1) Braham R, Dawson B, Goodman C. "The effect of glucosamine supplementation on people experiencing regular knee pain." BR J Sports Med 2003; 37:45-49.
ABSTRACT
Braham R, Dawson B, Goodman C.
Department of Human Movement and Exercise Science, University of Western Australia, Crawley, Western Australia 6009.
Reprint Request: Rebecca.Braham@med.monash.edu.au
OBJECTIVE: The purpose of this study was to examine the effects of oral glucosamine supplementation on the functional ability and degree of pain felt by individuals who had regular knee pain, most likely due to previous articular cartilage damage, and possibly osteoarthritis. METHODS: Subjects were randomly supplemented with either glucosamine (G) (n=24) or placebo (P) (lactose) (n=22) for 12 weeks at a dose of 2,000 mg per day. Over this period, four testing sessions were conducted, with changes in knee pain and function assessed by clinical and functional tests, (joint line palpation, a 3 metre "duck walk" and a repeated, walking stair climb), two questionnaires (the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Knee Pain Scale (KPS)) and participant subjective evaluations. RESULTS: The clinical and functional test scores improved with time (main effects: p<0.05, p<0.01) but there were no significant differences between the two groups. The questionnaire results also recorded a significant main effect for time (p<0.05), but the glucosamine group was found to have significantly better KOOS quality of life scores at week eight and 12 (p<0.05), and lower KPS scores (p<0.05) at week eight than the placebo group. On self report evaluations of changes across the 12 week supplementation period, 88% (n=21) of the glucosamine group reported some degree of improvement in their knee pain versus only 17% (n=3) in the placebo group. CONCLUSIONS: These results suggest that glucosamine supplementation can provide some degree of pain relief and improved function in persons who experience regular knee pain, which may be caused by prior cartilage injury and/or osteoarthritis. The trends in the results also suggest that, at a dosage of 2,000 mg per day, the majority of improvements are present after eight weeks.
2) Houpt J, McMillan R, Wein C. "Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee." Journal of Rheumatology 1999; 26:2423-2430.
ABSTRACT
Houpt JB, McMillan R, Wein C, Paget-Dellio SD.
Mount Sinai Hospital Rheumatic Disease Unit, University of Toronto, Ontario, Canada.
Reprint Request: jhoupt@kingshealthcentre.ca
OBJECTIVE: Glucosamine products have been used extensively for the management of pain in osteoarthritis (OA). We investigated the efficacy of the hydrochloride salt of glucosamine on pain and disability in knee OA. METHODS: At Week -2, subjects were examined, randomized, and instructed to take only prescribed acetaminophen for pain. At Week 0 patients were examined, prescribed acetaminophen, and either placebo or glucosamine hydrochloride (glucosamine). At Week 4 the prescriptions for acetaminophen and placebo or glucosamine were renewed. At Weeks 4 and 8, patients returned diaries and unused medications, and were examined. The WOMAC questionnaire was administered at Weeks -2, 0, and 8. After completing the randomized 8 week trial, subjects were offered known glucosamine hydrochloride capsules in an 8 week open label trial, with followup telephone survey after the 8 week open label trial. RESULTS: The primary endpoint (statistically significant difference in WOMAC pain score between Week 0 and Week 8) was not met. However, positive trends were noted for the glucosamine group in 23 of 24 WOMAC questions. A significant difference was noted from Week 5 through Week 8 in the knee examination (p = 0.026) and in the response to a daily diary pain question (p = 0.018). However, responding to the question, "Are you better than at the start of the trial?", 40% of placebo and only 49% of glucosamine subjects answered in the affirmative (p = 0.58). At the end of the randomized trial, 34% of placebo and 47% of glucosamine subjects believed that they had been given glucosamine. After the end of the 8 week open label trial, 77% of the subjects were still taking glucosamine, although now obliged to pay for commercially available products. CONCLUSION: There was no significant difference in pain reduction between the glucosamine hydrochloride and placebo groups as measured by WOMAC. However, the secondary endpoints of cumulative pain reduction as measured by daily diary and knee examination were favorable, suggesting that glucosamine hydrochloride benefits some patients with knee OA.
3) Das AK, Eitel J, Hammad TA. "Efficacy of a new class of agents (glucosamine hydrochloride and chondroitin sulfate) in the treatment of osteoarthritis of the knee." Paper #180 presented at the 66th annual meeting, American Academy of Orthopedic Surgeons, Anaheim, CA, February 6, 1999. Accepted for publication in Osteoarthritis & Cartilage.
