Glucosamine for Knee Pain

Like many people I have periodically suffered from knee pain, which I usually attribute to increased wear and tear from running. Fortunately, I have observed over time that my painful knees tend to resolve on their own regardless of whether I do anything about them or not. On a couple of occasions I have tried supplementation with glucosamine but I could never be sure whether the subsequent resolution of my knee pain was a result of treatment or just natural resolution. So I was interested to see some new research published in the New England Journal of Medicine last week.
The study by Clegg et al was a randomized, placebo- and celecoxib-controlled (Celebrex) trial of 1500 mg of glucosamine hydrochloride daily, 1200 mg of chondroitin sulfate daily, or the two in combination. The study did not find a difference between the three supplement groups and placebo. However, there was a significantly greater response seen in the celecoxib group compared to placebo. In an editorial, Hochberg notes that the findings are not surprising and consistent with a meta-analysis of eight randomized trials of glucosamine hydrochloride or sulfate. Although there are other studies to the contrary that demonstrate that glucosamine sulfate and chondroitin sulfate have resulted in improved function in patients with arthritis of the knee. So what does this all mean? Hochberg recommends that patients with symptomatic osteoarthritis of the knee should try treatment with glucosamine sulfate and chondroitin sulfate for three months to establish if there are any benefits. He also notes that there is no evidence that these agents prevent the formation of osteoarthritis in healthy persons or that they are effective in persons with knee pain and normal radiographs. So unless you have been diagnosed with osteoarthritis then I would save your money.
The big problem that I have with nutritional supplements is that they are not subjected to the same standards as regular drugs in terms of determining whether they are safe and efficacious, and are not reviewed by the FDA before they are marketed. In addition, many are not manufactured to the same standards as regular drugs, so it is not unusual to find that there is a lot of variability in the contents of products. So be careful what you buy. If you do buy supplements then try to find a company that adheres to good manufacturing practices.