> Health and Disease > Bones, Joints, and Muscles > arthritis (osteo-)

Arthritis refers to inflammation of the joints. The most common form of arthritis is osteoarthritis, which is also known as degenerative joint disease because it is characterized by joint degeneration and loss of cartilage--the shock-absorbing, gel-like material between joints.

The percentage of people with osteoarthritis increases dramatically with age. Surveys have indicated that over 40 million Americans have osteoarthritis, including 80 per cent of persons over the age of 50.

The weight-bearing joints, such as the knees, hips and spine, as well as the hands, are the joints most often affected with the degenerative changes of osteoarthritis. These joints are under greater stress because of weight and use.

The onset of osteoarthritis can be subtle. Morning joint stiffness is often the first symptom. As the disease progresses, there is pain during motion of the involved joint, made worse by prolonged activity and relieved by rest.

Osteoarthritis is usually quite easily distinguished from other types of arthritis. In more inflammatory forms of arthritis like rheumatoid arthritis and gout, the joints will appear red, spongy and warm. In osteoarthritis, however, the joint will generally be cooler and bony-hard. If you think you have arthritis, consult a physician for an accurate diagnosis.

The primary drugs used in the treatment of osteoarthritis are the so-called nonsteroidal anti-inflammatory drugs or NSAIDS which include aspirin. Although these drugs are used extensively, research indicates that they may actually accelerate the progression of joint destruction and cause more problems down the road. These drugs are also associated with side effects including gastroinintestinal upset, headaches and dizziness, and are therefore recommended for only short periods of time.

A safe and natural product that can be used instead of NSAIDs is glucosamine sulfate. Glucosamine is a simple molecule that can be naturally produced in the body. The main function of glucosamine on joints is to stimulate the manufacture of molecules known as glycosaminoglycans (GAGs)--key structural components of cartilage. It appears that as some people age, they lose the ability to manufacture sufficient levels of glucosamine. The result is that cartilage loses its ability to act as a shock absorber. The body’s inability to manufacture glucosamine has been suggested to be the major factor leading to osteoarthritis.

Glucosamine has been the subject of more than 300 scientific investigations and over 20 double-blind clinical studies. Glucosamine sulfate was signifi-cantly effective in improving pain and movement after only four weeks of use. Previous studies have shown that the longer glucosamine sulfate is used, the more obvious the therapeutic benefit.

There are questions about taking glucosamine sulfate and chondroitin sulfate together. The few clinical studies that have been done with orally administered chondroitin sulfate demonstrate it is much less effective than glucosamine sulfate.

While the absorption rate of glucosamine sulfate is 90 to 98 per cent, the absorption of intact chondroitin sulfate is estimated to be less than 13 per cent. Chondroitin sulfate molecules are at least 50 to 300 times larger than glucosamine sulfate, too large to pass the normal intact intestinal barrier. One of the key reasons glucosamine sulfate is so effective is that its small molecular size allows it to penetrate the joint cartilage and be delivered to the chondrocyte and stimulate GAG synthesis. It would be nearly impossible for large chondroitin sulfate molecules to produce this effect.

Researchers concluded that, "Pooled literature on chondroitin sulfate biochemistry offers enough information to assert that neither intact, nor polymerized chondroitin sulfate is absorbed by the mammalian gastrointestinal tract. Therefore, any direct action of orally administered chondroitin sulfate on cartilage and chondrocytes is not possible."

A study comparing glucosamine hydrochloride to placebo was done in Ontario. Researchers found very little difference between the placebo group and the glucosamine hydrochloride.

Glucosamine is not reported to have any adverse drug interactions. Individuals taking diuretics may need to take higher dosages, such as 20 mg per kilogram (2.2 pounds), of body weight daily. I recommend 500 mg of stabilized glucosamine sulfate three times per day. Individuals over 200 pounds may need higher dosages based on body weight It is important that the glucosamine sulfate you choose be stabilized and clinically proven.

All of the research has been done with glucosamine sulfate. It is the only form of glucosamine with proven effectiveness. Glucosamine sulfate is approved as a treatment for osteoarthritis in over 70 countries of the world and has been used by millions of people safely and effectively.

Consumers should be aware that many companies marketing other forms of glucosamine may mislead people into believing that other forms of glucosamine are better absorbed, more stable and better used than glucosamine sulfate. These contentions are without support in the scientific literature. Glucosamine sulfate is clearly the preferred form.

References

1. Shield, MJ. Anti-inflammatory drugs and their effects on cartilage synthesis and renal function. Ear J Rheumatol Inflam 13, 1993.


2. Newman, NM and Ling, RSM. Acetabular vone destruction related to non-steroidal anti-inflammatory drugs. The Lancet ii, 1985.


3. Conte, A et al. Biochemical and phamacokinetic aspects of oral treatment with chondroitin sulfate. Arzneum Forsch 45, 1995.

Dr Michael Murray is a faculty member of Bastyr University in Seattle, WA. In addition to maintaining a private practice, Dr Murray is the author of over 20 books.

Source: alive #210, April 2000

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