Chondroitin

Overview

Chondroitin is a molecule that occurs naturally in the body. It is a major component of cartilage -- the tough, connective tissue that cushions the joints. Commercial chondroitin is derived from natural sources, such as shark and bovine cartilage, or synthetic production. Chondroitin helps keep cartilage healthy by absorbing fluid (particularly water) into the connective tissue. It may also block enzymes that break down cartilage, and it provides the building blocks for the body to produce new cartilage.

A number of scientific studies suggest that chondroitin may be an effective treatment for osteoarthritis (OA). OA is a type of arthritis characterized by the breakdown and eventual loss of cartilage, either due to injury or to normal wear and tear. It commonly occurs as people age. In some studies, chondroitin supplements have decreased the pain of OA. Not all studies are positive, though, and several have not shown any beneficial effect from taking chondroitin. It's not clear why the studies have different findings, and experts disagree on whether chondroitin is helpful in treating OA.

In the past, some researchers thought chondroitin may actually slow progression of the disease, unlike other current medical treatments for OA. (Many people take either acetaminophen or nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen, for OA pain). So far studies have not shown conclusively that chondroitin helps repair or grow new cartilage or stops cartilage from being further damaged. Chondroitin is often taken with glucosamine, another supplement that has been studied along with chondroitin for OA. Like chondroitin, glucosamine also has conflicting results.

Therapeutic Uses

Treatment

Osteoarthritis

Results from several well-designed scientific studies suggest that chondroitin supplements may be an effective treatment for OA, particularly OA of the knee or hip, though one recent review of several studies found no benefit from use of chondroitin alone. In general, findings from these studies suggest that chondroitin:

  • Reduces OA pain
  • Improves functional status of people with hip or knee OA
  • Reduces joint swelling and stiffness
  • Provides relief from OA symptoms for up to 3 months after treatment is stopped

However, the largest clinical trial so far, the 2006 Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), sponsored by the National Institutes of Health, showed conflicting and somewhat confusing results. The study of about 1,600 people with OA of the knee found that glucosamine and chondroitin did not reduce pain in the overall group, although it did appear to reduce pain among those with moderate to severe OA of the knee. The study has raised questions for further research. Since glucosamine and chondroitin were combined in this study, it is not possible to determine the effect of chondroitin alone. In addition, researchers are now studying whether the glucosamine chondroitin combination may help those with more severe OA.

A second phase of the study in 2008 looked at some participants who continued with the study for another 28 months. They were tested to see whether glucosamine or chondroitin (together or alone) slowed the loss of cartilage in their knees. They showed no difference in cartilage loss compared with people who took placebo. But all groups -- those taking placebo, those taking both supplements, and those taking only one supplement -- lost less cartilage than expected.

Results continue to be mixed. One analysis of a number of studies found smaller trials tended to find that chondroitin was effective, while larger, more thorough studies tended to find that it wasn't.

Most studies have shown that chondroitin needs to be taken for 2 - 4 months before subjects experience benefits, although some improvement may be experienced sooner. Glucosamine and chondroitin can be used along with NSAIDs to treat OA.

Bladder Conditions

One study found that intravesicular chondroitin (irrigating the bladder with chondroitin) may help relieve symptoms of interstitial cystitis. Another single study found that chondroitin, taken orally, might help reduce symptoms of overactive bladder.

Other

Other conditions for which chondroitin has been suggested include preterm labor, Alzheimer's disease, heart disease, and osteoporosis. However, no studies have yet evaluated these claims.

Dietary Sources

There are no major dietary sources of chondroitin, so people who want to take it must take supplements.

Dosage and Administration

Chondroitin is commonly sold as chondroitin sulfate, in capsules or tablets. It is often combined with glucosamine and sometimes manganese as well. Manganese is a trace element necessary for bone health. The total amount of manganese from foods and supplements should not exceed 11 mg per day, but several combination supplements for arthritis (containing glucosamine, chondroitin, and manganese) have more than that. Read labels carefully, and consider choosing a supplement without manganese.

Pediatric

Chondroitin is not recommended for children. It is mainly used for treatment of osteoarthritis (OA), a condition that affects adults, and its safety for children has not been studied.

Adult

400 mg 3 times a day or 600 mg 2 times a day, taken by mouth.

Precautions

In the past, researchers have found that some chondroitin supplements did not contain the amount of chondroitin stated on the label. The same was true of some combination glucosamine and chondroitin supplements. Ask your doctor to recommend a brand or choose a brand you trust.

Many chondroitin supplements are made from cow cartilage. If you are a vegetarian, look for a supplement made from algae instead.

Asthma -- there is some concern that chondroitin may worsen asthma symptoms: use with caution.

Prostate Cancer -- Preliminary research suggests that chondroitin may cause the spread or recurrence of prostate cancer. This effect has not been shown with chondroitin sulfate supplements. Still, until more is known, don't take chondroitin sulfate if you have prostate cancer or are at high risk for developing it (you have a brother or father with prostrate cancer).

Diabetes -- Chondroitin supplements may affect blood sugar levels. If you have diabetes, check with your doctor or health care professional before you change your diet or the dose of your diabetic medicine.

Side Effects

Chondroitin is safe and relatively free of side effects when used at the recommended daily dosage, at least for short periods of time. Some people may experience mild stomach upset, allergic reactions, drowsiness, and headaches. So far, few studies have investigated the safety and effectiveness of chondroitin when used for long periods of time. One particular safety concern with chromium sulfate is the possibility of mad cow disease.  Though no cases of this disease have been reported in association with taking chromium sulfate supplements, there has been a case reported in an American herd raising the question of potential risk.

