Glucosamine Sulfate Does Help With Arthritis, Despite What You've Heard

It has been reported on the news that glucosamine sulfate does not help patients with arthritis, based on a recent study that was published in the New England Journal of Medicine(1). Let's take a look at this study and let's see if the conclusions that were written by the authors and what was reported by the popular press.

This study examined patients with osteoarthritis of the knee and had them take either glucosamine sulfate, chondroitin sulfate, both in combination, Celebrex (an anti-inflammatory made by Pfizer), or a placebo. The conclusion drawn by the authors of the study was that glucosamine and chondroitin did not effectively reduce pain in patients with osteoarthritis of the knee.  Therefore, according to the authors, only Celebrex was effective in pain relief in these patients. The popular press reported that glucosamine sulfate doesn't work.

First of all, we'd like to point out that some of the authors of this study have some serious conflicts of interest, which was pointed out by Dr. Jay Gordon(2).  Let me first point out the lead author, Daniel Clegg, MD, receives grants, consulting fees, and lecture fees from Pfizer Pharmaceuticals, the company that makes Celebrex, one of the medications studied. Are you surprised that Dr. Clegg concluded that glucosamine did not work but that Celebrex did?   

In addition to Dr. Clegg, other authors of this study also received money from Pfizer and other drug companies. Drs. Brandt, Moskowitz, Schnitzer, and Schumacher received consulting fees or have served on advisory boards for Pfizer. Dr. Brandt reports owning stock in Pfizer.  Moskowitz and Weisman received lecture fees from Pfizer. Bingham, Hooper, Jackson, Molitor, Sawitzke, and Schnitzer received grants from Pfizer. Mokowitz served as an expert consultant for Pfizer. Brandt received royalties from a book on osteoarthitis. Bingham, Brandt, Clegg, Hooper, and Schnitzer reported receiving various fees from other pharmaceutical companies. 

In other words, the doctors and scientists who conducted this study receive millions from the companies whose drugs they studied.  

What the study actually showed is that in patients with mild pain resulting from osteoarthritis of the knee, taking glucosamine and chondroitin sulfate provided almost as much pain relief as Celebrex. Here are the percentage of patients that had pain relief:  placebo: 60%;  glucosamine: 64%; chondroitin sulfate: 65%;  glucosamine and chondroitin: 66%;  Celebrex: 70%. You could have concluded that glucosamine and chondroitin produced almost as effective pain relief as Celebrex. Unfortunately, only Celebrex reached a level of statistical significance. I would point out that while Celebrex is a cox-2 inhibitor like Vioxx and it appears to cause an increased risk of heart attack and stroke, unlike glucosamine and chondroitin, which are virtually risk free.  

What is even more interesting is that in the subgroup of patients who have moderate to severe arthritis pain of the knee, glucosamine and chondroitin sulfate produced very significant relief, even more than a prescription pain killer like Celebrex.  In this group, here are the results for pain relief: placebo: 54%;  Celebrex: 69%;  and glucosamine and chondroitin sulfate: 79%.  79% pain relief from glucosamine and chondroitin in the patients with the most severe pain!  And with supplements that are extremely safe and may be helping to regenerate the cartilage in the knee, thereby not merely relieving pain, but slowing down or reversing the degenerative process. Why didn't this result get more press?

The conclusion that should have been drawn from this data is that glucosamine and chondroitin sulfate supplements are extremely effective in relieving the pain of moderate to severe osteoarthritis of the knee and slightly effectivein patients with mild osteoarthritis. This result corresponds with results of other studies that have shown glucosamine to be effective not only in pain relief, but in helping the cartilage to regenerate, as measured by increasing joint space width as seen on x-ray.(3)

1. Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. NEJM; 2006. Feb; 354 (8):795-808.
2. Gordon JN. Did you understand the arthritis study? I did.
3. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Reginster JY, Deroisy R, Rovati LC, et al. The Lancet 2001; 357: 251-256.