The Glucosamine Pain Management Conversation Continues

Osteoarthritis (OA), also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. This type of arthritis affects over 27 million people in the United States or roughly 3% of the population. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. There is a variety of causes of OA including hereditary, developmental, metabolic, and mechanical. Each of these causes may initiate processes leading to loss of cartilage.



When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax. Treatment generally involves a combination of exercise, lifestyle modification and analgesics. If pain becomes debilitating joint replacement surgery may be used to improve the quality of life. However, over recent years the use of Glucosamine and Chondroitin has sky-rocketed to treat and prevent this type of arthritis. The question is does it really work or is it the placebo effect at work?



Glucosamine is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. Glucosamine is part of the structure of the polysaccharides chitosan and chitin, which compose the exoskeletons of crustaceans and other arthropods, cell walls in fungi and many higher organisms. Glucosamine is one of the most abundant monosaccharides.It is produced commercially by the hydrolysis of crustacean exoskeletons or, less commonly by fermentation of a grain such as corn or wheat. In the US it is one of the most common non-vitamin, non-mineral, dietary supplements used by adults.



Chondroitin Sulfate is a sulfated glycosaminoglycan (GAG) composed of a chain of alternating sugars (N-acetylgalactosamine and glucuronic acid). It is usually found attached to proteins as part of a proteoglycan. A chondroitin chain can have over 100 individual sugars, each of which can be sulfated in variable positions and quantities. Chondroitin sulfate is an important structural component of cartilage and provides much of its resistance to compression. Chondroitin was first extracted and purified in the 1960s. It is currently manufactured from natural sources (shark/beef cartilage or bovine trachea) or by synthetic means.



To maintain healthy joints, the most important aspect is healthy cartilage. Cartilage needs three primary things to maintain its health: water for lubrication and nourishment, proteoglycans to attract and hold the water, and collagen to keep the proteoglycans in place. Proteoglycans are a type of molecule found in the connective tissue of the body. Connective tissue is fibrous tissue that provides support for other body structures. Proteoglycans make up a major part of the extracellular matrix, the material between cells that provides structural support.



Unlike in other body tissues, the extracellular matrix is the most important part of connective tissue proteoglycans are like a rope that threads itself through the collage and are essential as they hold many times their own weight of water, which both lubricates and nourishes the collagen. If the cartilage is damaged the proteoglycans becomes weak and leaks out and thus the collagen loses its nourishment as the proteoglycans lose their grip and float away. Thus the cartilage cannot withstand shocks, cracks and may wear out completely.



Glucosamine is a key building block of the proteoglycans. Besides being a structure for the synthesis of proteoglycans, its mere presence acts as a stimulus to the cells that produce proteoglycans. Glucosamine has been shown to speed up production of both proteoglycans and collagen and it normalizes cartilage metabolism which helps keep cartilage from breaking down. Chrondoiton Sulfate is a long chain molecule with a negative charge attached to it. As these chains wrap around proteoglycans they repel each other and thus create spaces between each proteoglycan. These are what are known as matrixes within the cartilage and this is where the fluid flows. There may be as many as 10,000 of these chains on a single proteoglycan molecule – thus we have a super water retainer as these chains make sure all these molecules are away from each other and cannot clump together.



In a recent study by the University of Utah it was found that for a subset of participants with moderate-to-severe pain, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared with placebo—about 79 percent had a 20 percent or greater reduction in pain versus about 54 percent for placebo. According to the researchers, because of the small size of this subgroup these findings should be considered preliminary and need to be confirmed in further studies. It is evident based on this study that there may be some merit to taking these supplements. If you are interested in learning more, please consult your doctor or Arizona pain specialist.