The pharmacological effects of glucosamine chondroitin, chitosan, and phytoestrogen on knee osteoarthritis

Putu Kermawan; I. Wayan Putu Sutirta Yasa; I. Made Jawi; I. Ketut Suyasa; Made Bramantya Karna

doi:10.18203/2320-6012.ijrms20241958

Authors

Putu Kermawan Department of Biomedical, Doctoral Degree, Faculty of Medicine, Udayana University, Bali, Indonesia
I. Wayan Putu Sutirta Yasa Department of Biomedical, Doctoral Degree, Faculty of Medicine, Udayana University, Bali, Indonesia
I. Made Jawi Department of Biomedical, Doctoral Degree, Faculty of Medicine, Udayana University, Bali, Indonesia
I. Ketut Suyasa Department Orthopaedic and Traumatology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia
Made Bramantya Karna Department Orthopaedic and Traumatology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia

DOI:

https://doi.org/10.18203/2320-6012.ijrms20241958

Keywords:

Knee OA, Glucosamine chondroitin, Chitosan, Phytoestrogens

Abstract

Osteoarthritis (OA) of the knee significantly disrupts daily activities and reduces quality of life due to pain. The primary treatment involves anti-inflammatories, which can cause stomach issues. Alternative therapies, including glucosamine, chondroitin, chitosan, and phytoestrogens, are being explored, but their effects need further study. While some benefits may be due to the placebo effect, researchers conducted a literature review to determine their actual benefits. A review of seven meta-analyses found that glucosamine and chondroitin can alleviate pain, reduce stiffness, improve function, and reduce joint space narrowing (JSN) in OA patients. Chitosan's use in intra-articular injections for OA has been studied in four observational studies and clinical trials on animals, but the effects of oral chitosan supplements remain unknown. A literature review on phytoestrogens in OA, particularly in post-menopausal women, identified four relevant studies. The review suggests that glucosamine, chondroitin, chitosan, and phytoestrogens have significant therapeutic benefits for OA, such as reducing pain (measured by VAS score), relieving stiffness, and improving functionality due to their anti-inflammatory and chondroprotective effects. Therefore, additional randomized controlled trials are needed to confirm their effectiveness in managing knee OA.

Metrics

Metrics Loading ...

References

Bajerska J, Łagowska K, Mori M, Reguła J, Skoczek-Rubińska A, Toda T, et al. A Meta-Analysis of Randomized Controlled Trials of the Effects of Soy Intake on Inflammatory Markers in Postmenopausal Women. J Nutr. 2022;152(1):5-15.

Coaccioli S, Sarzi-Puttini P, Zis P, Rinonapoli G. Osteoarthritis: New Insight on Its Pathophysiology. J Clin Med. 2022;11(20):6013.

Carreon LY, Puno RM, Lenke LG, Richards BS, Sucato DJ, Emans JB, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Jt Surg Ser A. 2007;89(11):2427-32.

Gundogdu G, Demirkaya Miloglu F, Gundogdu K, Tasci SY, Albayrak M, Demirci T, et al. Investigation of the efficacy of daidzein in experimental knee osteoarthritis-induced with monosodium iodoacetate in rats. Clin Rheumatol. 2020;39(8):2399-408.

Kloppenburg M, Berenbaum F. Osteoarthritis year in review 2019: epidemiology and therapy. Osteoarthr Cartil. 2020;28(3):242-8.

Meng Z, Liu J, Zhou N. Efficacy and safety of the combination of glucosamine and chondroitin for knee osteoarthritis: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2023;143(1):409-21.

Ogata T, Ideno Y, Akai M, Seichi A, Hagino H, Iwaya T, et al. Effects of glucosamine in patients with osteoarthritis of the knee: a systematic review and meta-analysis. Clin Rheumatol. 2018;37(9):2479-87.

Manohar VS, Vinay M, Jayasree T, Kishan PV, Ubedulla S, Dixit R. Prescribing pattern of gastroprotective agents with non-steroidal anti-inflammatory drugs. J Pharmacol Pharmacother. 2013;4(1):59-60.

Liu Y, Luo B, Shi R. Nonerythropoietic Erythropoietin-Derived Peptide Suppresses Adipogenesis, Inflammation, Obesity and Insulin Resistance. Sci Rep. 2015;5.

Lynen NA, Eichhorn C, Portelange N, Chausson M, Weyenberg W. Long-Term Efficacy Following Intra-articular Injection of Carboxymethyl-chitosan, a New Product Class for Knee Osteoarthritis: Results from an Observational Study in Germany. Rheumatol Ther. 2024;11(3):649-62.

Rabade A, Viswanatha GL, Nandakumar K, Kishore A. Evaluation of efficacy and safety of glucosamine sulfate, chondroitin sulfate, and their combination regimen in the management of knee osteoarthritis: a systematic review and meta-analysis. Inflammopharmacology. 2024;32(3):1759-75.

Rieger R, Boulocher C, Kaderli S, Hoc T. Chitosan in viscosupplementation: in vivo effect on rabbit subchondral bone. BMC Musculoskelet Disord. 2017;18(1):350.

Singh JA, Noorbaloochi S, MacDonald R, Maxwell LJ. Chondroitin for osteoarthritis. Cochrane database Syst Rev. 2015;I(1):5614.

Simental-Mendía M, Sánchez-García A, Vilchez-Cavazos F, Acosta-Olivo CA, Peña-Martínez VM, Simental-Mendía LE. Effect of glucosamine and chondroitin sulfate in symptomatic knee osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials. Rheumatol Int. 2018;38(8):1413-28.

Zhu X, Sang L, Wu D, Rong J, Jiang L. Effectiveness and safety of glucosamine and chondroitin for the treatment of osteoarthritis: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2018;13(1):170.

Zeng C, Wei J, Li H, Wang YL, Xie DX, Yang T, et al. Effectiveness and safety of Glucosamine, chondroitin, the two in combination, or celecoxib in the treatment of osteoarthritis of the knee. Sci Rep. 2015;5:16827.

Zou Y, Liu Q, Guo P, Huang Y, Ye Z, Hu J. Anti‑chondrocyte apoptosis effect of genistein in treating inflammation‑induced osteoarthritis. Mol Med Rep. 2020;22(3):2032-42.

Emans P. First-in-human study to evaluate a single injection of KiOmedine®cm-Chitosan for treating symptomatic knee osteoarthritis. Open Rheumatol J. 2022;16(1).10

Miao Q. The Bone-Protective Effect of Genistein in the Animal Model of Bilateral Ovariectomy: Roles of Fitoestrogens and PTH/PTHR1 Against Post-Menopausal Osteoporosis. Int J Mol. 2012;13:56-70.

Naeem MA, Usman M, Latif MK. The relationship of D-dimer levels with risk for developing deep-vein thrombosis and/or pulmonary thromboembolism after orthopaedic trauma surgery. J Ayub Med Coll Abbottabad. 2009;21:113-6.

Kirkham, S. and Samarasinghe R. Review Article: Glukosamin. J Orthop Surg. 2009;17(1):72-6.

Liu FC, Wang CC, Lu JW, Lee CH, Chen SC, Ho YJ, et al. Chondroprotective Effects of Genistein against Osteoarthritis Induced Joint Inflammation. Nutrients. 2019;11(5):1180.