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Glucosamine/Chondroitin Sulfate

 
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Glucosamine/Chondroitin Sulfate - December 29, 2004 1:20:00 PM   
chiroortho

 

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GS/CS are getting lots of press, have been for years.

We've used Dona (Rotta Pharm) of late, but this is purely GS, no CS included. The research is impressive.

My question is this: what do you think about GS only, vis a vis GS/CS combo? My concern about the CS is that it may be of bovine origin, and since the FDA doesn't regulate it we don't know where the cows come from. Can you say Mad Cow?

What do you think?

_____________________________

Greg Priest, DC, DABCO
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Re: Glucosamine/Chondroitin Sulfate - December 29, 2004 5:23:00 PM   
Andrew M. Ball PT PhD

 

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Joined: July 29, 2002
From: Charlotte, NC
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Interesting question Greg. The saturation of Mad Cow into the US bovine population is nil, so I'm not sure if the threat is all that great --- which is not to say impossible.

In CAM circles, GM is generally considered more ?evidence-based? than chondoritin. That said, let?s examine the evidence-base for GM first. In my opinion, the jury of real science is still out with respect to either of these nutritional supplements despite a growing number of testimonials. Every now and then we?ll see a study like the following, which raises an eyebrow by demonstration of metabolism inhibition of chondrocytes and synoviocytes:

Nakamura H, et al. Effects of glucosamine hydrochloride on the production of prostaglandin E2, nitric oxide and metalloproteases by chondrocytes and synoviocytes in osteoarthritis. Clin Exp Rheumatol, 22(3): 293-9 2004.

Then we?ll turn around and find a double-blind study (which should be viewed with greater weight of evidence) like the following that shows that glucosamine is clearly no better than placebo:

McAlindon T , et al. Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an internet-based randomized double-blind controlled trial. Am J Med, 117(9): 643-9 2004.

N = 205. The study comprised 205 subjects aged 45 years or older with symptomatic knee osteoarthritis who were recruited over the Internet; eligibility was authenticated through medical record review. Participants were assigned randomly to 1.5 g/d of glucosamine (n = 101) or placebo (n = 104), of whom 108 completed the intervention (93 in each arm). There was no difference between treatment and control groups in terms of change in pain score, stiffness, physical function, or analgesic use between the two groups. Stratification by osteoarthritis severity, glucosamine product, and use of a nonsteroidal anti-inflammatory drug, as well as exclusion of opiate users, did not alter the results.

I could list numerous other studies, some for, some against, but I think that it was put best by the following authors in their review of the evidence base:

Biggee BA , McAlindon T. Glucosamine for osteoarthritis: part I, review of the clinical evidence. Med Health R I, 87(6): 176-9 2004

?Glucosamine is a popular nutritional supplement for OA. This supplement has shown moderate efficacy in meta-analysis and large industry-sponsored clinical trials. However, smaller independent studies have not shown significant benefit. It is difficult to compare these clinical trials due to heterogeneity in trial design, differences in glucosamine products, and differences in osteoarthritic populations being studied. The National Center for Complementary and Alternative Medicine and the National Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS/NCCAM) have funded a multicenter five arm placebo controlled study called The Glucosamine Arthritis Intervention Trial (GAIT). GAIT spans 24 weeks, enrolling 1588 subjects, at 13 centers comparing the efficacy of glucosamine sulfate, chondroitin sulfate, glucosamine with chondroitin, to placebo and compared to celecoxib for knee OA. This study may have final data in March 2005.?


In the meantime, it may be worth a review of the following reviews and testimonials. I?ve not been able to locate the source article that the authors are critiquing, let me know if you do:

Grove ML. A randomized, double blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee. J Rheumatol, 31(4): 826; author reply 826-7 2004.

Theodosakis J A randomized, double blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee. J Rheumatol, 31(4): 826; author reply 826-7 2004.


For a non-evidence-based read/testimonial, check out the following light reading:
Longyhore DS , Seaton TL Glucosamine and chondroitin effective for knee osteoarthritis. J Fam Pract, 52(12): 919-20 2003

Hope that helps,
Dr. Andrew M. Ball
Physical Therapist

_____________________________

Andrew M. Ball, PT, DPT, Ph.D.
Orthopedic Physical Therapy Resident
Carolinas Rehabilitation

(in reply to chiroortho)
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