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Are Glucosamine and Chondroitin Helpful for Arthritis?

Are glucosamine and chondroitin supplements really helpful for patients with arthritis? As more and more people are interested in their personal health, taking a supplements seems like a good idea. Considering that 62 million people suffer with arthritis, just in the United States, the supplements market is very profitable and is expected to grow every year. However, what is the scientific evidence behind using these supplements?

In this article, I will discuss

  1. What are glucosamine and chondroitin?
  2. What are supplements?
  3. Are glucosamine and chondroitin helpful for arthritis?
  4. How long should patients use glucosamine and chondroitin? 
  5. Are supplements recommended by the Osteoarthritis Guidelines?

Let’s find out….

What are glucosamine and chondroitin?

Glucosamine and chondroitin are both normal components of the cartilage tissue. They will participate in building the components of your joints. In certain diseases like osteoarthritis, both chondroitin and glucosamine are decreased. Naturally, many believe that taking a supplement will be an efficient way to stop or slow down the progression of arthritis. 

What are supplements?

Supplements -are natural and/or synthetic products marketed to be added to your diet for optimal health results. However, because dietary supplements are categorized as “food,” not drugs, they are not required to undergo rigorous testing that prescription drugs/ medication undergo. The dietary supplement manufacturers are responsible to ensure these are safe before they are marketed, but they do not require any approval from the Food and Drug Administration (FDA). These manufacturers may not claim to treat, prevent, or cure any specific disease.

Are glucosamine and chondroitin helpful for arthritis?

Glucosamine and chondroitin are the most commonly used supplements for arthritis. However, the use of glucosamine and chondroitin remains controversial. 

Where is this controversy coming from? 

 Well, some people are saying that the dose that you take is important.  Many studies used doses of glucosamine sulfate of 1500 mg/day and, or chondroitin of 800 mg/day  (1,2). 

Other people are saying that the brand of the product matters or the type of product (3). For example, this study suggested that a pharmaceutical grade of chondroitin might actually be better (4). 

 Let’s look further into this study and understand the findings better. They included 600 patients that received 800 mg of chondroitin daily.  These researchers showed that pharmaceutical grade chondroitin was superior to placebo but similar to non-steroidal anti-inflammatory medications like celecoxib in reducing pain and improving the function in patients with osteoarthritis of the knee.  These patients used chondroitin for 6 months. 

I think it is important to know that the study was supported by the company that produced the chondroitin. 

How long should patients use glucosamine and chondroitin? 

 

The use of glucosamine and chondroitin in osteoarthritis long term results

It is very important to understand for how long you should use supplements to see an effect. One study published in 2010 showed that patients that take these supplements for long term, two to three years may have delayed progression of osteoarthritis.  

 There are also studies that do not support these findings, and I think it is important to know about these too (5,6). 

Think about the placebo effect. What is the placebo effect?  A placebo is anything that seems to be like “real” medical treatment — but isn’t.  When you get “placebo” pills they do not contain the active substance.  In many studies, the researchers compare the effect of a medication with placebo, to understand the effect of that medication. 

Now, let’s come back to glucosamine and chondroitin and I will discuss a landmark study called GAIT (or Glucosamine/Chondroitin Intervention Trial)They included about 1500 patients with knee osteoarthritis. The researchers compared glucosamine, chondroitin, alone or in combination with placebo and anti-inflammatory medications (7).

Gait Trial – NEJM

Overall, the glucosamine and chondroitin alone and in combination DID NOT decrease pain in patients with knee osteoarthritis . However a subgroup of patients might actually benefit from these supplements. Those are patients with moderate to severe osteoarthritis (7). 

GAIT TRIAL results -glucosamine and chondroitin in osteoarthritis

 

Another study, called the MOVES trial (8) found the combination of glucosamine and chondroitin was as effective as celecoxib (a very well known anti-inflammatory medication) in relieving pain and swelling in knee osteoarthritis. 

Compare glucosamine and chondroitin with NSAIDs

What is that meaning? 

These supplements could be a good alternative for people who aren’t good candidates for NSAIDs because they have cardiovascular or other gastrointestinal conditions (8). 

 Are these supplements recommended by the Osteoarthritis Guidelines? 

