There have also been reports directly comparing glucosamine to the effects of ibuprofen. Glucosamine was at least equivalent to ibuprofen, and in one case outperformed it. A study regarding glucosamine hydrochloride (the other available chemical form of glucosamine in the treatment of osteoarthritis) in 118 people showed an equivalent reduction of discomfort to ibuprofen treatments. Only one paper has previously looked at whether glucosamine might improve the structure of an osteoarthritic joint. This paper by Drovanti showed an improvement in structure of cartilage in those treated with glucosamine than those on placebo. Unfortunately only four patients out of the eighty studied had cartilage available for review by electron microscopy. More recently there has been the report involving 212 patients over 3 years that showed a minimal deterioration in joint space in patients treated with glucosamine. This study relied on x-rays to demonstrate the reduction in joint space, rather than electron microscopy used in the previous study. The result of Reginster’s study suggests glucosamine may have a significant role in joint protection, or chondro protection. There was also an improvement in the symptoms of osteoarthritis using a pain scale. This is the first major long term study evaluating the efficacy of glucosamine. Prior to this the majority of studies were between 3 to 8 weeks in duration, which is an inadequate time to show a significant improvement in the structure of a joint. Assessment of the cartilage was made by image analysis of x-rays taken at baseline, 1 year and 3 years using a digitalized radiograph. This showed the deterioration in the osteoarthritic joint treated with glucosamine was 0.06 mm. The deterioration in joint space loss in the placebo group was 0.31 mm. When these figures were analysed statistically, this was found to be significant.Glucosamine has been viewed as a safe natural product that is well tolerated. There have been few side effects on glucosamine when compared to placebo treatments, which has long been seen as an advantage over the NSAIDs. These side effects have mainly been gastrointestinal in nature. These included dyspepsia, abdominal pain, diarrhea, as well as fatigue, headache, dizziness and a depressed mood. There were also reports of photosensitivity, increases in blood pressure, small amounts of protein leaking in the urine and an elevation of a muscle enzyme called creatine phosphokinase. All of these changes were reversible on stopping glucosamine. Since glucosamine is a sugar, the question of whether it can precipitate or aggravate diabetes has been raised. Animal studies have shown glucosamine affects glucose metabolism when infused directly into the blood vessels, resulting in insulin resistance. The concentrations used were higher than that usually achieved by swallowing oral glucosamine. In our experience, ceasing glucosamine treatment in poorly controlled diabetes did not result in better glucose control. There are no formal studies involving diabetes and osteoarthritis. The American Arthritis Foundation have recommended that diabetics perform home blood glucose monitoring more frequently when on glucosamine.There are still unanswered questions about glucosamine. These include what is the recommended daily dosage and which chemical form is more effective. The reports on the internet suggest glucosamine hydrochloride provides the same benefit in protecting the joint as glucosamine sulfate. The medical literature is not clear. The evidence is not yet in on whether glucosamine creams are as effective in the easing of joint discomfort.
