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Old 04-07-2003, 01:19 PM   #10
aikidoc
Dojo: Aikido of Midland
Location: Midland Texas
Join Date: Dec 2000
Posts: 1,652
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Kevin:

Here's one article. Medscape has a good list of the recent research. Obviously, it is not all in but the trend lately is that there is a benefit with GS. It's side effects are what is appealing-not many. Whereas, medication for the treatment of OA are more prone to side effects-especially with long term use. This is exerted from Medscape.

An Evidence-Based Assessment of Glucosamine Sulfate, St. John's Wort, and Echinacea

Jack J. Chen, PharmD Disclosures

An Evidence-Based Assessment of Glucosamine Sulfate, St. John's Wort, and Echinacea

Jack J. Chen, PharmD, BCPS, FCPhA

Case Study: Glucosamine Sulfate

Joseph Pepping, PharmD, Pain Management and Nutritional Medicine Consultant for the Kaiser Moanalua Medical Center, Honolulu, Hawaii, reviewed 4 double-blinded, randomized clinical trials on the effect of glucosamine sulfate for the management of knee osteoarthritis (Table 8).[12-15] Particular attention was focused on a well-designed, randomized, double-blind, placebo-controlled trial investigating the long-term effects of glucosamine sulfate.[12] In this study, patients with severe osteoarthritis or morbid obesity were excluded. Symptoms were scored by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, a well-validated tool for measuring osteoarthritis-related outcomes such as pain, stiffness, and disability. Long-term progression of osteoarthritis was evaluated by measuring the change in width of the medial tibiofemoral joint space using digitized radiographs over a period of 3 years. Treatment with crystalline glucosamine sulfate (Dona, Viartril-S, Xicil, Rotta Research Group, Monza, Italy) 1500 mg once daily for 3 years (normally glucosamine sulfate is administered 500 mg 3 times daily) was well tolerated and associated with beneficial structure- and symptom-modifying effects in patients with mild to moderate osteoarthritis of the knee. The treatment period of 3 years is the longest to date of all studies of glucosamine in the management of osteoarthritis. This study is also remarkable in that the results suggest that oral glucosamine sulfate may act as a disease-modifying agent in patients with mild to moderate osteoarthritis of the knee.

Based on the evidence, Dr. Pepping recommended that stabilized glucosamine sulfate administered at a dosage of 1500 mg/day has beneficial effects on osteoarthritis symptoms (Grade A recommendation) and that long-term treatment is well tolerated (with superior safety over nonsteroidal anti-inflammatory agents) and may slow the progression of cartilage degeneration. Glucosamine sulfate "can be responsibly offered as either a first-line or adjunctive agent in the treatment of osteoarthritis," Pepping said. A caveat is that these studies used the sulfate salt of glucosamine (stabilized with potassium chloride or sodium chloride), and other forms of glucosamine may not be as effective. When counseling patients on glucosamine sulfate, clinicians should emphasize that the product should be taken with meals and routinely (not as needed). Additionally, a trial of at least 4 weeks is necessary to assess benefits. Diabetic patients should be informed that there are case reports of glucosamine sulfate causing an increase in blood glucose levels and that blood glucose levels should be monitored. However, in the 4 large clinical trials that were reviewed, significant changes in blood glucose levels were not noted.

Table 8. Evidence Table: Glucosamine Sulfate in the Long-term Treatment of Osteoarthritis

Study Subjects (N) Results Control LOE Limitations

Reginster[12] 212 Positive Placebo I Minor

Noack[13] 252 Positive Placebo I Minor

Muller-Fassbender[14] 200 Equivalent Ibuprofen I Minor

Qiu[15] 178 Equivalent Ibuprofen II Major

LOE = level of evidence

Conclusions

As scientific evidence on dietary supplements and botanical products become increasingly available, clinicians should use the evidence-based medicine process to objectively evaluate the data and to formulate appropriate recommendations. Based on the available evidence to date, the following recommendations can be made: Echinacea purpurea is effective for reducing the duration of symptoms of the common cold (but not for prevention), St. John's wort is effective for treating mild to moderate depression, and glucosamine sulfate is beneficial for treating osteoarthritis of the knee.

1. Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomized, placebo-controlled clinical trial. Lancet. 2001;357:251-256.

2. Noack W, Fischer M, Forster KK, et al. Glucosamine sulfate in osteoarthritis of the knee. Osteoarthritis Cartilage. 1994;2:51-59.

3. Muller-Fassbender H, Bach GL, Haase W, et al. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage. 1994;2:61-69.

4. Qiu GX, Gao SN, Giacovelli G, et al. Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis. Arzneimittelforschung. 1998;48:469-474.
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