Article

Glucosamine Administration in Athletes: Effects on Recovery of Acute Knee Injury

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Abstract

The main aim of this study was to examine the effects of 4 weeks of glucosamine administration on the functional ability and the degree of pain intensity in competitive male athletes after acute knee injury. This study was a randomized, double-blind parallel trial of glucosamine (1500 mg per day) or a placebo for 28 days, utilising 106 patients with an acute knee injury. Pain and functional ability were evaluated at the beginning of the study and at 7, 14, 21, and 28 days after starting treatment. Pain intensity at rest and while walking was assessed using a visual analog scale. Passive knee flexibility (flexion and extension) of the injured limb was measured using a modified goniometer, and the degree of knee swelling was measured and compared with the noninjured limb. No significant difference was found between the glucosamine, and placebo group in mean pain intensity scores for resting and walking, and degree of knee swelling at the 7-day, 14-day, 21-day, and 28-day assessment. There was no significant difference between passive knee flexibility at the 7-day, 14-day, and 21-day assessment. After 28 days of treatment the patients from the glucosamine group demonstrated significant improvement in knee flexion and extension as compared with the placebo group.

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... Nutritional supplements, including glucosamine, chondroitin and collagen, are used for joint health to treat or prevent sports-related cartilage injuries (i.e., OA) in athletes (22)(23)(24)(25)(26)(27). Among these, glucosamine, a naturally occurring amino monosaccharide, has been widely used to treat OA in humans (28)(29)(30). ...
... Glucosamine is present in the connective and cartilage tissues as a component of glycosaminoglycans (proteoglycans) and contributes to maintaining the strength, flexibility and elasticity of these tissues. Glucosamine inhibits degradation and stimulates synthesis of glycosaminoglycans, thereby exhibiting chondroprotective actions (27,31). In addition, glucosamine inhibits the expression of collagen-degrading enzymes, matrix metalloproteinases (MMPs), but augments the synthesis of type II collagen in chondrocytes (32,33). ...
... The majority of athletes (>70%) are known to routinely utilize nutritional supplements, including glucosamine, chondroitin, collagen, vitamins, calcium and magnesium (22)(23)(24)(25)(26)(27). In the present study, the effect of glucosamine, a chondroprotective agent for OA, on cartilage and bone metabolism was investigated in bicycle racers, using cartilage-and bone-specific biomarkers, including CTX-II, CPII, NTx and BAP. ...
Article
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In the present study, the effect of glucosamine administration (1.5 or 3 g/day) on cartilage and bone metabolism was investigated in bicycle racers, using cartilage‑ and bone‑specific biomarkers, including C‑terminal cross‑linked telopeptides of type II collagen (CTX‑II), C‑terminal propeptides of type II procollagen (CPII), N‑terminal telopeptides of bone‑specific type I collagen (NTx) and bone alkaline phosphatase (BAP). The results indicate that CPII (a marker of type II collagen synthesis) was not substantially changed, however, CTX‑II (a marker of type II degradation) was reduced by glucosamine administration, particularly at a dose of 3 g/day. Consistent with these observations, the ratio of CTX‑II/CPII was reduced by glucosamine administration and the effect of glucosamine was dose‑dependent. By contrast, the levels of NTx (a bone resorption marker) and BAP (a bone formation marker) were not altered by glucosamine administration. A previous study by this group reported that glucosamine exerts a chondroprotective action in soccer players by preventing type II collagen degradation but maintaining type II collagen synthesis. Together these observations indicate that glucosamine may exert a chondroprotective action by preventing type II collagen degradation in athletes of various sports, including soccer players and bicycle racers.
... GlcN is a naturally occurring amino monosaccharide that is mainly located in connective tissue and cartilage as a component of glycosaminoglycans, such as hyaluronic acid and chondroitin sulfate [16]. In the human body, GlcN contributes to maintaining the strength, flexibility, and elasticity of these tissues, and is widely used as a health food to improve joint function [17,18]. ...
... GlcN is an amino monosaccharide that is widely used as a dietary supplement to enable the bending and stretching of the knee joint and reduce discomfort [17,18]. Several studies have shown that GlcN also positively affects bone metabolism, including promotion of mineralization in mouse and human osteoblasts [19,20] and increase in bone mineral density of mouse femurs [21]. ...
Article
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The stepwise development of bone is rigidly controlled from mesenchymal cells through osteoblasts. Dysregulation of this process causes various bone diseases, such as osteoporosis and osteogenesis imperfecta. Recently, it has been noted that the decrease in bone density due to aging occurs not only in the axial skeleton but also in the facial bone. To address this issue, we focused on neural crest-derived osteoblasts that form craniofacial bone, and evaluated several functional ingredients that have been reported to activate osteoblast function using mineralization ability as an index. Glucosamine is a major component of glycosaminoglycans, is highly expressed in connective and cartilage tissues, and is known as a health food that improves joint function. Recent studies suggest that glucosamine promotes oste-oblast activation; however, the underlying mechanism of this phenomenon remains unclear. This study is the first to elucidate the effects of glucosamine on neural crest-derived osteoblast differentiation using human induced pluripotent stem cells. We confirmed that glucosamine promotes osteogenesis of neural crest-derived mesenchymal stromal cells and osteoblasts. Furthermore, glucosamine increased the gene expression as well as the protein levels of osteopontin (OPN) and screlostin (SOST) which are involved in the following two processes: (1) conversion of mesenchymal stromal cells into osteoblasts, and (2) maturation of osteoblasts. These findings suggest that glucosamine plays a role in promoting osteo-genesis and contributes to maintaining a healthy bone condition.
... For its biological properties, GlcN is prescribed as a drug or a dietary supplement in the management of one of the most common joint disorders such as osteoarthritis (OA) to delay the progression of tissue degeneration and to diminish the symptoms in humans [1,4,5]. Moreover, GlcN is recommended for joint health to prevent sports-related cartilage injuries in athlete [6]. To date, GlcN preparations are the most widely used nutraceutical for OA [7,8]. ...
... Despite considerable knowledge of the biological activities of glucosamine (GlcN) including chondroprotective and anti-in ammatory action [1][2][3][4][5][6][7], its role in osteogenesis and bone tissue remains to be investigated in detail. The evidence collected so far on bone cells is mainly based on the use of monolayered non-human cell lines such as mouse MC3T3-E1 [14] and RAW 264.7 [21], fetal osteoblastic cell line hFOB1.19 ...
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Background: Glucosamine (GlcN) functions as a building block of the cartilage matrix and its multifaceted roles in promoting joint health has been extensively investigated. On the contrary, the role of GlcN in osteogenesis and bone tissue is poorly understood, mainly due to the lack of adequate experimental models. Consequently, the benefit of GlcN in bone disorders remains controversial. In order to broaden the pharmacological relevance and potential therapeutic/nutraceutic efficacy of GlcN, we investigated the effect of GlcN on human primary osteoclasts (hOCs) and osteoblasts (hOBs) that were grown with 2D traditional methods or co-cultured in a more complex culture system one step closer to the in vivo bone microenvironment, consisting in a three-dimensional (3D) dynamic system. Methods: Osteoclasts derived from peripheral blood monocytes (hMCs) of either healthy or osteoarthritis (OA) donors, were used and kept in culture with osteoclastogenic inducers. hMCs were also combined with hOBs in a 3D dynamic co‐culture system by using RCCS-4TM bioreactor in osteogenic medium without osteoclastogenic inducers. In this condition osteoclastogenesis was supported by hOBs and sizeable self assembling aggregates were obtained. The differentiated osteoclasts were evaluated by the tartrate-resistant acid phosphatase assay, osteogenic differentiation was monitored by analyzing mineral matrix deposition through Alizarin Red staining, and expression of osteogenic markers through RT-qPCR. The cells were treated with DONA® Crystalline Glucosamine Sulfate (i.e. the original GlcN sulfate product). Results: DONA® was effective in decreasing the hOCs differentiation and function. Osteoclasts from OA donors were more sensitive than those from healthy donors. At the same time, DONA® showed anabolic effects on osteoblasts both in 2D conventional cell culture and in osteoclasts/osteoblasts 3D dynamic co-culture system. Conclusions: Here we demonstrated the effectiveness of a 3D dynamic co-culture system to provide useful information on the spectrum of action of GlcN on bone microenvironment. This can pave the way to better define the potential applications of a compound such as GlcN which is positioned between pharmaceuticals and nutraceuticals. Therefore, based on our observations, we hypothesize that GlcN could have potential benefits either in the treatment of osteopenic diseases such as osteoporosis, or in the bone health maintenance.
... These findings and others indicate that glucosamine, chondroitin, and/or MSM supplementation may have some therapeutic benefits for OA patients. For this reason, dietary supplementation of glucosamine, chondroitin, and/or MSM has been recommended particularly for active individuals [5,272829. Theoretically, glucosamine, chondroitin, and MSM supplementation may provide additive benefits to individuals with knee OA initiating an exercise and weight loss program. The purpose of this study was 1) to determine whether sedentary obese women with knee OA initiating an exercise and weight loss program will experience more favorable changes in body composition, functional status, and/ or markers of health when following a higher protein diet compared to a higher carbohydrate-based diet; 2) to determine whether dietary supplementation of glucosamine , chondroitin, and MSM during a weight loss and exercise program lessens symptoms of pain, improves functional capacity, and/or promotes greater health benefits in women with knee OA; and, 3) to determine whether there are any additive benefits of combining these strategies. ...
... It is the most prevalent musculoskeletal disorder diagnosed in the United States which affects nearly 15% of Americans and costs an estimated $80 billion dollars annually [41]. Athletes with prior knee injuries and individuals who maintain an active lifestyle as they age are also at risk to experience knee pain or degenerative joint issues [5,27,28]. Although the etiology of OA involves multiple factors, obesity has been identified as a primary risk factor involved in the development of the disease [9] . ...
