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12/Feb/2020

The jury is no longer out – the evidence is in

For many years, glucosamine has been one of the most commonly used supplements for osteoarthritis (OA). And even though the jury has been out on how well it works, it has been considered safe to use.

When it comes to glucosamine, there’s been a lot of conflicting research with some studies showing positive results and some showing no effect. To add to the confusion, studies have used different preparations of glucosamine – for example glucosamine sulfate, glucosamine hydrochloride, glucosamine sulfate with chondroitin etcetera – and different dosages. Which makes it difficult to determine how effective glucosamine really is for treating the symptoms of OA.

Until recently, despite the evidence indicating that glucosamine has little, if any benefit for people with OA, it’s been seen to be relatively safe for most people.

Now, a recent study has raised some serious concerns about the side effects of glucosamine for people with shellfish allergy.

What is glucosamine?

At the ends of most of our bones we have a slippery cushion called cartilage. It absorbs shocks and helps our joints move smoothly. Glucosamine is a naturally occurring substance found in our cartilage.

For people who have osteoarthritis, this cushiony cartilage becomes brittle and breaks down. Some pieces of cartilage may even break away and float around inside the joint causing inflammation and pain. The cartilage no longer has a smooth, even surface, so the joint becomes stiff and painful to move.

Treating osteoarthritis

Until recently, treatments for OA have focused on managing the symptoms – controlling pain and reducing inflammation. Medications included analgesics – e.g. paracetamol – and anti-inflammatories – e.g. ibuprofen (*see note). Along with exercise and weight management, these were the mainstays of osteoarthritis treatment. There has been no silver bullet or treatment that worked quickly and effectively.

So when glucosamine first came on the market, with positive reviews, many people were excited at the prospect of this new, ‘natural’ treatment and began taking glucosamine regularly. Glucosamine seemed to provide pain relief for many people with osteoarthritis and improve their joint function.

However over the years as more research has taken place, the evidence for the use of glucosamine has come under more and more scrutiny. Earlier, positive research was mostly funded by pharmaceutical industry, and later research, that showed glucosamine provided limited improvements, was publicly funded. This called into question the potential for bias in the earlier reporting of the benefits of glucosamine.

The peak bodies respond

Based on recent independent evidence, the American College of Rheumatology (ACR) and the Australian Rheumatology Association (ARA) have both responded publicly.

In their latest guidelines for treating OA, the ACR “strongly recommend against” using glucosamine for osteoarthritis. And the ARA has stated that this new information highlights growing evidence that glucosamine doesn’t help people with OA and it‘s a reminder that people with a shellfish allergy shouldn’t take glucosamine.

Safety concerns

It’s been known for some time that glucosamine can interact with blood thinners such as warfarin, and that it may raise blood sugar levels in people with diabetes. Glucosamine may also have a negative effect on cholesterol and chemotherapy drugs and has been linked to worsening asthma

However it’s not been widely known to the general public that many glucosamine supplements are made from shellfish and can cause serious allergic reactions.

Recent research from the University of Adelaide investigated “spontaneous adverse drug reactions [or side effects]…to glucosamine and chondroitin in the Australian population between 2000 and 2011, with a primary focus on hypersensitivity reactions.”

They found that during that period, the Therapeutic Goods Administration (TGA) was notified of 366 recorded adverse reactions. This is more than the combined adverse reactions of other supplements such as echinacea, valerian, black cohosh, ginkgo and St John’s wort. However, hundreds of thousands of people also took glucosamine during that time with no ill effects, highlighting that the risk of a severe reaction was still very low.

A major issue raised is the labelling of glucosamine. Labelling must report that it contains seafood, but not specifically shellfish. And this information is often in small writing. So people who are aware that they have a shellfish allergy may not realise that they’re taking something that’s harmful to them.

In 2016, the TGA changed the rules for this, and required manufacturers to be clear if products contain shellfish. And this information must be easy for consumers to find. However they also gave manufactures until August 2020 to do this. So many products publicly available may still not may it clear to consumers if the product contains shellfish.

So what should you do if you currently take glucosamine?

  • If you have a shellfish allergy stop taking glucosamine immediately and discuss with your doctor.
  • If you have taken glucosamine for some time and haven’t had any negative side effects, and want to continue taking it, then you can do so under the advice of your doctor.
  • Talk to your pharmacist about any potential interactions with other medicines you may be taking.
  • Talk with your doctor about other treatment options – including exercise, weight management, pain management techniques.
  • Call our MSK Help Line weekdays on 1800 263 265 or email helpline@msk.org.au and talk with our nurses about OA and ways you can manage it without glucosamine.
  • Stay up-to-date. As well as being painful, living with a chronic musculoskeletal condition can be confusing and frustrating, especially with so much conflicting information circulating through the news, social media, and our network of family, friends and acquaintances. Follow us on Facebook and sign up for our eNewsletter to stay informed about the latest information, research, events and much more.

* Note

We now know that these medications provide very little benefit for managing the ongoing symptoms of OA. Currently the best evidence is for weight management (maintaining a healthy weight or losing weight if you’re overweight) and exercise. Treatments such as massage, heat and the short term use of anti-inflammatories may provide temporary relief, but the evidence is not as strong.

References


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28/Jun/2018

Many of us are using complementary medicine. It may be to help with a specific health condition or to improve our overall health. But what is complementary medicine and what do you need to think about before trying it?

Complementary medicine is a wide range of treatments that generally aren’t considered to be mainstream or conventional medical treatments. It includes acupuncture, vitamins and minerals, aromatherapy, herbal treatments, yoga and naturopathy.

We’re often drawn to these treatments because they appear to be more natural and safer than conventional medicine. But that’s not necessarily true. As with any treatment, they may cause harm and make you unwell if they’re not taken correctly, if they interact with one of your other medications, or if the practitioner you see isn’t properly trained or qualified.

Our top tips

Let your doctor know what you’re doing. Keep them informed about any things you’re taking or considering taking (e.g. supplements, homeopathic treatments, herbal medicines) as well as any other therapies you’re trying or considering trying (e.g. acupuncture, yoga).

Do your research and ask lots of questions. Some treatments may help you manage your pain, while others will have no effect. Is there any current evidence that says the treatment is effective and safe for people with your condition? Is the treatment affordable? What are the possible side effects? Will the treatment interact with your other treatments or medications?

Check the qualifications of the person providing the treatment. Do they receive regular training and updates? Have they treated other people with your condition or health issues? Are they a member of their peak body? Are they accredited?

Buy Australian. Australian complementary medicines are subject to strict safety and quality regulations. This may not be the case in other countries. In Australia the Therapeutic Goods Administration (TGA) ensures the safety of medicines and other therapeutic treatments.

If in doubt, don’t take it. Talk with your doctor or contact our MSK Help Line weekdays on 1800 263 265, or email helpline@msk.org.au.

More to explore


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27/May/2018

A book by people like you

Chronic pain is a common and complex problem that affects 1 in 5 Australians.

It’s exhausting, a bit tricky and hard to know where to start.

Fortunately, with our book Managing your pain: An A-Z guide you can start anywhere!

Medications, sleep, laughter, fatigue, breathing. Think of it as a ‘choose your own adventure’ to getting on top of your pain.

The book emphasises practical strategies tried and tested by people like you – consumers living with musculoskeletal conditions. There are also a bunch of quotes and useful insights to keep it real.

You might also like…

We also have a helpful kids pain book called The worst pain in the world. It’s beautifully illustrated and loaded with practical advice for children living with pain (not just those with arthritis). It also gives kids who don’t live with pain an understanding of what their friends or family are going through. Copies can also be ordered through the our online shop.




Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

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