New Treatment Method for Osteoarthritis

The origins of many pharmaceutical compounds, such as penicillin, warfarin, and digoxin, are plant-based. However, many physicians remain skeptical about the use of natural compounds. This skepticism is based on the idea that, in these cases, the patient is self-diagnosing and self-treating, and there is no scientific method to prove the validity of these claims.

Nutritional Supplements

A new group of natural compounds, known as nutritional supplements, have proven pharmacological effectiveness and properties. Deficiencies in regulating these substances can lead to issues with the purity and quality control of products. However, patients are exposed to these products and many respond well to these natural and plant-based compounds. The annual sales of glucosamine and chondroitin sulfate alone in the United States reach $600 million. Total sales of natural substances and vitamin supplements in the U.S. reached $12 billion in 1991. Glucosamine and chondroitin sulfate have been tested in tissue cultures, animal models of arthritis, veterinary clinical trials, and controlled human studies.

All published studies have shown positive effects, with no significant side effects reported.

Glucosamine

Glucosamine and chondroitin sulfate are components of joint cartilage and play a role in the physiological and mechanical properties of this tissue. Glucosamine serves as a precursor for the disaccharide unit in the glucosaminoglycan molecule of cartilage. Crystalline glucosamine sulfate (glucosamine) is a substance made from chitin and contains glucosamine, sulfate, and chloride sodium in varying proportions. Chondroitin sulfate is a glucosaminoglycan that is part of the cartilage structure. It helps bind collagen fibrils and reduces the separation of glucosaminoglycans, thus limiting its water content.

Chondroitin sulfate plays a role in enhancing cartilage’s resistance to tensile stress under various conditions, providing it with strength and elasticity.

Non-Cartilage Effects of Glucosamine

Glucosamine also has non-cartilage effects: it prevents the formation of superoxide radicals and inhibits the production of nitric oxide. This could explain the rapid reduction in symptoms observed in short-term studies of this drug in osteoarthritis patients. Long-term results could be due to its reported effects on cartilage metabolism, such as stimulating anabolic activities (like proteoglycan synthesis) and reducing catabolic activities (such as metalloprotease effects). Glucosamine stimulates chondrocytes to secrete glycosaminoglycans and proteoglycans. There is evidence suggesting this substance has anti-inflammatory activity, which is not related to prostaglandin metabolism, and likely works through a free radical scavenging effect.

Osteoarthritis

Osteoarthritis results from the activity of enzymes that degrade and destroy cartilage, and these enzymes are inhibited by chondroitin sulfate. Laboratory studies have shown a synergistic effect between chondroitin sulfate and glucosamine when they are administered together. Studies by Woodward and Leppel have shown that combined administration of chondroitin sulfate and glucosamine (at a dose of 250 mg) leads to a 4SO increase in glycosaminoglycan content compared to when either of these substances is administered alone. This combined effect was also observed in an anti-protease activity test.

Treatment with Chondroitin Sulfate

In an animal model where cartilage damage was induced by chymopapain, two scientists demonstrated that treatment with chondroitin sulfate (at a dose of 1500 mg) resulted in a significant reduction in proteoglycan loss (compared to untreated groups). When this compound was given to healthy dogs, serum glucosaminoglycan levels increased. Using an indirect cartilage metabolism assay, they found that in the serum of treated patients, biosynthesis activity increased (using radioactive glucosamine), and proteolytic degradation was reduced.

Research

In a human trial with 20 patients suffering from knee osteoarthritis, they were randomly given either a placebo or 250 mg of glucosamine sulfate daily for three months. The group receiving treatment showed significant improvements in pain, joint tenderness, and swelling, while no improvement was observed in the control group. In 1982, Lopez reported the results of a one-year, double-blind, cross-over study comparing a daily regimen of 1200 mg ibuprofen with 1500 mg of glucosamine for six weeks. The improvement in symptoms with the ibuprofen regimen was faster, but stabilized within two weeks.

Research Process

Clinical improvement with glucosamine sulfate was slower but continued over 8 weeks of treatment. At the end of the study, patients who took glucosamine sulfate were significantly better than those who took ibuprofen. Furthermore, after stopping glucosamine, the improvement persisted for up to two months, while after stopping ibuprofen, the improvement reverted to baseline within two weeks. This improvement was observed in the reduction of knee pain, but there was no improvement in lower back pain.

Radiological Evidence

In a study evaluating patients using the Womac index, it was found that the control group experienced a reduction in joint space (which indicates continued cartilage degradation). However, in patients treated with glucosamine, no reduction in joint space was observed. This is the strongest evidence suggesting the potential of glucosamine to alter the natural course of knee inflammation, a result not shown with non-steroidal anti-inflammatory drugs.

Osteoarthritis Treatment

Multiple studies from basic sciences (biochemistry, cell culture, tissue culture, animal models of arthritis) indicate that glucosamine and chondroitin sulfate are beneficial agents for the treatment of osteoarthritis. Additional evidence in both human and animal studies shows that these agents are effective in reducing arthritis symptoms. Moreover, there is evidence that both drugs have the potential to alter the progression and structure of osteoarthritis, a potential not demonstrated by non-steroidal anti-inflammatory drugs.

Osteoarthritis Disease Complications

Patients should be aware of the risks of self-diagnosis and continuously undergo medical supervision for all aspects and complications of their osteoarthritis. However, once the diagnosis of osteoarthritis is confirmed, these two natural substances play a primary role in symptomatic treatment and have the potential to alter the nature and structure of the disease. While further research is needed to determine the optimal dosage and administration methods for glucosamine, reviews of various articles suggest that glucosamine should be administered at a dose of 400 mg daily intramuscularly or 1500 mg daily orally.

Source: Nazaem, Khalilollah, Tavakoli, Abdolreza, and Bozorgi Poorbooyini, Behsad. (2004). New Treatment Method for Osteoarthritis (Review Article).