I've been interested for ages in the concept of dietary supplements (or what the Americans call "Nutraceuticals" ) in the treatment of joint pains, osteoarthritis in particular.
I've got several friends who are vets - all of whom are very familiar with the benefits of things like oral fish oils, oral hyaluronic acid etc for large animals - but we humans seem much more reticent about the whole issue. Glucosamine is the only one of the many available OTC compounds that has broken through into GP prescribing so far, but does it work?
A group of epidemiologists from Aberdeen have just published evidence suggesting some improvement in knee osteoarthritis symptoms with glucosamine sulphate - but the results are very modest (on paper at least)!.
They looked at randomised controlled trials that lasted longer than 12 months and tried to select only high quality studies. They found that the research available reported inconsistent conclusions with, at best, modest effects on reported pain and function. These outcome benefits were modest - and although they were present and measurable in the studies, it was unclear if these outcomes correllated with any perceived clinical benefits for the patient.
In terms of x-ray changes the effects on joint space size were more consistent, but small and of uncertain clinical significance. Previous studies have also highlighted problems with measurement errors when doing this kind of x-ray analysis.
I've got several friends who are vets - all of whom are very familiar with the benefits of things like oral fish oils, oral hyaluronic acid etc for large animals - but we humans seem much more reticent about the whole issue. Glucosamine is the only one of the many available OTC compounds that has broken through into GP prescribing so far, but does it work?
A group of epidemiologists from Aberdeen have just published evidence suggesting some improvement in knee osteoarthritis symptoms with glucosamine sulphate - but the results are very modest (on paper at least)!.
They looked at randomised controlled trials that lasted longer than 12 months and tried to select only high quality studies. They found that the research available reported inconsistent conclusions with, at best, modest effects on reported pain and function. These outcome benefits were modest - and although they were present and measurable in the studies, it was unclear if these outcomes correllated with any perceived clinical benefits for the patient.
In terms of x-ray changes the effects on joint space size were more consistent, but small and of uncertain clinical significance. Previous studies have also highlighted problems with measurement errors when doing this kind of x-ray analysis.
Two studies found a reduction in the need for a knee replacement from 14.5% to 6.3% at eight years follow up but both of these were directly funded by the company who manufacture one of the main glucosamine products.
Even more interestingly, many glucosamine products combine it with chondroitin and in this research the evidence for the effectiveness of chondroitin was very inconsistent, raising doubts that it is an active product in the mixture. Beyond that, no study showed any benefit at all for glucosamine hydrochloride - leading some commenetators to suggest that it is the "sulphate" part of the molecule and not the "glucosamine" which is the active ingredient. This is possibly stating things a bit too strongly .... !
Dr Corrinda Black, the lead researcher and a consultant in public health in the University of Aberdeen warned that none of the evidence came from UK trials. She said: 'in the absence of good UK data about current referral practice, management and surgical rate, caution should be exercised in generalising these data to the UK health-care setting.'
So where does that leave us out there in GP world?
My own practice is that I dont prescribe glucosamine to patients but I don't actively discourage them if they want to try it for themselves. The main issues seem to be the wide discrepancy in costs, the duration of treatment before benefit is likely, and the vast range of different products with different strengths and different combinations.
What do you do in your practice? Leave a comment ....
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