Reader Comment
Reader Comment
Comment: With regard to your July 2001 glucosamine article, I would like to bring three points to your attention. First, the claim that glucosamine can increase proteoglycan synthesis comes from old abstracts of in vitro work that were never published in article form. It has never been proven in the human model that glucosamine can increase proteoglycan synthesis, rather it likely prevents further breakdown by supporting and strengthening the existing cartilage. Secondly, a common misconception—that glucosamine is a well known and effective analgesic—was included. Glucosamine works as an analgesic (with chronic use) by supporting cartilage and the extracellular matrix. Lastly, I feel it is important to point out that the Reginster study showed 1,500 mg once daily to be as efficacious and well-tolerated as 500 mg tid, an important finding for patients who cannot follow three-times daily dosing.
Candy Tsourounis, PharmD
Assistant Clinical Professor
Department of Pharmacy
School of Pharmacy
University of California-San Francisco
Response: We do not know what oral glucosamine does in vivo in human cartilage; Dr. Tsourounis’ speculations in this regard are no more conclusively proven than the data cited in the article. Her hypothesis about why glucosamine works as an analgesic is interesting, but there are no data to support it. Interestingly, we do not even know why there is pain in osteoarthritis. Finally, the Reginster study did not compare a once-daily dose to a three-times daily dose; they used only a once-daily dose vs. placebo. No comparison of tolerability or efficacy was made.
Sharon L. Kolasinski, MD, FACP, FACR
Assistant Professor of Medicine, School of Medicine
Director, Rheumatology Fellowship Program
Chief of Clinical Service, Division of Rheumatology
University of Pennsylvania, Philadelphia
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