Chondroitin sulfate supplement and glcusoamine for arthritis treatment, 400 mg tablets, for osteoarthritis treatment, benefit and side effects, by Ray Sahelian, M.D.
July 18 2014

Chondroitin sulfate consists of repeating chains of molecules called glycosaminoglycans. It is a major constituent of cartilage, tendons and ligaments, providing structure, holding water and nutrients, and allowing other molecules to move through cartilage — an important property, as there is no blood supply to cartilage. This nutrient may work by acting as a building block for proteoglycan molecules, and may also have anti-inflammatory properties. Taking orally does lead to effective absorption.

Arthritis and osteoarthritis benefit

In degenerative joint disease, such as osteoarthritis, there is a loss of chondroitin sulfate as the cartilage erodes. Animal studies indicate that it may promote healing of bone, which is consistent with the fact that the majority of glycosaminoglycans found in bone consist of chondroitin sulfate. This nutrient has been shown in numerous trials to relieve symptoms and possibly slow the progression of, or in some cases, reverse osteoarthritis.

Back in the mid 1990s the American public became aware of effective nutritional alternatives to standard medical drugs for the treatment of osteoarthritis. Glucosamine was the first nutrient that became popular. Since then, many other nutrients and herbs have been promoted, including chondroitin sulfate, a major constituent of cartilage providing structure, holding water, and allowing other molecules to move through cartilage. This is an important property as there is no blood supply to cartilage.

A study from Switzerland finds the supplement chondroitin sulfate to be effective for relieving joint pain in patients with osteoarthritis of the hand. Arthritis & Rheumatology, published 2011.

Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI. Ann Rheum Dis. 2011. Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, Montreal, Canada.
To determine the effect of chondroitin sulphate (CS) treatment on cartilage volume loss, subchondral bone marrow lesions (BML), synovitis and disease symptoms in patients with knee osteoarthritis (OA). In this pilot multicentre, randomised, double-blind, controlled trial in primary knee OA, 69 patients with clinical signs of synovitis were randomised to receive CS 800 mg or placebo once daily for 6 months followed by an open-label phase of 6 months in which patients in both groups received CS 800 mg once daily. Cartilage volume and BML were assessed by MRI at baseline and at 6 and 12 months; synovial membrane thickness was assessed at baseline and at 6 months. The CS group showed significantly less cartilage volume loss than the placebo group as early as 6 months for the global knee, lateral compartment and tibial plateaus, with significance persisting at 12 months. Significantly lower BML scores were found for the CS group at 12 months in the lateral compartment and the lateral femoral condyle. Disease symptoms were similar between the two groups. CS treatment significantly reduced the cartilage volume loss in knee OA starting at 6 months of treatment, and BML at 12 months. These findings suggest a joint structure protective effect of CS and provide new in vivo information on its mode of action in knee OA.

Buy Chondroitin Sulfate supplement 400 mg each pill, 60 Tablets


Chondroitin Sulfate is a mucopolysaccharide found in cartilage, tendons and ligaments, where it is bound to proteins such as collagen and elastin. In our joints, it contributes to strength, flexibility and shock absorption. Current research indicates that supplementation may help maintain proper joint function.
 

Buy Chondroitin sulfate supplement tablets, Joint Power Rx formula, or see a complete list of top quality products 
Supplement Facts
Chondroitin sulfate 400 mg per tablet

Suggested Use, dosage: 2 to 4 tablets daily, or as recommended by your health care professional.
The most common dose of glucosamine is 1500 mg a day while that of chondroitin is 500 to 1200 mg per day.

The ingredients in Joint Power Rx include glucosamine sulfate  (from shellfish), Chondroitin and MSM, CMO complex, boswellia serrata extract, turmeric, cat's claw extract, devil's claw extract, grape seed extract, and Sea cucumber.

Cholesterol, does it influence levels?
We have not heard of any relation to levels of cholesterol being influenced by the intake of glucosamine or chondroitin.

Diabetes and blood sugar
One study providing a combination of glucosamine and chondroitin for a period of 90 days did not find any change in blood sugar levels so it appears to be safe for diabetics.

Psoriasis and skin
In 2005 a small study was published: Clinical And Histopathological Improvement Of Psoriasis With Oral Chondroitin Sulfate: A Serendipitous Finding. Although small scale it showed extremely promising results on all but one (10 out of 11) cases of psoriasis. However psoriasis seems responsive to placebos quite regularly, yet in this case the trial was originally about osteoarthritus of the knee so arguably the placebo affect should not have affected outcome regarding psoriasis coverage. Have you since seen any medical studies regarding its role in psoriasis treatment?
    I have not seen any such psoriasis studies since the one in 2005, but it does look quite encouraging.

