Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis?
Glucosamine in its acetylated form is a natural constituent of some glycosaminoglycans (e.g. hyaluronic acid and keratan sulfate) in the proteoglycans found in articular cartilage, intervertebral disc and synovial fluid.
Glucosamine can be extracted and stabilized by chemical modification and used as a drug or a nutraceutical. It has been approved for the treatment of osteoarthritis (OA) in Europe to promote cartilage and joint health and is sold over the counter as a dietary supplement in the United States.
Various formulations of glucosamine have been tested including glucosamine sulfate and glucosamine hydrochloride. In vitro and in vivo studies have uncovered glucosamine's mechanisms of action on articular tissues (cartilage, synovial membrane and subchondral bone) and justified its efficacy by demonstrating structure-modifying and anti-inflammatory effects at the high concentration.
However, results from clinical trials have raised many concerns. Pharmacokinetic studies have shown that glucosamine is easily absorbed, but the current treatment doses (eg, 1500mg/day) barely reach the required therapeutic concentration in plasma and tissue.
The symptomatic effect size of glucosamine varies greatly depending on the formulation used and the quality of clinical trials. Importantly, the effect size reduces when evidence is accumulated chronologically and evidence for structure modifying effect of glucosamine are sparse.
Hence, glucosamine was at first recommended by EULAR and OARSI for the management of knee pain and structure improvement in OA patients, but not in the most recent NICE British guidelines. Consequently, the published recommendations for the management of OA require revision.
Glucosamine is generally safe and although there are concerns about potential allergic and salt-related side effects of some formulations, no major adverse events have been reported so far. This paper examines all the in vitro and in vivo evidence for the mechanism of action of glucosamine as reviewing the results of clinical trials.
The pharmacokinetics, side effects and differences observed with different formulations of glucosamine and combination therapies are also considered. Finally the importance of study design and criteria of evaluation are highlighted as new compounds represent new interesting options for the management of OA.
Author: Yves HenrotinAli MobasheriMarc Marty
Credits/Source: Arthritis Research &Therapy 2012, 13:251
Published on: 2012-01-26
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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