Dad with chondroitin and glucosamine for joints

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Part 1: Chondroitin and glucosamine: Fundamentals and mechanisms of action

Section 1.1: joint cartilage: structure, function and degeneration

The articular cartilage is a specialized connective tissue covering the ends of the bones in the joints. Its main function is to ensure a smooth, practically non -frequency surface that allows bones to slide smoothly relative to each other during movement. In addition, the cartilage amortizes blows and loads, protecting the bones from damage.

  • The structure of the articular cartilage: Cartilage consists of cells called chondrocytes and extracellular matrix. Matrix is ​​a complex network consisting mainly of type II collagen, proteoglycans (in particular, aggrakan) and water. Type II collagen provides tensile strength, and proteoglycans give the cartilage elasticity and the ability to retain water. Water is up to 80% of the mass of cartilage and plays a key role in its depreciation properties. The cartilage does not contain blood vessels and nerves, therefore, nutrients and oxygen come to chondrocytes by diffusion from synovial fluid.

  • Joint cartilage function: The main functions of the cartilage include:

    • Smooth sliding: Reducing friction between bones during movement.
    • Depreciation: Absorption of shocks and reducing the load on the bones.
    • Load distribution: Uniform distribution of load on the surface of the joint.

  • Horseradish degeneration (osteoarthritis): Osteoarthritis (OA) is a degenerative joint disease characterized by the gradual destruction of the joint cartilage. As a result, cartilage is thinner, loses elasticity and smoothness. This leads to pain, stiffness, limitation of mobility and inflammation in the joint. Factors contributing to the degeneration of cartilage include:

    • Age: with age, the ability of cartilage to regeneration is reduced.
    • Trauma: repeated injuries or a single serious injury can damage cartilage.
    • Excess weight: increases the load on the joints, especially on the knee and hip.
    • Genetic predisposition: some people are genetically more predisposed to the development of OA.
    • Inflammatory joint diseases: rheumatoid arthritis and other inflammatory diseases can damage cartilage.
    • Repeating movements: some activities associated with repeating movements can increase the risk of OA development.

Section 1.2: chondroitin sulfate: structure, sources and mechanism of action

Chondroitin sulfate (XC) is glycosaminoglican (GAG), which is an important component of the extracellular matrix of the articular cartilage.

  • Structure chondroitin sulfa: CHC consists of repeated disaccharide units, consisting of n-acetylgalactosamine and glucuronic acid. These disaccharides are sulfate in various provisions, which determines the various types of cholesterol (CHS, cholesterol, chinese, XC). The type of cholesterol can affect its biological activity.

  • Sources of chondroitin sulfate: XC is obtained from various sources of animal origin, including:

    • Carty trachea of ​​cattle
    • Shark cartilage
    • Pork cartilage
    • Bird cartilage

    Differences in sources can lead to differences in the structure and purity of cholesterol, which, in turn, can affect its effectiveness.

  • The mechanism of action of chondroitin sulfate: CHC has a number of favorable effects on the joint cartilage and joints in general:

    • Stimulation of the synthesis of proteoglycans and collagen: CHC stimulates chondrocytes to the synthesis of proteoglycans (in particular, an aggrakan) and type II collagen, the main components of the extracellular matrix of the cartilage. This contributes to the restoration and strengthening of cartilage.
    • Inhibition of enzymes that destroy the cartilage: CHC inhibits the activity of enzymes, such as matrix metal proproteinase (MMP) and agrekanase, which are involved in the destruction of cartilaginous tissue in OA.
    • Anti -inflammatory action: CHC has an anti-inflammatory effect, reducing the production of pro-inflammatory mediators, such as Interleukin-1β (IL-1β) and a factor of tumor-α (TNF-α) necrosis. This helps to reduce inflammation in the joint and relieve pain.
    • Increase in hyaluronic acid products: CHC can stimulate the production of hyaluronic acid, which is an important component of synovial fluid. Hyaluronic acid improves the viscosity of the synovial fluid, providing better lubrication of the joint and depreciation.
    • Protection chondrocyte from apoptosis: CHC can protect chondrocytes from apoptosis (programmable cell death), which helps to preserve cartilage tissue.

