‘Choice’ magazine misses the mark on Glucosamine
The overall message of the article in the latest ‘Choice’ magazine, May 2008 “Spotlight on glucosamine”, is that glucosamine doesn’t work for osteoarthritis and has a ‘placebo effect’ only (a positive reaction to a dummy pill induced by a belief that it is the real thing).
Why is ‘Choice’ making these negative claims?
These claims seem to be based on evidence from the large U.S. Glucosamine/chondroitin Arthritis Intervention Trial (GAIT). In this trial of patients with knee osteoarthritis, overall results showed that glucosamine and chondroitin were not significantly better than a dummy pill in reducing knee pain by 20%. The results show that there was a greater rate of pain relief in subjects on glucosamine, chondroitin and combined glucosamine with chondroitin than in those subjects taking dummy pills (placebos) but the pain relief did not reach a level that was statistically significant, so couldn’t be proven to be a positive result. In a sub-group of patients with more severe osteoarthritis, glucosamine with chondroitin did significantly relieve pain.
What’s wrong with the GAIT results?
Measuring pain, especially mild pain, is difficult as it is very subjective and varies according to changes in lifestyle and other factors. Unusually, in the GAIT, many people responded to the dummy pills and didn’t respond as expected to osteoarthritis drugs, which suggests that there was something wrong with the way pain was measured in this study. The trial also selected an arbitrary 20% improvement in pain score, that may have excluded patients from the results who had a lesser degree of improvement that still may have been meaningful from a pain and disability perspective. The subjects in the GAIT had a relatively mild degree of pain from osteoarthritis that may have also limited the ability to detect benefits. Most other studies have been on patients with more severe symptoms in which improvements would be more marked and easier to measure.
How should we measure glucosamine effectiveness?
Although glucosamine has anti-inflammatory activity and has been shown to have small-to-moderate effects on pain relief in some studies, it works mainly as a structural compound that helps maintain cartilage in joints. Therefore, it’s more sensible to measure changes in joint structure over time if we really want to know if glucosamine is helpful. This can be measured objectively by X-ray rather than by symptoms.
A review of a number of clinical trials that used X-rays to measure improvement concluded that glucosamine can reduce the progression of osteoarthritis by 54%, a considerable benefit by any standard.
Researchers themselves believe that GAIT is not the final answer and an important new Australian study called the Long-term Evaluation of Glucosamine Sulphate (LEGS) is currently in progress through the George Institute of International Health and the University of Sydney. This has been designed to assess the long-term effectiveness of glucosamine and/or chondroitin for knee osteoarthritis and will measure results by X-ray measurements of disease progression, as well as the amount of pain-relieving drugs used. The results of this study should help answer some of the questions about glucosamine.
Glucosamine even helps animals with arthritis
Veterinary studies have found that glucosamine can help joint problems in animals and many customers give it to their dogs and cats. As animals would not know what they are being given, you can’t write off improvements as a placebo effect in the way Choice has tried to do with human studies.
Our customers love glucosamine
Many customers who use glucosamine continue using it long-term and find it very helpful.
Ms. T. from Carrum, Victoria reports:
“I’m in my 60’s and work as a gardener and found that my fingers were stiffening up badly, to the point that I couldn’t bend them properly, and they would throb with pain all night after a day’s work. My knees also stiffened up and I couldn’t stand up from a chair without help. I saw an ad for glucosamine and started taking it. Now my fingers are free of pain and I can bend them easily again and my knees have improved so much that I have no problems sitting down and getting up. I’m thrilled with the result.”
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