March 2020

Glucosamine & Chondroitin: Do They Really Work for OA?

The American College of Rheumatology (ACR) and the Arthritis Foundation recently published new guidelines for osteoarthritis management. In contrast to previous conditional recommendations, the updated guidelines now strongly recommend against the use of both glucosamine and chondroitin. What should you tell patients?

When findings from clinical research are pooled and analyzed together, they show that glucosamine sulfate reduces pain and improves function in patients with osteoarthritis. But according to the new guidelines, there are serious concerns about publication bias. The guidelines claim that industry-sponsored trials and publicly funded research don’t line up. Some of this concern may be related to the fact that a specific pharmaceutical-grade product (DONA by Rotta Pharmaceuticals) is used in many of these industry-sponsored trials. Although DONA has consistently demonstrated benefit, these same benefits aren’t consistently seen when other glucosamine sulfate formulations are used. It’s unclear if this discrepancy is because DONA is a higher quality product, or if there is bias due to industry funding. Similarly, some research shows that taking specific pharmaceutical-grade products containing chondroitin sulfate alone or in combination with glucosamine helps reduce symptoms of osteoarthritis. But other research shows no benefit when non-commercial preparations are used. Studies analyzing glucosamine and chondroitin supplement products have confirmed that quality issues are common and that these products might not have the same activity as pharmaceutical-grade products.

Tell patients that, despite these new guidelines, most research still shows that taking glucosamine sulfate can provide pain relief for people with osteoarthritis, especially those with osteoarthritis of the knees. DONA is the product that shows the most consistent benefit. If patients want to give it a try, tell them to use 1500 mg daily. But make sure they understand that it might take longer to achieve pain relief compared to NSAIDs and other pain relievers. The same benefits haven’t been seen for glucosamine hydrochloride. And evidence for chondroitin isn’t strong enough to recommend it for most patients.

For more details, check out our recently updated monographs on glucosamine sulfateglucosamine hydrochloriden-acetyl glucosamine, and chondroitin sulfate.

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