Section 1.3: Glucosamine: structure, sources and mechanism of action

Glucosamine is an aminosahar, which is a predecessor of glycosaminoglycans (GAG), including chondroitin sulfate and hyaluronic acid.

  • Glucosamine structure: Glucosamine is a monosaccharide, which is amino production glucose. There are two main forms of glucosamine used in dietary supplements: glucosamine sulfate and hydrochloride glucosamine.

  • Sources of glucosamine: Glucosamine is obtained mainly from exoskeletons of crustaceans (shrimp, crabs, lobsters). For vegetarians, there are alternative sources, such as glucosamine obtained by fermentation of corn.

  • Glucosamine mechanism: Glucosamine has a number of favorable effects on the joint cartilage and joints:

    • Stimulation of the synthesis of GAG and proteoglycans: Glucosamine is a building block for the synthesis of the GAG, including chondroitin sulfate and hyaluronic acid. It stimulates chondrocytes to the synthesis of these important components of the extracellular matrix cartilage.
    • Anti -inflammatory action: Glucosamine has an anti -inflammatory effect, reducing the production of pro -inflammatory mediators and enzymes that destroy cartilage.
    • Reducing the activity of enzymes destroying cartilage: Glucosamine can inhibit the activity of MMP and other enzymes involved in the destruction of cartilage.
    • Improving the viscosity of synovial fluid: Glucosamine can help increase the production of hyaluronic acid, which improves the viscosity of synovial fluid and provides better lubrication of the joint.
    • Antioxidant action: Some studies show that glucosamine can have an antioxidant effect, protecting chondrocytes from damage to free radicals.

Section 1.4: Synergizm Chondroitin and Glucosamine

The combined use of chondroitin and glucosamine is often recommended due to the alleged synergistic effect. It is believed that these two substances complement and enhance the action of each other.

  • The alleged mechanisms of synergism:
    • Strengthening stimulation of cartilage synthesis: Glucosamine provides building blocks for the synthesis of the GAG, and chondroitin sulfate stimulates chondrocytes to their synthesis. Combined use can provide both the necessary components and stimulation for the restoration of cartilage.
    • Strengthening anti -inflammatory action: Both substances have an anti -inflammatory effect, and their combined use can lead to a more pronounced decrease in inflammation in the joint.
    • Complex cartilage protection: Glucosamine can improve the viscosity of synovial fluid, and chondroitin sulfate protects the cartilage from destruction by enzymes. Combined use provides complex protection of cartilage.

Part 2: Clinical studies and the effectiveness of dietary supplements with chondroitin and glucosamine

Section 2.1: Large clinical research: Gait and Moves

The effectiveness of chondroitin and glucosamine for the treatment of OA is the subject of numerous clinical studies. Two large and influential studies, Gait (Glucosamine/Chondroitin arthritis intervention Trial) and Moves (MultiCenter OsteoartHritis Intervention Trial with Sysadoa), made an important contribution to the understanding of this issue.

  • GAIT (Glucosamine/Chondroitin Arthritis Intervention Trial): This is a multicenter, double blind, placebo-controlled study conducted by the US National Institutes (NIH). The study was attended by more than 1,500 patients with an OA of the knee joint. Patients were randomized in five groups:

    • Glucosamine hydrochloride (500 mg three times a day)
    • Chondroitin sulfate (400 mg three times a day)
    • Glucosamine + chondroitin
    • Celecoxib (200 mg per day) (control group with non -steroidal anti -inflammatory drug – NSAID)
    • Placebo

    The results of the study showed that glucosamine and chondroitin, both separately and in combination, did not provide a statistically significant improvement in pain compared to placebo in the general group of patients. However, in the subgroup of patients with moderate and severe knee pain, a combination of glucosamine and chondroitin provided a statistically significant improvement in pain compared to placebo. Celecoxib also showed a significant improvement in pain compared to placebo.

