Glucosamine chondroitin sulfate for osteoarthritis

Glucosamine and chondroitin are often found together in joint formula products. Many people find this combination helpful for arthritis pain reduction. This web page discusses the research with this nutrient and its role in improving symptoms of patients with osteoarthritis.

Joint Power Rx Formulated by Ray Sahelian, M.D.
Because joint pain is so debilitating, glucosamine sulfate and chondroitin sulfate alone are often not enough. This powerful joint formula includes several additional herbal extracts and nutrients including MSM, CMO, boswellia serrata, turmeric, cat's claw extract, grape seed extract, and sea cucumber for optimal joint health.  

Joint Power Rx Supplement has:
Glucosamine sulfate (from shellfish) - glucosamine is a popular ingredient in many joint health products
Chondroitin sulfate - chondroitin is a popular ingredient in many joint health products
MSM nutrient which stands for methylsulfonylmethane
CMO complex also known as cetyl myristoleate
Boswellia serrata extract is used in Ayurvedic medicine
Turmeric is an herb that contains curcumin
Cat's claw extract comes from the Amazon jungle
Devil's claw is a plant widely used in South African traditional medicine,
Grape seed extracts have compounds called procyanidolic oligomers which are powerful antioxidants, perhaps much greater than vitamins C and E.
Sea cucumbers have a number of substances that have therapeutic value.

Glucosamine and chondroitin for knee and hip osteoarthritis
Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis.
Drugs Aging. 2007;24(7):573-80. WHO Collaborating Center for Public Health Aspect of Osteoarticular Disorders, University of Liège, Liege, Belgium.
This review evaluates published studies of the effect of glucosamine salts and chondroitin sulfate preparations on the progression of knee or hip osteoarthritis. Despite multiple double-blind, controlled clinical trials of the use of glucosamine and chondroitin sulfate in osteoarthritis, controversy regarding the efficacy of these agents with respect to symptomatic improvement remains. Several potential confounders, including placebo response, use of prescription medicines versus over-the-counter pills or food supplements, or use of glucosamine sulfate versus glucosamine hydrochloride, may have relevance when attempting to interpret the seemingly contradictory results of different clinical trials. The National Institutes of Health-sponsored GAIT (Glucosamine chondroitin Arthritis Intervention Trial) compared placebo, glucosamine hydrochloride, chondroitin sulfate, a combination of glucosamine and chondroitin sulfate and celecoxib in a parallel, blinded 6-month multicentre study of patients with knee osteoarthritis. This trial showed that glucosamine hydrochloride and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee. However, exploratory analyses suggest that the combination of glucosamine hydrochloride and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain. There is some evidence to suggest a structure-modifying effect of glucosamine sulfate and chondroitin sulfate. On the basis of the results of recent randomised controlled trials and meta-analyses, we can conclude that glucosamine sulfate (but not glucosamine hydrochloride) and chondroitin sulfate have small-to-moderate symptomatic efficacy in osteoarthritis, although this is still debated.

Glucosamine and chondroitin for knee osteoarthritis
Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis.
N Engl J Med. 2006 Feb 23;354(8):795-808. Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ.
Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
Glucosamine and chondroitin sulfate are used to treat osteoarthritis. The multicenter, double-blind, placebo- and celecoxib-controlled Glucosamine chondroitin Arthritis Intervention Trial (GAIT) evaluated their efficacy and safety as a treatment for knee pain from osteoarthritis. We randomly assigned 1583 patients with symptomatic knee osteoarthritis to receive 1500 mg of glucosamine daily, 1200 mg of chondroitin sulfate daily, both glucosamine and chondroitin sulfate, 200 mg of celecoxib daily, or placebo for 24 weeks. Up to 4000 mg of acetaminophen daily was allowed as rescue analgesia. Overall, glucosamine and chondroitin sulfate were not significantly better than placebo in reducing knee pain by 20 percent. As compared with the rate of response to placebo (60.1 percent), the rate of response to glucosamine was 3.9 percentage points higher, the rate of response to chondroitin sulfate was 5.3 percentage points higher, and the rate of response to combined treatment was 6.5 percentage points higher. The rate of response in the celecoxib control group was 10.0 percentage points higher than that in the placebo control group. For patients with moderate-to-severe pain at baseline, the rate of response was significantly higher with combined therapy than with placebo (79 percent vs. 54 percent). Adverse events were mild, infrequent, and evenly distributed among the groups. Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee. Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain.
   Comments: This study had a major flaw in that subjects were allowed to use acetaminophen which could have masked the benefits of the glucosamine chondroitin treatment. It does appear that glucosamine and chondroitin were helpful in those with severe pain. The high placebo response rate of 60 percent adds additional confusion to the interpretation of this study.

Glucosamine chondroitin sulfate questions
Q. I have noticed improvement from glucosamine and chondroitin sulfate. Considering that I am already taking glucosamine chondroitin sulfate, would guggul extract also help with my knee osteoarthritis problem? I am asking because I saw an article "The effectiveness of Commiphora mukul guggul for osteoarthritis of the knee: an outcomes study." Are there any studies related to guggul supplement use in combination with glucosamine chondroitin sulfate?
   A. We are not aware of any studies that have tested guggul supplement along with glucosamine chondroitin sulfate combinations.

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