Posted on: Saturday, May 21, 2005

PRESCRIPTIONS
Glucosamine not shown effective for joint pain

By Landis Lum

Q. What do you think of glucosamine for chronic hip and knee pain?

A. You likely have osteoarthritis, in which the cartilage that coats and protects the ends of the bone breaks down. Glucosamine is one of the building-block molecules of cartilage.

I had thought it worked pretty well, because a search I did in March in the highly regarded Cochrane Database of Systematic Reviews had said "Glucosamine therapy is effective and safe in treating osteoarthritis in the short term; more research is needed for long-term effects."

However, an update that just came out last month analyzed newer and higher-quality studies and found that if you just looked at the most accurate studies, then glucosamine was no better than a fake pill, known as a placebo, in reducing hip or knee pain.

Indeed, this Cochrane review provides the best evidence we have today of the effectiveness of glucosamine. It searched for all the randomized studies (the most accurate type of scientific study) ever done on glucosam-ine and found 20 of them involving more than 2,500 people.

Now to be fair, if you looked at something called the Le-quesne Index, which asks 10 questions — five on pain, one on walking distance and four on activities of daily living, then the glucosamine sulfate brand made by Rotta Pharmaceuticals of Italy did improve pain and function. But if you used the WOMAC index, which is also widely used and asks 24 questions on pain, stiffness, and physical function, then the Rotta glucosamine did no better than the fake pill.

And Rotta was the sponsor of most of the glucosamine studies, which makes one wonder whether they were biased. Only one study was of glucosamine hydrochloride (Rotta makes the sulfate form), and it did not show any pain reduction.

I also went to another excellent resource called Clinical Evidence, which likewise analyzes only the highest-quality studies, and it also rated glucosamine, chondroitin, and the two in combination as being of unknown effectiveness in reducing joint pain.

Anti-inflammatories like Motrin can cause problems like ulcers, while glucosamine was as safe as a placebo in the above studies.

However, like other supplements, it is not regulated by the FDA, so various preparations may have contaminants or may not contain the stated amounts. I like to start off with acetaminophen (Tylenol) because of its safety. And if stronger medicines or measures like capsaicin (Zostrix) cream, therapeutic exercise, TEN's units and joint injections don't work, don't be afraid to ask your doctor about joint-replacement surgery.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.