  • MOVES (Multicenter Osteoarthritis interVEntion trial with SYSADOA): This is a European, multicenter, randomized, double blind study that compares the effectiveness of a combination of glucosamine sulfate and chondroitin sulfate with a celloxibe in patients with an OA of the knee joint. More than 600 patients participated in the study. Patients were randomized in two groups:

    • Combination of glucosamine sulfate (750 mg twice a day) and chondroitin sulfate (800 mg twice a day)
    • Celecoxib (200 mg per day)

    The results of the study showed that the combination of glucosamine and chondroitin was not inferior to Celecoxib in relief of knee pain after 6 months.

  • Interpretation of the results of Gait and Moves: The results of these two large studies were ambiguous and caused a lot of disputes. Gait showed the lack of a significant effect in the general group, but a positive effect in a subgroup with moderate and severe pain. Moves has shown comparable effectiveness with a celloxyb. These differences can be associated with the differences in the design of studies, the forms of glucosamine and chondroitin, criteria for including patients and other factors.

Section 2.2: meta analysis and systematic reviews of clinical research

In addition to individual clinical studies, many meta analyzes and systematic reviews were carried out that combine several studies to assess the overall effectiveness of chondroitin and glucosamine. The results of these meta analyzes were also contradictory.

  • Various conclusions of meta analyzes: Some meta-analyzes have shown that chondroitin and glucosamine can provide a small but statistically significant improvement in pain and joint function in patients with OA. Other meta analyzes did not reveal a significant effect or came to the conclusion that the effect, if it is, is clinically insignificant. Differences in the conclusions of meta-analyzes can be associated with various criteria for including research, data analysis and other factors.

  • Factors affecting research results: Various factors, including::

    • Form glucosamine and chondroitin: Different forms of glucosamine (sulfate, hydrochloride) and chondroitin can have different bioavailability and effectiveness.
    • Dosage: Effective dosage of chondroitin and glucosamine can vary depending on the severity of the OA and the individual characteristics of the patient.
    • Chondroitin source: Chondroitin, obtained from different sources, can have different structure and purity, which can affect its effectiveness.
    • Criteria for including patients: Research results may depend on the criteria for the inclusion of patients, such as the severity of the OA, the presence of other diseases and the drugs taken.
    • Duration of research: To evaluate the long -term effectiveness of chondroitin and glucosamine, long -term studies are necessary.
    • Research methodology: The quality and methodology of research can affect the results. Double blind, placebo-controlled studies are considered the most reliable.

Section 2.3: Opinions of authoritative organizations and recommendations

The opinions of authoritative medical organizations regarding the effectiveness of chondroitin and glucosamine in OA are different.

  • ESCEO (European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Diseases of the Power Office): ESCEO recommends glucosamine sulfate and chondroitin sulfate as symptomatic drugs for the treatment of OA.

  • Oarsi (International Society for the Study of Osteoarthritis): Oarsi provides various recommendations depending on the specific drug and the localization of the OA. In general, the Orsi recommendations are more careful than the ESCEO recommendations.

  • AAOS (American Academy of Orthopedic Surgeons): AAOS does not recommend the use of glucosamine and chondroitin to treat an OA of the knee joint based on the analysis of the available data.

  • Individual approach: It is important to note that recommendations can change over time as new data appears. The decision on the use of chondroitin and glucosamine should be made individually, after consulting a doctor, taking into account the severity of the OA, the presence of other diseases and drugs taken.

Part 3: forms of release, dosage and rules for taking dietary supplement with chondroitin and glucosamine

Section 3.1: forms of producing dietary supplements with chondroitin and glucosamine

Bades with chondroitin and glucosamine are available in various forms of release, which allows you to choose the most convenient version of the reception.

  • Capsules: Capsules are one of the most common forms of release. They are convenient to use, easily swallow and allow you to accurately dose the drug.

  • Tablets: Tablets are also widespread and have similar advantages with capsules. However, some people may have difficulty swallowing large tablets.

  • Powder: The powder can be dissolved in water or other drinks. This form can be convenient for people who have difficulty swallowing capsules or tablets.

  • Liquid: Liquid forms of dietary supplements with chondroitin and glucosamine also exist, but are less common. They can be convenient for people who have difficulty swallowing solid forms.

