by James J. Galligan,  Ph.D., Associate  Chair,
Department of Pharmacology and  Toxicology

As an aging but still committed recreational athlete, I am all too familiar with the aches and pains associated with trying to stay in shape.  Ice, frozen peas, non-steroidal anti-inflammatory drugs (NSAIDS) and afternoon naps are all part of the routine to fight off stiffness and soreness.  All recreational athletes have their own weak spot that causes the most trouble and in my case it’s the knees (the knees always go first).

A commonly used remedy for joint pain in general is the liberal use of glucosamine and/or chondroitin.  These are over-the-counter supplements are components of joint cartilage, the connective tissue in joints that provides cushioning and prevents bone on bone contact that can cause pain and ultimately osteoarthritis.

World wide sales of glucosamine and chondroitin are in the billions of dollars.  At one time I was on a daily regimen of glucosamine and there were some days that I thought I felt better while other days were as painful and stiff as before glucosamine use.  I gave up the glucosamine habit when an article published in the New England Journal of Medicine provided evidence that glucosamine and chrondroitin reduced pain and joint stiffness no better than a placebo (an inert substance) in subjects with moderate joint pain.  This study did not make any assessments of joint structure after treatment; the investigators simply asked the subjects if they felt better after supplement or placebo treatment.  Subjects on placebo reported the same level of improvement as the subjects on the supposed cartilage stimulating supplements.  Needless to say there was a firestorm of criticism of the study from both patients and physicians.  Patients swore that the supplements made them feel better and improved their joint flexibility while physicians claimed that if their patients said they felt better, then they must be better.  Besides, glucosamine and chrondroitin are harmless (as far as we know at this time), so there is no risk (except to the wallet).  I have friends who swear by the supplements, despite my best efforts to explain the placebo effect.

Further evidence against the effectiveness of glucosamine and chrondroitin (alone or in combination) in relieving joint pain or improving joint structure comes from a recent study published in the British Medical Journal.  This study reviewed a large number of published works on this topic.  The authors concluded that glucosamine and chondroitin produced no improvement in joint structure or joint pain over placebo.  They went even further by recommending that health care providers should not be cover the costs of the supplements and physicians should no longer recommend glucosamine and/or chondroitin to their patients with joint pain and osteoarthritis.

There will no doubt be another firestorm of letters to the editor and backlash from patients who swear they are much better because of their use of glucosamine and chondroitin.  But as I always tell my students when they do an experiment that yields results that they don’t understand or that don’t support their trusted hypothesis: “the data are the data and data don’t lie”.