By Nancy Walsh, Staff Writer, MedPage Today
Published: November 02, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
, November 2, 2011  —  Six months of treatment with chondroitin led to significant improvements in pain and function among patients with osteoarthritis (OA) in their hands, a single-center randomized trial found.

Global hand pain rated on a 100-mm visual analog scale fell by 20 mm for patients taking chondroitin, compared with 11.3 mm for patients receiving placebo, for a between-group difference in change of −8.7 mm (P=0.016), according to Cem Gabay, MD, of University Hospitals of Geneva in Switzerland, and colleagues.

In addition, scores on the 30-point Functional Index for Hand OA decreased by 2.9 points in the chondroitin group and by 0.7 points in the placebo group, giving a between-group difference in change of −2.14 (P=0.008), the researchers reported in the November Arthritis & Rheumatism.

More than half of people older than 60 experience hand OA, with the most commonly involved joints being the distal and proximal interphalangeal, the trapeziometacarpal, and the thumb interphalangeal.

But the therapeutic options are few and data on the efficacy of these therapies are scarce, the authors stated.

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful for pain relief, but they can cause gastrointestinal side effects and their long-term use is hampered by potentially serious cardiovascular adverse effects.

Topical anti-inflammatory agents also can be somewhat effective, but are not generally convenient for use in a chronic condition.

Acetaminophen is another option, although in the population most affected by hand OA, this drug can have negative effects on blood pressure.

To explore the potential clinical benefits of chondroitin, Gabay and colleagues enrolled 162 patients with severely symptomatic OA, assigning them to six months of daily chondroitin (800 mg) or placebo. Chondrotin is marketed as a dietary supplement in the U.S., but licensed as a prescription OA treatment in much of Europe.

The study drug contained purified chondroitin sulfate derived from fish sources.

Patients all had baseline pain scores of at least 40 mm on the 100-mm visual analog scale and had at least two joints with radiographic evidence of OA.

They were allowed to take rescue acetaminophen in maximum daily doses up to 4 grams.

Their mean age was 63, and two-thirds were women.

Mean pain score at baseline in the target hand was 54 and mean functional score was 11.

The mean number of painful flares during the previous year was 35 in the chondroitin group and 30 in the placebo group.

Patients who had erosive arthritis and involvement of the basal thumb joint had worse functional scores at baseline, but their pain scores were not significantly increased.

These features did not influence treatment outcome, however, on multivariate analysis.

A secondary outcome favoring chondroitin was duration of morning stiffness, which decreased by 4.8 minutes in the active treatment group but increased by 0.3 minutes in the placebo group (between-group difference in change −5.1, P=0.031).

Physician global assessment of efficacy increased during the trial for the chondroitin group, while between-group differences were not seen on acetaminophen use or change in hand grip strength.

Adverse events were reported by 42.5% of the chondroitin patients and by 41.5% of the placebo group.

Two patients in each group experienced serious adverse events, with only one case of abdominal pain in a placebo patient being considered possibly related to treatment.

Three patients in the active treatment group withdrew because of adverse events, as did eight patients in the placebo group.

At the end of the study, tolerability was rated as good or excellent in 96.3% of the active treatment patients and 90.8% of placebo patients.

Chondroitin has not been directly compared with NSAIDs, but the overall magnitude of effect appears to be similar, according to the researchers.

The effect size for pain was “relatively modest,” but the improvement in functional scores seen at six months “is indicative of a positive clinical effect of [chondroitin] in this study population,” they observed.

They noted that the advantage of anti-inflammatory drugs is prompt relief of symptoms, with the drawback of long-term safety concerns.

“In contrast, the benefits of [chondroitin] appear to take several months to develop, but with hardly any side effects, and this could help reduce the need for long-term [NSAID] therapy in patients with hand OA,” they explained.

Limitations of the study included an inadequate numbers of patients to detect differences in some secondary outcomes and in subgroups of patients. Also, a restriction to patients with severe disease.

The lead author disclosed receiving fees and honoraria from IBSA, Roche, MSD, Pfizer, and Bristol-Myers Squibb.


Primary source: Arthritis & Rheumatism
Source reference:
Gabay C, et al “Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial at a single center” Arthritis Rheum 2011; 63: 3383-3391.




Q. What is Chondroitin?


A. Chondroitin is a chondrin derivative.

Types include:


Chondroitin is a supplement that has gained popularity among people with arthritis. The natural form is made from cow and shark cartilage; supplement manufacturers can also make a synthetic form of this protein in laboratories. The body uses chondroitin to make new bone, tendons, and cartilage. Cartilage is the tough, white, fibrous portion of the joint that normally allows pain-free movement. Chondroitin is believed to help draw fluid into the cartilage, making it spongy and flexible. It’s also touted to help vital nutrients enter the cartilage, which help keep it healthy. In clinical trials, the usual dose was 1200mg daily, either in one dose, or divided and taken in two or three doses per day. Medical research has shown that chondroitin can reduce osteoarthritis pain.



