DR ROD HUGHES MD FRCP
CONSULTANT RHEUMATOLOGIST AT ASHFORD AND ST PETER’S NHS TRUST
The human skeleton starts life with over 300 bones, some of which then fuse together in development, leaving us with 206 bones as an adult. Bones support the flesh and organs of the body, and joints and muscles allow the bones to move.
Bones are connected to other bones at many different types of joints, that include fixed joints (such as in the skull), hinged joints (such as in the fingers, toes and knees) and ball-and-socket joints (such as the shoulders and hips). The surface of a moving joint, like the knee, is covered by articular cartilage to create a friction-free sliding surface that is over 10 times as slippery as ice, allowing free and easy movement.
As we get older the articular cartilage of our joints, especially those that bear our weight, may become worn (osteoarthritis) and can be further damaged by injury, overuse or by being overweight or unfit. This then causes loss of articular cartilage and joints that become stiff, painful and sometimes swollen. This can lead to loss of function and eventually restricted mobility.
Preserving the health of our articular joint cartilage is essential to maintaining our overall fitness and free, easy and painless movement throughout our life.
Glucosamine: the evidence
Following many reports that people had found anecdotal benefit, with pain relief and improvement in function after taking glucosamine for their painful osteoarthritis (OA), glucosamine has attracted the attention of clinical researchers over the last decade.
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A: Normal knee showing good preservation of cartilage shown as joint space between the bones. B: An osteoarthritic knee showing narrowing of joint space as a result of wearing away of the articular cartilage.
There are now several independent studies that suggest glucosamine, and glucosamine and chondroitin in combination, can be effective in reducing the pain of osteoarthritis in various joints, including the knee and spine. It has also been shown to slow OA progress in the knee as measured by X-ray changes. The evidence is best summarised by the Cochrane Database review (a collection of evidence of several clinical trials), available as Cochrane Database Syst Rev 2005 (2) CD002946.
This review details twenty studies of glucosamine which were analysed together and an average effect calculated. They found glucosamine improved overall pain in OA better than placebo (dummy treatment). Those taking glucosamine showed a 28% improvement in pain in their affected joints and a 21% improvement in function. Most studies were performed on OA knees. Importantly glucosamine proved as safe as placebo, with few reports of side effects even when taken by patients with diabetes.
Two studies also showed preliminary evidence that glucosamine can slow the progression of OA of the knee over a three year period. These studies involved analysis of X-rays taken at the start of the study and again after three years, and the results showed less cartilage loss in those taking glucosamine preparations.
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