Clinical and histopathological improvement of psoriasis with oral chondroitin sulfate: a serendipitous finding.
Dermatol Online J. 2005.
We describe the clinical and histopathological results of plaque psoriasis in eleven adult patients with knee osteoarthritis and long-standing, moderate to severe psoriasis resistant to conventional therapy treated with chondroitin sulfate. Patients received 800 mg per day for 2 months. All patients but one presented a dramatic improvement of the condition of the skin, with a reduction of swelling, redness, flaking, and itching (clearance of psoriasis in one patient), increase in the hydration and softening of the skin, and amelioration of scaling. Histopathologically, there was a statistically significant decrease in epidermal thickness, a decrease in the thickness between the stratum basale and the stratum granulosum, a significant improvement of the degree of psoriasis activity, and a decrease in the number of keratinocytes stained with Ki-67. The confirmation of these serendipitous findings in controlled prospective studies could represent an important advance in the therapeutic armamentarium for patients with psoriasis given the excellent safety profile of chondroitin sulfate.

Source
Commercially available chondroitin is derived mainly from shark and cow cartilage. it can also be derived from porcine sources. I have not seen much research comparing the benefits or risks of chondroitin derived from different sources.

Glucosamine chondroitin side effects, allergy
Allergic reactions are possible with glucosamine or chondroitin. Otherwise, no major side effects have yet been reported.

I am looking to buy chondroitin sulfate for my arthritic knees. I get an upset stomach with chondroitin and glucosamine. I am allergic to penicillin and sulfa drugs. Does chondroitin sulfate fall into this category?
    I am not aware of any research that indicates that does who are allergic to penicillin or sulfa drugs are more likely to be allergic to this supplement. However, as with the use of any medication or natural pill, caution is advised and one should initially begin with low dosages.


Is chondroitin necessary if someone is already taking glucosamine?
The research with chondroitin  is not as consistent and extensive as it is with glucosamine. If you have arthritis, one option is to start with glucosamine 500 mg three times a day for a month. If, after a month, you haven't been helped, double your dose of glucosamine. If, after another month, you need additional relief, you can try chondroitin at 500 mg three times a day. Another option is to start taking both together along with a few other nutrients and herb found through research to be helpful for arthritis.

Chondroitin from shark cartilage, glucosamine hydrochloride and quercetin for osteoarthritis
A combination supplement of 1200 mg glucosamine hydrochloride, 300 mg shark cartilage (consisting of about 100 mg of chondroitin), and 45 mg of quercetin, taken daily, was found to be helpful as a treatment for osteoarthritis.

Effects of an Oral Administration of Glucosamine Chondroitin Quercetin Glucoside on the Synovial Fluid Properties in Patients with Osteoarthritis and Rheumatoid Arthritis.
Biosci Biotechnol Biochem. 2009.
Forty-six osteoarthritis and twenty-two rheumatoid arthritis patients were administered with the glucosamine chondroitin quercetin supplement orally for 3 months. The osteoarthritis patients showed a significant improvement in pain symptoms, daily activities (walking and climbing up and down stairs), and changes in the synovial fluid properties with respect to the protein concentration, molecular size of hyaluronic acid, and chondroitin 6-sulphate concentration were also observed. However, no such effects were observed in the rheumatoid arthritis patients.

Chondroitin Research studies
2006 -
 In a study published in the New England Journal of Medicine, glucosamine plus chondroitin sulfate did not provide significant relief from osteoarthritis pain among all participants. However, a smaller subgroup of study participants with moderate-to-severe pain showed significant relief with the combined supplements. Rheumatologist Daniel O. Clegg, MD, of the University of Utah, School of Medicine, Salt Lake City, conducted the 4-year study known as the Glucosamine / chondroitin Arthritis Intervention Trial (GAIT) at 16 sites across the United States. Participants were randomly assigned to receive one of five treatments daily for 24 weeks: glucosamine alone (1,500 mg), chondroitin sulfate alone (1,200 mg), glucosamine and chondroitin sulfate combined (same doses), a placebo, or celecoxib (200 mg). Celecoxib is an FDA-approved drug for the management of osteoarthritis pain and served as a positive control for the study. A positive response to treatment was defined as a 20 percent or greater reduction in pain at week 24 compared to the start of the study. The researchers found that participants taking celecoxib experienced statistically significant pain relief, as expected, versus placebo -- about 70 percent of those taking celecoxib versus 60% taking placebo had a 20% or greater pain reduction. For all participants, there were no significant differences between the other treatments tested and placebo. However, for participants in the moderate-to-severe pain subgroup, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared to placebo -- about 79% in this group had a 20% or greater pain reduction compared to 54% for placebo. In the subgroup of participants with mild pain, glucosamine and chondroitin sulfate together or alone did not provide statistically significant relief compared to placebo. On entering the study, a participant's level of pain was assessed as either mild or moderate to severe using standard pain assessment tools and scales, such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Of the 1,583 study participants, 78% were in the mild pain subgroup and the other 22% were in the moderate-to-severe pain subgroup. Level of pain was evaluated at weeks 4, 8, 16, and 24 using the WOMAC scale and other tools. In addition to taking their daily study treatment, participants could take up to 4,000 mg of acetaminophen daily for pain, except for the 24 hours before they were assessed by study staff. Few side effects from any of the treatments were reported. Those reported were generally mild, such as upset stomach, and distributed evenly across the treatment groups. The GAIT team continues their research with a smaller study to see whether glucosamine and chondroitin sulfate can alter the progression of osteoarthritis, such as delaying the narrowing of the joint spaces. About one-half of the participants in the larger GAIT study were eligible to enroll in this ancillary study. The results are expected in about a year.