Article
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The purpose of this study was to determine whether sedentary obese women with knee OA initiating an exercise and weight loss program may experience more beneficial changes in body composition, functional capacity, and/or markers of health following a higher protein diet compared to a higher carbohydrate diet with or without GCM supplementation. Thirty sedentary women (54 ± 9 yrs, 163 ± 6 cm, 88.6 ± 13 kg, 46.1 ± 3% fat, 33.3 ± 5 kg/m2) with clinically diagnosed knee OA participated in a 14-week exercise and weight loss program. Participants followed an isoenergenic low fat higher carbohydrate (HC) or higher protein (HP) diet while participating in a supervised 30-minute circuit resistance-training program three times per week for 14-weeks. In a randomized and double blind manner, participants ingested supplements containing 1,500 mg/d of glucosamine (as d-glucosamine HCL), 1,200 mg/d of chondroitin sulfate (from chondroitin sulfate sodium), and 900 mg/d of methylsulfonylmethane or a placebo. At 0, 10, and 14-weeks, participants completed a battery of assessments. Data were analyzed by MANOVA with repeated measures. Participants in both groups experienced significant reductions in body mass (-2.4 ± 3%), fat mass (-6.0 ± 6%), and body fat (-3.5 ± 4%) with no significant changes in fat free mass or resting energy expenditure. Perception of knee pain (-49 ± 39%) and knee stiffness (-42 ± 37%) was decreased while maximal strength (12%), muscular endurance (20%), balance indices (7% to 20%), lipid levels (-8% to -12%), homeostasis model assessment for estimating insulin resistance (-17%), leptin (-30%), and measures of physical functioning (59%), vitality (120%), and social function (66%) were improved in both groups with no differences among groups. Functional aerobic capacity was increased to a greater degree for those in the HP and GCM groups while there were some trends suggesting that supplementation affected perceptions of knee pain (p < 0.08). Circuit style resistance-training and weight loss improved functional capacity in women with knee OA. The type of diet and dietary supplementation of GCM provided marginal additive benefits. ClinicalTrials.gov: NCT01271218.
... With this term we mean supplements based on glucosamine, chondroitin and methylsulfonylmethane (MSM) in different quantity, general ranging from 100 to 400 mg for each; the rationale for use is to provide the fundamental components of tendons and ligaments to favor their tropism and eventually prevent injuries; in CSs the joints are placed under critical stress (jumps, twists, impact from blows) therefore it could be a supplement to consider, even if the specific literature is scarce, there are no specific works in the CSs; this group of molecules has been tested more for support to osteoarticular pathologies, or, in sport, for recovery from injuries [64,65]; our suggestion is to use it in an alternate way, for example, one month on and one-off, in ratio glucosamine/chondroitin/MSM at 400/400/200 mg per day. ...
Article
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In recent years, nutrition applied to the sport has had a great response from technicians and science, justifying more and more the use of the support of food supplements, especially when considering elite athletes and/or professionals. The term combat sport refers to a varied and heterogeneous group of sporting activities, some recognized by the International Olympic Committee, others not; many aspects unite them. They are considered “minor” sports if compared to football, basketball, baseball, as they are less popular at a professional level, but with a great deal of participation at the amateur level; in this sense, everything concerning nutrition and food supplementation is often delegated to the practitioners themselves. This work would like to resume the current (however not abundant) literature and suggest a correct integration, based on the literature available even if not sport-specific, providing a tool for technicians and a starting point for specific works in the future.
... For its biological properties, GlcN is prescribed as a drug or a dietary supplement in the management of one of the most common joint disorders, osteoarthritis (OA), to delay the progression of tissue degeneration and to attenuate the symptoms in humans (1,4,5). Furthermore, GlcN is recommended for joint health to prevent sports-related cartilage injuries in athletes (6). At present, GlcN preparations are the most widely used nutraceutical for OA (7,8). ...
Article
Full-text available
Glucosamine (GlcN) functions as a building block of the cartilage matrix, and its multifaceted roles in promoting joint health have been extensively investigated. However, the role of GlcN in osteogenesis and bone tissue is poorly understood, mainly due to the lack of adequate experimental models. As a result, the benefit of GlcN application in bone disorders remains controversial. In order to further elucidate the pharmacological relevance and potential therapeutic/nutraceutic efficacy of GlcN, the effect of GlcN treatment was investigated in human primary osteoclasts (hOCs) and osteoblasts (hOBs) that were cultured with two‑dimensional (2D) traditional methods or co‑cultured in a 3D dynamic system more closely resembling the in vivo bone microenvironment. Under these conditions, osteoclastogenesis was supported by hOBs and sizeable self‑assembling aggregates were obtained. The differentiated hOCs were evaluated using tartrate‑resistant acid phosphatase assays and osteogenic differentiation was monitored by analyzing mineral matrix deposition via Alizarin Red staining, with expression of specific osteogenic markers determined via reverse transcription‑quantitative PCR. It was found that crystalline GlcN sulfate was effective in decreasing osteoclastic cell differentiation and function. hOCs isolated from patients with OA were more sensitive compared with those from healthy donors. Additionally, GlcN exhibited anabolic effects on hOCs both in 2D conventional cell culture and in hOC/hOB 3D dynamic co‑culture. The present study demonstrated for the first time the effectiveness of a 3D dynamic co‑culture system for characterizing the spectrum of action of GlcN on the bone microenvironment, which may pave the way for more fully determining the potential applications of a compound such as GlcN, which is positioned between pharmaceuticals and nutraceuticals. Based on the present findings, it is hypothesized that GlcN may have potential benefits in the treatment of osteopenic diseases such as osteoporosis, as well as in bone maintenance.
... Glucosamine has been reported to have a positive effect on the synthesis and degradation of cartilage (14-17) and a stimulatory effect on production of hyaluronic acid in the synovium (18). In a study performed in young athletes, 4 wk of glucosamine consumption improved the passive range of motion in injured knees (19). Thus far, there are no reports of glucosamine improving the active range of motion at any joint. ...
Article
Care of the musculoskeletal system, including the muscles, joints, and bones, is important for a healthy life expectancy in today’s aging society. The aim of this randomized, double-blind, placebo-controlled study was to investigate the effect of consumption of milk-fat globule membrane (MFGM) and glucosamine on joint function and physical performance. Participants were healthy Japanese men and women, aged 60-74 y, with a history of mild knee or low back pain at rest. They were randomized to receive tablets containing MFGM 1.0 g+glucosamine 1.5 g or placebo tablets for 8 wk. We assessed passive range of motion, active range of motion (self-reported VAS score), JKOM and JLEQ, and physical performance. Data were available for analysis for 25 participants in the active treatment group and 28 in the placebo group. The active group showed significant improvements in passive range of motion at the knee and active range of motion at both the knee and low back. The active group also showed significant improvements in some physical performance, including obstacle walking speed and speed of ascending stairs. The findings of this study suggest that consumption of a combination of MFGM and glucosamine may improve joint function and physical performance.
... Nutritional supplements containing such as glucosamine, chondroitin and collagen are often administered for 'joint health' of sports-related cartilage injuries (osteoarthritis) in athletes (10)(11)(12)(13). Among these substances, glucosamine, an amino monosaccharide, has been widely used to prevent or treat osteoarthritis in humans (14)(15)(16)(17). ...
Article
A randomized double‑blind placebo‑controlled clinical study was conducted to evaluate the chondroprotective action of glucosamine on healthy subjects (soccer players) without joint disorders. Collegiate soccer players (n=43) without joint disorders were randomly assigned to receive a glucosamine (2 g/day)‑containing supplement (n=22, glucosamine group) or a placebo (n=21, placebo group) for 16 weeks, and cartilage metabolism was evaluated by analyzing markers for type II collagen degradation urine C‑terminal telopeptide‑II (CTX‑II) and serum collagen type II cleavage (C2C) and synthesis urine C-terminal type II procollagen peptide (CPII). In the initial analysis of all subjects, urine CTX‑II level substantially decreased in the glucosamine group, but not in the placebo group after the intervention for 16 weeks (P=0.05). Moreover, CTX‑II level in the glucosamine group was also significantly lower than that in the placebo group at week 16 during the intervention. In the second analysis, to make the effect of the test supplement more clear, 41 subjects with less variation of exercise loading were evaluated. The results revealed that urine CTX‑II level significantly decreased in the glucosamine group (n=21), but not in the placebo group (n=20) after the intervention (P<0.05). Moreover, CTX‑II levels in the glucosamine group significantly decreased compared with the placebo group after the intervention (P<0.05). Both in the initial and second analyses, serum C2C level significantly decreased in the glucosamine group, but not in the placebo group after the intervention (P<0.05). In contrast, urine CPII level was not significantly changed even after the intervention in both the placebo and glucosamine groups. Importantly, no test supplement‑related adverse events were observed. These observations suggest that oral administration of glucosamine (2 g/day for 16 weeks) exerts a chondroprotective action on healthy subjects (soccer players) without joint disorders. This effect was achieved by improving cartilage metabolism (suppressing type II collagen degradation but maintaining type II collagen synthesis), without causing apparent adverse effects.
... Nutritional supplements, including glucosamine, N-acetylglucosamine, chondroitin and collagen, are used for ʻjoint healthʼ to treat or prevent cartilage disorders, including osteoarthritis (13)(14)(15). Among these, glucosamine inhibits the degradation and stimulates the synthesis of the characteristic glycosaminoglycan polysaccharide chains of proteoglycans (16,17). ...
Article
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Background: To evaluate the chondroprotective action of an N-acetyl-glucosamine (GlcNAc)-containing supplement on the joint health of healthy individuals without symptoms of arthritis, we conducted a randomized double-blind placebo-controlled clinical trial. Methods: Subjects (n=100, 51.3 ± 1.0 years (mean ± SE)) without symptoms of arthritis were randomly assigned to receive a 1000 mg GlcNAc-containing diet (GlcNAc group) or a placebo diet (placebo group) once a day for 16 weeks, and the effect on the cartilage metabolism was evaluated by analyzing the ratio of type II collagen degradation to synthesis using type II collagen degradation (C2C) and synthesis (PIICP) markers. Results: The results indicated that the changes in the C2C/PIICP ratios from the baseline were slightly suppressed in the GlcNAc group compared with those in the placebo group at weeks 16 during the intervention and 4 weeks after the intervention. However, there was no significant difference between the two groups. To make the effect of GlcNAc even more clear, the subjects with joint loading and impaired cartilage metabolism were evaluated. Interestingly, the changes in the C2C/PIICP ratios from the baseline were significantly suppressed in the GlcNAc group compared with the placebo group at weeks 16 during the intervention and 4 weeks after the intervention. Moreover, test supplement-related adverse events were not essentially observed during and after the intervention. Conclusions: These observations suggest that the oral administration of GlcNAc at a dose of 1000 mg/day exerts a chondroprotective action on the healthy individuals by lowering the C2C/PIICP ratio, which indicates relative reduction of type II collagen degradation and increase of type II collagen synthesis, without apparent adverse effect.
