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Some patients can’t wait to tell you what’s

worked for their osteoarthritis (OA)—

I recall in one week two unrelated elderly

gentlemen told me of the enormous benefit

they derived from spraying their knees with

WD-40! And I’m often asked about non-

prescription health supplements, especially

those for OA, such as chondroitin sulphate

(CS) and glucosamine. CS is a naturally

occurring molecule found in cartilage, blood

vessels, tendons and ligaments. It belongs

to the class of proteoglycans and consists

of galactosamine and glucuronic acid. But

research provides conflicting answers as to

whether CS helps ease the symptoms of OA

in the knee and slows its progression.

A randomised placebo controlled study

had half of a cohort of 300 people with OA

into take 800 mg of bovine-origin, highly

purified chondroitin 4- and 6-sulphate each

day for two years. At the end of the trial

period, there was no change in the average

joint space of those taking CS whereas

the group taking the placebo did have

narrowing. However, questionnaires did not

reveal any significant difference between

the groups in terms of pain and stiffness.

Elsewhere, a large study of 1583 people

found that CS, at a dose of 1200 mg per

day for 24 weeks, resulted in a significant

decrease in knee swelling. While more than

60 per cent of the placebo group achieved

a 20 per cent or greater decrease in pain,

65 per cent of those taking CS had a similar

response. It was concluded that CS was

therefore no better than placebo in terms

of significantly reducing knee pain.

Meanwhile, in an international randomised

placebo controlled double-blind study, 309

people with OA took 800 mg of CS (bovine

origin, types 4- and 6-) and 313 similar

patients took placebo, once a day for two

years. Pain relief increased faster over time

during the first nine months in those taking

CS compared to those taking placebo, while

the percentage of patients with joint space

narrowing greater than or equal to 0.25 mm

was greater in those on the placebo (41 per

cent) compared to those on CS (28 per cent).

Not all CS is the same. One study

examined the effect of three different CS

compounds—one sourced from pigs

and two from cattle—but all from different

manufacturers. Not all acted similarly;

one increased the amount of damaging

constituents while decreasing the factors

which promoted articular cartilage health.

CS helps produce molecules called

proteoglycans from chondrocytes, reduces

the production of matrix metalloproteinases,

has an anti-inflammatory effect, and

interferes with the programmed cell

death (apoptosis) of chondrocytes. CS

also impairs the production of cytokines

by cartilage cells, which may mean less

stimulation of nerve cells signalling pain.

There are several possible reasons why

certain studies show less benefit than

others, including some researchers using

inferior forms of CS and some using

brands that have inconsistent quantities

of CS. Part of the reason why CS doesn’t

help all people with OA may be that not

all individuals have the same gut bacterial

populations and that these differing

populations degrade CS to varying extents.

Researchers examined 11 products from

the marketplace that contain CS. The

amount found after analysis was significantly

different from that indicated on the label,

with deviations ranging from as low as 33

per cent to 110 per cent. The only Australian

commercially available CS I could find at a

reasonable price for delivering 800 mg of the

correct type of CS per day was BioOrganics

Glucosamine 750 mg and Chondroitin 400

mg. A business variously called Chondrosulf

Australia or CS Ethical Pty Ltd advertises

that it distributes Chondrosulf in Australia,

however this appears to be a scam (the

Office of Fair Trading has been notified).

I suggest patients do their own research on

their bodies by working in conjunction with

a physiotherapist. At IceFire Physiotherapy,

the following steps are advised: have an

examination and complete a questionnaire

before taking CS; take at least 800 mg of

4- and 6- types daily for six months; repeat

the examination and questionnaire; cease

taking CS for another six months; repeat

the examination and questionnaire.

Jonathan Clerke holds a Bachelor

of Science (Hons) and a Bachelor of

Physiotherapy, both from the University

of Queensland. He is a past contributor

to InMotion, has co-authored articles in

peer-review scientific journals, and runs

two private practices in Brisbane.

Does chondroitin sulfate

help treat OA?


Icefire Physiotherapy’s Jonathan Clerke, APAM, delves into the potential value of chondroitin

sulphate (CS) to help ease the symptoms and slow the progression of knee osteoarthritis (OA).

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