Current Role of Glucosamine in the Treatment of Osteoarthritis
Objectives: To evaluate the interest of using the various preparations of glucosamine for symptomatic and structural management of osteoarthritis (OA).
Methods: A critical analysis of the literature based on an exhaustive search (Medline, PubMed and manual search within the bibliography of retrieved manuscripts) from 1980 to 2005.
Results: Despite multiple controlled clinical trials of the use of glucosamine in OA (mainly of the knee), controversy on efficacy related to symptomatic improvement continues. Differences in results originate from the differences in products, study design and study populations. Symptomatic efficacy described in multiple studies performed with glucosamine sulphate (GS) support continued consideration in the OA therapeutic armamentarium. The most compelling evidence of a potential for inhibiting the progression of OA is also obtain with GS.
Conclusions: GS has shown positive effects on symptomatic and structural outcomes of knee OA. These results should not be extrapolated to other glucosamine salts [hydrochloride or preparations (over-the-counter or food supplements)] in which no warranty exists about content, pharmacokinetics and pharmacodynamics of the tablets.
Osteoarthritis (OA), the most common form of arthritis, is a public health problem throughout the world. The prevalence of OA of the knee in Western Europe has been estimated as 18-25% in men and 24-40% in women between ages 60-79 in Holland and 28-34% in Spain. There are estimates of 100 million people with OA in the European Union. The estimated direct cost of OA in France in 2001 was 1.64 billion Euros. In the United States, the burden of arthritis is 69.9 million people in 2001.
Glucosamine is an aminosaccharide, acting as a preferred substrate for the biosynthesis of glycosaminoglycan chains and, subsequently, for the production of aggrecan and other proteoglycans of cartilage. Because of the essential role aggrecans play in giving the cartilage its hydrophilicity, compounds enhancing synthesis of aggrecans may be beneficial in cases of OA, a disorder characterized by an increase in matrix structural protein turnover, with catabolism being predominant over synthesis.
In vitro, glucosamine sulphate (GS) has been demonstrated to reduce prostaglandin E2 (PGE2) production and interfere with nuclear factor kappa B (NFαB) DNA binding in chondrocytes and synovial cells.
Glucosamine inhibits gene expression of OA cartilage in vitro. It was suggested that since glucosamine inhibits both anabolic and catabolic genes, the therapeutic effects of glucosamine might be due to anti-catabolic activities, rather than due to anabolic activities. GS is a stronger inhibitor of gene expression than glucosamine hydrochloride.
Objectives: To evaluate the interest of using the various preparations of glucosamine for symptomatic and structural management of osteoarthritis (OA).
Methods: A critical analysis of the literature based on an exhaustive search (Medline, PubMed and manual search within the bibliography of retrieved manuscripts) from 1980 to 2005.
Results: Despite multiple controlled clinical trials of the use of glucosamine in OA (mainly of the knee), controversy on efficacy related to symptomatic improvement continues. Differences in results originate from the differences in products, study design and study populations. Symptomatic efficacy described in multiple studies performed with glucosamine sulphate (GS) support continued consideration in the OA therapeutic armamentarium. The most compelling evidence of a potential for inhibiting the progression of OA is also obtain with GS.
Conclusions: GS has shown positive effects on symptomatic and structural outcomes of knee OA. These results should not be extrapolated to other glucosamine salts [hydrochloride or preparations (over-the-counter or food supplements)] in which no warranty exists about content, pharmacokinetics and pharmacodynamics of the tablets.
Osteoarthritis (OA), the most common form of arthritis, is a public health problem throughout the world. The prevalence of OA of the knee in Western Europe has been estimated as 18-25% in men and 24-40% in women between ages 60-79 in Holland and 28-34% in Spain. There are estimates of 100 million people with OA in the European Union. The estimated direct cost of OA in France in 2001 was 1.64 billion Euros. In the United States, the burden of arthritis is 69.9 million people in 2001.
Glucosamine is an aminosaccharide, acting as a preferred substrate for the biosynthesis of glycosaminoglycan chains and, subsequently, for the production of aggrecan and other proteoglycans of cartilage. Because of the essential role aggrecans play in giving the cartilage its hydrophilicity, compounds enhancing synthesis of aggrecans may be beneficial in cases of OA, a disorder characterized by an increase in matrix structural protein turnover, with catabolism being predominant over synthesis.
In vitro, glucosamine sulphate (GS) has been demonstrated to reduce prostaglandin E2 (PGE2) production and interfere with nuclear factor kappa B (NFαB) DNA binding in chondrocytes and synovial cells.
Glucosamine inhibits gene expression of OA cartilage in vitro. It was suggested that since glucosamine inhibits both anabolic and catabolic genes, the therapeutic effects of glucosamine might be due to anti-catabolic activities, rather than due to anabolic activities. GS is a stronger inhibitor of gene expression than glucosamine hydrochloride.
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