  • Creams and gels: There are also creams and gels containing chondroitin and glucosamine, which are designed for local use on affected joints. However, the effectiveness of the local use of chondroitin and glucosamine remains controversial, since their penetration through the skin is limited.

Section 3.2: recommended dosages of chondroitin and glucosamine

Recommended dosages of chondroitin and glucosamine can vary depending on the severity of the OA, the individual characteristics of the patient and the form used.

  • Glucosamine: The usually recommended dosage of glucosamine is 1,500 mg per day, divided into several tricks (for example, 500 mg three times a day or 750 mg twice a day).
  • Chondroitin: The usually recommended chondroitin dosage is 800-1200 mg per day, divided into several tricks (for example, 400 mg two or three times a day).

It is important to follow the instructions on the package of the dietary supplement and consult a doctor to determine the optimal dosage in your particular case.

Section 3.3: Rules adopted Badov with chondroitin and glucosamin

To achieve maximum efficiency and safety for receiving dietary supplements with chondroitin and glucosamine, certain rules should be adhered to.

  • Reception during eating: Reception of dietary supplements with chondroitin and glucosamine during food can improve their absorption.

  • Duration of admission: The effect of taking chondroitin and glucosamine is usually not immediately manifested. To assess the effectiveness, it is necessary to take dietary supplements for several months (usually 3-6 months).

  • A combination with other treatment methods: Reception of dietary supplements with chondroitin and glucosamine should not replace other methods of treatment with OA, such as physiotherapy, physiotherapy exercises, weight loss and taking drugs prescribed by a doctor.

  • Interaction with drugs: It is necessary to take into account the possible interaction of chondroitin and glucosamine with other drugs, especially with anticoagulants (drugs that thin blood). Consult a doctor if you take any medicine.

  • Contraindications and side effects: Before taking dietary supplements with chondroitin and glucosamine, it is necessary to familiarize yourself with contraindications and possible side effects.

Section 3.4: Safety and side effects

Chondroitin and glucosamine are usually considered safe when receiving in recommended dosages. However, some people may have side effects.

  • The most common side effects:

    • Gastrointestinal disorders: nausea, diarrhea, constipation, bloating, heartburn.
    • Headache
    • Skin rashes

  • Less common side effects:

    • Allergic reactions
    • Increasing blood sugar (in patients with diabetes)
    • Increasing blood pressure

  • Contraindications:

    • Individual intolerance to dietary supplements
    • Pregnancy and breastfeeding (not enough safety data)
    • Severe diseases of the kidneys and liver
    • Inflammatory diseases of the intestine (BCC) in the acute stage (with caution)
    • Seafood allergies (for glucosamine obtained from crustaceans)

Part 4: Choosing a dietary supplement with chondroitin and glucosamine: criteria and recommendations

Section 4.1: Criteria for choosing a quality diet

When choosing a dietary supplement with chondroitin and glucosamine, it is important to consider several criteria to ensure its quality and effectiveness.

  • Manufacturer: Give preference to dietary supplements from famous and reliable manufacturers who have a good reputation and comply with quality standards.

  • Certification: Make sure that the dietary supplement is certified by relevant organizations confirming its quality and safety.

  • Composition: Carefully study the composition of the dietary supplement. Make sure that it contains the indicated amounts of chondroitin and glucosamine, as well as the absence of undesirable additives.

  • Form glucosamine and chondroitin: The choice of glucosamine form (sulfate or hydrochloride) and chondroitin (depending on the source and degree of sulfate) can affect the effectiveness of dietary supplements.

  • Dosage: Make sure that the dosage of chondroitin and glucosamine in the dietary supplement corresponds to the recommended dosages.

  • Reviews: Study the reviews of other consumers about the dietary supplement. However, remember that reviews can be subjective and do not always reflect the real product efficiency.

  • Price: Too low price may indicate low dietary supplements. However, high price does not always guarantee high quality.

Section 4.2: Glucosamine forms: sulfate vs. Hydrochloride

There are two main forms of glucosamine used in dietary supplements: glucosamine sulfate and hydrochloride glucosamine. The question of which form is more effective is the subject of discussions.