2005 - ACR (American College of Rheumatology) Annual Scientific Meeting. Dr. Clegg, lead researcher of the NIH (GAIT) Glucosamine / Chondroitin Arthritis Intervention Trial, presented further data on the positive effects of chondroitin sulfate. Dr. Clegg explained that the study was designed to look at the action of chondroitin sulfate and glucosamine as drugs and not as dietary supplements. Chondroitin and glucosamine were required to meet pharmaceutical standards as the GAIT study was conducted under an Investigational New Drug application. New data that was presented by Dr. Clegg using the Omeract OARSI (Osteoarthritis Research Society International) response criteria for the total patient population indicated that the response for the combination of glucosamine and chondroitin was significantly higher than placebo. In Dr. Clegg's previous presentation, when using WOMAC response criteria, the result was that in the overall population, chondroitin sulfate and glucosamine did not outperform the positive control celecoxib, or were not significantly better than placebo. There were, however, promising signals in various sub-groups. In an exploratory analysis with patients that had moderate to high pain, the chondroitin / glucosamine combination showed a 79% response versus celecoxib at 69% and placebo at 54%. Dr. Clegg commented that "the combination appears to be more effective than placebo and outcome measures seem more robust." In more detailed analyzing results of chondroitin sulfate, it was found that in the overall population there was a significant improvement for patients experiencing joint swelling. Dr. Clegg concluded that chondroitin sulfate was risk-free and that further trials should be developed to explore the positive signals seen in the GAIT study. Further, to the anti-inflammatory and pain data from the GAIT study, Beat A. Michel, MD, followed with a presentation on the disease-modifying effects of chondroitin sulfate and its ability to control the progression of osteoarthritis. Dr. Michel presented data on the structure-modifying effects of chondroitin sulfate in knee osteoarthritis, the results of which were recently published in Arthritis Rheumatology 2005. The study concluded that chondroitin sulfate qualifies as a Disease Modifying Drug for the treatment of osteoarthritis and is especially active in overweight patients, patients under 60 years of age and patients with mild to moderate osteoarthritis. In all of the study's groups, chondroitin sulfate proved statistically superior to placebo.

A two-year study of chondroitin sulfate in erosive osteoarthritis of the hands: behavior of erosions, osteophytes, pain and hand dysfunction.
Drugs Exp Clin Res. 2004.
A total of 24 consecutive patients (22 women and 2 men) suffering from osteoarthritis with radiographic characteristics of osteoarthritis were evaluated. The patients were divided into two groups of 12 patients each. The first group took naproxen 500 mg only. The second group was treated with chondroitin sulfate 800 mg orally plus naproxen 500 mg. Joint counts, radiological hand examinations and assessment of disease activity were performed at baseline, at 12 months and at 24 months. In the second year the treated group showed significant worsening in erosion, Heberden, Bouchard and Dreiser scores was recorded. Physician and patient global assessments of disease activity showed no significant difference from baseline scores. The untreated group showed significant worsening in erosion, Heberden and Bouchard nodes, Dreiser index and physician and patient global assessment scores. This study confirms the partial efficacy of oral chondroitin sulfate in improving some aspects of osteoarthritis.

A randomized double-blind clinical trial of the effect of chondroitin sulfate and glucosamine hydrochloride on temporomandibular joint disorders: a pilot study.
Cranio. 2001.
Our aim was to study the effect of a daily dose of 1500 mg of glucosamine hydrochloride (GH) and 1200 mg of chondroitin sulfate taken for twelve weeks on subjects diagnosed with capsulitis, disk displacement, disk dislocation, or painful osteoarthritis of the temporomandibular joint (TMJ). Subjects taking chondroitin sulfate and GH had improvements in their pain as measured by one index of the McGill Pain Questionnaire, in TMJ tenderness, in TMJ sounds, and in the number of daily over-the-counter medications needed.

