The benefits of chondroitin sulfate and glucosamine in osteoarthritis have been described as life-changing by millions of arthritis sufferers over the past several decades. Both are components of cartilage, the tissue that connects our bones.
Chondroitin sulfate is a sulfated glycosaminoglycan that is a component of a cartilage molecule known as aggrecan.1 Four fractions have been identified: chondroitin-4-sulfate, chondroitin-6-sulfate, chondroitin-2,6-sulfate, and chondroitin-4,6-sulfate. While it has been suggested that glucosamine, the smaller molecule, is better absorbed than the larger chondroitin sulfate, both compounds have been effective in studies of arthritis patients.
Do Chondroitin Sulfate Supplements Get Absorbed?
A question has been raised concerning whether orally administered chondroitin sulfate results in the molecule being directly incorporated into cartilage. It has been suggested that chondroitin sulfate’s metabolic byproducts could be responsible for the benefits documented in clinical and experimental research. It is, however, notable that a study in which chondroitin sulfate was orally administered to 20 human subjects detected a more than 200% increase in plasma chondroitin sulfate levels, with the peak concentration reached after 2 hours.2 “This research extends previous results obtained by other researchers in man and experimental animals, both with chondroitin sulfate and other polysaccharides, confirming that molecules possessing high molecular mass and charge density can be absorbed orally,” author N. Volpi, of the University of Modena and Reggio Emilia concluded.
Relief from Osteoarthritis Pain and Inflammation
In a three-month randomized trial published in 1992 that included patients with osteoarthritis of the knees and hips, chondroitin sulfate decreased pain and the need for NSAIDs.3 This effect was carried over into a two-month, treatment-free phase following the initial treatment period. Another trial, involving patients with knee, hip and/or finger joint arthritis, resulted in a significant reduction in severe pain reflected in a 72% decrease in the need for NSAIDs during a three-month course of chondroitin sulfate therapy.4 The authors remarked that the reduction of pain to a level that could not have been achieved by NSAID therapy alone was of special interest.
Another randomized, double-blind trial compared the anti-inflammatory effects of chondroitin sulfate and the NSAID diclofenac sodium in 146 knee osteoarthritis patients.5 While participants who received NSAID therapy had more rapid relief of their symptoms (which reappeared at the end of treatment), those who received chondroitin sulfate experienced a later response which lasted for up to three months after the end of treatment.
In yet another randomized comparison trial, osteoarthritis patients treated with anti-inflammatory drugs who also received chondroitin sulfate and ibuprofen daily for six months had less pain and need for anti-inflammatories than those who received ibuprofen alone.6 This response also persisted for three months after the conclusion of the treatment phase.
A comparison of chondroitin sulfate plus naproxen to naproxen alone resulted in reduced progression of joint erosion among patients with osteoarthritis of the hands after two years of treatment.7 The number of finger joints with erosions detected by x-rays at two years was lower among those who received chondroitin sulfate compared to those who received naproxen alone.
In the recent ChONdroitin versus CElecoxib versus Placebo Trial(CONCEPT) trial, which compared the effects of chondroitin sulfate, the NSAID drug celecoxib, and a placebo among patients with osteoarthritis of the knee, pain reduction and improvement in function in association with chondroitin sulfate was similar to that of the NSAID and significantly greater than the placebo after 182 days of daily treatment.8 The authors recommend that chondroitin sulfate be considered a first-line treatment in the management of knee osteoarthritis.
Chondroitin sulfate is frequently combined with glucosamine to treat osteoarthritis symptoms. A randomized, double-blind, crossover trial of chondroitin sulfate, glucosamine hydrochloride (HCl) and manganese ascorbate conducted among U.S. Navy personnel with degenerative joint disease resulted in knee symptom relief.9 In another trial, the combination helped lower an index of severity of osteoarthritis of the knee at 4 and 6 months of treatment in patients with mild to moderate disease.10 Fifty-two percent of those who received chondroitin sulfate, glucosamine HCl and manganese ascorbate twice per day experienced a response to the treatment in comparison with 28% who received a placebo.
Chondroitin sulfate is not a pain blocker, but helps relieve pain by supporting the structure of the joint.11 In a pilot trial of 69 knee osteoarthritis patients, chondroitin sulfate consumed daily was associated with less cartilage volume loss at six months and 12 months as assessed by magnetic resonance imaging (MRI).12 “These findings suggest a joint structure protective effect of chondroitin sulfate and provide new in vivo information on its mode of action in knee osteoarthritis,” L. M. Wildi and colleagues conclude.
In a trial that included 300 participants with osteoarthritis of the knee, treatment with chondroitin sulfates was associated with the maintenance of cartilage at two years as revealed by x-ray evaluation of the knee joint.13 Those who received a placebo worsened over time. The author of the report concluded that chondroitin sulfates are “superior to the placebo with regard to the stabilization of minimum joint space width of the internal femorotibial articular space, the mean thickness and the surface.”
How Long Does Chondroitin Sulfate Take to Work?
Arthritis doesn’t develop overnight. Neither can chondroitin sulfate be expected to work immediately. It typically takes weeks for the effects of chondroitin sulfate and/or glucosamine to be noticed, but benefits can be long lasting. Even when used intermittently for just three months twice yearly during a two-year period, chondroitin sulfate helped maintain joint space width in patients with knee osteoarthritis.14
A randomized trial that compared the effects of a once-daily chondroitin sulfate oral gel, three times daily chondroitin sulfate capsules, and a placebo in 127 patients resulted in both groups who received chondroitin experiencing a significant reduction in clinical symptoms.15 The authors note that the effects of a single daily dose did not differ from those of thrice daily administration for all parameters evaluated.
Other supplements, such as fish oil, Korean angelica and Boswellia serrata canbe added to one’s arthritis regimen if fast relief is needed.
- Felson DT et al. Ann Intern Med. 2007 Apr 17;146(8):611-2.
- Volpi N. Osteoarthritis Cartilage. 2002 Oct;10(10):768-77.
- Mazières B et al. Rev Rhum Mal Osteoartic. 1992 Jul-Sep;59(7-8):466-72.
- Leeb BF et al. Wien Med Wochenschr. 1996;146(24):609-14.
- Morreale P et al. J Rheumatol. 1996 Aug;23(8):1385-91.
- Alekseeva LI et al. Ter Arkh. 1999;71(5):51-3.
- Rovetta G et al. Int J Tissue React. 2002;24(1):29-32.
- Reginster JY et al. Ann Rheum Dis. 2017 Sep;76(9):1537-1543.
- Leffler CT et al. Mil Med. 1999 Feb;164(2):85-91.
- Das A et al. Osteoarthritis Cartilage. 2000 Sep;8(5):343-50.
- Conrozier T. Presse Med. 1998 Nov 21;27(36):1862-5.
- Wildi LM et al. Ann Rheum Dis. 2011 Jun;70(6):982-9.
- Mathieu P. Presse Med. 2002 Sep 14;31(29):1386-90.
- Uebelhart D et al. Osteoarthritis Cartilage. 2004 Apr;12(4):269-76.
- Bourgeois P et al. Osteoarthritis Cartilage. 1998 May;6 Suppl A:25-30.