The Natural Connection

Spring has barely made it’s entrance in South Georgia, the promise of summer not far behind, and already my patients are announcing their plans for summer gardens, beach walks at sunset, grandkids on the knee at family reunions. But for those who are among the 21 million Americans with osteoarthritis, these happy events are often accompanied by stiff and gnarled fingers, painful hips, and swollen knees. “Ole Arthur is paying me a visit,” they say. “You got anything for that?”

Conventional medical therapy often includes medications known as non-steroidal anti-inflammatory agents (NSAIDS), such as ibuprofen and naproxen. These medications are often poorly tolerated by many people, however, due to their side effects of stomach ulcers, kidney failure, and liver problems. The newer NSAIDS, like Celebrex and Vioxx, while less irritating to the lining of the stomach, certainly irritate the pocketbook with monthly costs of over $100.

Many of my patients, like apparently millions of their fellow arthritis sufferers are also asking questions about using glucosamine sulfate for their symptoms. One billion capsules were sold in 1998 to Americans looking for “The Arthritis Cure”.  Ever since a popular book was published three years ago by the same name, physicians have been investigating whether there is any truth to the claims that glucosamine, a natural substance derived from the shells of lobster, shrimp, and crabs, can really do anything to alleviate the pain that plagues so many people with the most common form of degenerative joint disease,  osteoarthritis.

Glucosamine has been extensively studied in Europe and Asia for a number of years, and studies in those countries have been promising. A review of nine research trials published in 1998 concluded that glucosamine was apparently safe and could offer moderate, short-term relief from the pain of osteoarthritis, similar to NSAIDS. Some of these studies where of short duration, however, or had small numbers of patients. So still American arthritis specialists were skeptical.

In November of 1999, preliminary results of a large Belgian trial were presented at the American College of Rheumatology indicating that in a three-year period, the supplement not only reduced pain symptoms, but also slowed cartilage loss. I have personally seen electron micrographs of cartilage cells of patients before and after glucosamine therapy that show the cells to be healthier than in control patients. Many physicians feel that it is time for conventional medicine to take another look at glucosamine.

Due to the increasing data that seems to indicate that glucosamine is a safe, effective, and low cost alternative to prescription medication for some patients with mild arthritis, the National Institutes of Health (NIH) has recently awarded the University of Utah School of Medicine a $6.6 million grant to coordinate a clinical trial on 1,000 osteoarthritis patients. These patients will take either glucosamine, chondroitan (another supplement of interest in arthritis), a combination of both, or a placebo for four months. American physicians and their patients may soon have an answer to the problem of “Ole Arthur” after all.

For the countless patients who do not want to wait until the answer is in, or who are already taking some form of glucosamine, there are a few safety tips to remember. The most effective dose is not known, but appears to be in the range of 1500 mg daily. It is a slow acting supplement, and you may not see an effect for several weeks. However, if you have not had a response or decrease in pain in three months of therapy, you should probably stop the medication, or try switching to another brand. Glucosamine can be used safely with NSAIDS, and many people take both.

The quality of the glucosamine preparations on the market today is very variable. A company called Consumer Labs publishes reports of independent product testing to help patients and their physicians decide which of the countless formulas available are worth a try. Also, the sulfate form of the drug is more extensively studied than the hydrochloride (HCl) form. The back of the bottle will tell you which form is in your preparation.

Glucosamine has not been tested in pregnant women, children, or the very elderly. These groups should avoid the medication until more is known about the drug. Diabetics, in particular, should be aware that glucosamine is thought to increase insulin resistance, and in animal studies it has been shown to increase blood glucose levels. All patients should let their doctors know if they are trying glucosamine, and be sure to find out from your doctor if your aches and pains are from osteoarthritis. Glucosamine is not believed to be useful in other types of bone or joint disease.

If you would like to receive more information on the NIH trial of glucosamine or on the Consumer Lab test program,  please write to:

©2000-2003 Pauline M. Bellecci, MD