Glucosamine and Chondroitin Sulfate Treatment of Hand Osteoarthritis

STEOARTHRITIS OF THE hand is a common degenerative musculoskeletal condition affecting the health-related quality of life of many adults. Despite the high prevalence of symptomatic hand osteoarthritis, the therapeutic options are limited, and the mainstay of pharmacological treatment includes short-term use of oral analgesic and antiinflammatory medications. 1 However, the well-recognized systemic toxicities with these medications limit their use. 2 Recent public interest in alternative treatments for osteoarthritis has resulted from the limitations of conventional medications and the desire to decelerate the degenerative process. 3 Glucosamine and chondroitin sulfate (CS) are among the most popular nonprescription nutriceutical products in the United States and are widely promoted by manufacturers to have remarkable chondroprotective benefits. This article aims to review the best available evidence to facilitate an evidence-based discussion with patients regarding the efficacy and safety of these products in patients with osteoarthritis of the hand. BACKGROUND Glucosamine is an amino monosaccharide and a substrate for the biosynthesis of glycosaminoglycans (GAGs), important structural components of articular cartilage. 1 CS is a sulfated GAG macromolecule that is linked to proteins as part of a proteoglycan aggrecan. The highly charged sulfate groups of GAGs generate a strong affinity for water within the extracellular collagen matrix, contributing to the important compression resistance and viscoelastic properties of cartilage. 1 Os