Glucosamine and chondroitin sulfate are natural substances found in and around the cells of cartilage that may help alleviate arthritis symptoms. A popular combination supplement taken for joint pain in Europe, the glucosamine-chondroitin combo had been viewed skeptically by U.S. physicians until research began to show that it may be effective.
The role of this supplement in joint maintenance sounds logical. Glucosamine is an amino sugar that the body produces and distributes in cartilage and other connective tissue, and chondroitin sulfate is a complex carbohydrate that helps cartilage retain water and gives it elasticity.
Some promising new research
Logic is nice but doctors prefer proof, and results have been contradictory. Some of the smoke began to clear after a large, authoritative study was conducted by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The study looked at knee pain caused by arthritis, and compared the glucosamine-chondroitin combo against a proved prescription painkiller or a placebo. Published in the New England Journal of Medicine in February 2006, the $12.5 million study showed that the supplement provided measurable relief for people suffering moderate to severe pain but did not help those in mild pain. The researchers concluded that these results were statistically significant, but that more research is needed.
Still, many doctors recommend the glucosamine-chondroitin combo for arthritis patients. "I think a lot of practitioners feel that they're very unlikely to do harm and some people may benefit, and so they're easy to recommend. They're very low-toxicity medications," says Sharon Kolasinksi, MD, interim director of the division of rheumatology at the University of Pennsylvania.
Personal experience mattersand differs
Some patients are persuaded by their own experiences. Debra Fisher, 52, who has arthritis in her hands, took the supplement and says, "It seemed to help, but not for long."
Charles, 66, of Grantham, N.H., who had one hip replaced, believes glucosamine and chondroitin slowed down the progression of degeneration on his other hip, allowing him to delay a replacement operation for several years.
James McKoy, MD, a Honolulu-based rheumatologist and the chief of the pain service division at Kaiser Permanente in Hawaii, also saw the supplement's potential role to slow disease progression after he tried it himself.
"I started taking it to try to slow down my arthritis when I noticed really significant changes on my X-ray," says Dr. McKoy. "I've not seen that much of a change since then." His mobility, meanwhile, stabilized.
If you use glucosamine and chondroitin, stick with it
Dr. McKoy thinks that patients sometimes give up on glucosamine and chondroitin too quickly. "Many times patients take it for a week or so and if it's not working then they say that it is not helping." He recommends a month, at least, because the supplement is one of the safest treatments available to arthritis patients.
That said, Dr. McKoy cautions against expecting relief if there has been serious degeneration.
"Glucosamine is not going to replace the cartilage. Glucosamine is not going to be that panacea for pain relief," says Dr. McKoy. "But I think that if you have somebody with early to moderate degeneration changes, I think it's very helpful and very safe."
Dr. Kolasinski is less certain: "I feel that there is very little downside to taking glucosamine and chondroitin," she says. "But it is certainly not every patient who benefits from taking them."
Still, the supplement is gaining greater acceptance. When Charles's orthopedist suggested he take it, he was surprised.
"I smiled and looked at him and said I can remember when you guys didn't want any part of this!"