Flodol Glucosamine

Following are the details of a randomized, double blind study on the effects of a topical cream containing Glucosamine Sulfate for osteoarthritis of the knee.

The study was done by Marc Cohen, Rory Wolfe, Trudy Mai and Daniel Lewis.

Objective
To assess the ability of a topical preparation of glucosamine sulfate and chondroitin sulfate to reduce pain related to osteoarthritis (OA) of the knee.

Methods
63 patients were randomized to receive either a topical glucosamine and chondroitin preparation or placebo to be used as required over an 8-week period. Efficacy was assessed using a visual analog scale (VAS) for pain as well as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the SF-36 questionnaire.

Results
VAS scores indicated a greater mean reduction in pain for the glucosamine/chondroitin preparation group (mean change - 3.4cm, SD 2.6cm) compared to the placebo group (mean change - 1.6cm, SD 2.7cm) after 8 weeks. After 4 weeks the difference between active and placebo groups in their mean reduction from baseline was 1.2 (95 per cent CI 0.1 to 2.4, p = 0.03) and after 8 weeks was 1.8 (95 per cent CI for difference between groups, 0.6 to 2.9cm; p = 0.002).

Conclusion
Topical application of glucosamine and chondroitin sulfate is effective in relieving the pain from OA of the knee and improvement is evident within 4 weeks.

Glucosamine and chondroitin sulfate have been consistently shown to be agents of low toxicity that may relieve the pain and joint stiffness associated with osteoarthritis (OA). Longterm use of glucosamine may reduce radiographic progression of OA of the knee, suggesting it may be a chondroprotective, disease modifying agent in OA of the knee.

Although rapidly absorbed from the gastrointestinal tract, pharmacokinetic data show that when administered orally, glucosamine is subject to uptake and degradation by the liver and uptake into non-joint tissues so that the dose reaching the articular cartilage is a fraction of a percentage of the oral dose. While glucosamine has been shown to be active when given intramuscularly, direct topical application into the dermis surrounding an affected joint may potentially deliver a more concentrated dose to the affected area.


Chondroitin sulfate has also been shown to be effective in reducing OA pain and to enhance the pain relieving action of glucosamine, despite poor gastrointestinal bioavailability when administered orally. Chondroitin sulfate may further act as a carrier substance to enhance dermal penetration of topical substances. The study examines the use of a topical glucosamine/chondroitin sulfate preparation containing camphor and peppermint oil in relieving pain from OA of the knee.

Source: The Journal of Rheumatology 2003; 30:3, pgs 523-528.