La glucosamina protegge le articolazioni degli atleti di forza

Nel 2010 gli scienziati dell’Università di Copenaghen hanno confermato quello che decine di migliaia di atleti avevano già sperimentato da soli. 

La glucosamina è un composto zuccherino presente nelle articolazioni. È così che è nata l’idea che si possono rafforzare le articolazioni assumendo integratori di glucosamina. 

In studi recenti l’effetto della glucosamina è stato deludente.

Tuttavia, la maggior parte di questi studi sono stati condotti su persone con artrite avanzata, le cui articolazioni erano quindi già gravemente danneggiate. Questi soggetti avevano poca mobilità. Gli atleti con problemi articolari invece reagiscono bene alla glucosamina.

STUDIO
Studi hanno dimostrato che l’allenamento della forza ha un effetto positivo su chi soffre di artrite. I danesi si sono chiesti cosa sarebbe successo se avessero somministrato glucosamina a chi soffre di osteoartrite che si allena per la forza. Hanno anche esaminato gli effetti dell’ibuprofene, un antinfiammatorio che i medici prescrivono spesso alle persone con artrite.

L’esperimento è durato 12 settimane. 

I soggetti si sono allenati 3 volte a settimana. Hanno pedalato per 10 minuti e poi hanno allenato i muscoli delle gambe con le macchine leg-extension e leg-press.

Il gruppo ibuprofene ha assunto 600 mg due volte al giorno e il gruppo glucosamina ha assunto 500 mg di glucosamina solfato tre volte al giorno. 

La glucosamina usata era un prodotto Ferrosan.

RISULTATI

Il gruppo placebo, il gruppo glucosamina e il gruppo ibuprofene hanno fatto tutti gli stessi progressi quando si trattava di forza.

Prima dell’inizio dell’esperimento e due giorni dopo l’ultima sessione di allenamento della forza, i ricercatori hanno determinato la concentrazione della proteina della matrice oligomerica della cartilagine [COMP] nel sangue dei soggetti. 

Più di questo c’è il sangue, più forti sono i processi catabolici nelle articolazioni. 

I ricercatori hanno scoperto che l’integrazione con glucosamina riduceva significativamente la concentrazione di COMP.

Inoltre, alcuni studi sugli animali hanno dimostrato che la glucosamina può stimolare la rigenerazione della cartilagine. 

È quindi possibile che i livelli alterati di COMP osservati riflettano un alterato metabolismo della cartilagine e, se protratto per lungo tempo, potrebbe influenzare la morfologia articolare e la successiva analisi clinica.

S. G. Peterseny, T. Saxnez, D. Heinegardx, M. Hanseny, L. Holmy, S. Koskineny, C. Stordaly, H. Christensenk, P. Aagaard{ and M. Kjaery  Glucosamine but not ibuprofen alters cartilage turnover in osteoarthritis patients in response to physical training  Osteoarthritis and Cartilage (2010) 18, 34e40

Riferimenti

Brandt KD, Doherty M, Lohmander LS. Osteoarthritis. 2nd edn. Oxford University Press; 2003

Thorstensson CA, Petersson IF, Jacobsson LT, Boegard TL, Roos EM. Reduced functional performance in the lower extremity predicted radiographic knee osteoarthritis five years later. Ann Rheum Dis 2004; 63(4):402e7.

Becker R, Berth A, Nehring M, Awiszus F. Neuromuscular quadriceps dysfunction prior to osteoarthritis of the knee. J Orthop Res 2004; 22(4):768e73.

Baker KR, Xu L, Zhang Y, Nevitt M, Niu J, Aliabadi P, et al. Quadriceps weakness and its relationship to tibiofemoral and patellofemoral knee osteoarthritis in Chinese: the Beijing osteoarthritis study. Arthritis Rheum 2004;50(6):1815e21.

Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 1997;127(2):97e104.

Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16(2):137e62.

amtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I, et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Phys Ther 2008;88(1): 123e36.

Roddy E, Zhang W, Doherty M, Arden NK, Barlow J, Birrell F, et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee e the MOVE consensus. Rheumatology (Oxford) 2005;44(1):67e73.

Fransen M, McConnell S, Bell M. Exercise for osteoarthritis of the hip or knee. Cochrane Database Syst Rev 2003;(3):CD004286.

Ettinger Jr WH, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA 1997;277(1):25e31.

Baker KR, Nelson ME, Felson DT, Layne JE, Sarno R, Roubenoff R. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. J Rheumatol 2001;28(7):1655e65.

Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum 1989;32(11):1396e405.

