointestinal discomfort) compared with nonsteroidal anti-inflammatory drugs (NSAIDS).

Glucosamine supplements do not interfere with any NSAIDs, aspirin, Tylenol, or other anti-inflammatory or analgesic medicines and may help patients reduce their level of dependence on these strong drugs.

Glucosamine addresses the underlying problem of osteoarthritis (cartilage degeneration), whereas NSAIDS simply provide symptomatic relief and further contribute to the degenerative disease of osteoarthritis.

Glucosamine clinical studies

Glucosamine sulfate has been the subject of more than 300 scientific investigations and over 20 double-blind clinical studies. Nearly every study has reported positive findings, with osteoarthritis patients claiming reduction or elimination of joint pain.

Studies have shown glucosamine sulphate produces better long-term results than NSAIDs in relieving pain and inflammation of osteoarthritis and is virtually without side-effects.

Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) is the first, large-scale, multicenter clinical trial in the United States to test the effects of the dietary supplements glucosamine hydrochloride and sodium chondroitin sulfate for treatment of knee osteoarthritis. The study tested whether glucosamine and chondroitin sulfate used separately or in combination reduced pain in participants with knee osteoarthritis. GAIT was designed to test the short-term (6 months) effectiveness of glucosamine and chondroitin sulfate in reducing pain in a large number of participants with knee osteoarthritis.

Researchers found that for a subset of participants with moderate-to-severe pain, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared to placebo - about 79% had a 20% or greater reduction in pain versus about 54% for placebo. According to the researchers, because of the small size of this subgroup these findings should be considered preliminary and need to be confirmed in further studies.

A study conducted by Lopes Vaz (1982) evaluated the effectiveness of glucosamine sulfate (1,500 mg/day) versus ibuprofen (1,200 mg/day) in 32 patients with osteoarthritis, with approximately half the subjects undergoing the glucosamine treatment and half the ibuprofen treatment. After two weeks of therapy, ibuprofen provided greater pain relief, but after eight weeks, glucosamine provided more relief. This study used a pain scale and physicians observations to determine pain relief.

Conclusions

NSAIDs appear to only treat the symptoms of arthritis, not its cause. In contrast, glucosamine actually repairs damaged joints, in effect reversing degenerative arthritis. The longer glucosamine is used, the more dramatic and long-lasting the improvement. Glucosamine appears to be a safe and effective treatment for osteoarthritis especially in the early stages and may even be able to alter the progress of the disease.

NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) provides information about the NIH Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), including study design and key results, and suggests resources for more information.