Question from: 12/1/97

"Is there reliable research regarding glucosamine complex and osteoarthritis? What are the side effects of this supplement, if any? If it has been found effective, what is the suggested dosage and how long does it take to become effective?"

Charles H. Booras, M.D.
Co-Founder and Editor,
Jacksonville Medical Park

Answer: Many people inquire about the use of glucosamine for the treatment of arthritis. The drug was recently reviewed in the Sept. 26 issue of "The Medical Letter". A recently published book ("The Arthritis Cure"), several television news shows, and articles in the New York Times have suggested that it may be effective for the treatment of osteoarthritis. Glucosamine is sold as a "dietary supplement" in the U.S.A.

The Dietary Supplement Health and Education Act passed by the United States Congress in 1994 permits the marketing of a product claimed to affect the structure or function of the body as a "dietary supplement" without the approval of any government agency. The labeling must include a disclaimer saying that it has not been evaluated by the FDA and the product is not intended to diagnose, treat or prevent any disease.

In laboratory studies, glucosamine sulfate has a beneficial effect on inflammation, mechanical arthritis and other types of arthritis. The standard dose of glucosamine sulfate is 500 milligrams taken three times daily. One must usually take the medication for approximately four weeks to reach maximal effect.

In short-term controlled trials, glucosamine has been reported to be effective in relieving pain and increasing range of motion in patients with osteoarthritis. In all reports, the drug was generally well tolerated. Gastrointestinal discomfort and nausea have been reported, but the incidence was no higher than with placebo.

Glucosamine is available in pharmacies and health food stores as the sulfate, hydrochloride, n-acetyl or chlorhydrate salt. It is sometimes combined with chondroitin sulfate; a substance that maintains viscosity in joints stimulates cartilage repair mechanisms and inhibits enzymes that break down cartilage.

Glucosamine appears to be safe and might be effective for the treatment of osteoarthritis, but most published trials of the drug lasted only four to eight weeks and many consultants find them unconvincing. As with other "dietary supplements" the purity of the glucosamine products sold in pharmacies, health food stores and supermarkets in the USA is unknown.

Editor's Note: There are many potential complications associated with the use of standard anti-arthritis medications. I feel that glucosamine may well find its niche as a reasonable alternative to prescription anti-arthritis medications in the patients who are at high risk for complications. So far, glucosamine seems to be safe and effective. As of yet, I do not have enough clinical experience with the drug to make any formal recommendations about its use. Before considering the use of glucosamine, I strongly recommend discussing it with your personal physician.

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