Glucosamine Chondroitin

Chapter 12 Glucosamine Chondroitin

Diane Rigassio Radler

John is a 71-year-old man in good health. He was educated as a mechanical engineer and worked in industry until retirement 6 years ago. He is married and lives with his wife in an adult community. The couple has three adult children, two who live within 50 miles of them. John tries to remain fairly active and enjoys fishing from his boat and walking to the community center. Lately, walking and boarding his boat have become challenging because of his osteoarthritis pain.

Initial Examination

John is in excellent health for his age. He currently has mildly elevated prostate specific antigen (PSA), which is monitored every 6 months, and hypertension, which is controlled with captopril and hydrochlorothiazide. He has a history of diverticulitis, which has required hospitalization three times in the past 8 years. He was taking rofecoxib for his osteoarthritis pain and was switched to naproxen when rofecoxib was removed from market use. He is concerned about adverse events of gastrointestinal (GI) bleeding and seeks an alternative.

Client Report: John’s bilateral knee osteoarthritis limits his daily activities and is increasingly limiting his favorite recreation activities of boating, fishing, and walking to the recreation center in the community. He states that when he is sitting and watching television or socializing with friends, his knees really do not bother him. However, when he bears weight, the pain in his knees increases to a moderate level. Extensive walking (more than one-half mile) or climbing stairs causes significant pain.

Client Goals: To reduce the pain in his knees so that he can continue to enjoy fishing from his boat and walking to the recreation center

Employment: John is a retired engineer. His wife is also retired.

General Health: Good

Medications: Captopril, hydrochlorothiazide, na-proxen

Anthropometrics: Height: 6 feet, 0 inches; weight: 192 lbs; body mass index: 26; no recent weight change

Laboratory: Normal except for PSA 6 mg/ml

Radiographs: Narrowing of joint space and osteophyte formation

Integumentary: Mild swelling bilaterally

Cardiopulmonary: BP 143/80, HR 72

Neuromusculoskeletal ROM: Limited into extension by 5/5 degrees bilaterally, pain upon palpation and crepitus. Decreased quadriceps and hip extensor strength 4/5 bilaterally

Function: Limited by pain rating of 2/10 at rest, increasing to 6/10 with elevations and ambulation

Incorporating CAM into the Plan of Care

John is not satisfied with the relief he has received using naproxen and is wary of the possible adverse event of GI bleeding. He would like to be able to do his daily activities without limitation and with reduced pain. According to John’s BMI, he may be classified into the “overweight” category (BMI of 26 to 29). For John to be at the desirable BMI of 25, he would need to weigh 184 pounds, which would require a weight loss of 8 pounds. Although weight loss is advocated in people with arthritis who are overweight, John is at his usual weight with significant pain that may not be considerably affected by a 4% weight loss. Adding the dietary supplement containing glucosamine and chondroitin will be explored.

Information about herbals and supplements is prevalent in the popular press. Clients often ask their physical therapist for information about use of such supplements. Physical therapists in collaboration and consultation with other health care providers such as physicians and dietitians can serve as a resource for client education. In this chapter a physical therapist and a dietitian interact to educate a man with osteoarthritis (OA) of the knee, whose medication for pain secondary to arthritis, Vioxx, was withdrawn from the market. He wants to learn more about how the dietary supplement containing glucosamine and chondroitin may be used to alleviate his arthritis pain. He is interested in combining the dietary supplement with the appropriate exercise to improve his mobility.

INVESTIGATING THE LITERATURE

Preliminary Reading

Once the therapist is comfortable with understanding the patient’s diagnosis and the current management of OA, he does some preliminary reading on glucosamine and chondroitin to obtain some background information before investigating the literature. The background information will help the therapist develop a strategy for the literature review.

Glucosamine and chondroitin are over-the-counter products and are considered dietary supplements. A logical place to begin is an online database with an unbiased perspective on dietary supplements. Two helpful resources are the Natural Medicines Comprehensive Database, an evidence-based resource particular to dietary supplements used by clinicians of conventional and complementary medicine, and the PDR health site by Thomson Healthcare (see Additional Resources) that includes a database of nutritional supplements. Because glucosamine and chondroitin are used by people with OA, another resource for background information is the Arthritis Foundation (see Additional Resources). These resources may be accessed for overview information summarizing original research. A more comprehensive literature review may follow the preliminary reading.

