New Chondroitin Sulfate Research
Despite skepticism over the likelihood that macromolecular
chondroitin sulfate is effectively absorbed from the gastrointestinal
tract, an abundance of RCTs as well as a recent meta-analysis
(reviewed in the original WSCC Clinics Protocol) indicate
that oral chondroitin sulfate therapy is at least equivalent
in effectiveness to glucosamine sulfate therapy, including
evidence for disease stabilization measured by various imaging
methods1. Three new studies have been added to
the scientific literature.
A RCT conducted in France sought to evaluate the long-term
effects of chondroitin sulfate on stabilization of the osteoarthritic
internal femoro-tibial joint (the details of this study were
only available in English as an abstract)9. After
two years of treatment with 800 mg per day of chondroitin
sulfate or placebo, a significant difference in radiologically
evaluated cartilage maintenance was detected between the treatment
and placebo groups, with no apparent progression of disease
in the group taking chondroitin sulfate.
A recent Italian study reported the effects of chondroitin
sulfate therapy on the progression of erosive osteoarthritis
of the hands. As reviewed in the original WSCC Clinics Protocol,
a Belgian RCT had previously demonstrated that 1200 mg per
day of chondroitin sulfate reduced the development of new
erosive joints over a three-year period. The new study was
an open trial of 800 mg per day chondroitin sulfate combined
with 500 mg per day naproxen, compared to naproxen therapy
alone for two years10. While both groups developed
radiographically apparent new erosions, those taking chondroitin
sulfate had significantly fewer new erosions after one and
two years than the group taking only naproxen.
TMJ pain and dysfunction was the subject of a small, US RCT
involving chondroitin sulfate, which had disappointing results11.
Subjects diagnosed with capsulitis, disk displacement, disk
dislocation, or painful osteoarthritis of the TMJ were given
either a placebo or a combination of 1500 mg per day glucosamine
hydrochloride and 1200 mg per day of chondroitin sulfate.
Almost one quarter of the subjects recruited for this study
dropped out before the end of the 12-week trial. Both the
active treatment and placebo resulted in improvement in some
measures of TMJ pain, tenderness, or other signs. Given the
questionable effectiveness of the hydrochloride salt discussed
above, the number of dropouts, and the assortment of cartilaginous
and non-cartilaginous disorders treated, it is difficult to
regard these results as definitive. Other, similar studies
testing combinations of chondroitin sulfate, glucosamine hydrochloride,
and other constituents against placebo have demonstrated greater
effectiveness against osteoarthritis-related discomfort symptoms,
but have not addressed the possibility that chondroitin sulfate
alone might be equally effective.
Conclusion
Overall, the studies reviewed above continue to validate the
original recommendations of the WSCC Clinics Protocol on Glucosamine
and Chondroitin Sulfate, and provide additional evidence of
delayed progression of osteoarthritis-related discomfort with
long-term use of either of these supplements. Cost and convenience
considerations may favor glucosamine sulfate, which is less
expensive, usually requires fewer pills per daily dose, and
has been found effective when taken either in a single daily
dose or in divided doses. Patient factors arguing for an initial
choice of chondroitin sulfate would be hypersensitivity to
seafood (the source used for most glucosamine sulfate products)
or type 2 diabetes mellitus.
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Be sure to visit the Glucosamine Product Guide for a review of commercially available glucosamine products broken down by 9 different categories such as price per month, quality and type. Learn what the best products out there are and what criteria was used to ranked each.
References:
1 WSCC Clinics Protocol. Glucosamine and Chondroitin
Sulfate. Western States Chiropractic College, 2001. [Back
to article]
2 Reginster JY, Deroisy R, Rovati L, et al. Long-term
effects of glucosamine sulphate on osteoarthritis progression:
a randomised, placebo-controlled clinical trial. Lancet 2001;357:251-6.
[Back to article]
3 Pavelka K, Gatterova J, Olejarova M, et al. Glucosamine
sulfate use and delay of progression of knee osteoarthritis:
a 3-year, randomized, placebo-controlled, double-blind study.
Arch Intern Med. 2002;162:2113-23. [Back to article]
4 Bruyere O, Honore A, Ethgen O, et al. Correlation
between radiographic severity of knee osteoarthritis and future
disease progression. Results from a 3-year prospective, placebo-controlled
study evaluating the effect of glucosamine sulfate. Osteoarthritis
Cartilage 2003;11:1-5. [Back to article]
5 Thie NM, Prasad NG, Major PW. Evaluation of glucosamine
sulfate compared to ibuprofen for the treatment of temporomandibular
joint osteoarthritis: a randomized double blind controlled
3 month clinical trial. J Rheumatol 2001;28:1347-55. [Back
to article]
6 Hughes R, Carr A. A randomized, double-blind,
placebo-controlled trial of glucosamine sulphate as an analgesic
in osteoarthritis of the knee. Rheumatology (Oxford) 2002;41:279-84.
[Back to article]
7 Braham R, Dawson B, Goodman C. The effect of
glucosamine supplementation on people experiencing regular
knee pain. Br J Sports Med 2003;37:45-9. [Back to article]
8 Houpt JB, McMillan R, Wein C, et al. Effect of
glucosamine hydrochloride in the treatment of pain of osteoarthritis
of the knee. J Rheumatol 1999;26:2423-30. [Back to article]
9 Mathieu P. [Radiological progression of internal
femoro-tibial osteoarthritis in gonarthrosis. Chondro-protective
effect of chondroitin sulfates ACS4-ACS6] Presse Med 2002;31:1386-90.
[Article in French] [Back to article]
10 Rovetta G, Monteforte P, Molfetta G, Balestra
V. Chondroitin sulfate in erosive osteoarthritis of the hands.
Int J Tissue React 2002;24:29-32. [Back to article]
11 Nguyen P, Mohamed SE, Gardiner D, Salinas T.
A randomized double-blind clinical trial of the effect of
chondroitin sulfate and glucosamine hydrochloride on temporomandibular
joint disorders: a pilot study. Cranio 2001;19:130-9. [Back
to article]
© 2000-2001 Western States Chiropractic College. Used
with Permission. |
