Does Glucosamine really work to relieve joint pain?

Factual Questions
21

A new and major study of the effect of both glucosamine and chondroitin will be published in the prestigious New England Journal of Medicine on Thursday. (I must be a preferred customer, getting mine on Tuesday!).

The study included about 1500 patient volunteers with painful knee arthritis who were divided into five groups: placebo, glucosamine, chondroitin, glucosamine and chondroitin, and celebrex (i.e. celecoxib). Bottom line was that, overall, neither glucosamine nor chondroitin, alone or in combination with one and other, provided better better pain relief than placebo. That being said, the highly touted celebrex was, itself, hardly better than placebo (10% better, p=0.008).

In a (pre-specified) subgroup analysis, combined therapy with glucosamine and chondroitin was significantly better than placebo in that subgroup of patients with moderate-to-severe pain.

Given the reputation of the NEJM and the size of this study, you might think it would lead to a marked decrease in physician-recommendation of glucosamine and chondroitin for mild arthritis pain. But there’s the rub - notwithstanding the pain measures used in this study, who’s to say that someone’s pain is mild or moderate. Since glucosamine and chondroitin are safe, I think the study results will be interpreted in the ‘real world’ as providing no reason not to at least try the combination for any degree of arthritis pain.

Bottom line, rephrased, is that neither glucosamine nor chondroitin by themselves has any effect on arthritis pain. Only the combination seemed to work, and then, only in those with the most pain.

N Engl J Med 2006; 354:795-808.

22

My husband swears by it. He does MSM with glucosamine. He is virtually free of the shoulder pain he was plagued with. Go figure.

23

ThE NY Times reports today that The New England Journal of Medicine says that supplements don’t help. Here’s the link.

24

I read up on this a couple of years ago when my mother asked me to find her some information. I gave her the printouts I got, so I can’t give cites right now, but the gist was: There’s evidence glucosamine does work–not “gold standard” evidence (i.e, not large, double-blind, randomized human trials), but evidence. In addition to human studies, there are animal studies documenting some reduction of inflammation, less thickening of the joint capsule, and other good effects in animals dosed with the stuff. Just as important, there’s no evidence of any really nasty side effects.

That’s the good news. The bad news is few studies document any effects until you take the stuff for at least 6 weeks. It’s not an aspirin-type “take it and feel better” remedy; you have to commit to it for a while.