Glucosamine Chondroitin for Osteoarthritis

What are glucosamine and chondroitin?

Glucosamine and chondroitin sulfate are compounds that are thought to have a protective effect on the cartilage, as well as to help manage osteoarthritis, particularly of the knee. Currently there are still many controversies around the effectiveness glucosamine and chondroitin sulfate in actually preventing the degeneration of joint cartilage. In Europe, glucosamine is a prescription drug with a standardized formula. In the United States and some parts of Asia, glucosamine is sold over-the-counter as dietary supplements.

Both glucosamine and chondroitin sulfate are found in normal joint cartilage and synovial fluid. Researchers proposed that glucosamine may stimulate production of cartilage-building proteins. Glucosamine in supplements is extracted from animal tissues such as crab, lobster or shellfish and marketed as glucosamine sulfate or glucosamine hydrochloride. They are considered to be equally effective, but the hydrochloride form is absorbed more easily by the body and can be taken in lower dosage than glucosamine sulfate.

Chondroitin sulfate is part of a protein molecule that maintains cartilage elasticity and is also thought to have an anti-inflammatory effect. Chondroitin sulfate in supplements is extracted from animal cartilage such as trachea or shark cartilage.

Do glucosamine and chondroitin really work for osteoarthritis?

In reality, some studies have found that either glucosamine or chondroitin sulfate given together or separately may relieve osteoarthritis pain with fewer side effects than conventional arthritis drugs. However, there are also studies that have shown no benefit. Although currently positive reports outnumbered negative ones, the negative ones have been larger and better designed.

The largest clinical trial that studies the effect of glucosamine and chodroitin sulfate is the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), which is funded by the National Institutes of Health. In 2006, the researchers reported that glucosamine and chondroitin, alone or together, did not reduce osteoarthritis knee pain more effectively than a placebo. Follow up reports from this study also failed to show any promising result.

However, despite this discouraging result many people who take glucosamine and chondroitin sulfate supplements did report subjective reduction in arthritis pain. There are preliminary reports that suggest addition of vitamin C, bromelain, or manganese may enhance the effectiveness of glucosamine and chondroitin sulfate. And because these supplements are thought to have very few side effects, people keep taking them anyway.

Be wise if you decide to take glucosamine and chondroitin supplement.

Severe form of osteoarthritis may require surgery.

So, what to do? If you decide to try glucosamine and chondroitin sulfate supplements after all, give it three months time to evaluate their efficacy. The typical initial dose is 1500 mg of glucosamine and 1200 of chondroitin daily for 6 to 8 weeks. If a response is obtained, the dose can be reduced to 1000 mg of glucosamine and 800 of chondroitin or less. If you feel there is no change in symptoms after three months, these supplements should be discontinued.

If your symptoms are severe, you should stay on your usual arthritis medications even while you are taking glucosamine and chondroitin. As always, consult your physician before taking any form of supplements. Common side effects include stomach upset, gas, soft stools, drowsiness, headache, racing heart, and skin reactions. Patients with diabetes should pay extra caution because glucosamine is an amino sugar that may affect blood sugar levels. Also, because these supplements contain shellfish and other possible allergens, watch out for allergy symptoms.

Rheumatoid Arthritis: More Than Just Aching Joints

Rheumatoid arthritis is more than just aching joints. Unlike osteoarthritis where the primary damage occurs in the cartilage, rheumatoid arthritis is an autoimmune disease where the main problem lies in faulty immune system. Chronic inflammation of the joints and its surrounding tissue are not the only problems because the disease can also cause problems with your lungs, heart, and eyes.

In 2007 about 1.5 million people in the United States had rheumatoid arthritis. It usually starts in the middle ages, between 25 to 55 years old. Incidence increases with age and women are more likely to get it than men.

As with other autoimmune diseases, the exact cause of rheumatoid arthritis is unknown. Genetic factor, infection, and hormones may play a role in the development of this condition. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis causes inflammation on the synovium (the lining of your joints), causing damage to the cartilage that eventually result in bone erosion and joint deformity.

What are the symptoms?

Rheumatoid arthritis begins gradually, affecting small joints of the hands and feet at first, causing minor joint pain and stiffness that are accompanied by fatigue or low grade fever. Over time, symptoms often spread to the knees, ankles, elbows, hips and shoulders. Severity varies and symptoms may come and go. Periods of when the disease gets worse (flare-up), alternate with periods when the pain and swelling gets better (remission).

