An expert consensus meeting on the application of glucosamine in osteoarthritis was held in Beijing on March 19, 2008, sponsored by the editorial board of the Chinese Journal of Surgery, in which some orthopedic and rheumatologists from Beijing, Shanghai, Guangzhou, Chongqing and other places discussed extensively and thoroughly the types of glucosamine, the status of treatment of osteoarthritis, the mechanism of action, clinical efficacy and Some orthopedic and rheumatologic experts from Beijing, Shanghai, Guangzhou, and Chongqing discussed extensively and deeply about the types of glucosamine, its status, mechanism of action, clinical efficacy and safety, dose and method of use, and achieved some consensus. Osteoarthritis is a chronic degenerative disease that develops slowly and progressively, and is the most common form of arthritis, characterized by wear and tear of the articular cartilage, with clinical manifestations of joint pain, swelling, joint deformity, and restricted movement. Clinical treatment includes non-surgical and surgical treatment. The former is the mainstay. Drug therapy constitutes the main component of non-surgical treatment, including acetaminophen, non-steroidal anti-inflammatory analgesics, weak central analgesics, glucosamine, hyaluronic acid, hormones, etc. Among them, acetaminophen and non-steroidal anti-inflammatory analgesics are the most commonly used first-line drugs for osteoarthritis treatment because of their ability to relieve pain and control symptoms. Glucosamine, a natural amino monosaccharide derived from crabs and other shelled marine organisms, is an important structural component of glyeosaminoglyeam and hyaluronie acid, and thus serves as an alternative to endogenous articular cartilage nutrients. It can stimulate chondrocytes to produce proteoglycans with normal multimeric structure, improve the repair ability of chondrocytes, inhibit the release of hydrolytic enzymes such as lysosomal enzymes, collagenase and phospholipase A2, reduce the hydrolytic damage to the articular cartilage matrix, and prevent the production of superoxide radicals that damage cells, and promote the repair and reconstruction of the cartilage matrix, thus delaying the pathological process of osteoarthritis and the disease process. Thus, as a nutritional supplement for articular cartilage, glucosamine has a long history of use in the prevention and treatment of osteoarthritis, starting in Europe in the 1960s for the treatment of arthritis and becoming popular in the United States in the mid-1990s, where it is still the most popular nutritional drug for articular cartilage, available as a dietary supplement. It is still the most popular articular cartilage nutritional drug in the United States and is available as a dietary supplement, while in Europe it is administered and available to patients as a prescription drug due to the clinical efficacy shown by this product. It is because of the potential of glucosamine to modify the structure of articular cartilage. These products may be potential disease-modifying osteoarthritis drugs (DMOADs) because of their potential to modulate the metabolism of articular cartilage and may even have the effect of slowing the course of arthritis by repairing damaged articular cartilage. Although glucosamine has been used for the prevention and treatment of osteoarthritis for a long time, there is still much controversy regarding the extent of osteoarthritis for which glucosamine is indicated, its efficacy and safety, the effective therapeutic dose and administration, and which acidic glucosamine is effective. There is still a lack of rigorous, large sample of evidence that is consistent with clinical evidence-based medicine. A review of the available clinical studies on the use of glucosamine in the treatment of osteoarthritis reveals that almost all of the studies enrolled patients with mild to moderate joint pain, and that the degree of wear and tear of the articular cartilage was not to the extent of major cartilage wear or even more severe. From the known effects of glucosamine on articular cartilage, it appears that glucosamine serves to repair and protect damaged articular cartilage and delay the course of osteoarthritis by regulating the metabolism of articular cartilage and replenishing the components needed to synthesize articular cartilage. This is the theoretical basis for the use of glucosamine as a potential disease-prolonging drug DMOADs. Therefore, most experts believe that the most suitable patients for clinical treatment of osteoarthritis with glucosamine should be patients with mild or moderate wear of articular cartilage, whose morphology and structure basically exist, rather than patients with extensive or even complete wear of articular cartilage, which belongs to the early osteoarthritis using drugs. Therefore, glucosamine can be used as a treatment option for early and mid-stage osteoarthritis, while it is not effective for patients with end-stage osteoarthritis with severe wear of articular cartilage. The efficacy and safety of glucosamine in the treatment of osteoarthritis A large number of clinical studies have shown that the safety of glucosamine in the treatment of osteoarthritis is very good, as reflected in the very few adverse events during the use of the drug, and the patient’s compliance with the drug is satisfactory. This is one of the reasons why the U.S. Food and Drug Administration has been able to classify these products as over-the-counter dietary supplements. Many early clinical studies have suggested that glucosamine treatment of osteoarthritis for 8 to 12 weeks is effective in relieving joint pain and improving overall function of the affected joints (as evaluated by the WOMAC or Lequesne index), with an overall efficacy comparable to that of 1000 mg of acetaminophen daily and better than that of patients on placebo. In 2006, the American Journal of Family Physicians featured a discussion of the effectiveness and safety of glucosamine in the treatment of osteoarthritis based on evidence-based medical criteria, and several papers provided evidence-based analyses of published clinical studies of glucosamine in the treatment of osteoarthritis. Medical grade analysis. The results of a retrospective evaluation study showed that the findings of some published clinical studies suggested that glucosamine reduced pain due to hip and knee osteoarthritis, but there were also some studies that did not show a statistically significant difference despite concluding that glucosamine reduced osteoarthritis pain better than placebo. With