The role of glucosamine and chondroitin sulfate in treatment for and prevention of osteoarthritis in animals

Green Analytical Method for Simultaneous Determination of Glucosamine and Calcium in Dietary Supplements by Capillary Electrophoresis with Capacitively Coupled Contactless Conductivity Detection

The need for analytical methods that are fast, affordable, and ecologically friendly is expanding. Because of its low solvent consumption, minimal waste production, and speedy analysis, capillary electrophoresis is considered a "green" choice among analytical separation methods. With these "green" features, we have utilized the capillary electrophoresis method with capacitively coupled contactless conductivity detection (CE-C⁴D) to simultaneously determine glucosamine and Ca²⁺ in dietary supplements. The CE analysis was performed in fused silica capillaries (50 μm inner diameter, 40 cm total length, 30 cm effective length), and the analytical time was around 5 min. After optimization, the CE conditions for selective determination of glucosamine and Ca²⁺ were obtained, including a 10 mM tris (hydroxymethyl) aminomethane/acetic acid (Tris/Ace) buffer of pH 5.0 as the background electrolyte; separation voltage of 20 kV; and hydrodynamic injection (siphoning) at 25 cm height for 30 s. The method illustrated good linearity over the concentration range of 5.00 to 200 mg/L of for glucosamine (R ² = 0.9994) and 1.00 to 100 mg/L for Ca²⁺ (R ² = 0.9994). Under the optimum conditions, the detection limit of glucosamine was 1.00 mg/L, while that of Ca²⁺ was 0.05 mg/L. The validated method successfully analyzed glucosamine and Ca²⁺ in seven dietary supplement samples. The measured concentrations were generally in line with the values of label claims and with cross-checking data from reference methods (HPLC and ICP-OES).

2021 revised algorithm for the management of knee osteoarthritis-the Chinese viewpoint

AIM

The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide from 2014, but in 2019 an update was published. Based on this algorithm, a Working Group (WG), including ESCEO members and Chinese experts, wished to see how the new ESCEO algorithm was perceived by Chinese experts in knee OA and how it was integrated into their clinical practice.

METHODS

A WG was held between members of the international ESCEO task force and a group of Chinese experts.

RESULTS

Non-pharmacological approach should be combined with pharmacological interventions. In step 1, symptomatic slow-acting drugs for osteoarthritis (SYSADOA) are the most important background drugs. Evidence, supported by high-quality research, is available only for crystalline glucosamine sulfate (pCGS) and chondroitin sulfate. Topical NSAIDs could be used as an additional option. In step 2, oral NSAIDs could be useful, but cardiovascular/renal/gastrointestinal profiles of the patients should be considered. Intra-articular hyaluronic acid and corticosteroids are alternative to oral NSAIDs, but the evidence is still limited. If steps 1 and 2 are not sufficient, weak opioids could be used. Overall, the conclusions of the ESCEO algorithm are accepted in China for products available in this country. The WG suggests the importance of economic studies, specifically made in China.

CONCLUSION

This work provides evidence-based advice to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in China.

2019 revised algorithm for the management of knee osteoarthritis: the Southeast Asian viewpoint

Background

Since 2014, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide.

Aim

Based on this document, a Southeast Asia Working Group (SEAWG) wished to see how the new ESCEO algorithm developed in 2019 was perceived by Southeast Asian experts and how it was integrated into their clinical practice.

Methods

A SEAWG was set up between members of the international ESCEO task force and a group of Southeast Asian experts.

Results

Non-pharmacological management should always be combined with pharmacological management. In step 1, symptomatic slow-acting drugs for osteoarthritis are the main background therapy, for which high-quality evidence is available only for the formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. In step 2, oral NSAIDs are a useful option, considering the cardiovascular/renal/gastrointestinal profiles of the individual patient. Intra-articular hyaluronic acid and corticosteroids are a possible alternative to oral NSAIDs, but limited evidence is available. If steps 1 and 2 do not give adequate relief of symptoms, tramadol can be used, but its safety is debated. In general, the indications of the ESCEO algorithm are important in Southeast Asian countries, but the reimbursement criteria of local health systems are an important aspect for adherence to the ESCEO algorithm.

