Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis?

Abstract

Glucosamine in its acetylated form is a natural constituent of some glycosaminoglycans (for example, hyaluronic acid and keratan sulfate) in the proteoglycans found in articular cartilage, intervertebral disc and synovial fluid. Glucosamine can be extracted and stabilized by chemical modification and used as a drug or a nutraceutical. It has been approved for the treatment of osteoarthritis (OA) in Europe to promote cartilage and joint health and is sold over the counter as a dietary supplement in the United States. Various formulations of glucosamine have been tested, including glucosamine sulfate and glucosamine hydrochloride. In vitro and in vivo studies have uncovered glucosamine's mechanisms of action on articular tissues (cartilage, synovial membrane and subchondral bone) and justified its efficacy by demonstrating structure-modifying and anti-inflammatory effects at high concentrations. However, results from clinical trials have raised many concerns. Pharmacokinetic studies have shown that glucosamine is easily absorbed, but the current treatment doses (for example, 1,500 mg/day) barely reach the required therapeutic concentration in plasma and tissue. The symptomatic effect size of glucosamine varies greatly depending on the formulation used and the quality of clinical trials. Importantly, the effect size reduces when evidence is accumulated chronologically and evidence for the structure-modifying effects of glucosamine are sparse. Hence, glucosamine was at first recommended by EULAR and OARSI for the management of knee pain and structure improvement in OA patients, but not in the most recent NICE guidelines. Consequently, the published recommendations for the management of OA require revision. Glucosamine is generally safe and although there are concerns about potential allergic and salt-related side effects of some formulations, no major adverse events have been reported so far. This paper examines all the in vitro and in vivo evidence for the mechanism of action of glucosamine as well as reviews the results of clinical trials. The pharmacokinetics, side effects and differences observed with different formulations of glucosamine and combination therapies are also considered. Finally, the importance of study design and criteria of evaluation are highlighted as new compounds represent new interesting options for the management of OA.

NSAIDs for Musculoskeletal Pain Management: Current Perspectives and Novel Strategies to Improve Safety

“…Glucosamine and chondroitin, methylsulfonylmethane (MSM), and omega-3 fatty acids have been shown to reduce pain and improve physical function in patients with musculoskeletal-related conditions such as osteoarthritis and low back pain. [18][19][20][21] Because dietary supplements are not regulated by the U.S. Food and…”

Disc size markedly influences concentration profiles of intravenously administered solutes in the intervertebral disc: a computational study on glucosamine as a model solute

“…Its rate of uptake by the cells is also very slow [20] and thus effects of cellular metabolism on concentrations in the disc are minimal. Moreover, it is a solute of interest as it is widely taken around the world as a dietary supplement for prevention and treatment of osteoarthritis (OA) though its effects are controversial [21]. In vitro it appears to exert chondroprotective effects, upregulating proteoglycan synthesis and inhibiting activity of agents involved in tissue degradation [22].…”

Topical Issues of Osteoarthritis Treatment in Clinical Practice

“…Показаниями для назначения являются первичный и вторичный остеоартроз, в том числе коленного, тазобе-дренного суставов, и спондилоартроз [6,8,14,25,27,29,32].…”

“…В доступной нам научной литературе имеются выводы о значительной эффективно-сти оригинального кристаллического ГС в препарате ДОНА, который успеш-но применяется при первичном и вторичном ОА различной локализа-ции, спондилоартрозе, достоверно уменьшая суставную боль, обладая противовоспалительным действием. Хорошая переносимость препарата позволяет рекомендовать его для использования в реальной клиниче-ской практике, для улучшения каче-ства жизни пациентов с ОА [9,11,14,15,17,19,23,28,31]. Хотелось бы сослаться на личный опыт использования ДОНА -ориги-нального кристаллического ГС, кото-рый назначался для лечения ОА больным, находившимся на стацио-нарном лечении в ревматологиче-ском отделении НУЗ «Дорожная клиническая больница на станции Воронеж-1 ОАО «РЖД».…”