Okay it's personal. My mom has OA, my brother has OA, and now I have my own personal little Heberden's nodes all to myself. So I need to know. Should I be taking glucosamine?
Unfortunately the answer is elusive. There has been a fair amount of research done to date, both basic and clinical. Carpus, over atAspirations of a Joint Doc did a great review of a debate undertaken at the last ACR meeting. The short answer arrived at by him, and I would have to agree, is that it probably doesn't work.
Unfortunately, though, the available research isn't that great. In the May issue of Arthritis and Rheumatism, Felson and Kim, in an editorial, suggest that present methods of OA detection and follow-up are inadequate, rendering any such research futile. This agrees with the gut feeling I get when I see results such as those in the same issue, by Nevitt et al, who detected a .43mm loss of joint space in OA patients after three years. That's about .15 mm per year. On x-ray. We may need to await better imaging before we get to the bottom of this story. Not only is the cartilage change slow and hard to detect, but the associated pain bears little correlation with the observed severity of OA. In the knee studies, you only have to think of the myriad non OA causes of knee pain that might interfere with reporting.Further, as discussed by Felson, the glucosamine might affect cartilage biochemically but would not effect the mechanical forces which may be even more important in more advanced OA. He finishes by suggesting we study hand OA, earlier OA, as well as the mechanical side, unloading therapy. Interestingly, he also suggests looking at other tissue, including synovium and subchondral bone, which coincidentally was also addressed by another article in the same issue of Arthritis and Rheumatism.Wang et al found that glucosamine can attenuate the subchondral bone effects of experimental ACL transection in rabbits. Why glucosamine would do that, and why they thought it might is not certain. They are probably looking because a direct cartilage effect has not been promising, and anti-inflammatory effects are unproven. Maybe it works because of all the exercise these OA sufferers are getting by going out more often to buy their glucosamine. It seems like a lot of money and time being spent trying to find out how glucosamine works before finding out if, in fact, it works.
So anyway, back to the question. Should I be taking the stuff? No. Am I taking it? No. Will I take it if another DIP joint joins its grotesque neighbours. Probably. It's not likely to do anything, but at least I'll feel like I'm putting up a phyte, rather than putting up with one.