Critical Assessment and Review of the Glucosamine Literature

Introduction:

Glucosamine is a widely used nutritional supplement for the treatment of osteoarthritis. Although glucosamine is promoted in the media as an effective treatment for osteoarthritis, there is uncertainty and controversy in the scientific community as to whether or not it works. The objective of this research was to review all the studies published in the medical literature to determine how good the studies were and therefore how believable the results.

Project Methodology:

All clinical studies that compared glucosamine to either placebo (an inactive substance) or an active antiinflammatory drug published in English were obtained and assessed by two rheumatologists for how scientifically sound the studies were. Rigorous studies were further evaluated for the study findings.

Participant Recruitment:

Not applicable as only the published reports were assessed.

Relevance For People With Arthritis:

Of 14 clinical studies, 9 were satisfactory as far as the way they were conducted was concerned. Seven of these 9 studies reported glucosamine to be beneficial for the treatment of pain and disability due to knee osteoarthritis, while 2 recent studies reported no benefit at all. Two other studies evaluated how fast the osteoarthritis progressed, say from mild to severe, and showed that glucosamine slowed the damage from osteoarthritis seen on X-rays.

Results:

Most of the studies found glucosamine to be an effective treatment for knee osteoarthritis. But, the recent publication of negative studies has raised many questions such as whether glucosamine works only in some persons, whether its effectiveness depends on the type of glucosamine used or whether it has any benefit at all.

This study allows persons with arthritis, physicians and other health care providers, such as physiotherapists, to understand that glucosamine has not been shown conclusively to be of benefit for the treatment of osteoarthritis pain.

Clearly, more work needs to be done. A study has been conducted at the Arthritis Research Centre of Canada which failed to demonstrate a benefit on pain from osteoarthritis. A preliminary report from Harvard has found a similar result. A very large study is now underway in the US which will study glucosamine, chondroitin and the combination of glucosamine and chondroitin. This American study should give a definitive result.

Consumer Involvement:

Not applicable.

Time Frame:

June 2003 - March 2004

Funding Agency:

None.

Publications / Presentations

1. Presented at the 1999 Canadian Rheumatology Association annual meeting in Lake Louise, AB, Canada. The published summary of the presentation is available:
2. Cibere J, Esdaile JM. Glucosamine use in osteoarthritis: What is the evidence for its efficacy? J Rheumatol 1999;26:1628.

Project Team Members:

Principal Investigator

Jolanda Cibere  MD, PhD
Research Scientist, ARC

Co-Investigators

John M. Esdaile  MD, MPH
Scientific Director, ARC

Jacek Kopec  MD, PhD
Research Scientist,

ARC Joel Singer  MD, PhD

Anona Thorne  MSc