A natural substance found in cartilage, glucosamine is manufactured from shellfish shells. Glucosamine therapy is especially promising because it may treat the underlying disease by improving cartilage health. It strengthens and slows the breakdown of cartilage by stimulating production of proteoglycans used in the synthesis and repair of cartilage. Although providing more immediate pain relief, non-steroidal anti-inflammatory (NSAIDS) such as Motrin and Advil may actually accelerate progression of arthritis by inhibiting cartilage repair.

Clinical Evidence

Glucosamine may slow progression of osteoarthritis

• A 2002 study of 202 patients with mild to moderate osteoarthritis who were given glucosamine 1,500 mg once daily for 3 years showed no change in knee x-rays while those taking placebo showed narrowing suggesting that glucosamine had slowed progression. Twenty percent of these patients also reported symptomatic pain relief.

Glucosamine provides comparable pain relief to NSAIDs after 1 week of use
Since glucosamine may act by improving underlying cartilage health, don’t expect immediate pain relief. It may take several weeks before you see any benefits.

• Glucosamine (500 mg 3x daily) was compared with ibuprofen (400 mg 3x daily) for 4 weeks. While ibuprofen was more effective initially, there was comparable pain relief between the 2 therapies after one week. (52% of the ibuprofen group and 48% of the glucosamine group reported pain relief at the end of 4 weeks.)

Glucosamine better tolerated than NSAIDs

• Patients in the above study reported 35% adverse side effects with ibuprofen, primarily related to the gastrointestinal system, while those on glucosamine reported only 6% adverse side effects.

Latest Controversy
A recent 2006 study in the New England Journal of Medicine of 16,000 patients with osteoarthritis of the knee showed no benefit with glucosamine, chondroitin sulfate, or glucosamine and chondroitin combined when compared to placebo. It is difficult to draw any conclusions from this study as it had some very serious flaws.

• First the fake pill (placebo) provided pain relief for 60% of patients which is more than double of what should be expected. This makes it very difficult to detect and measure any positive effect for glucosamine. Despite this, glucosamine worked better than celebrex for those with moderate to severe symptoms.
• Most studies showed clinical benefits with the more widely available glucosamine sulfate, but this study used a different form of glucosamine called glucosamine hydrochloride.