Rogind H, Bibow-Nielsen B, Jensen B, Moller HC, Frimodt-Moller H, Bliddal H. The effects of a physical training program on patients with osteoarthritis of the knees. Arch Phys Med Rehabil 1998; 79(11):1421e7.

Mikesky AE, Mazzuca SA, Brandt KD, Perkins SM, Damush T, Lane KA. Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis Rheum 2006;55(5):690e9.

Lund H, Weile U, Christensen R, Rostock B, Downey A, Bartels EM, et al. A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis. J Rehabil Med 2008;40(2): 137e44.

Weigl M, Angst F, Stucki G, Lehmann S, Aeschlimann A. Inpatient rehabilitation for hip or knee osteoarthritis: 2 year follow up study. Ann Rheum Dis 2004;63(4):360e8.

Deyle GD, Allison SC, Matekel RL, Ryder MG, Stang JM, Gohdes DD, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther 2005;85(12):1301e17.

Hedbom E, Antonsson P, Hjerpe A, Aeschlimann D, Paulsson M, RosaPimentel E, et al. Cartilage matrix proteins. An acidic oligomeric protein (COMP) detected only in cartilage. J Biol Chem 1992;267(9): 6132e6.

Halasz K, Kassner A, Morgelin M, Heinegard D. COMP acts as a catalyst in collagen fibrillogenesis. J Biol Chem 2007;282(43):31166e73.

Rosenberg K, Olsson H, Morgelin M, Heinegard D. Cartilage oligomeric matrix protein shows high affinity zinc-dependent interaction with triple helical collagen. J Biol Chem 1998;273(32):20397e403.

Clark AG, Jordan JM, Vilim V, Renner JB, Dragomir AD, Luta G, et al. Serum cartilage oligomeric matrix protein reflects osteoarthritis presence and severity: the Johnston County Osteoarthritis Project. Arthritis Rheum 1999;42(11):2356e64.

Jordan JM, Luta G, Stabler T, Renner JB, Dragomir AD, Vilim V, et al. Ethnic and sex differences in serum levels of cartilage oligomeric matrix protein: the Johnston County Osteoarthritis Project. Arthritis Rheum 2003;48(3):675e81.

Neidhart M, Hauser N, Paulsson M, DiCesare PE, Michel BA, Hauselmann HJ. Small fragments of cartilage oligomeric matrix protein in synovial fluid and serum as markers for cartilage degradation. Br J Rheumatol 1997;36(11):1151e60.

Pavelka K, Forejtova S, Olejarova M, Gatterova J, Senolt L, Spacek P, et al. Hyaluronic acid levels may have predictive value for the progression of knee osteoarthritis. Osteoarthritis Cartilage 2004;12(4): 277e83.

Andersson ML, Thorstensson CA, Roos EM, Petersson IF, Heinegard D, Saxne T. Serum levels of cartilage oligomeric matrix protein (COMP) increase temporarily after physical exercise in patients with knee osteoarthritis. BMC Musculoskelet Disord 2006;7:98e106.

Petersson IF, Sandqvist L, Svensson B, Saxne T. Cartilage markers in synovial fluid in symptomatic knee osteoarthritis. Ann Rheum Dis 1997;56(1):64e7.

Petersson IF, Boegard T, Svensson B, Heinegard D, Saxne T. Changes in cartilage and bone metabolism identified by serum markers in early osteoarthritis of the knee joint. Br J Rheumatol 1998;37(1):46e50.

Sharif M, Kirwan JR, Elson CJ, Granell R, Clarke S. Suggestion of nonlinear or phasic progression of knee osteoarthritis based on measurements of serum cartilage oligomeric matrix protein levels over five years. Arthritis Rheum 2004;50(8):2479e88.

Sharif M, Saxne T, Shepstone L, Kirwan JR, Elson CJ, Heinegard D, et al. Relationship between serum cartilage oligomeric matrix protein levels and disease progression in osteoarthritis of the knee joint. Br J Rheumatol 1995;34(4):306e10.

Neidhart M, Muller-Ladner U, Frey W, Bosserhoff AK, Colombani PC, Frey-Rindova P, et al. Increased serum levels of non-collagenous matrix proteins (cartilage oligomeric matrix protein and melanoma Osteoarthritis and Cartilage Vol. 18, No. 1 39 inhibitory activity) in marathon runners. Osteoarthritis Cartilage 2000; 8(3):222e9.

Mundermann A, Dyrby CO, Andriacchi TP, King KB. Serum concentration of cartilage oligomeric matrix protein (COMP) is sensitive to physiological cyclic loading in healthy adults. Osteoarthritis Cartilage 2005; 13(1):34e8.

