Abstract
This review summarizes recent knowledge on the efficacy of glucosamine (GS) and/or chondroitin sulfate (CS) in the therapy of mild to moderate osteoarthritis (OA). OA, the most common joint disease is a significant source of disability, quality of life impairment and a considerable burden to any health care system. In the Czech Republic, glucosamine sulfate (GS) and chondroitin sulfate (CS) are available both as prescription drugs and as food supplements. Based on available data both are useful in the earlier stages of OA when combined with other modalities such as weight loss and exercises. They appear to relieve pain and improve range of the joint motion. In addition, they also display mild anti-inflammatory effects. However, controversy still exists over their ability to change significantly the natural history of the osteoarthritic joint. This effect is not easy to demonstrate for any other treatment modalities apart from joint replacement. Monitoring the cure efficacy by X-ray has been recently criticised and hence future techniques are anticipated for this reason. Further, long-term oral administration is required to obtain slightly increased levels of GS and/or CS in human blood. Both reviewed saccharides are well tolerated with negligible adverse reactions. In conclusion, the authors suggest that GS and CS should be classified as food supplements only.
Highlights
Chondroitin sulfate Chondroitin sulfate consists of an alternating sequence of D-glucuronate and N-acetyl-D-galactosamine-4/6-sulfate residues linked through alternating bonds (Scheme 1)
Drugs or nutraceuticals? A plethora of drugs and food supplements consisting of glucosamine and chondroitin sulfate are on the market in the Czech Republic (Table 2)
Food supplements do not need approval from the State Institute for Drug Control. We believe that this mini-review shows that the potential difference between the above products is not significant enough to justify the existence of two controversial terms for one single substance
Summary
Osteoarthritis (OA) is the most common disorder of the synovial joints in middle aged and older people. It is characterised predominantly by a focal or global loss of articular cartilage, bone changes and an imbalance in inflammatory and non-inflammatory pathways including proteolysis of aggrecans and collagens combined with distortion of their synthesis by chondrocytes. It is a source of great morbidity, impaired quality of life in affected individuals as well as a significant burden to any health care system. It is estimated that more than one third of people over 45 years complain of OA-related symptoms. Osteoarthritis (OA) is the most common disorder of the synovial joints in middle aged and older people.1 It is characterised predominantly by a focal or global loss of articular cartilage, bone changes and an imbalance in inflammatory and non-inflammatory pathways including proteolysis of aggrecans and collagens combined with distortion of their synthesis by chondrocytes.. Glycosaminoglycans are linear acidic polysaccharides containing disaccharide repeat units of D-glucuronate/L-iduronate/D-galactose linked to sulphonated N-acetylglucosamine/N-acetylgalactosamine Such complexes are naturally synthesized in each joint resulting in high local concentrations. Chondroitin sulfate Chondroitin sulfate consists of an alternating sequence of D-glucuronate and N-acetyl-D-galactosamine-4/6-sulfate residues linked through alternating bonds (Scheme 1) It is an essential component of the connective tissue extracellular matrix including the hyaline cartilage, providing its elasticity and other functions. The raw material is derived from chitin, a biopolymer present in the exoskeleton of marine intervertebrate animals. There may be significant differences in purity and other phar-
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