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Q: I'm 52 and was just diagnosed with Heberden's nodes on my thumbs. I want to prevent any further progression of osteoarthritis and am interested in trying glucosamine and/or chondroitin. Please let me know about any current research on these supplements and the doses.
A: Osteoarthritis, the most common form of arthritis, occurs when the cartilage that cushions joints wears down. This allows bone to rub against bone, causing pain and stiffness. In the hands, bony enlargements may form in the finger joints (the Heberden's nodes you mention).
Glucosamine and chondroitin appear not only to significantly relieve the symptoms of osteoarthritis, but also to slow joint degeneration. Conventional drugs used for osteoarthritis such as acetaminophen and NSAIDs (e.g., Motrin, Celebrex, Vioxx) do not offer the latter benefit.
My one reservation about taking glucosamine has been largely pushed aside. That reservation, based on scattered reports and some studies, was that glucosamine could raise blood sugar (glucose) levels. The latest research suggests this effect is not clinically important.
A small trial evaluated 22 people with Type 2 diabetes. Participants took either three tablets of Cosamin DS or placebo (inactive pill) daily for three months.
Three tablets of Cosamin DS provide 1,500 mg of glucosamine hydrochloride and 1,200 mg of chondroitin sulfate. As it turned out, there were no significant differences in blood sugar control between the treated group and placebo group.
This is a very important finding, particularly for individuals with diabetes.
Many people have both osteoarthritis and Type 2 diabetes. Those with diabetes are often cautioned that glucosamine might worsen their diabetes.
A prior, larger placebo-controlled trial evaluated 1,500 mg daily of glucosamine sulfate in 212 people with osteoarthritis of the knee over three years. This study also found no clinically significant changes in blood sugar control.
Based on this research, it appears that glucosamine can be more widely recommended for people with osteoarthritis, including those with Type 2 diabetes.
There's no evidence that chondroitin affects blood sugar control.
Be aware that glucosamine and chondroitin supplements take a few weeks to exert their effects. If you take conventional pain medication for osteoarthritis, you may want to continue it until the supplement starts working, then use the conventional medication only as needed.
It is possible that, rarely, some individuals taking glucosamine might experience a significant rise in blood sugar levels. For this reason, it wouldn't hurt to have your blood sugar checked during a routinely scheduled medical visit.
People with Type 2 diabetes, who monitor their blood sugar at home, might wish to watch it extra closely after starting glucosamine.
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(Richard Harkness is a consultant pharmacist who writes on health care topics. You can write him at 1224 King Henry Drive, Ocean Springs, MS 39564. His e-mail address is rharkn@aol.com. Volume of mail prohibits individual replies; selected letters will be answered in his column.)
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(c) 2003, The Sun Herald (Biloxi, Miss.). Distributed by Knight Ridder/Tribune News Service.
