The Specialist Forum Volume 13 No 11 November 2013 | Page 47

ARTHRITIS

Glucosamine sulphate safe and
effective to treat osteoarthritis

O

steoarthritis is a chronic, degenerative, complex joint disorder whose cause is not completely understood. Worldwide
estimates indicate that 9.6% of men and 18% of women
60 years have symptomatic osteoarthritis – making it the most
common form of arthritis. The knee is the most commonly affected
joint. Although the disease mostly affects middle-aged and elderly
people, younger people may also be affected as a result of injury
or overuse.
According to Rovati et al there is a growing need for medications
that offer medium and long term symptom management to delay
the progression of joint structure changes, and ultimately to modify
the evolution of the disease in order to prevent clinically significant
disease outcomes. The use of crystalline glucosamine sulphate
1500mg per day has been shown to be both safe and effective for
the treatment of osteoarthritis of the knee by several clinical studies.

Cost effectiveness
The National Institute for Health and Clinical Excellence (NICE)
conducted a cost effectiveness analysis of crystalline glucosamine
sulphate and concluded that the intervention is cost effective when
the incremental cost effectiveness ratio, or incremental cost per
quality-adjusted life year is below R260 000.

Conclusion
Rovati et al concluded that the safety and efficacy of crystalline glucosamine sulphate have been confirmed by clinical trials and recommend the use at 1500mg once daily for osteoarthritis of the knee.
Reference: Rovati C et al, Crystalline glucosamine sulphate in the
m
­ anagement of knee osteoarthritis: efficacy, safety and pharmacokinetic properties. Therapeutic advances in Musculoskeletal
Disease. 2012.? R

Efficacy
The efficacy of glucosamine sulphate, a specific symptom- and
structure-modifying drug in osteoarthritis of the knee has been
shown in various clinical studies and has scored the highest level of
evidence and strength of recommendation for osteoarthritis of the
knee by both the European League Against Rheumatism and the
Osteoarthritis Research Society.
A Cochrane Review, which included data from 4963 patients
who were included in 25 clinical trials, found that the drug showed
an effect on pain. According to Rovati et al, the effect is of major
clinical relevance because it was sustained over a long term period
ranging from six months to three years. This result is comparable to
that obtained with purely symptomatic drugs such as nonsteriodal
anti-inflammatory drugs (NSAIDs).
In addition, data showed that the drug also had a significant effect
on function limitation if used over an extended period. Data show
that significantly fewer patients using the drug for at least 12 months
had to undergo total joint replacement in the average five-year follow
up after drug withdrawal. This equates to a risk reduction of 57%
compared with placebo.

Safety
Comparative studies with traditional NSAIDS have shown that
crystalline glucosamine sulphate is better tolerated – especially in
patients with gastrointestinal disorders.
However, some reports of gastrointestinal problems including diarrhoea, constipation, flatulence, nausea, dyspepsia and abdominal pain
have been reported.
Some studies have also suggested that glucosamine might induce insulin resistance by decreasing glucose uptake. Experimental
studies­ using a euglycaemic hyperinsulinemic clamp have shown
that oral, intravenous or intra-arterial glucosamine doesn’t pay a role
in the regulation of insulin sensitivity in humans.
However, cautioned Rovati et al, long term studies about the use
of glucosamine are limited and it is the &Vf?&RGf?6&?RF?6??6V??????F?"F?R&???Bv?V6?6R?WfV?2?bF?V?G2v?F????&VBv?V6?6P?F??W&?6RBF?R7F'B?BV?B?bF?W&???F?R7V6??7Bf?'V????fV?&W"#0???F&?R?6?7BVffV7F?fV?W72?b7'?7F???Rv?V6?6??P?7V??FP?WF?? ??7GVG?????&??????7&V?V?F?&?&&??G??6?7@??b6?7@?VffV7F?fV?W72VffV7F?fV?W70?&F????66???F?76V??WB?#???W'&W&?&VV???@?#p??6?????F?2#3bC?fW'7W0??6V&???sR@?##c*??#?*?fW'7W0?&6WF?????F?????&Vv??7FW ?6???&?&F??r#?6V?G&Rf? ?6?&???0?6??F?F???2??&???6???VvP??b??6?6??2????4R#???F?&VP??V'0??#3S?fW'7W0??6V&???v?V6?6??P?7V??FR?0??FV?F????6?7BVffV7F?fP????4P?wV?FV??RFW?B????F?????fV??6???&?&F??r# ?6V?G&Rf? ?6?&???0?6??F?F???2??&???6???VvP??b??6?6??2????4R#???F?&VP??V'0??#C*?fW'7W0??6V&???v?V6?6??P?7V??FR?0??FV?F????6?7BVffV7F?fP????4P?wV?FV??RFW?B???&?6?WB???&V?????p?fV???fWF??P?# ??7??*?F??2??''W?W&P?#???##s|*3?C2R@?fW'7W27W'&V?B##c*?6&P?s2R@?#3?*??vR???