Q: What's the latest on taking glucosamine for knee arthritis? One health magazine says, Take it, an article in today's newspaper says, Don't bother. Which is it?

A: Despite all the media hype around taking glucosamine and/or chondroitin, guidelines for the nonoperative treatment of knee osteoarthritis from the American Academy of Orthopaedic Surgeons (AAOS) do NOT support the use of these supplements. There simply isn't enough evidence to show any clinical benefit of these supplements for individuals with active knee arthritis.

Some studies showed that taking a placebo (fake pill) was just as effective as taking the supplement. Other studies showed the glucosamine supplement was superior to taking a placebo. But stepping back and taking a look at the big picture from all the evidence available, the evidence doesn't support the use of these products.

The best way to manage knee pain from osteoarthritis is with Tylenol or a nonsteroidal antiinflammatory drug such as ibuprofen. The risk of toxicity is low with these medications and they work better than a placebo. Antiinflammatories seem to be more effective than Tylenol but they have greater side effects such as gastrointestinal problems. If these medications are not sufficient to control pain, steroid injection into the joint might be of some short-term help. Steroid injections are not advised for long-term use.

Patient education, self-management techniques, physiotherapy, and exercise are just a few ways this problem can be approached conservatively. The Arthritis Foundation is a good place to get up-to-date reliable information. Your medical doctor, specialist (e.g., rheumatologist if you have one), and/or physiotherapist can help you keep track of what is the current scientific evidence to support (or refute) various current treatment approaches.

John Richmond, MD (Chair), et al. Treatment of Osteoarthritis of the Knee (Nonarthroplasty). In Journal of the American Academy of Orthopaedic Surgeons. September 2009. Vol. 17. No. 9. Pp. 591-600.