Conclusion

This guidance provides evidence-based and easy-to-follow advice on how to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in Southeast Asian countries.

Oral Supplementation with Ultramicronized Palmitoylethanolamide for Joint Disease and Lameness Management in Four Jumping Horses: A Case Report

Simple Summary

This paper reports the efficacy of Ultramicronized Palmitoylethanolamide (PEA-um) supplementation for four show-jumping horses with lameness and joint disease. Joint disease is often associated with inflammatory states and pain that lead to lameness or impairment in athletic performances. PEA-um is a nutraceutical compound that is well-known for its anti-inflammatory and analgesic proprieties, and is widely used in human medicine and small animal veterinary medicine. Although it includes a small number of cases, our study describes for the first time the efficacy of the use of PEA-um in horses. PEA-um was introduced to the normal diet of four horses with non-responsive lameness and significant impairment of athletic performance. After four months of PEA-um supplementation, all horses showed remissions of lameness that led to their reintroduction into showjumping competitions without disease recurrence. Therefore, despite the small number of cases included in this study, the observations suggest that PEA-um may be beneficial in the maintenance of joint disease in athletic horses.

Abstract

Background: Four show jumping horses were evaluated for non-responsive lameness, which caused their withdrawal from show jumping competitions. The clinical evaluation was performed by radiographic examination, flexion tests, diagnostic anesthesia and lameness evaluation using the American Association of Equine Practitioners (AAEP) scale. The diagnoses were a case of navicular syndrome, a complicated case of chronic navicular syndrome and arthrosis of the distal interphalangeal joint of the right anterior limb and two cases of distal intertarsal joint arthritis. Nutraceuticals are often an important management strategy or coadjutant of pharmacological therapies in joint disease. Ultramicronized Palmitoylethanolamide (PEA-um) is an endogenous fatty acid amide that is well-known for its anti-inflammatory and analgesic proprieties widely used in human medicine and small animal veterinary medicine. Although it includes a small number of cases, our study describes for the first time the efficacy of the use of PEA-um in horses. The four horses with non-responsive lameness and significant impairment in athletic performance were daily treated with PEA-um into their normal diet. After four months of PEA-um supplementation, all horses showed remissions of lameness that led to their reintroduction into showjumping competitions without disease recurrence. Therefore, despite the small number of cases included in this study, these observations suggest a good prospective for developing a controlled experiment to test PEA in a larger cohort of horses.

Anti-inflammatory effects in a mouse osteoarthritis model of a mixture of glucosamine and chitooligosaccharides produced by bi-enzyme single-step hydrolysis

We developed a novel technique of bi-enzyme single-step hydrolysis, using recombinant chitosanase (McChoA) and exo-β-D-glucosaminidase (AorCsxA) constructed previously in our lab, to degrade chitosan. The hydrolysis product was shown by HPLC, FTIR, and chemical analyses to be a mixture (termed “GC”) composed primarily of glucosamine (80.00%) and chitooligosaccharides (9.80%). We performed experiments with a mouse osteoarthritis (OA) model to evaluate the anti-inflammatory effects of GC against OA. The three “GC groups” (which underwent knee joint damage followed by oral administration of GC at concentrations 40, 80, and 160 mg/kg·bw·d for 15 days) showed significantly downregulated serum expression of pre-inflammatory cytokines (IL-1β, IL-6, TNF-α), and significant, dose-dependent enhancement of anti-inflammatory cytokine IL-2, in comparison with Model group. Levels of C-reactive protein, which typically rise in response to inflammatory processes, were significantly lower in the GC groups than in Model group. Thymus index and levels of immunoglobulins (IgG, IgA, IgM) were higher in the GC groups. Knee joint swelling was relieved and typical OA symptoms were partially ameliorated in the GC-treated groups. Our findings indicate that GC has strong anti-inflammatory effects and potential as a therapeutic agent against OA and other inflammatory diseases.