... De alguna manera protege de la movilidad excesiva o la carga y mejora la marcha, incluso en actividades deportivas, determinadas por biomarcadores, como keratan sulfato, ácido hialurónico, condroitín sulfato y en especial la eliminación urinaria de productos de degradación del telopéptido C terminal del colágeno (CTX II); pero una vez que cesa la administración del medicamento no se mantiene el efecto. Vale la pena comunicar que existe un informe que puso en evidencia que, en aquellas personas que consumían este producto, había disminución de la mortalidad, de manera especial las portadoras de cáncer y enfermedades respiratorias, a pesar de los errores de sesgo que pudieran existir [55][56][57][58][59][60][61][62][63][64][65][66] . ...
Article
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La osteoartrosis, en lo que se refiere a sus aspectos diagnósticos como las imágenes y los marcadores bioquímicos, está evolucionando de manera satisfactoria; en lo que se refiere a terapéutica, y en particular el objetivo de esta revisión, que el uso de la glucosamina y el condroitín sulfato en seres humanos es seguro, mejora el dolor y la inflamación, disminuye la utilización de los cada vez menos recomendados, para usarlos de manera continua en el anciano, antiinflamatorios no esteroideos (DAINEs), y algunos estudios prospectivos, aleatorios, doble ciego y controlados con placebo, demuestran que previenen su evolución y retrasan la posibilidad de una artroplastia de rodilla.
... It was reported that 76% of them gained full recovery. Ostojic, Arsic, Prodanovic, Vukovic, and Zlatanovic (2007) administered 1500 mg of glucosamine sulfate and placebo to the athletes with acute knee injuries for 4 weeks. No significant difference was found between the groups in pain scores and degree of knee swelling. ...
Article
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Although glucosamine is commonly consumed by athletes, its effectiveness in sports injuries is still under debate. We aimed to investigate the effects of glucosamine to the rehabilitation outcomes of anterior cruciate ligament (ACL) reconstructed athletes. Glucosamine-sulfate (1000 mg daily, for 8 weeks) was administered to half of the cohort of 30 male athletes, the other half used a placebo. Both groups received the same rehabilitation protocol. Knee pain and functions were evaluated by a visual analogue scale (VAS), International Knee Documentation Committee (IKDC) and Lysholm scores before and after oral administration. Additionally, an isokinetic test was performed after the administration period. The scores revealed significant improvements in both groups after 8 weeks, but no significant difference was detected between groups in any of the parameters. Glucosamine supplementation did not improve the rehabilitation outcomes of athletes after ACL reconstruction. This is the first study investigating this topic. Further studies will help to obtain clear evidence about glucosamine efficacy on ACL injured or ACL reconstructed athletes.
... The applicant provided two human studies as pertinent to the claim. The first study was a randomized, double-blind, placebo-controlled trial [50] including 121 male patients who had a recent history of acute knee sport injury. They received either 1.5 g GlcN (n=62) per day or placebo (cellulose; n = 59) for 28 days. ...
Article
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The aim of this paper was to provide an overview of the current knowledge and understanding of the potential beneficial physiological effects of glucosamine (GlcN) on joint health. The objective was to reach a consensus on four critical questions and to provide recommendations for future research priorities. To this end, nine scientists from Europe and the United States were selected according to their expertise in this particular field and were invited to participate in the Hohenheim conference held in August 2011. Each expert was asked to address a question that had previously been posed by the chairman of the conference. Based on a systematic review of the literature and the collection of recent data, the experts documented the effects of GlcN on cartilage ageing, metabolic/kinetic and maintenance of joint health as well as reduction of risk of OA development. After extensive debate and discussion the expert panel addressed each question and a general consensus statement was developed, agreeing on the current state-of-the-art and future areas for basic and clinical studies. This paper summarizes the available evidence for beneficial effects of GlcN on joint health and proposes new insight into the design of future clinical trials aimed at identifying beneficial physiological effect of GlcN on joint tissues.
... In addition, we focused on the potential of nutraceuticals for the prevention and treatment of such subclinical joint pains. Glucosamine and chondroitin are two popular dietary supplements being promoted for the maintenance of joint health among athletes (12)(13)(14)(15). In addition, our previous study demonstrated that the intake of a dietary supplement containing chicken comb extract (CCE) rich in hyaluronan (HA) (CCE supplement) was effective in improving pain and dysfunction of afflicted joints in patients with knee OA (16). ...
Article
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Much of our focus of attention has been on sub-clinical or subtle joint pain experienced by healthy soccer players. The present study aimed to determine at which joint such subclinical pains are the most prominent, and to examine the pain-relieving effect of a chicken comb extract (CCE)-containing supplement product (test product) on these athletes. A total of 46 collegiate soccer players, consisting of 24 leading and 22 substitute players, belonging to a university soccer team were enrolled for measuring the pains at 4 different joints (ankle, knee, hip and shoulder) using 3 pain subscales of a 100-mm visual analog scale (VAS) ('pain at rest', 'pain on pressing' and 'pain on moving'), and participated in a prospective, double-blind, controlled study. A total of 23 subjects each received the test product (4,800 mg/day) (test group) and placebo (placebo group) for 12 weeks. VAS pain scores of individual joints were evaluated at baseline and following 4, 8 and 12 weeks of the intervention. VAS scores for the 'pain on moving' subscale in 46 enrolled subjects were highest at the ankle joint, and thus the values (abbreviated as 'pain scores') were used as a parameter for efficacy assessment of the test product. Compared to the baseline, the pain scores were significantly decreased for the dominant foot (but not for the non-dominant foot) in the total subpopulation (at week 4; p<0.01) and the leading player subpopulation (at week 4; p<0.01 and at week 12; p<0.05) in the test group (n=19 and 11, respectively). In comparison between the test product and placebo groups, the pain scores were significantly changed for the dominant foot (p<0.05) at week 4 in the total subpopulation and at week 12 in the leading player subpopulation in the test group. Thus, subclinical joint pain is most prominently observed at the ankle joint of the dominant foot in healthy young soccer players and may be improved by the daily intake of the CCE-containing supplement.
Article
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Preface: Aging is a stage of life that increases the risk of physical diseases, some of which are chronic and can affect different dimensions of life’s quality. In addition, These days, exercising is effective in preventing chronic diseases such as osteoarthritis. The goal of the present research is to study the effect of a period of exercise in water program on the scale of knee pain, the rate of symptoms and the movement problems in daily activities, sports activities and pastime activities and the quality of old adults life.
Article
In endurance athletes with intense joint loading, cartilage metabolism (degradation of type II collagen) is enhanced compared with non-athletes and non-endurance athletes. Recently, we have revealed that glucosamine, a functional food, exerts a protective action on cartilage metabolism in not only osteoarthritis patients but also endurance athletes (such as soccer players) by suppressing the degradation of type II collagen. In this review, to demonstrate these findings, the following topics will be presented: 1. Biomarkers for cartilage metabolism; 2. Evaluation of cartilage metabolism in endurance athletes by using biomarkers for cartilage metabolism; 3. Chondroprotective action of glucosamine on endurance athletes.
Article
It has been reported that cartilage metabolism (type II collagen degradation) is enhanced in endurance athletes with intense joint loading. Notably, glucosamine, a chitosan monomer, exhibits a chondroprotective action on osteoarthritis by inhibiting type II collagen degradation. Here, we evaluated the action of glucosamine on cartilage metabolism in soccer and rugby players with intense joint loading. In soccer and rugby players, the urine level of type II collagen degradation maker (CTX-II) was significantly increased compared with non-athlete control, indicating that cartilage metabolism is enhanced in these athletes. In contrast, the urine level of type II collagen synthesis maker (CPII) was almost the same as in non-athletes. These findings suggest that type II collagen degradation is relatively increased compared with type II collagen synthesis in these athletes. Interestingly, the administration of glucosamine-containing diet significantly decreased the CTX-II level but not the CPII level in these athletes. These observations suggest that cartilage metabolism (type II collagen degradation) is increased in endurance athletes (such as soccer and rugby players), and glucosamine demonstrates a chondroprotective action on these athletes by preventing type II collagen degradation but maintaining type II collagen synthesis.
Article
Cartilage and bone metabolism (type II collagen degradation) is increased by endurance exercise with intense joint loading. Interestingly, glucosamine-containing diet exhibits a chondroprotective action on osteoarthritis by inhibiting type II collagen degradation and improves the symptoms. Thus, in the present study, we evaluated the effect of glucosamine on cartilage metabolism in collegiate soccer players and professional rugby players with intense joint loading. In soccer and rugby players, the urine level of type II collagen degradation maker CTX-II was significantly increased compared with non-athlete control, indicating that cartilage metabolism (type II collagen degradation) is increased in these athletes. In contrast, the urine level of type II collagen synthesis maker CPII was almost the same as in non-athletes. Based on these findings, the CTX-II/CPII ratios were higher in soccer and rugby players than non-athletes, suggesting that type II collagen degradation is relatively increased compared with type II collagen synthesis in these athletes. Importantly, the administration of glucosamine significantly decreased the CTX-II levels in soccer and rugby players; however, the CTX-II level returned to almost the pre-administration level after withdrawal of glucosamine administration. In contrast, the CPII level was not essentially changed during the test period. Based on these findings, the CTX-II/CPII ratios were reduced by glucosamine administration, and returned to the pre-administration level after withdrawal of glucosamine. Together these observations suggest that glucosamine exhibits a chondroprotective action on endurance athletes, such as soccer and rugby players by preventing type II collagen degradation but maintaining type II collagen synthesis. However, the effect is transient and disappears after withdrawal of the administration.
Article
Objective: This study was designed with the intent to serve as an exploratory pilot and first step toward integrating Lesbian, Gay, Bisexual, and Transgender (LGBT) clinical education into the curriculum of Osteopathic and southeastern medical schools. Methods: Using a quasi-experimental study, second year Osteopathic medical students were studied for their clinical knowledge of LGBT health, attitudes toward LGBT patients, and use of sensitive language while obtaining sexual history from Standardized Patients (SPs) before and after exposure to a didactic module. Results: We found attitudes of LGBT health to be unaffected by the intervention (P=0.63) while clinical knowledge improved (P=0.11). Sensitive language used by students during sexual history gathering was similar between groups with no correlation with student LGBT health/knowledge scores. The results support previous literature suggesting a change in medical school curriculum can increase student awareness of LGBT health needs. Attitude scores toward LGBT patients of the studied students were slightly lower than those of six other osteopathic schools, and within the constraints of this study it appears a single didactic module was insufficient in changing attitude scores. Conclusion: With research being limited on this topic, our study provides guidance and methods for implementing LGBT care training into Osteopathic medical education. We hope our baseline data in conjunction with other studies will provoke further research into the most effective means for implementation. Further research should include multi-modal didactics including small group sessions, lectures, and clinical exposure to LGBT individual(s), as has been suggested and implemented in few other studies.