Currently, due to these conflicting results, the Osteoarthritis guidelines are not endorsing the use of glucosamine and chondroitin (9).  Considering the safety profile is good, you may try to use them for about 6 months and see if your pain is improving.

Do you want to learn about other supplements?

In a previous blog, I have presented the scientific data about collagen supplements in patients with osteoarthritis. Check this blog to learn more.

Summary

Before you start any supplement, I do advise you to discuss your clinical situation with a physician that will be able to review your risks and benefits.  Supplements can be dangerous in some situations and can influence the way that other medications are absorbed. If you are interested to learn more about supplements and their scientific evidence, follow my blog posts and my YouTube channel. If you are looking for a consultation for arthritis or autoimmune disease, schedule on our website Rheumatologist OnCall.

We are happy to evaluate and treat you with the most comprehensive approach that will integrate the most cutting-edge science with integrative medicine that includes nutrition, supplements, stress management, mindfulness, exercise, and sleep management.

About the author:

Diana Girnita, MD, PhD is an US board certified internal medicine and rheumatology. She completed a PhD in immunology, postdoctoral fellowship at Harvard University, immunology fellowship at University of Pittsburgh and rheumatology fellowship at University of Cincinnati. She is the founder&CEO of Rheumatologist OnCall, a telemedicine company that serves multiple states in the US. Dr. Girnita is a graduate of the Nutrition Science course from Stanford University. Dr. Girnita was recognized many times with “Top Doctor”  award (2017-2020) and is frequently invited speaker of the US National Arthritis Foundation.

REFERENCES

1.Lee YH, Woo JH, Choi SJ, Ji JD, Song GG. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatol Int. 2010 Jan;30(3):357-63. doi: 10.1007/s00296-009-0969-5. Epub 2009 Jun 21. PMID: 19544061.

2. Hochberg MC. Structure-modifying effects of chondroitin sulfate in knee osteoarthritis: an updated meta-analysis of randomized placebo-controlled trials of 2-year duration. Osteoarthritis Cartilage. 2010 Jun;18 Suppl 1:S28-31. doi: 10.1016/j.joca.2010.02.016. Epub 2010 Apr 27. PMID: 20399895.

3.Eriksen P, Bartels EM, Altman RD, Bliddal H, Juhl C, Christensen R. Risk of bias and brand explain the observed inconsistency in trials on glucosamine for symptomatic relief of osteoarthritis: a meta-analysis of placebo-controlled trials. Arthritis Care Res (Hoboken). 2014 Dec;66(12):1844-55. doi: 10.1002/acr.22376. PMID: 24905534.

4.Reginster JY, Dudler J, Blicharski T, Pavelka K. Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT). Ann Rheum Dis. 2017 Sep;76(9):1537-1543. doi: 10.1136/annrheumdis-2016-210860. Epub 2017 May 22. PMID: 28533290; PMCID: PMC5561371.

5.Lee YH, Woo JH, Choi SJ, Ji JD, Song GG. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatol Int. 2010 Jan;30(3):357-63. doi: 10.1007/s00296-009-0969-5. Epub 2009 Jun 21. PMID: 19544061.

6.Hochberg MC. Structure-modifying effects of chondroitin sulfate in knee osteoarthritis: an updated meta-analysis of randomized placebo-controlled trials of 2-year duration. Osteoarthritis Cartilage. 2010 Jun;18 Suppl 1:S28-31. doi: 10.1016/j.joca.2010.02.016. Epub 2010 Apr 27. PMID: 20399895.

7. National Center for Complimentary and Alternative Medicine. The NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). J Pain Palliat Care Pharmacother. 2008;22(1):39-43. PMID: 19062354.

8.Hochberg MC, Martel-Pelletier J, Monfort J, Möller I, Castillo JR, Arden N, Berenbaum F, Blanco FJ, Conaghan PG, Doménech G, Henrotin Y, Pap T, Richette P, Sawitzke A, du Souich P, Pelletier JP; MOVES Investigation Group. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2016 Jan;75(1):37-44. doi: 10.1136/annrheumdis-2014-206792. Epub 2015 Jan 14. PMID: 25589511; PMCID: PMC4717399.

9.Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019 Nov;27(11):1578-1589. doi: 10.1016/j.joca.2019.06.011. Epub 2019 Jul 3. PMID: 31278997.

 

 

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