It seems that when a positive study on natural products comes out in a medical journal that it garners very little media attention. In contrast, when a study comes out that seemingly shows a dietary supplement does not produce good results it receives a lot of attention in all media channels.
A new study conducted by Marc C. Hochberg, MD, from the University of Maryland School of Medicine, Baltimore, and physicians from France, Germany, Poland, and Spain published in the Annals of the Rheumatic Diseases showed that that a combination glucosamine/chondroitin sulfate product produced a decrease in pain scores comparable to that seen in patients randomly assigned to receive celecoxib (Celebrex).
The results of this study provides further evidence that glucosamine and chrondroitin based products are effective in improving the underlying factors that lead to arthritis pain since the compounds have no real direct pain-relieving action.
Glucosamine and chondroitin are naturally produced in the body, but as some people age they may lose the ability to manufacture sufficient levels of these critical components of cartilage leading to osteoarthritis (OA). Extensive preclinical and clinical research, including long-term double-blind studies, support a rationale and role for glucosamine, as well as chondroitin sulfate, as an effective treatment of OA.
In fact, numerous head-to-head double-blind studies have shown glucosamine sulfate (GS) to produce much better results, compared with non-steroidal anti-inflammatory drugs like aspirin, ibuprofen, and celecoxib in relieving the pain and inflammation of OA. While some of the studies comparing GS to NSAIDs or acetaminophen show similar reduction in pain and symptom scores, only GS improves measures of joint function or markers showing improvement of cartilage structure. Typically the advantages of GS over these other treatments is seen after 4-6 weeks of use, but there is some evidence that the longer GS is used, the greater the therapeutic benefit.
In regards to chondroitin sulfate (CS), while many studies have combined it with glucosamine, it also has shown benefits in the treatment of osteoarthritis on its own and has also shown to promote healthier cartilage.
The name of the new study is the MOVES trial, which stands for the Multicentre Osteoarthritis Intervention Trial with Symptomatic Slow-acting Drugs for OA. The combination product used in the trial is a prescription drug in several countries in Europe and contains per capsule: 400 mg chondroitin sulfate plus 500 mg glucosamine hydrochloride (CS+GH).
A total of 606 patients with osteoarthritis of the knee were randomized to receive either three capsules of the CS+GH or celecoxib 200 mg every day for six months. The primary outcome was the average decrease in a standardized numerical assessment of pain (the WOMAC pain score) at 6 months. Secondary outcomes included joint function and stiffness, pain visual analog scale, presence of joint swelling, use of rescue medications, and various quality of life assessments.
The change in WOMAC pain score was −185.7 (−50.1%) with CS+GH vs −186.8 (−50.2%) with celecoxib. These results indicate that as far as pain relief goes, there were no differences between the two medications. There were also no significant differences in decrease in pain visual analog scale (48.0% with CS+GH vs 48.8% with celecoxib) or in any of the other measures of joint function or quality-of-life measures.
The CS+GH group used more rescue medication during the first month of study, but rescue medication use was low and similar for both groups thereafter.
The authors concluded, “The MOVES trial found that a fixed-dose combination of chondroitin sulfate plus glucosamine has comparable efficacy to celecoxib in reducing pain in patients with osteoarthritis of the knee with moderate-to-severe pain after 6 months of treatment. The reduction in pain was both clinically important and statistically significant (50% reduction in both groups), as was the improvement in stiffness (46.9% reduction with the combination vs 49.2% with celecoxib), and function (45.5% vs. 46.4%, respectively).”
While combination products containing CS and GH have shown benefit, I am not convinced that glucosamine hydrochloride is as beneficial as glucosamine sulfate. While glucosamine has shown significant clinical benefit (see above), unfortunately several large, well-publicized studies utilized glucosamine hydrochloride and failed to show benefit. It is thought that the sulfur component is critical to the overall effect of GS. In combination products containing CS and GH, the CS may be simply supplying an expensive form of sulfur. I prefer combination products that contain glucosamine and methyl-sulfonyl-methane (MSM), a physiological form of sulfur.
MSM has also shown benefits on its own in osteoarthritis by stabilising collagen and other connective tissue components. MSM works synergistically with glucosamine as well as trace minerals such as manganese and boron that aid in the manufacture of cartilage components and the promotion of bone health.
Hochberg MC, Martel-Pelletier J, Monfort J, et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2015 Jan 14. pii: annrheumdis-2014-206792. doi: 10.1136/annrheumdis-2014-206792. [Epub ahead of print]
Dr. Michael Murray