effectiveness of glucosamine treatment on the modulation of some immunological parameters in patients with knee osteoarthritis
رسل علي كاظم, صباح نعمة الثامر, علي محمد حسين القزاز
كلية الطب-جامعة بابل · العراق
Osteoarthritis is the most common condition to affect human joints and a frequent cause of disability. Aim of the study: The aim of this study was to determine the effect of oral glucosamine (1000–1500 mg/day) treatment prescribed to knee OA patients on serum C3, which represents the complement system as it plays an important role in all three pathways of complement system activation, and on some cytokines such as IFN-γ, which represents the function of Th-1, IL-4, which represents the function of Th-2, and IL-6, which represents the acute inflammatory phase protein. In addition, the study aims to evaluate the effect of the duration of glucosamine treatment on these parameters, as well as to know if glucosamine treatment had an effect on a grade of osteoarthritis more than another. Patients, Materials, and Methods: This study included 40 patients who had different grading of knee osteoarthritis on regular oral glucosamine (1000–1500 mg/day) for different durations of administration. Twenty patients had osteoarthritis on acetaminophen only without glucosamine treatment (1st control) and 20 healthy control people (2nd control). Blood samples were taken from all groups, and serum values of C3 were measured by nephelometric method using an automated machine (MININEPH), while serum values of IFN-γ, IL-4, and IL-6 were measured by ELISA technique. Statistical analysis was done using the SPSS computing program at (p<0.05) level of significance. Results: The concentration of C3 in serum of patients with OA on oral glucosamine was significantly lower (p<0.05) than that of OA patients without glucosamine, while there was no significant difference as compared with healthy control people. The concentration of IFN-γ, IL-4, IL-6 in OA patients on glucosamine was significantly lower (p<0.05) than that of both OA patients without glucosamine treatment and the healthy control group. However, it was significantly higher (p<0.05) in OA without glucosamine treatment as compared with the healthy group. Within the first three months of glucosamine treatment, serum C3 and IFN-γ were significantly higher (p<0.05) than that of the second, third, and fourth three months; in addition, the second three months were significantly higher (p<0.05) than that of the third and fourth three months. There was no significant difference between the third and fourth three months of glucosamine treatment. Within the first three months of glucosamine treatment in OA patients, serum concentration of both IL-4 and IL-6 was significantly higher (p<0.05) than that of the second, third, and fourth three months of treatment. There was no significant difference between the second, third, and fourth three months of glucosamine treatment. According to the grading of OA, the results showed that there were no significant differences in all parameters between the gradings of OA. Conclusion: Glucosamine played an important role in the modulation of inflammatory processes as reflected on the complement system, since glucosamine was able to normalize serum C3 concentration in OA patients. This normalization can be achieved nearly after six months of glucosamine treatment. Furthermore, glucosamine treatment can also reduce the pro-inflammatory cytokines, mainly IFN-γ, IL-4, and IL-6 levels in OA patients even below that of the healthy control group. The reduction of IFN-γ was achieved nearly after six months. In addition, the normalization of both IL-4 and IL-6 was achieved after three months of glucosamine treatment. However, glucosamine treatment was not significantly influenced by OA grading.