Many people take glucosamine supplements for arthritis, but how well does it really work? Unfortunately, the best evidence is less than overwhelming. What does seem clear is that, out of the many types of glucosamine pills, only glucosamine sulfate may work. There seems to be no good evidence for the other types of glucosamine — nor is there any good evidence for the usual second medicine in these pills, called chondroitin.

This evidence was recently reviewed from Health Technology Assessment, an arm of the UK’s NIH program. Their goal is to review the best evidence as well as to assess the public health cost-effectiveness of medicines and treatments. Here’s part of their conclusion from their paper (Executive summary of HTA journal title):

There was evidence that glucosamine sulphate shows some clinical effectiveness in the treatment of OA of the knee. No trial data came from the UK, and in the absence of good UK data about the current referral practice, management and surgical rate, caution should be exercised in generalising these data to the UK health-care setting. Cost-effectiveness was not conclusively demonstrated, with substantial uncertainty related to the magnitude and duration of QoL gain following treatment. There was evidence from biological studies to support the potential clinical impact of glucosamine sulphate. For other preparations, the evidence base was less consistent (chondroitin) or absent (glucosamine hydrochloride).

There’s also another website, Natural Medicines Database, which ranks glucosamine sulfate as “likely safe and likely effective” for arthritis. They also rank SAMe and capsicum topical as likely safe and effective.

The bottom line? People with arthritis pains can try glucosamine sulfate, usually twice a day, but need to give it a few months trial before considering whether to continue. As for instant pain relief, acetaminophen (Tylenol) is almost always the safest choice. Many elderly people take a lot of aspirin or ibuprofen for arthritis and are at high risk for slow gastrointestinal bleeding.