Joint symptoms may include:

• Joint pain that oftentimes affects the same joint on both sides of the body, accompanied with warmth and swelling.
• Morning stiffness that usually lasts for more than 1 hour. 
• Deformity of joints and the surrounding structure with limited range of motion

small joints of the hands and feet are usually affected first

Systemic symptoms may include:

• Fatigue
• Low grade fever
• Weight loss
• Anemia 
• Chest pain or shortness of breath 
• Dry eyes and mouth 
• Buring sensation and itchiness in both eyes
• Lumps under the skin, called rheumatic nodules.

What are the tests to support the diagnosis?

The two lab tests that often came up with abnormal results are rheumatoid factor test and Anti-CCP antibody test. Complete blood count any show anemia. C-reactive protein and erythrocyte sedimentatio rate may be elevated, a sign of chronic inflammation. Your physician may also preform joint imaging like x-ray, ultrasound, or MRI and synovial fluid analysis.

What are the complications?

Rheumatoid arthritis can affect almost every part of the body. Complications may include:

• Lung damage and scarring causing shortness of breath
• Inflammation of the heart muscle and the outer lining of the heart can progress to heart failure
• Hardening of the arteries which in turn leads to nerve, skin, and brain problems
• Spinal injury if the neck joints are affected
• Osteoporosis

What are the treatment options?

A treatment plan usually includes medications, physical therapy, exercise, and even surgery. Early and aggressive treatment can delay joint destruction, but the drugs can have significant side effects especially because they will be used for life-long.

The most important drugs that are used to treat rheumatoid arthritis are the disease modifying antireheumatic drugs (DMARDs) like methotrexate, leflunomide, and chloroquine. Anti-inflammatory drugs like aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids are used to reduce inflammation and joint pain. Biologic agents like rituximab, infliximab, etanercept, and tocilizumab may be used when the other drugs failed to give improvements. They work by suppressing the immune system and thus carry risks of infection.

The Most Common Joint Disorder: Osteoarthritis

What is osteoarthritis?

Osteoarthritis, also known as wear and tear arthritis, is the most common type of joint disorder, affecting around 27 million Americans. Risk of getting osteoarthritis increases with age. Most people over 60 years old have osteoarthritis to some degree, but severity varies. Before age 55, osteoarthritis affects men and women equally, but after age 55 women have greater risk.

The primary damage in osteoarthritis starts from the joint cartilage. Cartilage is a type of elastic substance that covers the ends of bones, functioning as 'shock absorbent' to reduce friction between bones in normal joints. Aging and repetitive mechanical stress are responsible for gradual breakdown of joint cartilage, causing it to lose elasticity and making it more susceptible to damage. Over time the cartilage may further deteriorates, eventually causing pain and swelling in the joints. Damage to the cartilage can also stimulate growth of bone spurs around the joints.

This condition can occur in any joints of the body, but weight bearing joints like the hips, knees, and spine are most commonly affected. Osteoarthritis can also affects the fingers, thumb, and neck joints, especially in people who work with computers.

What are the symptoms of osteoarthritis?

Symptoms of osteoarthritis usually develop gradually and become more apparent in middle age. Pain and joint stiffness are the most common symptoms. The pain is usually worse after exercise or overuse. You may also notice a grating, crackling, or rubbing sound when you move the joint. When you wake up in the morning, you may experience the so-called morning stiffness that usually lasts for 30 minutes or less. It is improved by mild activity that warms up the joint. Stiffness may also occur after long periods of inactivity.

most people over 60 years old have osteoarthritis

Factors that increase a person's chances of developing osteoarthritis include being overweight, previous joint injury, heredity, joint overuse, and other joint diseases such as rheumatoid arthritis. Controlling your weight helps prevent osteoarthritis on weight bearing joints, and reduces pain if the joints are already affected. Gentle exercises like swimming and walking on flat surfaces are recommended because they are less stressful on your joints. Avoid impact sport or sports that involved twisting movement like football, soccer, or basketball.

What is the treatment for osteoarthritis?

To reduce pain, your physician may recommend pain killers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. Topical capsaicin cream may also help to relieve pain. Supplements like glucosamine and chondroitin sulfate may help protect your cartilage from damage.