Glucosamine sulphate benefit for osteoarthritis pain reduction

Glucosamine sulphate appears to be helpful in reducing symptoms of osteoarthritis, even better than acetaminophen, a drug that can cause liver damage.

Is there a difference between glucosamine sulphate and glucosamine hydrochloride in terms of effectiveness?
    This is a good question. As of March 2010, we have not seen comparison studies between the two forms, and we will assume for the time being that they are equally effective.

How glucosamine works
Glucosamine increases hyaluronic acid production in human osteoarthritic synovium explants.
BMC Musculoskelet Disord. 2008 Sep 11;9: Uitterlinden EJ, Koevoet JL, Verkoelen CF, Bierma-Zeinstra SM, Jahr H, Weinans H, Verhaar JA, van Osch GJ. Uitterlinden EJ, Koevoet JL, Verkoelen CF, Bierma-Zeinstra SM, Jahr H, Weinans H, Verhaar JA, van Osch GJ. Dept, of Orthopaedics, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
Glucosamine used by patients with osteoarthritis was demonstrated to reduce pain, but the working mechanism is still not clear. Viscosupplementation with hyaluronic acid (HA) is also described to reduce pain in osteoarthritis. The synthesis of HA requires glucosamine as one of its main building blocks. We therefore hypothesized that addition of glucosamine might increase HA production by synovium tissue. Our data suggest that exogenous glucosamine can increase HA production by synovium tissue. This might indicate that glucosamine exerts its potential analgesic properties through stimulation of synovial HA production.

Glucosamine sulphate influence on cholesterol
The effect of glucosamine sulphate on the blood levels of cholesterol or triglycerides--a clinical study
Ugeskr Laeger. 2007 Jan 29;169(5):407-10. Østergaard K, Hviid T, Hyllested-Winge JL. Slidgigtinstituttet A/S, Ishøj.
This study was conducted in order to determine if glucosamine sulphate taken by patients as treatment for chronic joint pain influences the fasting blood levels of cholesterol and triglycerides. A 3 months', post-marketing, randomised, double-blinded, placebo-controlled, clinical trial was performed with parallel groups of 66 patients over 40 years of age with joint pain of long duration receiving either recommend dosage (1500 mg per day) of glucosamine sulphate or placebo. The primary outcome measures were cholesterol levels (total cholesterol, LDL (low density lipoprotein)-cholesterol and HDL (high density lipoprotein)-cholesterol) and triglycerides in fasting blood (plasma levels). Secondary outcome measures were self reported side-effects. No significant differences between the glucosamine sulphate group and the placebo group with respect to cholesterol and triglycerides were observed. There were no differences between the treatment groups with respect to side-effects. This study demonstrates that glucosamine sulphate does not significantly influence blood levels of cholesterol or triglycerides.

Glucosamine sulphate treatment of knee osteoarthritis
Glucosamine sulphate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator.
Arthritis Rheum. 2007 Feb;56(2):555-67. Rheumatology Department, Fundación Jiménez Díaz-Capio, Madrid, Spain.
To assess the effects of the prescription formulation of glucosamine sulphate (1,500 mg administered once daily) on the symptoms of knee osteoarthritis during a 6-month treatment course. Three hundred eighteen patients were enrolled in this randomized, placebo-controlled, double-blind trial in which acetaminophen, the currently preferred medication for symptomatic treatment of osteoarthritis, was used as a side comparator. Patients were randomly assigned to receive oral glucosamine sulphate 1,500 mg once daily, acetaminophen 3 gm/day, or placebo. The primary efficacy outcome measure was the change in the Lequesne index after 6 months. Secondary parameters included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and response according to the Osteoarthritis Research Society International criteria. At baseline, the study patients had moderately severe osteoarthritis symptoms (mean Lequesne index approximately 11 points). Glucosamine sulphate was more effective than placebo in improving the Lequesne score, with a final decrease of 3.1 points, versus 1.9 with placebo. The 2.7-point decrease with acetaminophen was not significantly different from that with placebo. Similar results were observed for the WOMAC. There were more responders to glucosamine sulphate (39%) and acetaminophen (33%) than to placebo (21%). Safety was good, and was comparable among groups. The findings of this study indicate that glucosamine sulphate at the oral once-daily dosage of 1,500 mg is more effective than placebo in treating knee osteoarthritis symptoms.

Glucosamine sulphate helpful for cartilage
Osteoarthritic patients with high cartilage turnover show increased responsiveness to the cartilage protecting effects of glucosamine sulphate.
Clin Exp Rheumatol. 2004 Jan-Feb;22(1):36-42. Nordic Bioscience A/S, Herlev, Denmark.
Glucosamine sulphate has been shown in a large double-blind, placebo-controlled clinical trial to prevent structural damage and improve clinical symptoms of osteoarthritis. We investigated whether early response in a newly developed biochemical marker of collagen type II degradation (CTX-II, CartiLaps ELISA) could reflect the long-term preservation of hyaline cartilage. Study subjects comprised 212 knee OA patients participating in a clinical trial of the effects of glucosamine sulphate. Disease symptoms were assessed quarterly by WOMAC scoring and X-ray analysis was performed at baseline and after 3 years. Urine samples were obtained at baseline and after 1, 2 and 3 years for measurement in the CartiLaps assay. At baseline the patients had an average concentration of urinary CTX-II of 222 ng/mmol creatinine. This was significantly above the CTX-II levels measured in urine samples from 415 healthy controls (169). There was no significant difference in the CTX-II response in the placebo group and the glucosamine treated group. However, those with high cartilage turnover presented a significant decrease in CTX-II after 12-month glucosamine treatment. The data indicate that measurement of urinary collagen type II C-telopeptide fragments enables the identification of OA patients with high cartilage turnover who at the same time are most responsive to therapy with structure modifying drugs.

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