Glucosamine, Chondroitin Sulphate, Fish Oil and Krill

I am frequently asked about whether glucosamine, chondroitin sulphate, fish oil and recently krill can treat osteoarthrosis. Osteoarthrosis is also known as osteoarthritis, and is wear and tear of the articular cartilage or joint surfaces. For most people it is an age related phenomenon. It can also occur as a result of an injury to the knee, previous surgery, as a result of an inflammatory condition, and there has also been a genetic link identified. People can have damage to just one joint surface only and this is known as chondral damage / chondromalacia / chondropathy. This is a pre-arthritic condition and eventually the other joint surface will get damaged. Osteoarthrosis ranges from mild to severe and I will run through what grade of arthrosis you have.

What is glucosamine and chondroitin sulphate? They are components of the scaffold that makes up the articular cartilage surface. They are integral to the health of articular cartilage and have been shown in scientific research to decrease in number as we age or when the joint surface has been damaged.

Natural supplements such as glucosamine, chondroitin, fish oil and krill, amongst others have been marketed as anything from a “cartilage builder” to a cure for osteoarthrosis. When glucosamine was first released onto the market the claims were that it rebuilt cartilage, it has not been shown to do so. Scientists have enough trouble growing cartilage in the laboratory. Glucosamine and possibly more importantly Chondroitin when taken in tablet form can reduce inflammation or swelling within the knee and consequently pain.

There is a lot of skepticism as to whether they provide any benefit at all and certainly when talking with patients about 30% are adamant that they work. From a research perspective there has been a lot of confusion, as some studies say it works, other studies say it does not. In the medical literature the results are skewed towards them not working, whist in the complimentary medicine literature the results are skewed towards them working. When doctors have put all the studies together (meta-analysis) or done a comprehensive (systematic) review it is quite clear that there is no difference and any effect may well be placebo. The American Academy of Surgeons in there recommendations for treatment of knee osteoarthrosis say that glucosamine and chondroitin sulphate should not be used. These implied negative statements do not mean that everyone should not use supplements.

In my opinion, when talking with patients with knee osteoarthrosis who do not require surgery at that time one of my recommendations is to trial supplements for 6 weeks. If they do not make any difference then I suggest trialing another brand. If these do not work then supplements are unlikely to work. If they do work and provide symptom relief, which delays an operation and improves their quality of life is a big positive for the patient. Of course the more severe the osteoarthrosis the less likely non-surgical treatments will benefit the patient. My line to patients is “give anything a go as if it works for you it does not matter what the literature says”.

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