Medical Evidence
Glucosamine, Chondroitin, and Manganese
Ascorbate for Degenerative Joint Disease of the Knee or Low Back:
A Randomized, Double-Blind, Placebo-Controlled Pilot Study Guarantor:
LCDR Alan F. Philippi, MC USNR Contributors: LT Christopher T.
Leffler, MC USNR* LCDR Alan F. Philippi, MC USNR* Susan G. Leffler,
MD ½, James C. Mosure, MD ½ LT Peter D. Kim, USNR* * Medical Department.
Naval Special Warfare Group Two, Naval Amphibious Base Little
Creek. Norfolk. VA 23521. ½ Division of Musculoskeletal Radiology,
Eastern Virginia Medical School, Norfolk, VA.
Objective: A 16-week randomized,
double-blind, placebo-controlled crossover trial of a combination
of glucosamine HCI (1,500 mg/day), chondroitin sulfate (1,200
mg/day), and manganese ascorbate (228 mg/day) in degenerative
joint disease (DJD) of the knee or low back was conducted.
Methods: Thirty four males
from the U.S. Navy diving and special warfare community with chronic
pain and radiographic DJD of the knee or low back were randomized.
A summary disease score incorporated results of pain and functional
questionnaires, physical examination scores, and running times.
Changes were presented as a percentage of the patient's average
score.
Results: Knee osteoarthritis
symptoms were relieved as demonstrated by the summary disease
score (- 16.3%; p = 0.05), patient assessment of treatment effect
(p = 0.02), visual analog scale for pain recorded at clinic visits
(-26.6%; p = 0.05) and in a diary (-28.6%; p = 0.02), and physical
examination score (-43.3%; p = 0.01). Running times did not change.
The study neither demonstrated, nor excluded, a benefit for spinal
DJD. Side effect frequency was similar to that at baseline. There
were no hematologic effects.
Conclusions: The combination
therapy relieves symptoms of knee osteoarthritis. A larger data
set is needed to determine the value of this therapy for spinal
DJD. Short-term combination therapy appears safe in this setting.
Source: Military Medicine,
164, 2:085, 1999
Dr. Theo's Comments: This
small study of the effects of a combination of the supplements
on people with chronic pain, presumably from osteoarthritis, has
some major flaws in design which likely underestimates the benefit
of the supplements. The first flaw is the short duration of treatment.
Though the study was 16 weeks in length, each group only received
the supplements for 8 weeks (and placebo for 8 weeks). We know
from some of the chondroitin studies (Morreale, et. al. 1996 and
Mazieres, et. al. 1992) that the full effect of chondroitin may
not become apparent for 16-20 weeks or more. The second major
flaw is the study design, a so-called crossover design. Hereās
how a crossover works: one group starts with the active compound
and the other with a placebo. Then, after eight weeks, the groups
switch. From clinical and research experience we know that some
people have pain relief long after stopping the supplements. The
residual pain relief from the group starting with the supplements
and finishing with the placebo would likely blunt the study results.
Even with these flaws the reduction in knee pain was significant.
The reduction in back pain from osteoarthritis is clearly evident
clinically and should be documented with a properly designed study.
The authors do point out that the product used in the study, Cosamin
® by Nutramax labs does contain more of the mineral manganese
than is probably necessary. I have had the same concern and ask
my patients who use Cosamin longer than a few months to consider
getting their manganese level checked via a blood test to see
if they should switch to a brand that does not have the mineral.