4) Leffler CT, Philippi AF, Leffler SG, Mosure JC, Kim PD. "Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double blind, placebo-controlled pilot study." Military Medicine February 1999; 164:2:85-91.
ABSTRACT
Leffler CT, Philippi AF, Leffler SG, Mosure JC, Kim PD.
Medical Department, Naval Special Warfare Group Two, Naval Amphibious Base Little Creek, Norfolk, VA 23521, USA.
Reprint Request: occdr@aol.com
OBJECTIVE: A 16-week randomized, double-blind, placebo-controlled crossover trial of a combination of glucosamine HCl (1,500 mg/day), chondroitin sulfate (1,200 mg/day), and manganese ascorbate (228 mg/day) in degenerative joint disease (DJD) of the knee or low back was conducted. METHODS: Thirty-four males from the U.S. Navy diving and special warfare community with chronic pain and radiographic DJD of the knee or low back were randomized. A summary disease score incorporated results of pain and functional questionnaires, physical examination scores, and running times. Changes were presented as a percentage of the patient's average score. RESULTS: Knee osteoarthritis symptoms were relieved as demonstrated by the summary disease score (-16.3%; p = 0.05), patient assessment of treatment effect (p = 0.02), visual analog scale for pain recorded at clinic visits (-26.6%; p = 0.05) and in a diary (-28.6%; p = 0.02), and physical examination score (-43.3%; p = 0.01). Running times did not change. The study neither demonstrated, nor excluded, a benefit for spinal DJD. Side effect frequency was similar to that at baseline. There were no hematologic effects. CONCLUSIONS: The combination therapy relieves symptoms of knee osteoarthritis. A larger data set is needed to determine the value of this therapy for spinal DJD. Short-term combination therapy appears safe in this setting.
5) Beren J, Hiss S, Hammad T, Rose N. "The therapeutic effect of glucosamine HCl/chondroitin sulfate combination of type II collagen-induced arthritis in D/A rats." Accepted for publication in the Proceedings of the Society for Experimental Biology and Medicine, 2000.
6) Lippiello L, Hammad T. "Dose response and synergistic effect of glucosamine HCl and chondroitin sulfate on in-vitro proteoglycan synthesis by bovine and human chondrocytes." Paper presented at the 67th annual meeting of the American Academy of Orthopedic Surgeons, Orlando, FL, 2000; Vol.3, No. 1:23-27.
7) Scroggie DA, Albright A, Harris MD., "The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial." Arch Intern Med. 2003 Jul 14;163(13):1587-90.
Scroggie DA, Albright A, Harris MD
Department of Rheumatology, 59th Medical Wing, Wilford Hall Medical Center,
Lackland Air Force Base, Lackland, TX 78236, USA. Daren.Scrogie@lackland.af.mil
ABSTRACT
BACKGROUND: With increasing use of glucosamine-containing supplements for the treatment of osteoarthritis, there is increasing concern in the medical community about possible toxic effects. The present study was undertaken to determine whether glucosamine supplementation altered hemoglobin A1c concentrations in patients with well-controlled diabetes mellitus. OBJECTIVE: To evaluate possible effects of glucosamine supplementation on glycemic control in a selected population of patients with type 2 diabetes mellitus. DESIGN: Placebo-controlled, double-blinded, randomized clinical trial. SETTING: Outpatient, diabetes monitoring clinic. PATIENTS: Patients were typically elderly patients, evenly divided between men and women. Most of the patients were being treated with 1 or 2 drugs for glycemic control. INTERVENTION: In daily doses for 90 days, patients received either placebo or a combination of 1500 mg of glucosamine hydrochloride with 1200 mg of chondroitin sulfate (Cosamin DS; Nutramax Laboratories Inc, Edgewood, Md).Main Outcome Measure Hemoglobin A1c levels before and after 90 days of therapy. RESULTS: There were 4 withdrawals from the glucosamine-treated group. Three were related to comorbidities (myocardial infarction, congestive heart failure, and atrial fibrillation) and 1 to a possible adverse reaction (excessive flatus). No other patient reported any adverse effects of glucosamine therapy, and no patient had any change in their diabetes management. Mean hemoglobin A1c concentrations were not significantly different between groups prior to glucosamine therapy. Posttreatment hemoglobin A1c concentrations were not significantly different between groups, nor were there any significant differences within groups before and after treatment. CONCLUSION: This study demonstrates that oral glucosamine supplementation does not result in clinically significant alterations in glucose metabolism in patients with type 2 diabetes mellitus.