Garnero P, Piperno M, Gineyts E, Christgau S, Delmas PD, Vignon E. Cross sectional evaluation of biochemical markers of bone, cartilage, and synovial tissue metabolism in patients with knee osteoarthritis: relations with disease activity and joint damage. Ann Rheum Dis 2001; 60(6):619e26.

Christgau S, Henrotin Y, Tanko LB, Rovati LC, Collette J, Bruyere O, et al. Osteoarthritic patients with high cartilage turnover show increased responsiveness to the cartilage protecting effects of glucosamine sulphate. Clin Exp Rheumatol 2004;22(1):36e42.

Reijman M, Hazes JM, Bierma-Zeinstra SM, Koes BW, Christgau S, Christiansen C, et al. A new marker for osteoarthritis: cross-sectional and longitudinal approach. Arthritis Rheum 2004;50(8):2471e8.

Jung M, Christgau S, Lukoschek M, Henriksen D, Richter W. Increased urinary concentration of collagen type II C-telopeptide fragments in patients with osteoarthritis. Pathobiology 2004;71(2):70e6.

Garnero P, Conrozier T, Christgau S, Mathieu P, Delmas PD, Vignon E. Urinary type II collagen C-telopeptide levels are increased in patients with rapidly destructive hip osteoarthritis. Ann Rheum Dis 2003; 62(10):939e43.

Sharif M, Kirwan J, Charni N, Sandell LJ, Whittles C, Garnero P. A 5-yr longitudinal study of type IIA collagen synthesis and total type II collagen degradation in patients with knee osteoarthritis e association with disease progression. Rheumatology (Oxford) 2007;46(6):938e43.

O’Kane JW, Hutchinson E, Atley LM, Eyre DR. Sport-related differences in biomarkers of bone resorption and cartilage degradation in endurance athletes. Osteoarthritis Cartilage 2006;14(1):71e6.

DeHaan MN, Guzman J, Bayley MT, Bell MJ. Knee osteoarthritis clinical practice guidelines e how are we doing? J Rheumatol 2007;34(10):2099e105.

Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR, et al. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. American College of Rheumatology. Arthritis Rheum 1995;38(11):1541e6.

Block G, Jensen CD, Norkus EP, Dalvi TB, Wong LG, McManus JF, et al. Usage patterns, health, and nutritional status of long-term multiple dietary supplement users: a cross-sectional study. Nutr J 2007;6:30e41.

Towheed TE, Maxwell L, Anastassiades TP, Shea B, Houpt J, Robinson V, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005;(2):CD002946.

Krasnokutsky S, Samuels J, Abramson SB. Osteoarthritis in 2007. Bull NYU Hosp Jt Dis 2007;65(3):222e8.

Blot L, Marcelis A, Devogelaer JP, Manicourt DH. Effects of diclofenac, aceclofenac and meloxicam on the metabolism of proteoglycans and hyaluronan in osteoarthritic human cartilage. Br J Pharmacol 2000; 131(7):1413e21.

Hwa SY, Burkhardt D, Little C, Ghosh P. The effects of orally administered diacerein on cartilage and subchondral bone in an ovine model of osteoarthritis. J Rheumatol 2001;28(4):825e34.

 Dooley M, Spencer CM, Dunn CJ. Aceclofenac: a reappraisal of its use in the management of pain and rheumatic disease. Drugs 2001;61(9):1351e78.

Mastbergen SC, Bijlsma JW, Lafeber FP. Selective COX-2 inhibition is favorable to human early and late-stage osteoarthritic cartilage: a human in vitro study. Osteoarthritis Cartilage 2005;13(6):519e26.

Cibere J, Thorne A, Kopec JA, Singer J, Canvin J, Robinson DB, et al. Glucosamine sulfate and cartilage type II collagen degradation in patients with knee osteoarthritis: randomized discontinuation trial results employing biomarkers. J Rheumatol 2005;32(5):896e902.

Gineyts E, Mo JA, Ko A, Henriksen DB, Curtis SP, Gertz BJ, et al. Effects of ibuprofen on molecular markers of cartilage and synovium turnover in patients with knee osteoarthritis. Ann Rheum Dis 2004;63(7):857e61.

Manicourt DH, Bevilacqua M, Righini V, Famaey JP, Devogelaer JP. Comparative effect of nimesulide and ibuprofen on the urinary levels of collagen type II C-telopeptide degradation products and on the serum levels of hyaluronan and matrix metalloproteinases-3 and -13 in patients with flare-up of osteoarthritis. Drugs R D 2005;6(5): 261e71.