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In endurance athletes with intense joint loading, cartilage metabolism (degradation of type II collagen) is enhanced compared with non-athletes and non-endurance athletes. Recently, we have revealed that glucosamine, a functional food, exerts a protective action on cartilage metabolism in not only osteoarthritis patients but also endurance athletes (such as soccer players and rugby players) by suppressing the degradation of type II collagen. In this review, to demonstrate these findings, the following topics will be explained: 1. Biomarkers for cartilage metabolism; 2. Evaluation of osteoarthritis and endurance sports by using biomarkers of cartilage metabolism; 3. Chondroprotective action of glucosamine on osteoarthritis patients and endurance sports athletes; 4. Glucosamine as a “Food with Function Claim”.
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Preface: Aging is a stage of life that increases the risk of physical diseases, some of which are chronic and can affect different dimensions of life’s quality. In addition, These days, exercising is effective in preventing chronic diseases such as osteoarthritis. The goal of the present research is to study the effect of a period of exercise in water program on the scale of knee pain, the rate of symptoms and the movement problems in daily activities, sports activities and pastime activities and the quality of old adults life. Materials and methods: Fifteen old men afflicted with osteoarthritis were chosen purposely as the testees by age mean and Std 58 ±6.5, length 167.12 ±7.35 cms, weight 75.64 ±7.64. We used global questionnaire of the consequences of knee injuries and osteoarthritis to collect data.The testees practiced the exercise in water program in ten weeks. we analyzed the achieved data by a correlated t-test at a meaningful level. (p<0.05). Results: Among the post-test and pre-test the symptoms scale p=0.043, knee pain p=0.024, movement operation in daily and pastime activities p=0.018 were recovered meaningfully after the program. Conclusion: The results showed that participating in an exercise in water program on a regular basis can be considered as an effective and reliable method to decrease pain, promote the operation of knee and the old men life's quality. 1. PREFACE
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Background: Strenuous, high-volume exercise is often associated with inflammation and joint pain. Cissus quadrangularis (CQ) has been reported to have anti-inflammatory activity. The purpose of our study was to determine the therapeutic effects of CQ supplementation in healthy, exercise-trained men with joint-specific pain. Methods: Twenty-nine men between the ages of 20 and 46 years, who reportedly experienced chronic joint pain as a result of strenuous exercise, participated in our pilot study. All men received CQ 3200 mg daily for 8 weeks. Before and after the 8-week intervention period, subjects completed a questionnaire to determine their degree of joint pain (Western Ontario and McMaster Universities Index of Osteoarthritis [WOMAC]). Clinical measures (eg, heart rate, blood pressure, blood biomarkers) were also collected for each subject pre- (baseline) and post-intervention. Results: Subject ratings for multiple variables within the WOMAC Index improved (decreased) significantly (P < 0.05), with the subject mean total WOMAC score decreasing from 25.4 ± 2.4 to 17.4 ± 2.1 (~31%), pre- to post-intervention. No clinical measure was significantly impacted by use of CQ supplementation. Conclusion: An 8-week course of supplementation with CQ reduced joint pain in a sample of 29 young, otherwise healthy, exercise-trained men. Additional study is needed to extend these findings, including comparison with a placebo-controlled cohort, and possibly, examining effects of CQ use in women and older adult subjects.
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Through a well-established enzymatic transformation glucosinolates release reactive isothiocyanates that can undergo further metabolic pathways affording a plethora of reactive metabolites. This study explores in detail the reaction of benzyl isothiocyanate, which possesses antitumor activity as alkylating agent, with d-glucosamine, commonly employed in oral treatments against osteoarthritis and inflammation. Structures of the resulting products and their evolution have been assessed and compared with those involving d-glucose, reported previously. Chemical results suggest that clinical treatments with d-glucosamine could reduce the beneficial effects associated with diets based on glucosinolate-rich foods.
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Aim: To assess suspected turbinate mucosal distractive changes of CO2 laser partial turbinectomy as compared to submucosal diathermy technique of hypertrophied inferior turbinates and thus risk of appearance of mucosal atrophic changes Introduction:CO2 laser turbinotomy or turbinectomy has become an established well documented line of treatment of hypertrophied inferior turbinates not responding to medical treatment. Although there have been several reports discussing the clinical aspects of laser turbinectomy, but exact pathological changes that take place following laser application to the turbinate have not been described completely and clearly. For this reason this study was conducted to confirm these possible histopathological changes and compared with those following submucosal diathermy technique. Patients and methods : Twenty patients with chronic hypertrophied inferior turbinates and presenting mainly with nasal obstruction, ten out of them were subjected to CO2 laser turbinectomy while other half underwent to submucosal diathermy technique. Tiny biopsies were taken immediately after surgery (within one week after surgery), as well as 4-6 weeks later and processed for further histopathological evaluation. Results : By 100%, the all patients of two groups showed areas of epithelial loss were observed immediately after both techniques. 4-6 weeks after laser application 60% of patients showed normal epithelial areas as compared to second group where 20% of patients who showed normal epithelial picture. Conclusion : CO2 laser turbinectomy can be considered as more preservative technique for nasal mucosa as well as the function of the nose as compared to submucosal diathermy technique
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In the present study, to investigate the effect of glucosamine, a component of glycosaminoglycans with a chondroprotective action, on articular cartilage in athletes, we looked at soccer players, who expose their joints to excessive motion and loading, and compared the levels of biomarkers for type II collagen degradation (CTX-II) and type II collagen synthesis (CPII) between soccer players and non-athlete controls, and in soccer players before and after glucosamine-administration. CTX-II (P<0.01) and CPII (P=0.08) levels were substantially elevated in soccer players compared with those in controls, indicating that cartilage metabolism (type II collagen degradation and synthesis) is increased in soccer players. Of note, glucosamine administration (1.5 g and 3 g/day for 3 months) significantly decreased the CTX-II level (P<0.05); however, the effect disappeared after withdrawal of administration. In contrast, glucosamine administration did not essentially affect the increased level of CPII. Furthermore, cartilage damage was evaluated by using the ratio of type II collagen breakdown to synthesis (CTX-II/CPII). The ratio in soccer players was significantly higher than that in controls (P<0.05), suggesting that type II collagen degradation is relatively enhanced compared with type II collagen synthesis in soccer players than in control students. Of importance, the ratio was reduced by glucosamine administration but returned to the pre-administration level after withdrawal of administration. Together these observations suggest that glucosamine is expected to exert a chondroprotective action in athletes (soccer players) by preventing type II collagen degradation but maintaining type II collagen synthesis, although the effect is transient and disappears after withdrawal of administration.
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A questionnaire using a system of visual analog scales was developed for analyzing subjective knee com plaints. This system was tested on 117 consecutive patients who had undergone knee surgery and 65 patients at their initial office evaluation of a knee disor der. The validity of and patient affinity for this type of questionnaire was compared with that of three other established subjective evaluation methods. The visual analog scale system was shown to be valid and comparable to other methods while offering several advantages. It brought greater sensitivity and greater statistical power to data collection and analysis by allowing a broader range of responses than did traditional categorical responses. It removed bias that was introduced by examiner questioning, and it allowed graphic temporal comparisons. Most importantly, pa tient affinity was higher for this type of subjective evaluation than for other methods.
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Eighty inpatients with established osteoarthrosis received either 1.5 gm of glucosamine sulfate or placebo daily, in three divided oral doses, for 30 days. Articular pain, joint tenderness and swelling, and restriction of active and passive movements were scored at one-week intervals, as were possible side reactions. Hematologic analysis, urine analysis, and occult blood in feces were recorded before and after treatment. Samples of articular cartilage from two patients of each group and from one healthy subject were submitted to scanning electron microscopy after the end of treatment. All symptoms decreased in both groups. The patients treated with glucosamine sulfate experienced a reduction in overall symptoms that was almost twice as large (73% vs. 41%) and twice as fast (time to reduce symptoms by 50%: 20 days vs. 36 days) as those who had placebo. The improvement of autonomous mobility was relatively less, compared to improvement in the other symptoms, for patients with placebo; with glucosamine sulfate, on the contrary, the improvement was as great and as fast as that of the other symptoms. Thus a direct action of glucosamine sulfate on the cartilage is hypothesized. This hypothesis is supported by the findings of electron microscopy. The patients who had placebo showed a typical picture of established osteoarthrosis. Those who had glucosamine sulfate showed a picture more similar to healthy cartilage. It is concluded that glucosamine sulfate tends to rebuild the damaged cartilage, thus restoring articular function in most chronic arthrosic patients.
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To review the pharmacology and pharmacokinetics of glucosamine and critically evaluate currently available literature regarding its safety and efficacy. A MEDLINE search was conducted between January 1965 and May 1997. Key words used in the search were osteoarthritis, osteoarthrosis, gonarthrosis, and glucosamine. In addition, references cited in articles obtained from the MEDLINE search were reviewed for additional literature. All articles were considered for inclusion in the review. Articles were excluded from critical evaluation for lack of randomization, lack of a control group, 30 or fewer study participants, inconsistent treatment regimen, incomplete dosing information, or incomplete reporting of results. Osteoarthritis affects approximately 12% of the US population; the incidence increases with increasing age. Currently used pharmacologic treatments, including acetaminophen and nonsteroidal antiinflammatory drugs, do not slow or reverse the degenerative process in osteoarthritis. Glucosamine has recently received a great deal of attention from the public as a potential treatment of osteoarthritis, prompting healthcare professionals to investigate its clinical usefulness and potential for adverse effects. The drug has been proposed to stop and possibly reverse the degenerative process in osteoarthritis. Following absorption of an oral dose, glucosamine is incorporated into plasma proteins during first-pass metabolism, resulting in 26% bioavailability. Unbound glucosamine is concentrated in the articular cartilage. Each of the three critically evaluated studies reported a decrease in the symptoms of osteoarthritis (e.g., decreased Lequesne index, decreased pain severity, increased range of motion) for the glucosamine group, which was greater than that obtained in the control group. Flaws in study design, however, prevent the use of these results in modifying current clinical practice. Reported short-term adverse effects include mild gastrointestinal problems, drowsiness, skin reactions, and headache. Improvement in the symptoms of osteoarthritis associated with the use of glucosamine has been observed in clinical trials; however, those trials have flaws in design and data analysis. Further research needs to be conducted before glucosamine can be recommended as a treatment for osteoarthritis.