  • Glucosamine sulfate: Some studies show that sulfate glucosamine can be more effective than hydrochloride glucosamine, in relief of pain and improving joint function with OA. It is assumed that the sulfate group in glucosamine sulfate plays an important role in its biological activity.

  • Glucosamine hydrochloride: Glucosamine hydrochloride is a more common and less expensive form of glucosamine. Some studies have not revealed significant differences in the effectiveness between glucosamine sulfate and hydrochloride glucosamine.

  • Meta-analyzes and systematic reviews: The results of meta-analyzes and systematic reviews comparing the effectiveness of glucosamine of sulfate and glucosamine of hydrochloride are also contradictory. Some meta-analyzes show a small advantage of glucosamine sulfate, while others do not reveal significant differences.

  • Individual answer: Ultimately, the choice between glucosamine sulfate and glucoseamin hydrochloride can depend on the individual characteristics of the patient and his response to treatment.

Section 4.3: sources of chondroitin: animal vs. Synthetic

Chondroitin is mainly obtained from animal raw materials (the cartilage of the trachea of ​​cattle, shark cartilage, pork cartilage). Synthetic chondroitin also exists, but less common.

  • Animal chondroitin: Animal chondroitin is the most common source of chondroitin in dietary supplements. The quality of animal chondroitin can vary depending on the source and production method. It is important to choose dietary supplements from reliable manufacturers that guarantee the quality and purity of chondroitin.

  • Synthetic chondroitin: Synthetic chondroitin is made chemically. It can be cleaner and more standardized than animal chondroitin. However, studies of the effectiveness of synthetic chondroitin are limited.

  • Molecular weight of chondroitin: The molecular weight of chondroitin can affect its assimilation. Low molecular weight chondroitin can be better absorbed than high molecular weight. However, studies on this issue are limited.

Section 4.4: Combined drugs: additional ingredients

Many dietary supplements with chondroitin and glucosamine contain additional ingredients that can enhance their effect or have additional useful effects.

  • Methyl sulfonylmetatan (MSM): MSM is an organic compound of sulfur, which has anti -inflammatory and antioxidant properties. It can help reduce pain and inflammation in the joints.

  • Hyaluronic acid: Hyaluronic acid is an important component of the synovial fluid that provides the lubrication of the joint. Adding hyaluronic acid to dietary supplements can improve the viscosity of the synovial fluid and facilitate movement in the joint.

  • Collagen: Collagen is the main protein of connective tissue, including articular cartilage. Adding collagen to dietary supplements can contribute to the restoration and strengthening of cartilage.

  • Vitamin D: Vitamin D plays an important role in the health of bones and joints. Vitamin D deficiency can increase the risk of OA development.

  • Curcumin: Kurkumin is an active substance contained in turmeric, which has anti -inflammatory and antioxidant properties.

  • Boswellia: Bosvelia is a plant extract that has anti -inflammatory properties and can help reduce pain and joint inflammation.

Part 5: Alternative and additional methods of treatment of osteoarthritis

Section 5.1: non -drug treatment methods

In addition to dietary supplements, there are various non -drug methods of treatment of OA, which can help reduce pain, improve joint function and slow down the progression of the disease.

  • Physiotherapy: Physiotherapy includes various exercises and procedures aimed at strengthening muscles, improving joint mobility and reducing pain.
  • Medical physical education (exercise therapy): Exercise therapy is an important part of OA treatment. LFK exercises help strengthen the muscles that support joints, improve the range of movements and reduce pain.
  • Weight loss: Reducing weight reduces the load on the joints, especially on the knee and hip.
  • Ortez and rims: Orthes and bandages can support joints, reduce the load on them and relieve pain.
  • Harshes and walkers: Using a cane or walker can help reduce the load on the joints and improve stability.
  • Thermal and cold procedures: The use of heat or cold on the affected joints can help reduce pain and inflammation.
  • Acupuncture: Acupuncture is a method of traditional Chinese medicine, which consists in introducing thin needles into certain points on the body. Some studies show that acupuncture can help reduce the pain with OA.
  • Massage: Massage can help relax muscles, reduce pain and improve blood circulation in the affected joints.
  • Transcanated electroneurostimulation (Tens): Tens is a treatment method in which weak electrical impulses are served through the skin, which can help reduce pain.
  • Life change change: Change in lifestyle, such as regular physical activity, healthy nutrition and rejection of smoking, can help improve the general state of health and reduce the symptoms of OA.

