Can glucosamine and chondroitin help alleviate osteoarthritis symptoms?

From the Guidelines

Glucosamine and chondroitin supplements are not recommended for alleviating osteoarthritis symptoms due to a lack of efficacy and large placebo effects, as stated in the 2020 American College of Rheumatology guideline 1. The evidence from recent studies suggests that these supplements do not provide significant benefits for patients with osteoarthritis.

• The 2020 guideline strongly recommends against the use of glucosamine in patients with knee, hip, and/or hand OA, citing a lack of clear biologic understanding of how efficacy would vary with the type of salt studied and discrepancies in efficacy reported in industry-sponsored versus publicly funded studies 1.
• In contrast, the 2022 AAOS clinical practice guideline summary suggests that glucosamine and chondroitin may be helpful in reducing pain and improving function for patients with mild-to-moderate knee osteoarthritis, but notes that the evidence is inconsistent and limited 1.
• However, the highest quality and most recent evidence from the 2020 guideline takes precedence, and patients with osteoarthritis should consider alternative treatments, such as self-management programs, strengthening, low-impact aerobic exercise, and neuromuscular education, as well as pharmacologic therapies like oral or topical nonsteroidal anti-inflammatory drugs or tramadol 1. To manage osteoarthritis symptoms, consider the following:

• Participate in self-management programs and low-impact aerobic exercise
• Consult your doctor about recommended pharmacologic therapies
• Be aware of the potential risks and benefits of alternative treatments, and discuss them with your doctor before starting any new therapies.

From the Research

Efficacy of Glucosamine and Chondroitin in Alleviating Osteoarthritis Symptoms

• The use of glucosamine and chondroitin as a treatment for osteoarthritis has been studied extensively, with some studies suggesting a potential benefit in alleviating symptoms 2, 3, 4.
• However, other studies have reported conflicting results, with some finding no significant difference in symptom relief compared to placebo 5, 3.
• A study published in the New England Journal of Medicine found that glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee, but may be effective in the subgroup of patients with moderate-to-severe knee pain 3.
• Another study published in the World Journal of Orthopedics found that glucosamine and chondroitin may have a small effect on clinical and radiological findings, but the effect sizes are generally small and probably not clinically relevant 5.

Safety Profile of Glucosamine and Chondroitin

• Glucosamine and chondroitin are considered safe, with some uncommon and minor adverse effects reported, including epigastric pain or tenderness, heartburn, diarrhea, and nausea 2, 3.
• A study published in the Journal of Orthopedic Nursing found that glucosamine and chondroitin sulfate have the potential to provide pain-relieving benefits as well as possibly decrease the effects of joint space narrowing, with a good safety profile 4.

Clinical Evidence and Recommendations

• The American Academy of Orthopaedic Surgeons has published clinical practice guidelines recommending against the use of glucosamine and chondroitin sulfate 4.
• However, some studies suggest that glucosamine and chondroitin may be a useful adjunct treatment for symptomatic osteoarthritis of the knee, particularly in patients with moderate-to-severe pain 3, 4.
• A review published in Current Rheumatology Reports emphasized the importance of the quality of tested compounds for achieving high-quality clinical trials, and suggested that pharmaceutical-grade glucosamine and chondroitin may have symptomatic and structure-modifying effects 6.