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Glucosamine and chondroitin preparations are widely touted in the lay press as remedies for osteoarthritis (OA), but uncertainty about their efficacy exists among the medical community. To evaluate benefit of glucosamine and chondroitin preparations for OA symptoms using meta-analysis combined with systematic quality assessment of clinical trials of these preparations in knee and/or hip OA. We searched for human clinical trials in MEDLINE (1966 to June 1999) and the Cochrane Controlled Trials Register using the terms osteoarthritis, osteoarthrosis, degenerative arthritis, glucosamine, chondroitin, and glycosaminoglycans. We also manually searched review articles, manuscripts, and supplements from rheumatology and OA journals and sought unpublished data by contacting content experts, study authors, and manufacturers of glucosamine or chondroitin. Studies were included if they were published or unpublished double-blind, randomized, placebo-controlled trials of 4 or more weeks' duration that tested glucosamine or chondroitin for knee or hip OA and reported extractable data on the effect of treatment on symptoms. Fifteen of 37 studies were included in the analysis. Reviewers performed data extraction and scored each trial using a quality assessment instrument. We computed an effect size from the intergroup difference in mean outcome values at trial end, divided by the SD of the outcome value in the placebo group (0.2, small effect; 0.5, moderate; 0.8, large), and applied a correction factor to reduce bias. We tested for trial heterogeneity and publication bias and stratified for trial quality and size. We pooled effect sizes using a random effects model. Quality scores ranged from 12.3% to 55.4% of the maximum, with a mean (SD) of 35.5% (12%). Only 1 study described adequate allocation concealment and 2 reported an intent-to-treat analysis. Most were supported or performed by a manufacturer. Funnel plots showed significant asymmetry (P< or =.01) compatible with publication bias. Tests for heterogeneity were nonsignificant after removing 1 outlier trial. The aggregated effect sizes were 0.44 (95% confidence interval [CI], 0.24-0.64) for glucosamine and 0.78 (95% CI, 0.60-0.95) for chondroitin, but they were diminished when only high-quality or large trials were considered. The effect sizes were relatively consistent for pain and functional outcomes. Trials of glucosamine and chondroitin preparations for OA symptoms demonstrate moderate to large effects, but quality issues and likely publication bias suggest that these effects are exaggerated. Nevertheless, some degree of efficacy appears probable for these preparations.
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Chronic knee pain is common at all ages, particularly in the elderly, among whom it has its greatest impact. Chronic knee pain is often ascribed to osteoarthritis in adults and to chondromalacia patellae in children and adolescents. Pathological findings in both these conditions correlate poorly, however, with the severity of knee pain and disability. Psychometric variables correlate better with the impact of knee osteoarthritis, suggesting that this disorder has characteristics of a regional pain syndrome. This perception may reflect our lack of understanding of the biological mechanisms in these disorders. This possibility has been highlighted by the advent of magnetic resonance imaging, and by recent studies of muscle function, reflex quadriceps inhibition and proprioception in people with knee osteoarthritis. Established risk factors for knee osteoarthritis include increased body weight, knee injury and aspects of occupational activity. Recent studies have also suggested a possible role for oestrogens and vitamins C and D in the secondary prevention of this disorder. The emergence of 'nutraceuticals' such as glucosamine as treatments for osteoarthritis has captured the public imagination and merits further study.
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Treatment of osteoarthritis is usually limited to short-term symptom control. We assessed the effects of the specific drug glucosamine sulphate on the long-term progression of osteoarthritis joint structure changes and symptoms. We did a randomised, double-blind placebo controlled trial, in which 212 patients with knee osteoarthritis were randomly assigned 1500 mg sulphate oral glucosamine or placebo once daily for 3 years. Weightbearing, anteroposterior radiographs of each knee in full extension were taken at enrolment and after 1 and 3 years. Mean joint-space width of the medial compartment of the tibiofemoral joint was assessed by digital image analysis, whereas minimum joint-space width--ie, at the narrowest point--was measured by visual inspection with a magnifying lens. Symptoms were scored by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. The 106 patients on placebo had a progressive joint-space narrowing, with a mean joint-space loss after 3 years of -0.31 mm (95% CI -0.48 to -0.13). There was no significant joint-space loss in the 106 patients on glucosamine sulphate: -0.06 mm (-0.22 to 0.09). Similar results were reported with minimum joint-space narrowing. As assessed by WOMAC scores, symptoms worsened slightly in patients on placebo compared with the improvement observed after treatment with glucosamine sulphate. There were no differences in safety or reasons for early withdrawal between the treatment and placebo groups. The long-term combined structure-modifying and symptom-modifying effects of gluosamine sulphate suggest that it could be a disease modifying agent in osteoarthritis.
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Conventional symptomatic treatments for osteoarthritis do not favorably affect disease progression. The aim of this randomized, placebo-controlled trial was to determine whether long-term (3-year) treatment with glucosamine sulfate can modify the progression of joint structure and symptom changes in knee osteoarthritis, as previously suggested. Two hundred two patients with knee osteoarthritis (using American College of Rheumatology criteria) were randomized to receive oral glucosamine sulfate, 1500 mg once a day, or placebo. Changes in radiographic minimum joint space width were measured in the medial compartment of the tibiofemoral joint, and symptoms were assessed using the algo-functional indexes of Lequesne and WOMAC (Western Ontario and McMaster Universities). Osteoarthritis was of mild to moderate severity at enrollment, with average joint space widths of slightly less than 4 mm and a Lequesne index score of less than 9 points. Progressive joint space narrowing with placebo use was -0.19 mm (95% confidence interval, -0.29 to -0.09 mm) after 3 years. Conversely, there was no average change with glucosamine sulfate use (0.04 mm; 95% confidence interval, -0.06 to 0.14 mm), with a significant difference between groups (P =.001). Fewer patients treated with glucosamine sulfate experienced predefined severe narrowings (>0.5 mm): 5% vs 14% (P =.05). Symptoms improved modestly with placebo use but as much as 20% to 25% with glucosamine sulfate use, with significant final differences on the Lequesne index and the WOMAC total index and pain, function, and stiffness subscales. Safety was good and without differences between groups. Long-term treatment with glucosamine sulfate retarded the progression of knee osteoarthritis, possibly determining disease modification.
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The purpose of this study was to examine the effects of oral glucosamine supplementation on the functional ability and degree of pain felt by individuals who had regular knee pain, most likely due to previous articular cartilage damage, and possibly osteoarthritis. Subjects were randomly supplemented with either glucosamine (G) (n=24) or placebo (P) (lactose) (n=22) for 12 weeks at a dose of 2,000 mg per day. Over this period, four testing sessions were conducted, with changes in knee pain and function assessed by clinical and functional tests, (joint line palpation, a 3 metre "duck walk" and a repeated, walking stair climb), two questionnaires (the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Knee Pain Scale (KPS)) and participant subjective evaluations. The clinical and functional test scores improved with time (main effects: p<0.05, p<0.01) but there were no significant differences between the two groups. The questionnaire results also recorded a significant main effect for time (p<0.05), but the glucosamine group was found to have significantly better KOOS quality of life scores at week eight and 12 (p<0.05), and lower KPS scores (p<0.05) at week eight than the placebo group. On self report evaluations of changes across the 12 week supplementation period, 88% (n=21) of the glucosamine group reported some degree of improvement in their knee pain versus only 17% (n=3) in the placebo group. These results suggest that glucosamine supplementation can provide some degree of pain relief and improved function in persons who experience regular knee pain, which may be caused by prior cartilage injury and/or osteoarthritis. The trends in the results also suggest that, at a dosage of 2,000 mg per day, the majority of improvements are present after eight weeks.
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To investigate the structural and symptomatic efficacy and safety of glucosamine in knee osteoarthritis (OA). Clinical trials of glucosamine were identified through electronic searches (MEDLINE, EMBASE, BIOSIS, EMB review, the Cochrane Library) using the key words glucosamine, osteoarthritis, degenerative joint disease, degenerative arthritis, osteoarthrosis, gonarthrosis, knee, disease progression, and clinical trial. The bibliographic databases were searched from their respective inception dates to August 2004. We also hand-searched reference lists of relevant articles. Studies were included if they were double-blind, randomized, controlled trials that evaluated oral glucosamine long-term treatment in knee OA; lasting at least one year; and reporting as outcome measures the symptom severity and disease progression as assessed by joint space narrowing. Two authors interpreted data independently. Disagreements were resolved through discussion. Glucosamine sulfate was more effective than placebo in delaying structural progression in knee OA. The risk of disease progression was reduced by 54% (pooled RR 0.46; 95% CI 0.28 to 0.73; p = 0.0011). The number-needed-to-treat was 9 (95% CI 6 to 20). The pooled effect sizes for pain reduction and improvement in physical function were 0.41 (95% CI 0.21 to 0.60; p < 0.0001) and 0.46 (95% CI 0.27 to 0.66; p < 0.0001), respectively, in favor of glucosamine sulfate. Glucosamine sulfate caused no more adverse effects than placebo. The available evidence suggests that glucosamine sulfate may be effective and safe in delaying the progression and improving the symptoms of knee OA. Due to the sparse data on structural efficacy and safety, further studies are warranted.
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To determine whether glucosamine sulfate has an effect on cartilage type II collagen degradation in patients with knee osteoarthritis (OA). A randomized, double blind, placebo controlled glucosamine discontinuation trial was conducted in 137 subjects with knee OA, who had had at least moderate relief of knee pain after starting glucosamine. Subjects were randomized to glucosamine at prestudy dose or placebo at an equivalent dose. Treatment was continued to Week 24 or disease flare, whichever occurred first. Serum and urine samples were collected at Weeks 0, 4, 12, and 24 or flare visit. Samples were analyzed in triplicate for 2 type II collagen degradation biomarkers: C2C epitope (COL2-3/4C(long)) and C1,2C epitope (COL2-3/4C(short)). The primary outcome was the mean change in serum and urine C1,2C/C2C ratio in the glucosamine and placebo groups from baseline to final (flare or Week 24) visit. Linear regression analyses were conducted to adjust for potential confounders. Due to non-normal distributions, the data were log-transformed (lnC1,2C/C2C). Secondary outcomes included comparison of mean change scores at final visit compared to baseline for serum and urine C1,2C and C2C in the 2 treatment groups and in Flare versus No-Flare groups. Baseline and final visit samples were available in 130 subjects for serum analysis and 126 subjects for urinalysis. No significant difference was seen between placebo and glucosamine groups in the serum C1,2C/C2C ratio, with a mean (SD) change from baseline to final visit of 0.8 (27.8) and -0.1 (1.8), respectively (mean difference 0.9; 95% CI -6.0, 7.7, p = 0.80). Similarly, no differences between treatment groups were seen for mean change in urine C1,2C/C2C (p = 0.82), or for mean change in C2C or C1,2C. In linear regression analysis, after adjustment for sex, radiographic severity, baseline lnC1,2C/C2C ratio, WOMAC function, and flare status, treatment was not a significant predictor of final serum or urine lnC1,2C/C2C ratio. When those who experienced flare were contrasted with those without flare, there was a nonsignificant trend toward a difference in mean baseline to final visit change score for serum C1,2C/C2C ratio (p = 0.12). In addition, in the multivariable linear regression analysis, flare status showed a borderline association with final visit serum lnC1,2C/C2C ratio (p = 0.16). No statistically significant effect of glucosamine sulfate on type II collagen fragment levels in serum or urine was observed for knee OA over 6 months. Further research is necessary to elucidate which biopathologic systems, if any, are affected by glucosamine treatment. While collagen degradation products may be of value in predicting progression, at least as defined by clinical flare, a larger dataset would be needed to prove this.
