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Glucosamine supplements are popular today because they can help osteoarthritis patients relieve pain. They work on the principle of stimulating the body’s replenishing of glucosamine stores, which are plentiful between joints to lubricate and cushion movement, but which get eroded due to wear and tear.
This explains why osteoarthritis usually affects people in their 50’s and beyond – the time when most people’s glucosamine stores are worn down to the bone.
But while there are many brands of glucosamine supplements in the marketplace, the one you choose may not work for you.

What do doctors recommend?

Professor Feng Pao Hsii is Emeritus Consultant at Tan Tock Seng Hospital (TTSH), Visiting Consultant to National University Hospital (NUH), Singapore General Hospital (SGH) and Khoo Teck Puat Hospital (KTPH), and Adjunct Professor at Yong Loo Lin School of Medicine, National University of Singapore.
He is best known for establishing the only Department of Rheumatology in Singapore at the time at Tan Tock Seng Hospital in August 1995, training most of today’s generation of rheumatologists at most restructured hospitals and in the private sector.
As a winner of the Lee Foundation-NHG (National Healthcare Group) Lifetime Achievement Award 2002, his numerous titles include Emeritus Consultant with the Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital (TTSH) and Adjunct Professor with the Faculty of Medicine, National University of Singapore (NUS).
Prof Feng Pao Hsii believes that patient education is key to managing many chronic diseases, such as hypertension, diabetes mellitus, and arthritis.
We asked this internationally respected physician for his views on glucosamine supplements, and how they should be used.

LW: Do you currently recommend/prescribe glucosamine supplements in your practice?

Prof Feng: Yes but only in those who have not responded to standard medication like analgesics and NSAIDs (nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen), or in those whom NSAIDs are contra-indicated.

LW: As a practicing physician, does the brand of supplement matter? What would induce you to prescribe or recommend any one over another? 

Prof Feng: There are hundreds of glucosamine on the market.  The only one that has stood scientific scrutiny is Viatril-S® which has a specific crystalline structure and other physical characteristics. Many samples sold on the internet are nothing more than plain chalk.  Even those sold in supplement firms has different crystalline structure and have not been studied scientifically. 
I usually prescribe the supplement in those who has failed the standard treatment.  However only about 30-40 % respond to glucosamine just like not all patients respond to one particular medication.  When I prescribe glucosamine, I insist that patients take it according to instructions ie between 1000-1500 mgm per day DAILY for at least 3-4 months.  If there is no response then stop - if there is response then continue at a lower dose. 
Many patients take glucosamine “whenever they like” - that is why many patients say the supplement is ineffective.  I have patients taking glucosamine (from whatever source) sometimes one tablet a day, some time forget and so on for five or more years.  That is a waste of time and money.

LW: Two issues ago, we published an article in which we reported that Prof Amnuay Kananthai from Chiangmai University said that concurrent use of NSAIDs inhibits action of the G6PS enzyme, lowering the efficacy of glucosamine supplements. Would you ever recommend that a patient stop taking NSAIDs to increase the efficacy of his glucosamine supplement?

Prof Feng: That is a chemcial reaction - I have often combined both and they seem to be effective.  Once the pain has gone I stop the NSAIDs and just use glucosamine alone or I use topical agents. 
However through all these, one must emphasise moderate exercise and weight management in ALL patients with OA - not just take pain relieving drugs and supplements. LW

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