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| |  DG DISPATCH - AAOS: Glucosamine Might Have A Role In Arthritis By Cameron Johnston Special to DG News
SAN FRANCISCO, CA -- March 1, 2001 -- Glucosamine might actually be as beneficial as many widely used non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis, it was reported here yesterday (Feb. 28) at the annual meeting of the American Academy of Orthopedic Surgeons. According to Dr. Joseph Lane, professor of orthopedic surgery and assistant dean of medicine at Cornell University Medical College, in New York, clinical trials to-date using glucosamine have showed a benefit "in the order of 50-80 percent as compared with 20 to 30 percent for placebo." A meta-analysis of six studies involving a total of 911 people who used glucosamine showed that there was "moderate benefit", he said in a presentation that discussed complementary and alternative forms of medicine in the treatment of arthritis. The success, or lack of it was measured according to two widely used, and scientifically validated measures - the WOMAC (Western Ontario/McMaster Osteoarthritis Index) and the Lequesne Index. The meta-analysis revealed that the benefits of glucosamine seemed to continue even when use of the supplement was discontinued, as compared with NSAIDs, which lost their benefit almost as soon as the patient stopped using them. Dr. Lane noted that only half of the people who use glucosamine show any kind of benefit at all, but still, the study may challenge the idea that glucosamine is just another "snake oil" remedy that exploits the placebo effect and offers false hope where none exists. It is still unclear whether there is any real chondro-protective benefit, he said, adding that some doubt still remains as to the value of the study since the studies were influenced by the manufacturers of glucosamine and may not have been conducted according to what would be considered truly rigorous scientific methodology. Dr. Lane also pointed out that to date, only one study has shown any benefit with chondroitin, and though the benefit was significant, this was out-weighted by several other studies that showed little, if any benefit. Meanwhile, Dr. William Arnold, of the Illinois Bone and Joint Institute, in Des Plaines, Iowa, cautioned that while nutritional supplements such as glucosamine and chondroitin might, indeed, have some benefit, the potential exists for complications to develop in some patients. "Despite the perception that 'natural' is synonymous with 'safe', herbs and nutritional supplements are potent agents that should be treated with respect by both the physician and the patient," he said. Chondroitin and glucosamine are known to interfere with blood glucose metabolism and, therefore, should be used with extreme caution by people who are diabetic or have sugar metabolism disorders. Likewise, St. John’s Wort is known to interfere with anesthetics, meaning serious complications could arise among patients who are using the product then require surgery where a general anesthetic might be needed.
Reference: McAlindon TE et al, Glucosamine and Chondroitin for treatment of osteoarthritis: a systemic quality assessment and meta-analysis. JAMA 2000; 283: 1469-75.
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