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Physical training and competition in football markedly increase the need for macro- and micronutrient intake. This requirement can generally be met by dietary management without the need for dietary supplements. In fact, the efficacy of most supplements available on the market is unproven. In addition, players must be cautious of inadequate product labelling and supplement impurities that may cause a positive drug test. Nonetheless, a number of dietary supplements may beneficially affect football performance. A high endurance capacity is a prerequisite for optimal match performance, particularly if extra time is played. In this context, the potential of low-dose caffeine ingestion (2 - 5 mg . kg body mass(-1)) to enhance endurance performance is well established. However, in the case of football, care must be taken not to overdose because visual information processing might be impaired. Scoring and preventing goals as a rule requires production of high power output. Dietary creatine supplementation (loading dose: 15 - 20 g . day(-1), 4 - 5 days; maintenance dose: 2 - 5 g g . day(-1)) has been found to increase muscle power output, especially during intermittent sprint exercises. Furthermore, creatine intake can augment muscle adaptations to resistance training. Team success and performance also depend on player availability, and thus injury prevention and health maintenance. Glucosamine or chondroitin may be useful in the treatment of joint pain and osteoarthritis, but there is no evidence to support the view that the administration of these supplements will be preventative. Ephedra-containing weight-loss cocktails should certainly be avoided due to reported adverse health effects and positive doping outcomes. Finally, the efficacy of antioxidant or vitamin C intake in excess of the normal recommended dietary dose is equivocal. Responses to dietary supplements can vary substantially between individuals, and therefore the ingestion of any supplement must be assessed in training before being used in competition. It is recommended that dietary supplements are only used based on the advice of a qualified sports nutrition professional.
Article
Purpose of review The role of nutrition and nutritional supplements in the development and progression of I osteoarthritis is now, a topic of considerable public, industry, and academic interest. This review focuses on how the evidence for a role of nutritional factors or nutritional supplements in the management of knee osteoarthritis,has been changed by recent research. Recent findings Recent studies include clinical trials of weight loss and exercise as interventions for osteoarthritis of the knee the elucidation of mechanisms of oxidative stress on the, chondrocyte genome, further study of vitamin C supplementation in an animal with spontaneous osteoarthritis, and further clinical and pharmacodynamic in evaluations of glucosamine and chondroitin sulfa e. Perplexing findings among these studies include the deleterious effects of vitamin C on osteoarthritis in the Hartley guinea pig, the low levels,of, glucosamine, achieved in serum after an oral dose, recent negative clinical studies of glucosamine, and the heterogeneity of, results among glucosamine trials. Summary With an intensification of research in this field come, new clinical and basic science data, sometimes with surprising results. These confirm the considerable potential foe a role Of nutritional interventions for osteoarthritis, but they emphasize the need for systematic scientific evaluation the claims made for such products.
Article
Objective: The purpose of this study was to examine the effects of oral glucosamine supplementation on the functional ability and degree of pain felt by individuals who had regular knee pain, most likely due to previous articular cartilage damage, and possibly osteoarthritis. Methods: Subjects were randomly supplemented with either glucosamine (G) (n=24) or placebo (P) (lactose) (n=22) for 12 weeks at a dose of 2000 mg per day. Over this period, four testing sessions were conducted, with changes in knee pain and function assessed by clinical and functional tests, (joint line palpation, a 3 metre “duck walk” and a repeated, walking stair climb), two questionnaires (the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Knee Pain Scale (KPS)) and participant subjective evaluations. Results: The clinical and functional test scores improved with time (main effects: p<0.05, p<0.01) but there were no significant differences between the two groups. The questionnaire results also recorded a significant main effect for time (p<0.05), but the glucosamine group was found to have significantly better KOOS quality of life scores at week eight and 12 (p<0.05), and lower KPS scores (p<0.05) at week eight than the placebo group. On self report evaluations of changes across the 12 week supplementation period, 88% (n=21) of the glucosamine group reported some degree of improvement in their knee pain versus only 17% (n=3) in the placebo group. Conclusions: These results suggest that glucosamine supplementation can provide some degree of pain relief and improved function in persons who experience regular knee pain, which may be caused by prior cartilage injury and/or osteoarthritis. The trends in the results also suggest that, at a dosage of 2000 mg per day, the majority of improvements are present after eight weeks.
Article
Context Glucosamine and chondroitin preparations are widely touted in the lay press as remedies for osteoarthritis (OA), but uncertainty about their efficacy exists among the medical community.Objective To evaluate benefit of glucosamine and chondroitin preparations for OA symptoms using meta-analysis combined with systematic quality assessment of clinical trials of these preparations in knee and/or hip OA.Data Sources We searched for human clinical trials in MEDLINE (1966 to June 1999) and the Cochrane Controlled Trials Register using the terms osteoarthritis, osteoarthrosis, degenerative arthritis, glucosamine, chondroitin, and glycosaminoglycans. We also manually searched review articles, manuscripts, and supplements from rheumatology and OA journals and sought unpublished data by contacting content experts, study authors, and manufacturers of glucosamine or chondroitin.Study Selection Studies were included if they were published or unpublished double-blind, randomized, placebo-controlled trials of 4 or more weeks' duration that tested glucosamine or chondroitin for knee or hip OA and reported extractable data on the effect of treatment on symptoms. Fifteen of 37 studies were included in the analysis.Data Extraction Reviewers performed data extraction and scored each trial using a quality assessment instrument. We computed an effect size from the intergroup difference in mean outcome values at trial end, divided by the SD of the outcome value in the placebo group (0.2, small effect; 0.5, moderate; 0.8, large), and applied a correction factor to reduce bias. We tested for trial heterogeneity and publication bias and stratified for trial quality and size. We pooled effect sizes using a random effects model.Data Synthesis Quality scores ranged from 12.3% to 55.4% of the maximum, with a mean (SD) of 35.5% (12%). Only 1 study described adequate allocation concealment and 2 reported an intent-to-treat analysis. Most were supported or performed by a manufacturer. Funnel plots showed significant asymmetry (P≤.01) compatible with publication bias. Tests for heterogeneity were nonsignificant after removing 1 outlier trial. The aggregated effect sizes were 0.44 (95% confidence interval [CI], 0.24-0.64) for glucosamine and 0.78 (95% CI, 0.60-0.95) for chondroitin, but they were diminished when only high-quality or large trials were considered. The effect sizes were relatively consistent for pain and functional outcomes.Conclusions Trials of glucosamine and chondroitin preparations for OA symptoms demonstrate moderate to large effects, but quality issues and likely publication bias suggest that these effects are exaggerated. Nevertheless, some degree of efficacy appears probable for these preparations.
Article
Although gratifying approaches to the management of osteoarthritis (OA) are available as a result of improved knowledge about disease pathophysiology (see below), responses are limited in many patients by less than optimal responses to available modalities or by intolerance or toxicity to currently available medications. Accordingly, the search continues for agents that are characterized by greater symptomatic relief, less overall toxicity and, optimally, agents that may have a beneficial effect on the basis of disease structural modification. A veritable explosion of new agents considered to have potential efficacy in the treatment of OA has taken place. Carefully performed clinical studies, using designs of sufficient precision and power to avoid errors in conclusions and interpretation, are essential to support the use of these agents in treatment of OA. Current treatment of osteoarthritis includes: Non-Pharmacologic Therapy Patient education Programmed exercises Weight loss Joint protection Thermal modalities Pharmacologic Therapy Nonopioid analgesics (e.g., acetaminophen) Topical analgesics (e.g., capsaicin) Nonsteroidal anti-inflammatory drugs Intra-articular steroids Intra-articular hyaluronate Opioid analgesics Surgical Approaches Arthroscopic debridement Osteotomy Total joint arthroplasty Glucosamine and chondroitin sulfate, agents marketed as nutritional supplements in the United States, have been purported to be effective in the treatment of OA in various studies over the past 3 to 4 decades. 4,5,6,7,8,9,10,14,15,16,17,19,20,32,33,35,36 Interest relative to their role in the treatment of OA and other arthritides was markedly accentuated in 1997 with the publication of The Arthritis Cure 28 and a subsequent volume, Maximizing the Arthritis Cure, 29 by Jason Theodasakis, MD, who described them as effective drugs for treatment of symptoms of OA and the potential to reduce structural damage in OA cartilage. Subsequently, the intake of these agents in the United States market has increased considerably, and at present, they are widely used by patients. A parallel increase in their use for the treatment of arthritis has been noted in veterinary medicine. A review of the literature reveals that a number of short-term studies, particularly studies in Europe and Asia, suggests that these agents have efficacy equal to that of currently used nonsteroidal anti-inflammatory agents (NSAIDs), although their onset of action is slower. The widespread use of these agents, in addition to short-term trials suggestive of efficacy, has prompted initiation of a larger trial by the Office of Alternative Medicine of the National Institutes of Health comparing their efficacy relative to placebo. This article defines current knowledge of glucosamine, chondroitin sulfate, and collagen hydrolysate to provide a perspective of the current status of these agents in the treatment of osteoarthritis.
Article
The main aim of the present study was to evaluate whether players in different positional roles were sustaining different types and numbers of injuries in Serbian professional soccer. During the 2001 season (from the spring through the fall), the same medical doctor (a certified sports medicine specialist) evaluated all sports injuries seen in the sports medicine ambulance. After the evaluation, the sports medicine specialist completed a standardized injury report for each injury, and injury reports were retrospectively compiled and categorized by team position and anatomic site of injury. There were an average of 8.7 injuries sustained by each subject. During the period of this study, goalkeepers were the most frequently injured players (p < 0.05); other positional roles were injured less frequently. The most frequent injury site was the ankle (p < 0.05). The main finding of the present study was that goalkeepers are the most frequently injured players in professional soccer during the season, whereas other positions are less likely to be injured. This injury pattern could give coaches, athletic trainers, and team physicians better working knowledge to help plan prevention and treatment.