Chemical structure of one unit in a chondroitin sulfate chain. Chondroitin-4-sulfate: R1 = H; R2 = SO3H; R3 = H. Chondroitin-6-sulfate: R1 = SO3H; R2, R3 = H.



Chondroitin sulfate




How does Glucosamine and Chondroitin Work


By: Richard Stenlake, Compounding Chemist
Article used with permission.

Richard Stenlake is a registered pharmacist who owns the largest compounding pharmacy in Australia. Over many years he has pioneered the introduction of innovative medication ideas to the Australian market.

Arthritis is a degenerative joint disease that causes pain, inflammation and limited joint movement.

In osteoarthritis the joint that is affected has degenerated cartilage. As this is the cushion between the joints, one gets bone rubbing against bone and thus pain, inflammation and lack of mobility follows. Up until now the only relief from this pain was by way of treatment with nonsteroidal anti-inflammatory drugs (e.g. brufen, orudis) or by injection with steroids (e.g. cortisone). However, these only mask the symptoms and relieve the pain, and the disease continues to get worse. Thus, the spiral continues increasing the dose as the pain worsens. However here we create another problem as these drugs have deleterious side effects and may in fact cause certain features of osteoarthritis to progress faster.

Thus over the years the only relieve that may be obtained is by joint replaced by your surgeon. Even with artificial joints, the problem is not solved as these too have a finite life and will have to be replaced further down the track.


In the last few years, excellent results have however best achieved with a combination of natural nutritional supplements. In many cases these have been able to slow and eventually eliminate disease. This approach includes a combination of glucosamine and chrondroiton sulphate. These are substances we already consume and are produced in small amounts in our bodies and as such have no known side effects. There has been extensive study done on them, which has proved that both glucosamine and chondroitan work in both animals and humans.


Firstly healthy cartilage needs three things: water for lubrication and nourishment, proteoglycans to attract and hold the water, and collagen to keep the proteoglycans in place.

Proteoglycans are like a rope that threads itself through the collage and are essential as they hold many times their own weight of water, which both lubricates and nourishes the collagen. If the cartilage is damaged the thread of rope becomes weak and ‘leaks’ out and thus the collagen loses its nourishment as the proteoglycans lose their grip and float away. Thus the cartilage cannot withstand shocks, cracks and may wear out completely.

Glucosamine is a major building block of the water – loving proteoglycans. Besides being a building block for the synthesis of proteoglycans, its mere presence acts as a stimulus to the cells that produce proteoglycans – in fact glucosamine is a key factor in determining how many proteoglycans are produced by the cells.

Glucosamine has been shown to speed up production of both proteoglycans and collagen and it normalises cartilage metabolism which helps keep cartilage from breaking down.

Thus because of the affect of glucosamine on cartilage metabolism it can in fact help the body to repair damaged or eroded cartilage. In other words, glucosamine strengthens your body’s natural repair mechanisms.
Besides stimulating cartilage production, glucosamine also reduces joint pain and inflammation.


Where glucosamine helps form the proteoglycans that sit within the space in the cartilage, chrondroiton sulphate acts like ‘liquid magnets’. Chrondroiton is a long chain of repeating nigans that attracts fluid into the proteoglycan molecules.

This is important for two reasons:

the fluid acts as a spongy shock absorber
the fluid sweeps the nutrients into the cartilage. Joint cartilage has no blood supply thus all of its nourishment and lubrication comes from the fluid that ebbs and flows as pressure is applied and released to the joint. Without this fluid, cartilage would become malnourished, drier, thinner and more fragile.


Chrondoiton Sulphate is a long chain molecule with a negative charge attached to it. As these chains wrap around proteoglycans they repel each other and thus create spaces between each proteoglycan. These are what are known as matrixes within the cartilage and this is where the fluid flows. There may be as many as 10,000 of these chains on a single proteoglycan molecule – thus we have a super water retainer as these chains make sure all these molecules are away from each other and cannot clump together.

Besides drawing in precious fluid, chrondroiton :
protects cartilage and stops it from breaking down and inhibits certain ‘cartilage chewing’ enzymes interferes with the metabolism of other enzymes that will starve the cartilage of fluid stimulates production of proteoglycans, glucosamine and collagen.





Osteoarthritis: What Is It?

Also called “wear and tear” arthritis or degenerative joint disease, osteoarthritis (OA) is the progressive breakdown of the joints’ natural shock absorbers. This can cause discomfort when you use the affected joints –- perhaps an ache when you bend at the hips or knees, or sore fingers when you type. Most people over 60 have some degree of OA, but it also affects people in their 20s and 30s.



Osteoarthritis: Symptoms

The symptoms of osteoarthritis tend to develop slowly. You may notice pain or soreness when you move certain joints or when you’ve been inactive for a prolonged period. The affected joints may also be stiff or creaky. Typically, osteoarthritis leads to morning stiffness that resolves in 30 minutes. When osteoarthritis affects the hands, some people develop bony enlargements in the fingers, which may or may not cause pain.



