Glucosamine

1. Glucosamine A Shark’s Tale?

2. Glucosamine and Chondroitin • What is it? • What does it do? • Does it work? • When should we use it? • What is it’s role in management of OA? • Should we prescribe it?

3. What Is It?? • Glucosamine is a sugar - part of the disaccharide units in proteoglycans which are a constitiuent of cartilage.

4. Glucosamine from shrimp, crab and lobster shells. • Chondroitin from animal cartilage - trachea or shark cartilage.

5. What does it do? • Glucosamine is part of the GAG in articular cartilage. • Addition of GS increases proteoglycan synthesis. • Restores and maintains cartilage • Antiinflammatory properties.

6. Does it work? • Cochrane review Towhead et al 2000 • 16 RCTs (2029 pts) - GS effective and safe in OA • 13 RCTS glucosamine better than placebo • 4 RCTs glucosamine vs NSAIDS - superior in 2 equivalent in 2. • Dose 1500mg per day. 6 weeks • OA knee - decreased pain and increased function. • Side effects in 12% - mild GI. • Reginster Lancet 2001 - prospective trial showed modified disease progression • 3 yr study • knee OA (mean 8yr duration age 66) • joint space narrowing reduced. • Improved function - effects after one month • no significant side effects

7. When should we use it? • OA knee • glucosamine +/- chondroitin • Early stages of disease • Instead of NSAIDs/alongside NSAIDs • Instead of Cox 2 inhibitors.

8. Role in OA Management • BMJ 4th Dec 2004 • NSAIDS reduce short term pain only slightly more than placebo • Paracetamol first line • Physio/exercise • acupuncture • topical anti inflammatories • GS and C. • Intra-articular injections. • Surgery

9. Prescribing - BMJ March 19 • Seven Seas GS + C £9.99/30 • Holland and Barrett GS+C £17.99/60 ‘now only’ £8.72 • Glucosamine 500mg £12.49/60 ‘now only’ £4.99