Glucosamine vs NSAIDs in the treatment of osteoarthritis

Conventional treatment for osteoarthritis: NSAIDs
Glucosamine - Natural treatment alternative for osteoarthritis
Glucosamine vs. NSAIDs
Conclusions

Conventional treatment for osteoarthritis: NSAIDs

Pharmacological treatment for osteoarthritis can be divided into two groups: symptom-modifying drugs and disease-modifying drugs. Symptom-modifying drugs are currently the prescription of choice for patients with osteoarthritis, as disease-modifying drugs (i.e. drugs which alter disease progression) are not yet available in usual care.

Conventional treatment for osteoarthritis relies almost entirely upon painkillers. The most widely used drugs for osteoarthrisis are the non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs differ from analgesics in an important aspect: while analgesics treat pain, NSAIDs treat both pain and inflammation. NSAIDs work by blocking the production of prostaglandins, which are hormone-like substances that contribute to pain and inflammation.

However, prostaglandins also have beneficial functions in the body, including protecting the stomach lining and helping to maintain kidney function. By blocking these actions of prostaglandins along with the pain and inflammatory, traditional NSAIDs can lead to an upset stomach and peptic ulcers, or interfere with kidney function. Commonly prescribed NSAIDs, include: ibuprofen (Advil, Motrin), diclofenac potassium (Cataflam), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), nabumetone (Relafen), naproxen (Naprosyn).

NSAIDs can cause a number of side effects, some of which may be very serious. The most common side effects are stomach pain or cramps, nausea, vomiting, indigestion, diarrhea, heartburn, headache, dizziness or lightheadedness, and drowsiness. The most serious side effects are gastrointestinal ulcers, internal bleeding, kidney failure, liver failure. These side effects are more likely when the NSAID drugs are taken in large doses or for a long time. Some NSAIDs have even been implicated in the worsening of osteoarthritis. Because of such safety issues, other therapeutic options are needed.

Glucosamine - Natural treatment alternative for osteoarthritis

Glucosamine has become a popular therapeutic option for treatment of osteoarthritis.

Glucosamine is a naturally occurring amino-sugar compound, a monosaccharide. It has many biological functions. It is involved in the production, maintenance, and repair of cartilage. Glucosamine is not found in significant amounts in the food sources and must be synthesised by the body. This ability declines with age, inhibiting repair from wear and tear to joint cartilage. It predisposes the body to osteoarthritis.

How does Glucosamine work for osteoarthritis?

In the body, the main action of glucosamine on joints is to stimulate the production of cartilage components, necessary for joint repair. If sufficient levels of glucosamine are not available in the body, the cartilage loses its ability to effectively regenerate itself and act as the joint's shock absorber. When given orally as glucosamine sulfate, it is selectively taken up by joint tissues to exert a powerful therapeutic effect in osteoarthritis. In addition, glucosamine has anti-inflammatory and antioxidant factors.

Glucosamine provides several benefits for people with osteoarthritis including pain reduction (as effective as ibuprofen and other NSAIDs), improved function and mobility, and slowed progression or even prevention of joint destruction when taken for 3 or more years. In comparison to NSAIDs, glucosamine takes longer to begin working, however, pain control lasts longer with glucosamine and the supplements cause fewer side effects.

Glucosamine vs. NSAIDs

While NSAIDs offer purely symptomatic relief and may actually promote the disease process, glucosamine addresses the cause of osteoarthritis. By getting at the root of the problem, glucosamine sulfate not only improves the symptoms including pain, it also helps the body repair damaged joints. This is outstanding, but what is even more outstanding is the safety and the lack of side effects associated with oral glucosamine sulfate. In contrast, the side effects and risks associated with NSAIDs currently used in the treatment of osteoarthritis are significant.

Symptom-modifying action. Glucosamine has been demonstrated to effectively relieve osteoarthritis pain in many clinical studies. The onset of pain relief is quicker with NSAIDs than it is with glucosamine (1-2 weeks versus 2-4 weeks). But, once glucosamine starts working, it will produce much better results compared to NSAIDs.
Disease-modifying action. NSAIDs are used to treat only symptoms of osteoarthritis, they do not change the underlying condition of the disease. Unlike NSAIDs, glucosamine sulfate act on the cause of osteoarthritis - cartilage breakdown. Glucosamine sulfate helps the body repair damaged joints. Along with a termination in the progression of joint damage, reversal of damage is also highly likely.
Analgesia is not a direct effect of glucosamine. The pain relieving effects are believed to be due to the rebuilding of cartilage within the joint. This may explain the delayed onset of pain relief effect.
Side effects. Side effects and risks associated with the use of NSAIDs in the treatment of osteoarthritis are significant. When the NSAID drugs are taken in large doses or for a long time this drugs may cause very serious side effects, such as gastrointestinal ulcers, internal bleeding, kidney damage, liver damage.

In contrast, side effects of gluocosamine are minimal. The short term side effects of glucosamine are uncommon and include nausea and gastrointestinal distress and can usually be remedied by taking the supplement with food. However, long term toxicity data are lacking. Glucosamine has no known interactions with any pharmaceutical or nutraceutical medicines.
Joint destruction. NSAIDs accelerate joint destruction. NSAIDs work by inhibiting the synthesis of prostaglandins, the substances within our bodies responsible for pain and inflammation. Prostaglandins responsible for building and repairing cartilage tissue are also inhibited by NSAIDs. This leads to worsening of the disease over time. Glucosamine do not work by prostaglandin inhibition, so continued use of the glucosamine supplements will not lead to progressive joint destruction.

Conclusions

Glucosamine supports and stimulates the growth and repair of cartilage tissue, decreasing pain and improving mobility. Unlike NSAIDs, glucosamine treats the cause of osteoarthritis. It is better tolerated with fewer side effects than NSAIDs. Glucosamine sulfate has been proven in clinical trials to work as effectively in relieving pain assotiated with breakdown of the joint's cartilage as commonly prescribed NSAIDs. However, caution is required, as long term studies have not been carried out and patients with diabetes should be warned before starting treatment.

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