The role of glucosamine in the treatment of mild to moderate osteoarthritis
The term osteoarthritis (OA) describes a group of intertwining conditions with different etiologies, but with similar biological, morphological and clinical consequences.
Osteoarthritis involves the involvement of articular cartilage, subchondral bone, joint synovium or. capsules and joint ligaments. So it's about joint disease as
“Whole organ” and not just cartilage. Osteoarthritis is slightly more common in the female population, but otherwise the small joints of the hands are most often affected, half less the knee joints and even less often the hip joints. The incidence increases with age, jumping quite steeply after the sixth decade of life. At age 70, about 40% of women and 30% of men have osteoarthritis of the knee. In addition to age and gender, the main risk factors are Caucasian race, obesity, hormonal status, nutritional factors, bone density, and local risk factors include previous injuries, inflammation, joint deformities and weakness, and muscle and ligament looseness.
The clinical picture is very diverse and also poorly correlates with the appearance of the joint on X-ray. In the latter, as part of arthrosis, we mainly observe narrowing of the joint space, sclerosis of the subchondral bone, cysts in it and the presence of osteophytes. It is not uncommon to observe only moderate symptoms in an otherwise advanced X-ray condition and vice versa. It is mainly the presence of pain, stiffness, limping, crepitations, swelling and joint instability.
Due to the chronicity of the symptoms they often affect the patient's social life and psychological state, sleep, emotional response and the appearance of symptoms of depression.
Treatment of osteoarthritis is staged and in the case of conservative regardless of the decision affected. Surgical treatment with prosthesis insertion is a definitive measure and is indicated only when all conservative measures have been exhausted, and especially in the case of advanced osteoarthritis.
Conservative measures themselves are divided into non-pharmacological, which include educating the patient by adjusting lifestyle and using devices, and pharmacological, which include often prescribed simple analgesics (paracetamol), nonsteroidal antirheumatic drugs (NSAIDs). symptomatic slow-acting drugs (glucosamine, chondroitin) and intra-articular injections (corticosteroids. hyaluronic acid).
While, as in the clinical picture, the responses of symptoms to most of these active substances are very diverse, insight into the latest data on their actual effects is provided by recent meta-analysis published in the Journal of the American Medical Association (JAMA) Gregory and co-workers performed an analysis of all studies that included any of the mentioned active ingredients in the treatment of osteoarthritis of the knee, limiting themselves to only those that observed the effect of therapy for at least one year, which is also the first meta-analysis. which focused primarily on the long-term effect of therapy. They included more than 22,000 patients in whom studies assessed pain as the predominant symptom, knee joint function, and its structure. In the latter, they focused on X-ray disease progression in terms of joint slit narrowing as an indirect indicator of articular cartilage deterioration.
Interestingly, glucosamine alone has a positive long-term effect on relieving symptoms in mild to moderate osteoarthritis of the knee. , while the effects of the other active substances were not statistically significant or even worse than placebo compared to placebo. It is important to mention that not all glucosamines showed such an effect . Namely, various formulations available on the market were included in the research, but they were positive effects expressed only in patients receiving glucosamine sulfate at a dose of 1500 mg daily.
Special formulation of glucosamine sulphate - crystallized glucosamine sulphate (DONA, Mylan) has included the European Society for the Clinical and Economic Aspects of Osteoarthritis and Musculoskeletal Diseases (ESCEO) in its guidelines for the treatment of osteoarthritis 2. ESCEO highlighted the difference between crystallized and other glucosamine sulfate formulations and crystallized glucosamine sulfate was accompanied by strong recommendations for the long-term treatment of knee OA.
The characteristic of crystallized glucosamine sulfate is different biochemical bio-availability . The crystallized form is a chemical bond between two molecules of glucosamine sulfate, which makes it circulating in the bloodstream. more durable and in sufficient concentrations reach the joint space itself , where it also exerts its effect by inhibiting the action of cytokines, especially interleukin-6. It turned out. Yes crystallized glucosamine sulfate at a single daily dose of 1500 mg, it reduces pain more than paracetamol and, similar to NSAIDs. Crystallized glucosamine sulphate, in addition to reducing pain, also has a strong effect on joint functionality and delays the need for joint replacement.
Doc Dr. Robbie Kelz. dr med. specialist in orthopedic surgery
1 Gregor D Et al JAMA 2018 Dec 25 320 (24) 2564 2579
2 Bruyere O et al Semmars in Arthrilis and Rheumasm 49 (2019) 3 37 350
