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Glucosamine Sulphate
Effective Treatment for Osteoarthritis

Osteoarthritis is the most common form of arthritis. Although many medications are available to relieve the symptoms, conventional medicine has nothing to offer in terms of controlling or reversing the condition. In fact, there is evidence that long-term use of nonsteroidal anti-inflammatory drugs (NSAID’s) actually accelerates joint destruction in patients with osteoarthritis. Furthermore, NSAID’s have a number of side effects, including peptic ulceration and damage to the liver or kidneys.

Practitioners of nutritional and natural medicine are aware of several effective alternatives to conventional medications. Many patients with osteoarthritis have hidden food allergies which play a major role in their joint problems. Identification and avoidance of allergenic food frequently provides relief, and sometimes complete relief of symptoms. Niacinamide therapy is also effective in many cases, particularly for osteoarthritis of the knees. Niacinamide appears not only to ameliorate the symptoms, but somehow to control the disease process, as well. Vitamin E at a dose of 600 IU/day has also been shown to produce symptomatic relief of osteoarthritis. S-Adenosyl-methionine (SAM), a naturally occurring metabolic intermediate, has been shown to be at least as effective as NSAID’s, with significantly fewer side effects. Unfortunately, SAM is not commercially available in the United States.

Another naturally occurring substance which shows great promise in the treatment of osteoarthritis is glucosamine sulphate. Although much of the research on glucosamine sulphate is more than ten years old, this substance has not, until recently, been available in the United States. Now that it is available, a brief review of its chemistry and medicinal potential is warranted.

Glucosamine is one of the building blocks of proteoglycans, the ground substance of articular cartilage. Glucosamine is also the preferred substrate and a stimulant of proteoglycan biosynthesis. Furthermore, glucosamine inhibits the degradation of proteoglycans and rebuilds experimentally damaged cartilage. It has been suggested that altered glucosamine metabolism plays a role in the development of osteoarthritis and that administration of glucosamine tends to normalize cartilage metabolism.

Italian researchers have investigated the effect of glucosamine sulphate in patients with osteoarthritis. In most cases, glucosamine sulphate was used instead of glucosamine, because the effect of glucosamine on cartilage metabolism appears to be enhanced by the presence of sulphate, another component of proteoglycans. In one study, 30 patients with chronic osteoarthritis were divided into two groups. Half of the patients received glucosamine sulphate, 400 mg/day parenterally for 7 days, followed by 500 mg three times a day by mouth for another 14 days. The control group received injections of piperazine/chlorbutanol combination daily for 7 days, followed by oral placebo capsules for another 14 days. Symptoms improved during both initial parenteral treatments, but to a significantly greater extent in the glucosamine sulphate group than in the control group. During the oral treatment period, symptoms improved further in the patients receiving glucosamine sulphate, but reverted almost to pretreatment levels in the placebo group. After three weeks, the total symptom score had improved by 71% in the glucosamine group, but was little changed in the placebo group. These results were replicated by another group of investigators.

In another study, 40 patients with unilateral osteoarthritis of the knee received glucosamine sulphate, 500 mg, three times a day, or 1.2 g/day of ibuprofen, in an eight week double-blind study. Pain scores decreased faster during the first two weeks with ibuprofen than with glucosamine sulphate. Although the rate of improvement was slower in the glucosamine sulphate group, the improvement became progressively more pronounced in that group throughout the study, to the point that glucosamine sulphate was significantly more effective than ibuprofen by the eight week.

In another study, 20 patients with osteoarthritis of the knee received glucosamine sulphate, 500 mg, three times a day, or a placebo, for 6-8 weeks. Glucosamine sulphate was significantly superior to placebo in terms of relieving pain, joint tenderness, and swelling. The results were rated as “excellent” in all 10 patients receiving glucosamine sulphate, whereas all 10 patients receiving the placebo rated the results as “fair” or “poor”.

These studies indicate that glucosamine sulphate is effective in the treatment of osteoarthritis, apparently more so than NSAID’s. Glucosamine sulphate is not an analgesic or an anti-inflammatory agent per se; rather, it appears to exert a beneficial effect on the disease process. Consequently, improvements occur more slowly with glucosamine sulphate than with NSAID’s, but eventually the former overtakes the latter in terms of effectiveness. In addition glucosamine sulphate is virtually free of side effects and there are no known contraindications to its use. In contrast, conventional medications can cause relatively severe side effects. Glucosamine sulphate should therefore be considered one of the “treatments of choice” for osteoarthritis.

Glucosamine sulphate is distributed by Enzymatic Therapy, Green Bay, Wisconsin, and by Bio-Therapeutics, Green Bay, Wisconsin. Glucosamine combined with chondroitin sulphate is distributed by Nutramax Laboratories, Baltimore, Maryland. The retail cost of a one-month supply is approximately $30.00, making it one of the more expensive “natural” remedies, but somewhat less expensive than many of the NSAID’s.

Alan R. Gaby, M.D.