Glucosamine, as the name implies, is an amino glucose. It is a component of cartilage proteoglycans and essential for the synthesis of glycoproteins, glycolipids, and glycosaminoglycans in the human body.¹ Supplements of glucosamine are derived from exoskeletons of marine life or are manufactured synthetically. Glucosamine sulfate is the form most widely available and used in clinical trials.

Glucosamine is thought to stimulate the metabolism of chondrocytes of articular cartilage and the synovial cells of synovial tissue and is purported to rebuild damaged cartilage and promote antiinflammatory and analgesic activity.^1,² By these actions, glucosamine may help provide relief of symptoms and slow the progression of OA.

Chondroitin, as chondroitin sulfate, is classified as a glucosaminoglycan, which is composed of glucuronic acid and galactosamine.¹ Supplements of chondroitin are derived from shark or bovine cartilage.³ Chondroitin plays a role in the formation of joint matrix structures in mammals and may protect cartilage degradation in OA.^1,³

Glucosamine and chondroitin are naturally occurring substances and fall under the category of dietary supplements. Hence, preliminary reading also should include background knowledge on the regulation of dietary supplements in the United States. The popularity of dietary supplements in the last decade has been the result of several factors, including the plethora of supplements available on the market in stores and through Internet sales.

The abundance of supplement manufacturers and the relative ease of getting a product to market are the result of the passage of the Dietary Supplement Health and Education Act of 1994 (DSHEA, pronounced “De-shay”). DSHEA was an amendment to the Food, Drug, and Cosmetic Act, which made dietary supplements and dietary supplement ingredients exempt from the regulations that apply to food and drugs.⁴ The DSHEA stipulated that the dietary supplement must include a disclaimer statement on the product label that the product has not been evaluated by the Food and Drug Administration (FDA); however, it conveys no judgment from an authoritative source that the product is effective or safe. At times the allowable “structure-function” claims on dietary supplements are confusing to consumers in that no regulation exists regarding the claims to health and wellness.

In practice, if a person wishes to use dietary supplements, the best choice is to buy from a reputable manufacturer and look for voluntary analyses by independent agencies. If a product undergoes and passes quality standards by an independent agency, the product can bear the seal of approval. A sample of four popular agencies and their corresponding seals are depicted in Table 12-1.

Table 12-1 Sample of Independent Agencies Assessing the Quality of Dietary Supplements

AGENCY	URL	QUALITY SEAL
ConsumerLab	http://www.consumerlab.com
NSF International	http://www.nsf.org
Shuster Labs	http://www.shusterlabs.com	Technically Advanced Quality Assurance (TAQA) program
US Pharmacopia	http://www.usp.org

Searching the Databases

After becoming familiar with the dietary supplements, the therapist reviews the available data for efficacy and safety of glucosamine and chondroitin. His search strategy begins with the health-related literature using MEDLINE, CINAHL, PsycINFO, and CAM on PubMed. As a busy clinician he chooses to evaluate efficacy and safety, targeting evidence-based reviews and meta-analyses. He searches evidence-based reviews on the Cochrane Central Register of Controlled trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and InfoPOEMs-InfoRetriever.

The initial search strategy for finding research on the use of glucosamine and chondroitin for OA is conducted on MEDLINE. A general search is done initially using the term osteoarthritis and including all the subcategories. Likewise, the terms glucosamine and then chondroitin are searched. Because this evaluation is to include the use of glucosamine and chondroitin, the terms are combined. Finally the terms glucosamine and chondroitin were combined with osteoarthritis. This search strategy is repeated in CINAHL, PsycINFO, CAM on PubMed, and all evidence-based reviews. Search results then may be further refined to return articles only with human participants and in the English language. As desired the search also can be limited to review articles, those available with full text online, or most recent publication dates. For purposes of this search, articles are limited to evidence-based reviews. See results of the search in Table 12-2.

Table 12-2 Literature Search Results

Only gold members can continue reading. Log In or Register to continue

Related

Stay updated, free articles. Join our Telegram channel

Tags: Complementary Therapies for Physical Therapy

Mar 11, 2017 | Posted by admin in MANUAL THERAPIST | Comments Off

Full access? Get Clinical Tree

Get Clinical Tree app for offline access

Get Clinical Tree app for offline access