5.
Sep 1, 2006 6:18 AM
in response to:
PastorB
The American Arthritis Foundation wholey supports taking the supplement and many doctors I know do tell their patients to take the supplement.
[i]Arthritis Today Special Report
Good News for Knees
Arthritis Today, JANUARY-FEBRUARY 2006
by Sara Altshul
Glucosamine and chondroitin have been on the radar screen of arthritis researchers for a decade. For most of that time, these natural substances have been viewed with a skeptical eye. Early but inconclusive evidence suggested glucosamine helped repair cartilage damage.
Early studies showing positive results were sponsored by glucosamine manufacturers, notes Beth Anne Biggee, MD, a researcher at Tufts-New England Medical Center in Boston. Non-industry funded studies were small and produced negative findings, such as the 12-week study Dr. Biggee and her team did in 2004. Her study of 205 people concluded that glucosamine was no more effective than placebo.
?This disparity invited skepticism. We needed the results of the two-year Glucosamine-chrondroitin Arthritis Intervention Trial (GAIT) to know whether glucosamine was effective,? says Dr. Biggee.
And now, the results are in. GAIT measured the effects of taking glucosamine alone, chondroitin alone, a glucosamine-chondroitin combination, and celecoxib alone against placebo in 1,583 people with either mild or moderate-to-severe pain from knee OA.
Results show that the combination of glucosamine and chondroitin is better than placebo, but the benefits appear to depend on pain severity.
Mild pain. The glucosamine and chondroitin combination did not show effectiveness for people with mild pain. Sixty-three percent of those with mild pain responded to the glucosamine and chondroitin combo, and 62 percent responded to the placebo.
Moderate-to-severe pain. Of the people with moderate-to-severe knee OA pain, 79 percent who took the glucosamine-chondroitin combo experienced pain relief, compared with 66 percent who took glucosamine alone, 61 percent who took chondroitin alone, and 54 percent who took placebo. ?The people with moderate-to-severe pain who took glucosamine and chondroitin sulfate together showed significant improvement in their knee pain,? says lead author Daniel O. Clegg, MD, professor of medicine and chief of the division of rheumatology at the University of Utah School of Medicine in Salt Lake City, one of 16 rheumatology centers involved in the NIH-sponsored GAIT.
The results of a second smaller trial, called the GUIDE trial, were also announced recently. Conducted in Spain and Portugal, the six-month-long study measured the effects of a 1,500-mg daily dose of glucosamine against a 3,000-mg daily dose of acetaminophen (Tylenol) or placebo in 318 people with knee OA. The researchers concluded that glucosamine relieved pain significantly better than the acetaminophen or placebo.
?Glucosamine is a safe compound, and its use should be considered in the early stages of OA,? says Gabriel Herrero-Beaumont, MD, a researcher at Fundacion Jimenez Diaz, a hospital in Madrid, Spain, and lead author of the GUIDE trial.
Researchers still don?t know exactly how glucosamine or chondroitin work, says Dr. Clegg. Studies on glucosamine and chondroitin are moving in the opposite direction of pharmaceutical studies. Pharmaceutical companies usually find and patent a chemical that produces a certain known effect, then test it in animals before people. Glucosamine and chondroitin were used by people first, so scientists already knew it was safe; now they?ve studied effectiveness, and next they will study exactly how it works. ?Scientists and funding agencies have been awaiting the GAIT results before contributing resources to evaluate biologic actions of these agents,? says Dr. Clegg.
How You Can Use this News
Interested in trying glucosamine and chondroitin? First discuss all treatment options with your doctor, says Daniel O. Clegg, MD, professor of medicine, and chief of the division of rheumatology at the University of Utah School of Medicine in Salt Lake City.
?Glucosamine and chondroitin may be another effective therapeutic option for managing pain in select OA patients but recent positive study results do not change the cornerstones of OA management: education, exercise, physical therapy, weight reduction (if appropriate) and simple analgesics,? he says.
If you get the green light, look for supplements containing a combination of 500-mg glucosamine and 400-mg chondroitin ? and take three times a day. Be aware you may not notice an effect until several days or weeks after starting glucosamine.
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Arthritis Foundation Statement on the Glucosamine/chondroitin Arthritis Intervention Trial
February 2006
Summary
The long-awaited results of the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) have now been published in the New England Journal of Medicine. This 24-week study was conducted to assess the safety and efficacy of glucosamine and chondroitin in the management of pain in knee osteoarthritis (OA). While the study overall concluded that glucosamine and chondroitin were not better than placebo in reducing knee pain in the majority of people with OA, it did find that the combination of the two supplements provided significant pain relief for people with moderate-to-severe knee OA. Based on the findings from this study, the Arthritis Foundation recommends that individuals with knee OA speak to their doctors about whether combined glucosamine-chondroitin therapy might be a beneficial addition to their overall treatment plans.
Full Statement
Over the past decade, the dietary supplements glucosamine and chondroitin have been widely promoted as an effective form of treatment to relieve the pain associated with knee OA. Osteoarthritis is one of the most prevalent and disabling forms of arthritis, affecting 21 million people. As the population ages, OA prevalence is predicted to surge over the next two decades. Arthritis is already the leading cause of disability in this country, costing more than $86 billion in medical care and indirect expenses, including lost wages and production. Effective treatments mean relief from the debilitating pain of OA and the ability to retain quality of life, employment and independence.
The Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) ? the most comprehensive clinical trial of these agents to date ? is a landmark study conducted to better define the role of glucosamine and chondroitin in the treatment of knee OA. Results from GAIT were published in the New England Journal of Medicine February 23, 2006.
Funded by the National Institutes of Health and conducted at 16 U.S. rheumatology centers, GAIT was designed to rigorously evaluate the efficacy and safety of these agents alone and in combination when taken over a 24-week period. The study measured the effects of taking glucosamine alone, chondroitin alone, a glucosamine-chondroitin combination or celecoxib alone against placebo in 1,258 people with mild or moderate-to-severe pain from knee OA.
Key findings of the study:
* The more severe the pain, the better the response.< People with moderate-to-severe knee OA pain experienced 25 percent greater pain relief than those taking other treatments. Only a small number of people ? 22 percent of all study participants - were in the moderate-to-severe subgroup. Further studies to better understand and confirm the benefit in this group of people are needed.
* The combination is important. Even among the moderate-to-severe group, the improvement in pain was only observed in people receiving the glucosamine-chondroitin combination therapy; no significant benefit was detected with glucosamine or chondroitin alone.
* No benefit was observed in people with mild knee OA pain. The glucosamine-chondroitin combination showed no greater effectiveness than placebo in people with mild knee OA pain. The majority ? 78 percent ? of study participants had mild pain at baseline. The explanations as to why pain differences were found in the moderate-to severe OA pain group and not those with mild pain are not clear.
* Side effects were minimal.No differences in adverse events were observed between the study groups.
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