Glucosamine for osteoarthritis

This summary of a Cochrane review presents what we know from research about the effect of glucosamine on osteoarthritis. 

People with osteoarthritis who take glucosamine:

- may reduce their pain

- may improve their physical function

- will probably not have side effects

What is osteoarthritis and glucosamine? 

Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. Drug and non-drug treatments are used to relieve pain and/or swelling.

Glucosamine can be found naturally in the body and is used by the body as one of the building blocks of cartilage.  Glucosamine can also be taken as a pill as a supplement to the diet, or sometimes as an injection.  It can come in combination with other supplements (such as chondroitin), or by itself in the form of glucosamine hydrochloride or sulphate.  The usual dose recommended on packages is 1500 mg per day or 500 mg three times a day.

In Europe, glucosamine is prescribed by health care providers.  But in North America, people can buy glucosamine supplements without a prescription.  This means that, in North America, glucosamine is not regulated and the pills may or may not truly contain the amount described on the label. 

Best estimate of what happens after about 6 months

Pain: The high quality studies showed that pain improved about the same whether people took glucosamine or fake pills. If all of the studies are examined (including low quality and old studies), then glucosamine improved pain more than fake pills.

People who took fake pills had a pain score of 7 points on a 0 to 100 scale. Pain may improve by 10 more points with glucosamine than with fake pills. 

Studies testing only the Rotta brand of glucosamine (including low quality and older studies) showed that glucosamine improved pain more than fake pills. People who took fake pills had a pain score of 6 points on a 0 to 20 scale. People who took the Rotta brand of glucosamine rated their pain 3 points lower than people who did not take glucosamine.

Function: The high quality studies show that glucosamine improved function more than fake pills when measured by one type of scale, but improved the same amount as fake pills when measured by another scale.

Studies testing only the Rotta brand of glucosamine (including low quality and older studies) showed that glucosamine improved function more than fake pills. People who took fake pills had a function score of 22 points on a 0 to 68 scale. People who took the Rotta brand of glucosamine had their ability to function improve by 2 points compared to people who did not take glucosamine.

There was no difference in the number of people who had side effects.  Side effects mainly included stomach upset and other joint pain.

Authors' conclusions: 

Pooled results from studies using a non-Rotta preparation or adequate allocation concealment failed to show benefit in pain and WOMAC function while those studies evaluating the Rotta preparation showed that glucosamine was superior to placebo in the treatment of pain and functional impairment resulting from symptomatic OA.

Read the full abstract...
Background: 

Osteoarthritis (OA) is a common form of arthritis and is often associated with significant disability and impaired quality of life. This is an update of a Cochrane review first published in 2001 and previously updated in 2005.

Objectives: 

To review randomized controlled trials (RCTs) evaluating the effectiveness and toxicity of glucosamine in OA.

Search strategy: 

We searched CENTRAL and the Cochrane Database of Systematic Reviews (The Cochrane Library), MEDLINE, PREMEDLINE, EMBASE, AMED, ACP Journal Club, DARE (to January 2008); contacted content experts, and handsearched reference lists and pertinent review articles.

Selection criteria: 

RCTs evaluating the effectiveness and safety of glucosamine in OA.

Data collection and analysis: 

Data abstraction was performed independently by two review authors and investigators were contacted for missing data.

Main results: 

This update includes 25 studies with 4963 patients. Analysis restricted to studies with adequate allocation concealment failed to show any benefit of glucosamine for pain (based on a pooled measure of different pain scales) and WOMAC pain, function and stiffness subscales; however, it was found to be better than placebo using the Lequesne index (standardized mean difference (SMD) -0.54; 95% confidence interval (CI) -0.96 to -0.12). Collectively, the 25 RCTs favoured glucosamine with a 22% (change from baseline) improvement in pain (SMD -0.47; 95% CI -0.72 to -0.23) and a 11% (change from baseline) improvement in function using the Lequesne index (SMD -0.47; 95% CI -0.82 to -0.12). However, the results were not uniformly positive and the reasons for this remain unexplained. WOMAC pain, function and stiffness outcomes did not reach statistical significance.

RCTs in which the Rotta preparation of glucosamine was compared to placebo found glucosamine superior for pain (SMD -1.11; 95% CI -1.66 to -0.57) and function (Lequesne index SMD -0.47; 95% CI -0.82 to -0.12). Pooled results for pain (SMD -0.05; 95% CI -0.15 to 0.05) and function using the WOMAC index (SMD -0.01; 95% CI -0.13 to 0.10) in those RCTs using a non-Rotta preparation of glucosamine did not reach statistical significance. Two RCTs using the Rotta preparation showed that glucosamine was able to slow radiological progression of OA of the knee over a three-year period (mean difference (MD) 0.32; 95% CI 0.05 to 0.58).

Glucosamine was as safe as placebo in terms of the number of participants reporting adverse reactions (relative risk ratio 0.99; 95% CI 0.91 to 1.07).

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