Section 5.2: Drug treatment of osteoarthritis

Drug treatment of OA includes various drugs that can help reduce pain, inflammation and slow down the progression of the disease.

  • Nonsteroidal anti -inflammatory drugs (NSAIDs): NSAIDs are the most common drugs for the treatment of OA. They help reduce pain and inflammation. However, NSAIDs can cause side effects, especially from the gastrointestinal tract.

  • Analgesics: Analgesics, such as paracetamol, can help reduce pain, but do not have an anti -inflammatory effect.

  • Opioid analgesics: Opioid analgesics are used to treat severe pain with OA. However, they can cause addiction and side effects.

  • Corticosteroids: Corticosteroids can be introduced into the joint to reduce inflammation and pain. However, they can cause side effects with prolonged use.

  • Hyaluronic acid drugs: Hyaluronic acid preparations can be introduced into the joint to improve the viscosity of synovial fluid and relieve movement in the joint.

  • SYSADOA (Symptomatic Slow-Acting Drugs for Osteoarthritis): Sysadoa includes glucosamine sulfate, chondroin sulfate, diacereein and inanimate compounds of avocado and soy (Piaschedine). These drugs have a symptomatic effect of a slow action and can help reduce pain and improve joint function with OA.

Section 5.3: injections in the joint: hyaluronic acid and corticosteroids

Injections in the joint are one of the methods of treatment of OA, aimed at reducing pain and inflammation.

  • Hyaluronic acid injections: Injections of hyaluronic acid into the joint help to improve the viscosity of the synovial fluid, providing a better lubrication of the joint and cushioning. The effect of hyaluronic acid injections can last several months.

  • Injections of corticosteroids: Injections of corticosteroids in the joint help reduce inflammation and pain. However, the effect of injections of corticosteroids is usually temporary.

  • Indications and contraindications: Injections in the joint have certain indications and contraindications. The decision on injection should be made by a doctor taking into account the individual characteristics of the patient.

Section 5.4: Surgical treatment of osteoarthritis

In severe cases of OA, when conservative methods of treatment are ineffective, surgical intervention may be required.

  • Arthroscopy: Arthroscopy is a minimum invasive surgical procedure in which an arthroscope (a thin tube with a camera) is introduced through small incisions into the joint. Arthroscopy can be used to remove damaged cartilage or bone growths.

  • Osteotomy: Osteotomy is a surgical procedure in which its bone is cut and its position changes in order to redistribute the load on the joint.

  • Joint endoprosthetics: The joint -prophetic of the joint is a surgical procedure in which the damaged joint is replaced by an artificial prosthesis. Actoprosthetics of the joint is an effective method of treating a severe OA.

Part 6: Prospects for research of chondroitin and glucosamine

Section 6.1: new forms and delivery methods

Studies in the field of chondroitin and glucosamine continue to develop new forms and delivery methods that can improve their effectiveness.

  • Nanoparticles: The use of nanoparticles for the delivery of chondroitin and glucosamine can improve their penetration into cartilage tissue and increase their bioavailability.

  • Liposomes: Liposomes are microscopic vesicles consisting of lipids that can be used to deliver drugs, including chondroitin and glucosamine, in target tissue.

  • Clack engineering: Fabric engineering is a field of research aimed at creating artificial fabrics and organs, including articular cartilage. Chondroitin and glucosamine can be used in tissue engineering to stimulate the growth and restoration of cartilage.

Section 6.2: Identification of biomarkers response to treatment

Identification of biomarkers that can predict the response to treatment with chondroitin and glucosamine can help personalize OA treatment and increase its effectiveness.

  • Genetic markers: Studies of genes related to the development of OA and response to treatment with chondroitin and glucosamine can help identify patients who

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