regard to the duration of dosing, some of the findings suggest relief of joint pain and improvement in joint function and patient quality of life already at 6 to 8 weeks of dosing, but there are other similar studies that did not reach the same conclusion. There are few clinical studies of long-term dosing and follow-up, and the results of 3 years of dosing showed moderate relief of joint pain due to osteoarthritis with glucosamine [1]. More consistent results came from safety evaluations of glucosamine, with none of the clinical studies showing a statistically significant difference in the safety of the various glucosamine used in the study compared to placebo [2]. In addition, some studies have also shown that glucosamine was effective in delaying the narrowing of the joint space and reducing joint pain in osteoarthritis, but the reduction in joint pain did not parallel the delay in the narrowing of the joint space, to the extent that delaying the narrowing of the joint space in osteoarthritis worked better, while reducing pain was less effective [3]. The experts at the meeting believed that the reason for such inconsistent results in so many clinical studies was related to the many manufacturers of glucosamine, the different varieties, and the poor quality of clinical study design, the lack of randomization and strict blinding, the lack of uniform criteria for the diagnosis and severity evaluation of osteoarthritis in enrolled cases, the short follow-up period, and the too small sample size. Since glucosamine is a nutritional health product in most regions of the world, it lacks a strict quality standard system similar to that of pharmaceutical production, therefore, the quality of glucosamine varies widely among different manufacturers, types and batches, and even the composition and quality of glucosamine from the same manufacturer, type and batch may vary, making it difficult to compare and judge its clinical efficacy. Factors such as the uncritical design of some clinical studies and research funding from manufacturers also bias the final clinical study results. However, overall, there is still enough evidence to support that glucosamine is a treatment option for hip and knee osteoarthritis. Compared with the adverse effects of long-term application of non-steroidal anti-inflammatory analgesics (NSAIDs) and acetaminophen, glucosamine is safe for long-term application, has few adverse effects, has certain efficacy, and can be used alone or in combination with NSAIDs for the treatment of osteoarthritis. Third, the effective dose and duration of treatment of osteoarthritis with glucosamine has not been very standardized in terms of dose and duration of use because glucosamine is applied as a food health product in most countries. There are three main types of glucosamine: glucosamine sulfate, glucosamine hydrochloride and N-acetylglucosamine, and the first two varieties are currently predominant in the market. Most clinical studies that have yielded effective results for glucosamine in the treatment of osteoarthritis have used oral glucosamine 1500 mg daily in 2 or 3 divided doses [4]. The results of a meta-analysis study also showed that 16 of 20 clinical studies applying glucosamine for symptomatic osteoarthritis with a total of 2029 patients enrolled on 1500 mg oral glucosamine sulfate daily resulted in 60% pain relief and 33% functional improvement compared to the baseline condition of patients enrolled in the clinical study (Lequesne index evaluation). It is important to note that glucosamine is an absorbable small molecule glycosamine, but it is less than 20% bioavailable. Also, the rate of glucosamine binding varies for any type of glucosamine depending on the acid root carrier to which it is bound, with glucosamine hydrochloride containing 83% glucosamine. Glucosamine sulfate contains 65% and N-acetylglucosamine contains 75%. Any clinical study must use the pure glucosamine contained as the dose standard regardless of the type of glucosamine used. The duration of glucosamine treatment for osteoarthritis is also an undetermined issue. Most clinical studies have reported results suggesting that continued application of 1500 mg of glucosamine for more than 8 weeks will show some efficacy, with more consistent results over 1 year of use. Fourth, the efficacy of hydrochloric acid and glucosamine sulfate debate So far, most clinical studies have used glucosamine sulfate, and there is less evidence-based medical research on glucosamine hydrochloride for osteoarthritis, so there is controversy about whether glucosamine hydrochloride is effective in treating osteoarthritis. However, some clinical studies using glucosamine hydrochloride for the treatment of osteoarthritis have reached conclusions similar to those of glucosamine sulfate. Many manufacturers are also still producing large quantities of glucosamine hydrochloride for the prevention and treatment of osteoarthritis. This suggests that glucosamine hydrochloride is still alive and well in the treatment of osteoarthritis. Basic studies have shown that the concentration of glucosamine in the form of hydrochloric acid is higher than that of sulfate. The relative bioavailability is higher; the salt content per effective dose of the glucosamine hydrochloride form is lower than that of the sulfate form because glucosamine sulfate requires sodium chloride as a stabilizer and can contain up to 30% salt, which is unfavorable for osteoarthritis patients who need to reduce dietary sodium intake; the therapeutic effect of glucosamine on osteoarthritis is mainly related to the absorbed glucosamine that has been broken down with the carrier The therapeutic effect of glucosamine in osteoarthritis is mainly related to the absorbed glucosamine that has been catabolized with the carrier and is not bioavailable. Therefore, regardless of the form of glucosamine, as long as it can be decomposed with the carrier in vivo and absorbed by the body, its biological effects should be similar. In conclusion, glucosamine has been clinically effective as a treatment option for osteoarthritis in terms of alleviating the disease and reducing symptoms, but it is advisable to use it for early and prophylactic use in arthritis and also for cartilage repair in patients with arthritis, preferably at 1500 mg daily for more than 8 weeks of continuous application. Long-term use alone or in combination with an NSAID is recommended, and evidence-based medical evidence continues to accumulate to further validate the safety and efficacy of glucosamine in the treatment of osteoarthritis.