Glucosamine: An untested Cure

The number of arthritis “cures” available to the gullible buyer are legion. Copper bracelets, descents into radon mines, electrical devices, creams, salves, herbal essences, bee venoms — the list is endless and as varied and colorful as a con man’s snake-oiled imagination. The unhappy fact is, though, none of them is a cure, many of them are absolutely useless, some are dangerous, and most are expensive — some outrageously so.

And now there’s glucosamine, a natural substance a lot of people with osteoarthritis (OA) have been taking — and talking excitedly about. In the arthritis world, glucosamine is hot: It’s the central substance in a recent book, The Arthritis Cure, and a “celebrity” in a host of newspapers, newsletters, health supplements and radio and TV shows. The real good news about glucosamine at this point, though, isn’t that it’s a remarkably effective new treatment for osteoarthritis (OA) — which is what people are claiming — but that it’s the subject of an unprecedented clinical trial at Toronto’s Mount Sinai Hospital.

There’s a buzz of excitement surrounding every positive report about a “new treatment for arthritis,” particularly natural remedies, butery few are ever given rigorous scientific testing that might determine whether there’s real, lasting merit to the claims. Which is where Dr. Joseph Houpt and his colleagues come in. Houpt’s interest in glucosamine began some months ago, when a television reporter showed him an article about its use in treating OA pain. Houpt began to note whether his patients with OA of the knees “found particular benefit with glucosamine which they purchased in health food stores.” He was sufficiently impressed by their anecdotal reports, as well as references in European medical literature, that he and his colleagues decided to embark on a double-blind, placebo-controlled trial (in which neither doctor nor patient knows who’s getting the “active” substance and who’s getting an inert substitute) of glucosamine hydrochloride for OA of the knee. Glucosamine hydrochloride isn’t as readily available in Canada as glucosamine sulphate — the form most people have been using — but it provides more “bang for your buck,” Houpt says, “by providing more glucosamine per 500mg capsule than glucosamine sulphate.”

Glucosamines are what’s known as amino monosaccharides, a kind of sugar. They’re one of the components of the connective, or soft, tissue that joins bones and joints and ties skin and organs together. They’re also a key element in the production of cartilage, the tough, springy material that lines our joints — cartilage that’s pitted and eroded by OA. In fact, it’s possible a dysfunction in our glucosamine may play a role in the development of OA.

That speculation led some people to equate adding glucosamine to their system with normalizing cartilage metabolism or in inhibiting cartilage degradation; some even theorize that it may stimulate the synthesis of cartilage around joints so that articular cartilage is partially restored.

If that is the case, glucosamine may address the underlying cause of OA in a way that NSAIDs (non-steroid anti-inflammatory drugs) and Aspirin?, which reduce pain and inflammation, don’t. And, while prolonged use of NSAIDs is associated with a number of unpleasant side effects, glucosamine’s only reported side effect — so far — is mild gastric upset. Furthermore, while prolonged use of NSAIDs may eventually cause more joint damage, prolonged use of glucosamine, if it lives up to anecdotal reports, may improve them.

So, why hasn’t it found widespread acceptance by the medical community? Some observers claim that most of the existing positive studies were poorly designed (in one trial it wasn’t even clear the patients actually had OA) or inadequately described. Moreover, according to pharmacist Stephanie Edwards in a 1996 issue of Pharmacy Practice, “none of the controlled studies showed long-term symptom relief or slowing of the underlying degenerative disease process. Studies to date do not indicate that glucosamine is useful for other types of arthritis.”

Plus, to date, no North American pharmaceutical company has applied to the U.S. Food and Drug Administration or the Canadian Health Protection Branch (HPB) to develop and test glucosamine for commercial release. This despite evidence that it is selling like hot cakes in many pharmacies and health food stores. The fact is, the scientifically-approved clinical studies to verify safety and effectiveness simply haven’t been done on glucosamine. Until they have, the benefits are just so much anecdotal evidence. Dr. Houpt’s clinical trial is the first step in rectifying that. In the meantime, there are a few doctors who are firmly behind it. Dr. Alan Russell, a family physician in Brampton, Ont., who was a consultant to the Mount Sinai study, says he’s treated some 300 patients with glucosamine all of whom have experienced significant pain relief and improvement in their range of motion.

If you do decide to try it, keep in mind that the glucosamine available in stores isn’t classified as a drug, so it has not been subject to the rigorous testing approved medications have undergone. So, no guarantees that what you’re buying is either safe or effective. There’s also no guarantee that glucosamine will work for everyone, nor for every type of OA, which means you should not abandon your prescribed treatment regimen without consulting your doctor.

If Houpt’s study confirms glucosamine’s potential, there’ll be more long-term, in-depth studies. If its potential is confirmed, glucosamine may end up in your doctor’s treatment arsenal.