Pharmacokinetic Analysis of an Oral Multicomponent Joint Dietary Supplement (Phycox®) in Dogs

Despite the lack of safety, efficacy and pharmacokinetic (PK) studies, multicomponent dietary supplements (nutraceuticals) have become increasingly popular as primary or adjunct therapies for clinical osteoarthritis in veterinary medicine. Phycox^® is a line of multicomponent joint support supplements marketed for joint health in dogs and horses. Many of the active constituents are recognized anti-inflammatory and antioxidant agents. Due to a lack of PK studies in the literature for the product, a pilot PK study of select constituents in Phycox^® was performed in healthy dogs. Two novel methods of analysis were developed and validated for quantification of glucosamine and select polyphenols using liquid chromatography-tandem mass spectrometry. After a single oral (PO) administrated dose of Phycox^®, a series of blood samples from dogs were collected for 24 h post-dose and analyzed for concentrations of glucosamine HCl, hesperetin, resveratrol and naringenin. Non-compartmental PK analyses were carried out. Glucosamine was detected up to 8 h post-dose with a T_max of 2 h and C_max of 9.69 μg/mL. The polyphenols were not found at detectable concentrations in serum samples. Co-administration of glucosamine in the Phycox^® formulation may enhance the absorption of glucosamine as determined by comparison of glucosamine PK data in the literature.

Glucosamine and chondroitin use in canines for osteoarthritis: A review

Osteoarthritis is a slowly progressive and debilitating disease that affects canines of all breeds. Pain and decreased mobility resulting from osteoarthritis often have a negative impact on the affected canine’s quality of life, level of comfort, daily functioning, activity, behaviour, and client-pet companionship. Despite limited and conflicting evidence, the natural products glucosamine hydrochloride (HCl) and chondroitin sulfate are commonly recommended by veterinarians for treating osteoarthritis in dogs. There is a paucity of well-designed clinical veterinary studies investigating the true treatment effect of glucosamine and chondroitin. The purposes of this review article are to provide a brief background on glucosamine and chondroitin use in canine osteoarthritis and to critically review the available literature on the role of these products for improving clinical outcomes. Based on critical review, recommendations for practice are suggested and a future study design is proposed.

AAHA/AAFP pain management guidelines for dogs and cats

Pain management in dogs and cats has undergone a dramatic evolution in the past decade. Current approaches focus on anticipation and prevention of pain, as well as both pharmacologic and non-pharmacologic management techniques. The veterinary team plays an essential role in educating pet owners about recognizing and managing pain in their pets. Journal of the American Animal Hospital Association 2007; 43:235–248.

Treatment of experimentally induced osteoarthritis in horses using an intravenous combination of sodium pentosan polysulfate, N-acetyl glucosamine, and sodium hyaluronan

OBJECTIVE

To assess the effects of sodium pentosan polysulfate (PPS), N-acetyl glucosamine (NAG), and sodium hyaluronan (HA) in horses with induced osteoarthritis (OA).

STUDY DESIGN

Experimental.

ANIMALS

Adult Standard bred horses (n = 16).

METHODS

OA was induced arthroscopically in 1 intercarpal joint; 8 horses were administered 3 mg/kg PPS, 4.8 mg/kg NAG, and 0.12 mg/kg HA (PGH), intravenously (IV), weekly and 8 horses were administered an equivalent volume of saline IV until study completion (day 70). Horses underwent a standardized treadmill exercise program. Clinical and radiographic findings and synovial fluid analysis were evaluated throughout the study. Macroscopic, histologic, histochemical, and biochemical findings were evaluated after necropsy. Comparisons of interest included OA and non-OA joints of saline treated horses and OA joints of PGH treated horses and OA joints of saline treated horses. Results were statistically analyzed with significance set at P < .05.

RESULTS

OA caused increases in clinical assessment scores, synovial fluid variables, radiographic, macroscopic, and histologic cartilage scores, synovial fluid and cartilage chondroitin sulfate 846-epitope and glycosaminoglycan concentration. Total radiographic scores, total macroscopic joint pathology and macroscopic cartilage pathology scores were significantly reduced in horses treated with PGH compared with saline treated horses. Synovial fluid total protein concentration and white blood cell count were higher in OA joints of PGH treated horses compared with saline treated horses. There were no other significant differences between treatment groups.