Pregnancy and Breastfeeding

Pregnant and breastfeeding women should not take chondroitin, since it has not been studied for safety in these groups.

Interactions and Depletions

If you are currently being treated with any of the following medications, you should talk to your doctor before taking chondroitin:

Anticoagulants (blood thinners) -- Because chondroitin is similar to heparin, a drug used to thin the blood, it is theoretically possible for chondroitin to enhance the effects of blood-thinning medications. Chondroitin could also enhance the blood-thinning effects of vitamins and supplements such as fish oil and vitamin E.

Nonsteroidal anti-inflammatory drugs (NSAIDs) -- If you take NSAIDs to relive the pain of OA, taking chondroitin may reduce the dose of NSAIDs you need to take. Since NSAIDs can cause stomach bleeding, reducing the dosage can be helpful. Talk to your doctor, however, before taking chondroitin, since it can take several months before any improvements are felt.

Supporting Research

Bourgeois P, Chales G, Dehais J, et al. Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3 x 400 mg/day vs placebo. Osteoarthritis Cartilage. 1998;6(suppl A):25-30.

Brown KE, Leong K, Huang C, et al. Gelatin/chondroitin 6-sulfate microspheres for the delivery of therapeutic proteins to the joint. Arthritis and Rheum. 1998;41(12):2185-2195.

Busci L, Poor G. Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of knee osteoarthritis. Osteoarthritis Cartilage. 1998;6(suppl A):31-36.

Chavez ML. Glucosamine sulfate and chondroitin sulfates. Hosp Pharm. 1997;32(9):1275-1285.

Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23;354(8):795-808.

Das A, Hammond TA. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage. 2000;8(5):343-350.

Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am. 1999;25:379-395.

Firestein: Kelley's Textbook of Rheumatology, 9th ed. Philadelphia, PA: Saunders, An Imprint of Elsevier. 2012.

Gabay C, Medinger-Sadowski C, Gascon D, Kolo F, Finckh A. Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial at a single center. Arthritis Rheum. 2011; 63(11):3383-91.

Gaby AR. Natural treatments for osteoarthritis. Altern Med Rev. 1999;4(5):330-341.

Goedert MR, Jakes R, Spillantini MG, et al. Assembly of microtubule-associated protein tau into Alzheimer-like filaments induced by sulphated glycosaminoglycans. Nature. 1996;383:550-553.

Hochberg MC, Clegg DO. Potential effects of chondroitin sulfate on joint swelling: a GAIT report. Osteoarthritis Cartilage. 2008;16 Suppl 3:S22-4.

Kelly GS. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Alt Med Rev. 1998;3(1):27-39.

Kubo M, Ando K, Mimura T, Matsusue Y, Mori K. Chondroitin sulfate for the treatment of hip and knee osteoarthritis: current status and future trends. Life Sci. 2009;85(13-14):477-83.

Lamari FN. The potential of chondroitin sulfate as a therapeutic agent. Connect Tissue Res. 2008;49(3):289-92. Review.

Leeb BF, Schweitzer H, Montag K, et al. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol. 2000;27:205-211.

Lippiello L, Woodward J, Karpman R, et al. In vivo chondroprotection and metabolic synergy of glucosamine and chondroitin sulfate. Clin Orthop. 2000;6(381):229-240.

McAlindon TE, Driban JB, Lo GH. Osteoarthritis year 2011 in review: clinical. Osteoarthritis Cartilage. 2012; 20(3):197-200.

McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000;283(11):1469-1475.

Miller K, Clegg D. Glucosamine and Chondroitin. Rheumatic Diseases Clinics of North America. Philadelphia, PA: Saunders, An Imprint of Elsevier. 2012;37(1).

Morreale P, Manopulo R, Galati M, et al. Comparison of the anti-inflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol. 1996;23:1385-1391.

Muller G, Kramer A. In vitro action of a combination of selected antimicrobial agents and chondroitin sulfate [abstract]. Chem Biol Interact. 2000;124(2):77-85.

National Center for Complimentary and Alternative Medicine. The NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). J Pain Palliat Care Pharmacother. 2008;22(1):39-43.

Obara M, Hirano H, Ogawa M, et al. Does chondroitin sulfate defend the human uterine cervix against ripening in threatened premature labor? Am J Obstet Gynecol. 2000;182:334-339.

Rakel. Integrative Medicine, 3rd ed. Philadelphia, PA: Saunders Elsevier; 2012.

Ronca F, Palmieri L, Panicucci P, et al. Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis Cartilage. 1998; 6(suppl A):14-21.

Sawitzke AD, Shi H, Finco MF, Dunlop DD, Bingham CO 3rd, Harris CL, Singer NG, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis Rheum. 2008 Oct;58(10):3183-91.

Towheed TE, Anastassiades TP. Glucosamine and chondroitin for treating symptoms of osteoarthritis. JAMA. 2000;283(11):1483-1484.

Uebelhart D. Clinical review of chondroitin sulfate in osteoarthritis. Osteoarthritis Cartilage. 2008;16 Suppl 3:S19-21. Review.

Van Vijven JP, Luijsterburg PA, Verhagen AP, et al. Symptomatic and chondroprotective treatment with collagen derivatives in osteoarthritis: a systematic review. Osteoarthritis Cartilage. 2012; 20(8):809-21.

Zhang JS, Imai T, Otagiri M. Effects of a cisplatin-chondroitin sulfate A complex in reducing the nephrotoxicity of cisplatin [abstract]. Arch Toxicol. 2000;74(6):300-307.

Version Info

  • Last Reviewed on 02/14/2013
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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This page was last updated: May 7, 2013

         
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