Arthritis is difficult to treat with conventional medicine, but glucosamine is gaining a reputation as an effective alternative remedy. Anne Woodham reports

Glucosamine is a glucose-based chemical produced in naturally healthy joints, where it is used to repair and maintain cartilage. It is also available as a supplement from health shops and many pharmacies. Glucosamine has a significantly reported success rate in relieving osteoarthritis symptoms, but news of its beneficial qualities have spread around the world largely by word of mouth.

Initially doctors were sceptical about claims made for glucosamine's benefits, even when patients insisted it was helping them, because there was little or no scientific research on glucosamine. But recent research indicates that it really is effective in easing pain and helping mobility and may even slow progression of the disease. The most convincing trial results relate to pain and stiffness from osteoarthritis of the knee. There is less trial evidence for benefits in other joints.

Joint pain relief
Osteoarthritis, the most common form of joint disease, affects 1.5 million people in the UK and is very difficult to treat. The incidence increases with age, particularly in women over 50. Cartilage, the slippery material that cushions the ends of bones, wears away, causing pain, stiffness, swelling, 'creaking' and ultimately incapacity. Non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed to relieve symptoms, but can have serious side effects.

Sales of glucosamine supplements took off with the publication in 1997 of The Arthritis Cure (Century) by an American physician, Dr Jason Theodosakis, a specialist in preventive medicine at the University of Arizona College of Medicine and a long-time sufferer of arthritis. In sampling alternative remedies, he hit upon a combination of dietary supplements - glucosamine and chondroitin, a related joint chemical - that vets were using for racehorses with tendon strain. Some European doctors had been quietly offering patients these supplements since the 1980s.

Cell stimulation
According to Theodosakis, glucosamine stimulates production of new cartilage cells in the joints, while chondroitin breaks down old cartilage. Within two weeks of taking the supplements, he claimed he was so much better that he abandoned his conventional medication.

His book was a bestseller and millions of people with arthritis who have tried glucosamine, either with or without chondroitin, claim almost miraculous improvements. Rheumatologists (doctors who specialise in arthritis) put such stories down to the placebo response - a person believes a treatment works and so feels better - but the sheer volume of reports obliged them to carry out clinical trials.

The most recent studies in top medical journals suggest that Theodosakis and his followers are right. In March 2000, the prestigious Journal of the American Medical Association reviewed trials of dietary supplements of glucosamine and chondroitin and concluded that 'some degree of efficacy appears probable.' Then in January 2001 a major three-year Belgian study of 212 patients with knee osteoarthritis was published in The Lancet. It found that glucosamine not only relieved symptoms but actually slowed cartilage deterioration.

Research programme
Meanwhile the US National Institutes of Health is running a US$14 million four-year investigation of glucosamine and chondroitin. It is said that researchers faced a challenge in finding 1,200 subjects with osteoarthritis of the knee who were not already taking the supplement.

Some experts suspect that glucosamine may work in a similar way to an antibiotic, doxycycline, which is the subject of trials at a number of American universities. This is thought to protect joints and slow down the progression of osteoarthritis by blocking enzymes involved in the breakdown of joint cartilage, but the long-term use of antibiotics raises more problems. Glucosamine could offer a safe and natural alternative.

2007 has seen something of a setback for the glucosamine story. A recent publication appeared in the July issue of the journal 'Arthritis and Rheumatism'. A team from Boston University Medical Centre reviewed the evidence from 15 previous trials on Glucosamine and concluded that 'its benefits have been overstated'.

In the UK, a spokeswoman from the Arthritis Research Campaign said, 'results from trials of glucosamine sulphate have certainly been very mixed, and the evidence base to show that it relieves pain and stiffness remains inconclusive. Nevertheless, many people with osteoarthritis find that glucosamine is effective, and as it appears to have no side-effects and is quite cheap, osteoarthritis sufferers will continue to take this supplement.'