Osteoarthritis: Where Does It Hurt?



In most cases, osteoarthritis develops in the weight-bearing joints of the knees, hips, or spine. It’s also common in the fingers, thumb, neck, and big toe. Other joints are usually not affected, unless an injury is involved.



Osteoarthritis: What Causes It?

Every joint comes with a natural shock absorber in the form of cartilage. This firm, rubbery material cushions the ends of the bones and reduces friction in healthy joints. As we age, joints become stiffer and cartilage is more vulnerable to wear and tear. At the same time, repetitive use of the joints over the years irritates the cartilage. If it deteriorates enough, bone rubs against bone, causing pain and reducing range of motion.


One of the major risk factors for osteoarthritis is something none of us can control – getting older. Gender also plays a role. Over age 50, more women than men develop osteoarthritis. In most cases, the condition results from normal wear and tear over the years. But some people have a genetic defect or joint abnormality that makes them more vulnerable.



Risk Factors You Can’t Control


Because injured joints are more vulnerable to osteoarthritis, doing anything that damages the joints can raise your risk. This includes sports that have a high rate of injury and jobs that require repetitive motion, such as bending the knees to install flooring. Obesity is another risk factor – it has been linked specifically to osteoarthritis of the knees and hips.




Impact on Daily Life

Osteoarthritis affects each person differently. Some people have few symptoms despite the deterioration of their joints. Others experience pain and stiffness that may interfere with daily activities. If bony knobs develop in the small joints of the fingers, tasks such as buttoning a shirt can become difficult. Osteoarthritis of the knees or hips can lead to a limp. And osteoarthritis of the spine can cause debilitating pain and/or numbness.



Diagnosing Osteoarthritis

To help your doctor make an accurate diagnosis, you’ll need to describe your symptoms in detail, including the location and frequency of any pain. Your doctor will examine the affected joints and may order X-rays or other imaging studies to see how much damage there is, and to rule out other joint conditions. In many cases, blood tests are used to rule out other forms of arthritis.



Long-Term Complications

Unlike rheumatoid arthritis, osteoarthritis does not affect the body’s organs or cause illness. But it can lead to deformities that take a toll on mobility. Severe loss of cartilage in the knee joints can cause the knees to curve out, creating a bow-legged appearance (shown on the left). Bony spurs along the spine can irritate nerves, leading to pain, numbness, or tingling in some parts of the body.



Treatment: Physical Therapy

There is no treatment to stop the erosion of cartilage in the joints, but there are ways to improve joint function. One of these is physical therapy to increase flexibility and strengthen the muscles around the affected joints. The therapist may also apply hot or cold therapies such as compresses to relieve pain.



Supportive Devices

Supportive devices, such as finger splints or knee braces, can reduce stress on the joints and ease pain. If walking is difficult, canes, crutches, or walkers may be helpful. People with osteoarthritis of the spine may benefit from switching to a firmer mattress and wearing a back brace or neck collar.



Medication for OA

When osteoarthritis flares up, many patients find relief with over-the-counter pain and anti-inflammatory medication, such as aspirin, ibuprofen, or acetaminophen. Pain-relieving creams or sprays can also help when applied directly to the sore area. If pain persists despite the use of pills or creams, your doctor may suggest an injection of steroids or hyaluronans directly into the joint.



Osteoarthritis and Weight

If you’re overweight, one of the most effective ways to relieve pain in the knee or hip joints is to shed a few pounds. Even modest weight loss has been shown to reduce symptoms of osteoarthritis by easing the strain on weight-bearing joints. Losing weight not only cuts down on pain, but may also reduce long-term joint damage.



Risk Factors You Can Control

If you’re overweight, one of the most effective ways to relieve pain in the knee or hip joints is to shed a few pounds. Even modest weight loss has been shown to reduce symptoms of osteoarthritis by easing the strain on weight-bearing joints. Losing weight not only cuts down on pain, but may also reduce long-term joint damage.



Osteoarthritis and Exercise

People with osteoarthritis may avoid exercise out of concern that it will cause pain. But low-impact activities such as swimming, walking, or bicycling can improve mobility and increase strength. Training with light weights can help by strengthening the muscles that surround your joints. For example, strengthening the quadriceps can reduce pain in the knees. Ask your doctor or physical therapist which exercises are best for you.



Is Surgery for You?


If osteoarthritis interferes significantly with everyday life and the symptoms don’t improve with physical therapy or medication, joint replacement surgery is an option. This procedure is used on those with severe OA and replaces a damaged joint with an artificial one. The knee and hip are the joints that are replaced most often.



Preventing Osteoarthritis

The most important thing you can do to ward off osteoarthritis is keep your weight in check. Over the years, extra weight puts stress on the joints and may even alter the normal joint structure. Preventing injuries is also important. Take precautions to avoid repetitive motion injuries on the job. If you play a sport, use proper equipment and observe safety guidelines.