CONCLUSIONS

Improvements in macroscopic variables were not supported by other outcomes. Further evidence is needed before PGH can be recommended as a therapeutic option for osteoarthritis in horses.

Effects of glucosamine-chondroitin sulfate supplementation on serum fructosamine concentration in healthy dogs

OBJECTIVE

To determine whether short-term administration of an oral glucosamine-chondroitin sulfate (Glu-CS) supplement alters serum fructosamine concentration in healthy dogs.

DESIGN

Prospective crossover study.

ANIMALS

12 healthy adult dogs.

PROCEDURES

Dogs received Glu-CS and a placebo for 3 weeks each, with a 4-week minimum washout period between treatments. Serum fructosamine concentration was measured 4 times for each dog: prior to the first treatment period, at the end of the first treatment period, at the end of the washout period, and at the end of the second treatment period.

RESULTS

No significant change in serum fructosamine concentration was identified after treatment with either Glu-CS or the placebo. The change in serum fructosamine concentration associated with Glu-CS administration was not significantly different from the change in concentration associated with administration of the placebo.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that in healthy dogs, short-term (ie, 21 days) oral Glu-CS administration does not affect glycemic control or cause diabetes mellitus.

Effect of dietary nutrients on osteochondrosis lesions and cartilage properties in pigs

OBJECTIVE

To evaluate dietary ingredients involved in cartilage and bone metabolism and their influence on osteochondrosis lesions in swine.

ANIMALS

80 crossbred gilts (mean initial weight, 39 kg).

PROCEDURES

Pigs (10 pigs/treatment) were fed a corn-soybean meal basal (control) diet or the basal diet supplemented with additional minerals (copper and manganese or silicon), amino acids (proline and glycine; a combination of leucine, isoleucine, and valine; or methionine and threonine), or fatty acids (provided by fish oil) for 84 days. Pigs were then slaughtered and the distal portion of the left femur was collected for determination of osteochondrosis lesions at the femoral condyle. After evaluation of external joint surfaces, the distal portion of the femur was sectioned to evaluate lesions in the growth plate and articular cartilage. Additionally, a cartilage specimen was obtained from the patella for analysis.

RESULTS

Pigs fed diets containing high amounts of methionine and threonine or the diet containing all additional ingredients had significantly lower total severity scores, compared with scores for pigs fed the control diet or a diet supplemented with fish oil. Pigs fed diets containing additional proline and glycine, copper and manganese, methionine and threonine, or all additional ingredients had significantly lower overall scores, compared with scores for pigs fed the control diet or a diet supplemented with fish oil.

CONCLUSIONS AND CLINICAL RELEVANCE

Dietary manipulation decreased the severity of osteochondrosis lesions, compared with results for pigs fed a control diet. However, additional research on optimal concentrations and combinations of dietary components is needed.

Glucosamine: an ingredient with skin and other benefits

Both glucosamine and its derivative N-acetyl glucosamine are amino-monosaccharides that serve key biochemical functions on their own and as substrate precursors for the biosynthesis of polymers such as glycosaminoglycans (e.g., hyaluronic acid) and for the production of proteoglycans. Glucosamine has an excellent safety profile and has been shown to provide benefits in several clinical disorders. Glucosamine compounds have been reported to have several beneficial effects on the skin or skin cells. Because of its stimulation of hyaluronic acid synthesis, glucosamine has been shown to accelerate wound healing, improve skin hydration, and decrease wrinkles. In addition, as an inhibitor of tyrosinase activation, it inhibits melanin production and is useful in treatment of disorders of hyperpigmentation. Mechanistically, glucosamine also has both anti-inflammatory and chondroprotective effects. Clinical trials have shown benefit in using oral glucosamine supplementation to improve symptoms and slow the progression of osteoarthritis in humans. Glucosamine has also been used to prevent and treat osteoarthritis in animals. Based on other observations, glucosamine has been suggested for additional clinical uses, including treatment of inflammatory bowel disease, migraine headaches, and viral infections. The current clinical uses for topical and oral glucosamine compounds and the mechanistic rationale for these uses are reviewed here.