Kullich WC, Niksic F, Klein G. Effect of nimesulide on metalloproteinases and matrix degradation in osteoarthritis: a pilot clinical study. Int J Clin Pract Suppl 2002;128:24e9.

Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957;16(4):494e502.

Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986;29(8):1039e49.

Muller-Fassbender H, Bach GL, Haase W, Rovati LC, Setnikar I. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage 1994;2(1):61e9.

Qiu GX, Gao SN, Giacovelli G, Rovati L, Setnikar I. Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis. Arzneimittelforschung 1998;48(5):469e74.

Holm L, Esmarck B, Suetta C, Matsumoto K, Doi T, Mizuno M, et al. Postexercise nutrient intake enhances leg protein balance in early postmenopausal women. J Gerontol A Biol Sci Med Sci 2005;60(9): 1212e8.

Christgau S, Garnero P, Fledelius C, Moniz C, Ensig M, Gineyts E, et al. Collagen type II C-telopeptide fragments as an index of cartilage degradation. Bone 2001;29(3):209e15.

Reginster JY, Deroisy R, Rovati LC, Lee RL, Lejeune E, Bruyere O, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001; 357(9252):251e6.

Pavelka K, Gatterova J, Olejarova M, Machacek S, Giacovelli G, Rovati LC. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med 2002;162(18):2113e23.

Richy F, Bruyere O, Ethgen O, Cucherat M, Henrotin Y, Reginster JY. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med 2003;163(13):1514e22.

Rindone JP, Hiller D, Collacott E, Nordhaugen N, Arriola G. Randomized, controlled trial of glucosamine for treating osteoarthritis of the knee. West J Med 2000;172(2):91e4.

Messier SP, Mihalko S, Loeser RF, Legault C, Jolla J, Pfruender J, et al. Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study. Osteoarthritis Cartilage 2007; 15(11):1256e66.

McAlindon T, Formica M, LaValley M, Lehmer M, Kabbara K. Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an internet-based randomized double-blind controlled trial. Am J Med 2004;117(9):643e9.

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):1469e75.

Vlad SC, LaValley MP, McAlindon TE, Felson DT. Glucosamine for pain in osteoarthritis: why do trial results differ? Arthritis Rheum 2007; 56(7):2267e77.

frech TM, Clegg DO. The utility of nutraceuticals in the treatment of osteoarthritis. Curr Rheumatol Rep 2007;9(1):25e30.

Dodge GR, Jimenez SA. Glucosamine sulfate modulates the levels of aggrecan and matrix metalloproteinase-3 synthesized by cultured human osteoarthritis articular chondrocytes. Osteoarthritis Cartilage 2003;11(6):424e32.

68. Johnson KA, Hulse DA, Hart RC, Kochevar D, Chu Q. Effects of an orally administered mixture of chondroitin sulfate, glucosamine hydrochloride and manganese ascorbate on synovial fluid chondroitin sulfate 3B3 and 7D4 epitope in a canine cruciate ligament transection model of osteoarthritis. Osteoarthritis Cartilage 2001;9(1): 14e21.

Lippiello L, Woodward J, Karpman R, Hammad TA. In vivo chondroprotection and metabolic synergy of glucosamine and chondroitin sulfate. Clin Orthop Relat Res 2000;381:229e40.

Andersson ML, Petersson IF, Karlsson KE, Jonsson EN, Mansson B, Heinegard D, et al. Diurnal variation in serum levels of cartilage oligomeric matrix protein in patients with knee osteoarthritis or rheumatoid arthritis. Ann Rheum Dis 2006;65(11):1490e4.

Kong SY, Stabler TV, Criscione LG, Elliott AL, Jordan JM, Kraus VB. Diurnal variation of serum and urine biomarkers in patients with radiographic knee osteoarthritis. Arthritis Rheum 2006;54(8): 2496e504.

Larsson E, Erlandsson HH, Lorentzen JC, Larsson A, Mansson B, Klareskog L, et al. Serum concentrations of cartilage oligomeric matrix protein, fibrinogen and hyaluronan distinguish inflammation and cartilage destruction in experimental arthritis in rats. Rheumatology (Oxford) 2002;41(9):996e1000.

Larsson E, Erlandsson HH, Larsson A, Mansson B, Saxne T, Klareskog L. Corticosteroid treatment of experimental arthritis retards cartilage destruction as determined by histology and serum COMP. Rheumatology (Oxford) 2004;43(4):428e34.

Muller G, Michel A, Altenburg E. COMP (cartilage oligomeric matrix protein) is synthesized in ligament, tendon, meniscus, and articular cartilage. Connect Tissue Res 1998;39(4):233e44.