Emails
Perhaps a month or two after I began to take a glucosamine and chondroitin supplement to protect against knee pain, I began to notice that my penis, which had always assumed a straight position in the erect state, was developing a noticeable bend. Over the next month or two, the bend became more pronounced and I was on the verge of consulting a urologist to look into the possibility of Peyronie's Disease, a condition that apparently afflicts our ex-president Clinton and can I understand, interfere with sex if it progresses too far. The only change in my daily routine I could think of during this time was the addition of the glucosamine and chondroiten to my usual vitamins and mineral regimin. I dropped the supplement and over the next couple of months the bend in the penis gradually disappeared. Perhaps it was a coincidence (although I don't think so).
   This is the first time I have heard of glucosamine and chondroitin involved in this after several years of looking into these combinations. I don't know what to say. I think it's possible. Were there other ingredients in the formula or just glucosamine and chondroitin? There's so little we know about the long term effects of supplements and herbs that I keep any side effects as a possibility. I guess a good way to find out for sure is to retake it and see what happens, since it appears to be reversible on stopping... but i can see one's reluctance in this trial when it comes to such an important member of the body :)

I just began taking a chondroitin glucosamine supplement (1500 / 1200 mg/day, respectively, as recommended on bottle). When taking it (all mg) during the day I I was much more tired than usual - almost fatigued. Last night I took it about 2 hours before bedtime and for the first time in memory slept clear through the night (I usually get up at least once to urinate and/or drink water for dehydration.) I can't find that anyone has reported this anecdotally or in medical lit.
   We have not had any feedback thus far that chondroitin and glucosamine cause sleepiness.

I read on a website that there does not seem to be a risk of mad cow disease regarding the use of chondroitin sulfate from bovine cartilage. Would you please do a Google search with the terms - chondroitin sulfate BSE.  Number six on the list after the scholarly articles says Caution - Know The Risk Of Your Chondroitin.  The website is activexamerica.com and talks about its product of chondroitin sulfate from shark cartialge.  Even though they have a product to sell, the sources they mention seem to be very credible. To your knowledge, are there any differences in the effects of shark cartilage versus bovine cartilage chondroitin sulfate on the human body? The reason I am asking is because I have had a scaling skin condition for 21 years on my lips and I found an article from a Google search with the terms - parakeratosis scaling skin treatment.  Number 22 on the list mentions an article witht the title, Clinical And Histopathological Improvement Of Psoriasis With Oral Chondroitin Sulfate: A Serendipitous Finding.  The study uses 800mg of chondroitin sulfate for two months from a bovine source and I would like to duplicate the effects on my lips. 
   There is some debate regarding the risk of mad cow disease and chondroitin sulfate consumption from a bovine source and not all questions have been completely answered. Thus far there have not been any cases of mad cow disease diagnosed in anyone who has consumed chondroitin sulfate, and it appears tens of millions of people have over the past few years. Furthermore, the risk of mad cow disease in the USA is so small that one would have a higher risk of injury or death by just getting in the car and taking a trip to the shopping mall, yet few people think of this risk when they get in their car but worry about extremely small and extremely unlikely scenarios such as mad cow disease. Therefore, at this point, for practical purposes, it appears that the use of chondroitin sulfate from bovine sources is acceptable and appears to be safe. Since human studies comparing shark cartilage derived chondroitin sulfate has not been compared to bovine source of chondroitin sulfate, we cannot say which form is better. Chances are they are similar.

A friend of mine forwarded to me an email that I hope you can comment on. This is what it said, "Chondroitin is now falling out of favor due to a new analysis published in Annals of Internal Medicine. Most of the early research on chondroitin shows substantial benefit for reducing pain and improving functionality in people with osteoarthritis of the knee. But research published since 2005 has been mostly negative. When the analyses evaluated ALL studies as a whole, it found that chondroitin significantly reduced pain. When only larger, higher-quality, and more recent studies were included there was no significant benefit. The method used for the analysis is stirring up a lot of controversy. And there are still questions about potential long-term benefits such as slowing disease progression. This is not likely to be the last word on chondroitin."
   I never rely on the findings of the latest study to come to a conclusion regarding the benefit or harm of that particular supplement. The research with chondroitin sulfate is not conclusive, but based on everything that I have read and my professional experience, as of May 2007 I think chondroitin should be included in a joint formula along with glucosamine and other herbs and nutrients for a potential synergistic effect on joint health. I will await results of further studies.