AAHA/AAFP pain management guidelines for dogs & cats

Pain management in dogs and cats has undergone a dramatic evolution in the past decade. Current approaches focus on anticipation and prevention of pain, as well as both pharmacologic and nonpharmacologic management techniques. The veterinary team plays an essential role in educating pet owners about recognizing and managing pain in their pets.

Themed Review: Nonpharmacologic Approaches to Osteoarthritis

Osteoarthritis is the most common form of arthritis, occurring primarily in the older population. Pain, stiffness, and disability are the major complaints of the disease, which are best treated with pharmacologic and nonpharmacologic measures. The goals of therapy are pain relief, maintenance of function, and correction of deformities whenever possible to restore lost function. Nonpharmacologic treatments enhance the role of medicinal therapy in the management of chronic osteoarthritic pain. They help to improve overall lifestyle, build self-reliance, and instill a sense of control over the pain, which in turn may improve pharmacologic compliance. Nonpharmacologic therapy improves outcomes of total joint replacement and some other types of joint surgery. Options include patient as well as caregiver education, physical medical and rehabilitation, weight reduction, sleep hygiene, surgery, and psychosocial intervention. Alternative or complementary medicine, also referred to as integrative medicine, has become quite popular among many patients. Their effectiveness is not to be ignored, but for the most part, scientific evidence is sparse or missing. Clearly, in most patients, symptomatic osteoarthritis can be improved through a comprehensive, multidisciplinary approach.

The role of nutritional supplements and feeding strategies in equine athletic performance

In human and animal nutrition, much interest has been focused on the potential role of dietary supplements in promoting health, athletic performance and disease mitigation. Supplements may include essential nutrients provided in amounts greater than required to prevent a deficiency state, or substances purported to have a role in metabolism or tissue function but that are not recognized as an essential nutrient. This review aims to provide the rationale and scientific evidence for use (or not) of some of the supplements marketed for use in horses, with emphasis on supplements purported to directly boost performance, such as creatine, carnitine and branched-chain amino acids. It also discusses the so-called ‘joint supplements’ (or slow-acting, disease-modifying osteoarthritis agents), such as glucosamine and chondroitin sulphate. The effects of selected feeding strategies on performance, including fat supplementation, are also examined. It is concluded that although the use of nutritional supplements is commonly alleged to boost performance or health in horses, for most, if not all, of these supplements there is little or no scientific evidence of efficacy.

Systemic Therapies for Joint Disease in Horses

Systemic therapies for joint disease may be prescribed when a single joint is involved or when multiple sites are affected. The precise therapeutic regimen recommended depends on the duration,cause, and site(s) of injury and is often an adjunct to intra-articular or supportive therapies. If the clinical signs of joint disease are acute and moderate in severity, nonsteroidal anti-inflammatory drugs are often administered to alleviate pain and inflammation. When aiming for more of a generalized maintenance or chondro-protective regimen, an alternative medication, such as hyaluronan,polysulfated glycosaminoglycan, or a nutraceutical will commonly be prescribed.

The Use of Nutraceuticals for Osteoarthritis in Horses

In horses, lameness is often attributable to some degree of osteoarthritis (OA), a complex disease process that is highlighted by eventual degradation of articular cartilage. Conventional therapies for OA in horses are designed to relieve pain and discomfort and often include pharmacologic intervention with nonsteroidal anti-inflammatory drugs or intra-articular steroids. Oral administration of nutraceutical products to the horse is common and easy and is perceived to be a benign treatment for OA in horses. The main goal for use of nutraceuticals is to use them in OA cases to attempt to lower the dose of other drugs that are more problematic while potentially preventing further degradation (disease or structure modifying). This article attempts to define a nutraceutical, identifies areas that need to be considered when these products are used, and describes the known scientific effects of the most common compounds contained in currently available equine nutraceuticals.