Article
We have studied the effect of low sulfate concentrations on the glycosaminoglycan synthesis in rat patellar cartilage in vivo as well as in vitro. The oral administration of 200 mg/kg paracetamol to male Wistar rats resulted in a significant reduction of the serum sulfate concentration. Reduced serum sulfate availability resulted in a 34% decrease of glycosaminoglycan synthesis in patellar cartilage. This is due to sulfate depletion since paracetamol had no direct effects on glycosaminoglycan synthesis and a slight but significant inhibitory effect on the catabolism of radiolabeled glycosaminoglycans in vitro.The glycosaminoglycans synthesized at low sulfate concentrations in vivo were similar to the glycosaminoglycans synthesized at physiological sulfate concentrations. Studying the effect of sulfate availability in vitro on glycosaminoglycan synthesis in patellar cartilage we found that incubation of rat patellae in medium containing less than 0.5 mM inorganic sulfate led to a decreased sulfate incorporation. The use of potential sulfate decreasing drugs can lead to inhibition of glycosaminoglycan synthesis. This argues for a reconsideration of the use of these drugs in patients with already dystunctioning cartilage metabolism as in rheumatoid arthritis and osteoarthrosis.
Article
The effects of different pharmacological concentrations of the non-steroidal anti-inflammatory drug (NSAID) sodium naproxen (NAP) were tested on several metabolic functions of differentiated human chondrocytes cultivated in clusters and compared with the action of acetylsalicylic acid (ASA). DNA synthesis was significantly inhibited by ASA but not by NAP. Proteoglycan production was also markedly decreased by ASA, while synthesis of type II collagen was not modified. By contrast, NAP did not affect these chondroformative processes. Both NSAIDs were potent inhibitors of prostaglandin E2 production. These results indicate that in terms of the parameters tested NAP does not lead to deleterious effects on human articular chondrocytes cultured in vitro.
Article
A new preparation of pure glucosamine sulphate, in injectable and oral form, was investigated in a controlled clinical trial in patients with osteoarthrosis. Two groups of 15 in-patients received either 400 mg glucosamine sulphate daily (12by the intramuscular and 3 by the intra-articular route) for 7 days, followed by 2 weeks at 1.5 g daily of oral glucosamine sulphate in 3 divided doses, or an intramuscular injection daily of a piperazine/chlorbutanol combination for 7 days, followed by oral placebo during the following 2 weeks. Semi-quantitative scoring of pain at rest and during active and passive movements, of restricted function and, where possible, of walking time over 20 metres, were taken as therapeutic activity indices, and tested before and after 1 and 3 weeks of treatment. Patients were positively questioned daily for possible intolerance symptoms. Laboratory tests were recorded before and after treatment. With both initial parenteral treatments, each symptom significantly improved, with a trend for faster and greater recovery with glucosamine, mainly in restricted function. During the maintenance period, a further significant improvement was recorded in the group receiving glucosamine, whereas with placebo the symptom scores rose to almost the pre-treatment levels. A similar pattern was shown in the measurement of walking speed. Clinical and biological tolerance were excellent with both treatments. No drug-related complaints were recorded, nor signs of interference in other illnesses or interactions with other drug treatments. It is suggested that injectable and/or oral treatment with pure glucosamine sulphate should be considered for the basic therapy of primary or secondary osteoarthrosis, mainly because it restores articular function to a certain extent.
Article
The pharmacokinetics of glucosamine sulfate (CAS 29031-19-4) was investigated in 6 healthy male volunteers (2 per administration route) using 14C uniformly labelled glucosamine sulfate and administering it in single dose by intravenous (i.v.), intramuscular (i.m.) or oral route. The results show that after i.v. administration the radioactivity due to glucosamine appears in plasma and is rapidly eliminated, with an initial t1/2 of 0.28 h. 1-2 h after administration the radioactivity due to glucosamine disappears almost completely and is replaced by a radioactivity originating from plasma proteins, in which glucosamine or its metabolites are incorporated. This radioactivity reaches a peak after 8-10 h and then declines with a t1/2 of 70 h. About 28% of the administered radioactivity is recovered in the urine of the 120 h following the administration and less than 1% is recovered in the feces. After i.m. administration similar pharmacokinetic patterns are observed. After oral administration a proportion close to 90% of glucosamine sulfate is absorbed. Free glucosamine is not detectable in plasma. The radioactivity incorporated in the plasma proteins follows pharmacokinetic patterns which are similar to those after i.v. or i.m. administration, but its concentration in plasma is about 5 times smaller than that after parenteral administration. The AUC after oral administration is 26% of that after i.v., or i.m. administration. The smaller plasma levels of radioactivity after oral administration are probably due to a first pass effect in the liver which metabolizes a notable proportion of glucosamine into smaller molecules and ultimately to CO2, water and urea.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Knee injuries are common, and many primary providers are uncomfortable with the clinical diagnosis of these conditions. The following article emphasizes the importance of obtaining a good history from the patient and accurately determining the mechanism of injury to narrow the diagnostic possibilities. It briefly reviews some pertinent points of anatomy to facilitate the physical examination and to understand the rationale of some clinical tests. A brief description of the most useful clinical tests in an acute situation also is given.
Article
An important component of effective postoperative pain management is a measure of the patient's pain intensity. This article examines three unidimensional pain measurement instruments and one multidimensional pain measurement instrument used in daily practice and clinical research. The strengths and weaknesses of the numerical rating scale, verbal descriptor scale, visual analogue scale, and the McGill Pain Questionnaire are discussed. Issues of validity and reliability, important in clinical research, are also presented.
Article
To characterize the usefulness of glucosamine sulfate in the treatment of patients with osteoarthritis (OA). Pertinent citations were identified via a MEDLINE search (January 1975-March 1997). Only trials available in the English language involving human subjects, OA, and glucosamine sulfate were selected for review. OA is the most common form of arthritis and represents a major cause of morbidity and disability in the elderly. The main symptom of OA is pain and most of the commonly prescribed medications (e.g. acetaminophen, nonsteroidal antiinflammatory drugs) have been targeted at relieving the pain. Some of these medications have serious adverse effects and do not necessarily change the natural course of the disease. Glucosamine sulfate, a nutritional supplement, has recently emerged as an alternative treatment option for patients with OA. The beneficial effects of this chondroprotective agent have been reported to reverse or at least stop the progression of the disease without inducing serious adverse effects. Limited data from short-term human trials suggest that glucosamine sulfate administered orally, intravenously, intramuscularly, and intraarticularly may produce a gradual and progressive reduction in joint pain and tenderness, as well as improved range of motion and walking speed. Results of the trials have also shown that glucosamine has produced consistent benefits (> 50% overall improvement in symptom scores) in patients with OA and that, in some cases, it may be equal or superior to ibuprofen in controlling symptoms. There is evidence that glucosamine sulfate may provide pain relief, reduce tenderness, and improve mobility in patients with OA. Most of the current data, however, are derived from the European and Asian literature and there are no studies supporting the use of this agent in the US. The studies published to date have been done in small numbers of patients; adequate long-term trials examining the safety, efficacy, and optimal dosage requirements of glucosamine sulfate are lacking. Most of the available clinical data are difficult to interpret due to serious deficiencies in study design. Furthermore, studies evaluating the appropriate place of glucosamine sulfate in the therapeutic armamentarium of OA remain to be done.
Article
Anecdotal reports of rapid symptomatic response to high-dose glucosamine in osteoarthritis are not credibly explained by the traditional view that glucosamine promotes synthesis of cartilage proteoglycans. An alternative or additional possibility is that glucosamine stimulates synovial production of hyaluronic acid (HA), which is primarily responsible for the lubricating and shock-absorbing properties of synovial fluid. Many clinical and veterinary studies have shown that intra-articular injections of high-molecular-weight HA produce rapid pain relief and improved mobility in osteoarthritis. HA has anti-inflammatory and analgesic properties, and promotes anabolic behavior in chondrocytes. The concentration and molecular weight of synovial fluid HA are decreased in osteoarthritis; by reversing this abnormality, high-dose glucosamine may provide rapid symptomatic benefit, and in the longer term aid the repair of damaged cartilage.
Article
Knee joint motion has been described in various ways in the literature. These are explained and commented on. Two methods for describing knee joint motion with 6 degrees of freedom (DOF)--Euler angle and the helical axis of motion--are discussed. Techniques to measure joint motion which can either approximate the motion to less than 6 DOF or fully measure the spatial motion are identified. These include electrical linkage methods, radiographic and video techniques, fluoroscopic techniques and electromagnetic devices. In those cases where the full spatial motion is measured, the data are available to describe the motion in simpler terms (or with less DOF) than three rotations with three translations. This is necessary for clinical application and to facilitate communication between the clinician and the engineer.
Article
Glucosamine products have been used extensively for the management of pain in osteoarthritis (OA). We investigated the efficacy of the hydrochloride salt of glucosamine on pain and disability in knee OA. At Week -2, subjects were examined, randomized, and instructed to take only prescribed acetaminophen for pain. At Week 0 patients were examined, prescribed acetaminophen, and either placebo or glucosamine hydrochloride (glucosamine). At Week 4 the prescriptions for acetaminophen and placebo or glucosamine were renewed. At Weeks 4 and 8, patients returned diaries and unused medications, and were examined. The WOMAC questionnaire was administered at Weeks -2, 0, and 8. After completing the randomized 8 week trial, subjects were offered known glucosamine hydrochloride capsules in an 8 week open label trial, with followup telephone survey after the 8 week open label trial. The primary endpoint (statistically significant difference in WOMAC pain score between Week 0 and Week 8) was not met. However, positive trends were noted for the glucosamine group in 23 of 24 WOMAC questions. A significant difference was noted from Week 5 through Week 8 in the knee examination (p = 0.026) and in the response to a daily diary pain question (p = 0.018). However, responding to the question, "Are you better than at the start of the trial?", 40% of placebo and only 49% of glucosamine subjects answered in the affirmative (p = 0.58). At the end of the randomized trial, 34% of placebo and 47% of glucosamine subjects believed that they had been given glucosamine. After the end of the 8 week open label trial, 77% of the subjects were still taking glucosamine, although now obliged to pay for commercially available products. There was no significant difference in pain reduction between the glucosamine hydrochloride and placebo groups as measured by WOMAC. However, the secondary endpoints of cumulative pain reduction as measured by daily diary and knee examination were favorable, suggesting that glucosamine hydrochloride benefits some patients with knee OA.
Article
Glucosamine sulfate, a constituent of cartilage, is evaluated for the treatment of osteoarthritis. Available data suggest that glucosamine decreases pain and improves function in osteoarthritis. Most of the glucosamine studies have methodological flaws or used parenteral formulations, making their data difficult to extrapolate into clinical practice. Glucosamine sulfate is shown to be as good as ibuprofen for osteoarthritis of the knee. Better designed clinical trials of glucosamine are needed to identify its role in the pharmacotherapy of osteoarthritis.
Article
Glucosamine sulfate is able to stimulate proteoglycan synthesis by chondrocytes and has mild anti-inflammatory properties. In clinical trials, glucosamine sulfate was more effective than placebo in controlling the symptoms of osteoarthritis (OA). In order to better characterize this therapeutic activity, we conducted a randomized, double-blind, parallel-group study of glucosamine sulfate 500 mg t.i.d. vs ibuprofen 400 mg t.i.d., orally for 4 weeks. The study included 200 hospitalized patients with active OA of the knee, symptoms for at least 3 months and a Lequesne's index of at least 7 points. Patients were evaluated weekly. Response was defined as a reduction in the Lequesne's index by at least 2 points if the enrollment value was higher than 12 points, or by at least 1 point if the enrollment value was 12 or less points, together with a positive overall assessment by the investigator. The improvement tended to be sooner under ibuprofen (48% responders vs 28% after the 1st treatment week; P = 0.06, Fisher's Exact test), but there was no difference from the 2nd week onward, with a success rate of 52% in the ibuprofen group and of 48% in the glucosamine group (P = 0.67) at the end of treatment. The average Lequesne's index at enrollment was around 16 points and decreased by over 6 points in both groups, again with the above described trend. On the other hand, 35% of patients on ibuprofen reported adverse events, mainly of gastrointestinal origin, vs 6% adverse events with glucosamine (P < 0.001, Fisher's Exact test). The number of adverse event related drop-outs was different between the two groups (7% vs 1%, respectively; P = 0.035). Glucosamine sulfate was therefore as effective as ibuprofen on symptoms of knee OA. These data confirm glucosamine sulfate as a safe symptomatic Slow Acting Drug for OA.
Article
Glucosamine sulfate is a drug used for the treatment of osteoarthritis (OA), based on its pharmacological and metabolic activities on the cartilage and chondrocytes, complemented by mild anti-inflammatory properties and a favorable pharmacokinetic profile. The aim of this study was to define the activity and safety of glucosamine sulfate on the symptoms of patients with OA, using a multicenter, randomized, placebo-controlled, double-blind, parallel-group study design. The study included 252 outpatients with OA of the knee (Lequesne's criteria), radiological stage between I and III, and Lequesne's severity index of at least 4 points and symptoms for at least 6 months. Patients were treated with either placebo or oral glucosamine sulfate 500 mg t.i.d. for 4 weeks, with weekly, with weekly clinic visits. Responders to treatment were defined as patients with a reduction of at least 3 points in the Lequesne's index with a positive overall assessment by the investigator. The Lequesne's index was 10.6 +/- 0.45 S.E.M. points in both groups at the start of the study. This decreased to 7.45 +/- 0.5 points in the treatment group (average 3.2) and 8.4 +/- 0.4 points in the placebo group (average 2.2) (P < 0.05, Student's t-test). The responder rate in the evaluable patients was 55% with glucosamine (N = 120) vs 38% with placebo (N = 121). These proportions were 52% vs 37% in an intention-to-treat analysis (P = 0.014 and 0.016, respectively; Fisher's Exact Test). The medications were well tolerated throughout the study, with no difference between the glucosamine and placebo treated groups. It is concluded that glucosamine sulfate may be a safe and effective symptomatic Slow Acting Drug for OA.
Article
Participation in sports increases the risk of joint injuries that can lead to posttraumatic osteoarthritis, a clinical syndrome caused by trauma-initiated joint degeneration that results in permanent and often progressive joint pain and dysfunction. Minimizing the risk of joint injuries and helping people with osteoarthritis participate in regular physical activity, including some sports, requires understanding of the relationships between joint use, joint injury, and joint degeneration. Lifelong participation in sports that cause minimal joint impact and torsional loading by individuals with normal joints and neuromuscular function does not increase the risik of posttraumatic osteoarthritis. In contrast, participation in sports that subject joints to high levels of impact and torsional loading increases the risk of joint injury and subsequent joint degeneration. Immediate diagnosis and appropriate treatment and rehabilitation following joint injuries decrease the risk of subsequent injuries and posttraumatic osteoarthritis. Individuals with abnormaljoint anatomy or alignment, previous significant joint injury, osteoarthritis, joint surgery, joint instability, disturbances of joint or muscle innervation or inadequate muscle strength have increased risk of joint damage during participation in athletics. These individuals can benefit from regular exercise, including selected sports, but they should have an evaluation of their joint structure and function, muscle strength, and neuromuscular function before participating in vigorous physical activity.
Article
To present the safety and effectiveness results of a prototypical 12-week, double-blind, randomized placebo-controlled trial of glucosamine among subjects with knee osteoarthritis who were recruited and followed entirely over the Internet. The study comprised 205 subjects aged 45 years or older with symptomatic knee osteoarthritis who were recruited over the Internet; eligibility was authenticated through medical record review. Participants were assigned randomly to 1.5 g/d of glucosamine (n = 101) or placebo (n = 104), of whom 108 completed the intervention (93 in each arm). The primary outcome measure was the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (Likert version). Additional outcome measures included the physical function and stiffness subscales and overall score of the questionnaire, and analgesic use. There was no difference between treatment and control groups in terms of change in pain score (2.0 +/- 3.4 vs. 2.5 +/- 3.8, P = 0.41), stiffness (0.7 +/- 1.6 vs. 0.8 +/- 1.5, P = 0.52), physical function (5.2 +/- 9.5 vs. 4.6 +/- 9.6, P = 0.49), overall score (7.8 +/- 13.1 vs. 7.8 +/- 13.5, P = 0.81), and analgesic use (133 +/- 553 vs. -88 +/- 755, P = 0.12). Stratification by osteoarthritis severity, glucosamine product, and use of a nonsteroidal anti-inflammatory drug, as well as exclusion of opiate users, did not alter the results. The number and type of adverse events reported was similar between the groups. Our results suggest that although glucosamine appears to be safe, it is no more effective than placebo in treating the symptoms of knee osteoarthritis.
Article
The use of nonsteroidal antiinflammatory medications (NSAIDs) and nutraceuticals, such as glucosamine and chondroitin, is common among athletes at all ages and levels of participation. The use of these drugs has significant effects on pain and swelling associated with injury; however, this use does have significant risks to the gastrointestinal, hepatic, and renal organ systems. In the athlete with degenerative changes in the joints, the use of these medications can become chronic and lead to an increased risk of adverse effects. The purpose of this article is to examine the incidence of injury in sports, the prevalence of osteoarthritis in athletes, and the use of common over-the-counter medications and supplements. In addition, the mechanism of action, adverse side effects, and behavioral patterns for use of these medications will be analyzed.
Article
This study estimated the inter- and intraobserver reliability of a set of noninstrumented physical examination measures for knee pain in older adults. Forty-five patients from primary care, and 13 patients from secondary care, were each examined by two out of a team of three physical therapists, and were reexamined by one of these observers 1 month later. The examination items were standardized and included dichotomous, ordinal and continuous variables considered relevant to a primary care context. For individual dichotomous items, median interobserver and intraobserver agreement (kappa) was 0.22 (interquartile range IQR=0.12-0.35) and 0.41 (IQR=0.28-0.56) respectively. For ordinally rated variables, weighted kappa ranged from -0.08 to 0.43 for interobserver agreement, and from 0.00 to 0.79 for intraobserver agreement. The median intraclass correlation coefficient for continuous examination variables was 0.80 (range 0.68-0.89) for interobserver agreement, and 0.84 (range 0.67-0.95) for intraobserver agreement. For trained but nonexpert examiners, agreement was generally poor for dichotomous and ordinal examination items; however, kappa-values are liable to be depressed by the low prevalence of clinical signs in this sample. Agreement on continuous variables was notably better.
Article
Most athletes experience musculoskeletal injuries during their sports activity that require rest at a minimum, and occasionally injuries are severe enough to necessitate surgical repair. Neurosurgeons are often consulted for athletically sustained injuries and prescribe medications for the associated pain. The use of both over-the-counter and prescription nonsteroidal medications is frequently recommended, but recent safety concerns must now be considered. The authors discuss the biochemical pathways of nonsteroidal drugs and review the potentially serious side effects of these medications. They also review the use of natural supplements, which may be a safer, and often as effective, alternative treatment for pain relief.
Article
Glucosamine sulphate has been shown in a large double-blind, placebo-controlled clinical trial to prevent structural damage and improve clinical symptoms of osteoarthritis (OA). We investigated whether early response in a newly developed biochemical marker of collagen type II degradation (CTX-II, CartiLaps ELISA) could reflect the long-term preservation of hyaline cartilage. Study subjects comprised 212 knee OA patients participating in a clinical trial of the effects of glucosamine sulphate. Disease symptoms were assessed quarterly by WOMAC scoring and X-ray analysis was performed at baseline and after 3 years. Urine samples were obtained at baseline and after 1, 2 and 3 years for measurement in the CartiLaps assay. The measurements were corrected for creatinine. At baseline the patients had an average concentration of urinary CTX-II of 222.4 +/- 159.5 ng/mmol creatinine. This was significantly above the CTX-II levels measured in urine samples from 415 healthy controls (169.1 +/- 92.3 ng/mmol, p < 0.0001). There was no significant difference in the CTX-II response in the placebo group and the glucosamine treated group. However, those with high cartilage turnover presented a significant decrease in CTX-II after 12-month glucosamine treatment. Thus, three group with CTX II concentrations above normal average + 1SD decreased 15.5% after 12-month therapy. The 12 months change in CTX-II in OA patients with elevated CTX-II at baseline correlated with the change in average joint space width observed after 36 months (R = 0.43, p < 0.05). Increased baseline levels of CTX-II were associated with a worsening of the WOMAC index (p < 0.01). The data indicate that measurement of urinary collagen type II C-telopeptide fragments enables the identification of OA patients with high cartilage turnover who at the same time are most responsive to therapy with structure modifying drugs.
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