Do Supplements Help Arthritis Pain?
Turn on the TV or flip through a magazine, and you’re likely to find an ad for supplements that claim to reduce or eliminate your arthritis pain. You may wonder if they actually help. Here’s what the current research says about how to treat arthritis pain and manage progression of the disease.
Arthritis defined
Osteoarthritis is often referred to as a “wear and tear” type of disease. It’s also known as degenerative joint disease, degenerative arthritis, ostoearthrosis, and hypertrophic arthritis. Osteoarthritis occurs when the cartilage loses elasticity and becomes more prone to damage as caused by age, injury, excess body weight, or other factors. This is the most common type of arthritis, with approximately 21 million Americans suffering today.
Study protocol
Just about any research statistic can be made to sound promising. To ascertain the validity of a study’s outcome, it’s important to determine the research method. A doubleblind study with a significant sampling (test group size) will produce the most accurate results. In a double-blind study, some patients are given the substance (medicine or supplement) being measured, while others are given a placebo (sugar pill). Neither group knows what they’re taking—hence the name double-blind.
Because accurate results are based upon statistical probabilities, the study should also be repeated. In addition, the clinical trial should be reviewed by other physicians in order to ensure there are no flaws in the trial’s design. All of these study criteria are especially important for conditions like arthritis because symptoms can come and go. In a clinical study that isn’t repeated, some patients may believe they’re getting better, when in reality it’s just the waxing and waning of their pain.
OTC supplements
Several over-the-counter (OTC) joint-pain-relief supplements have been evaluated by the National Institutes of Health (NIH) in a recent clinical trial. According to the June 2006 issue of Consumer Reports, this study measured the effectiveness of treating with glucosamine, chondroitin, and celecoxib (Celebrex) in reducing the pain of osteoarthritis and slowing the disease’s progression in almost 1,600 patients with knee osteoarthritis.
It’s hypothesized that glucosamine helps prevent cartilage breakdown by stimulating the production of cartilage-building proteins, while chondroitin may fight inflammation and inhibit the production of cartilagedestroying enzymes. Because there haven’t been repeated studies, the NIH couldn’t confirm that these substances modify the disease itself. Studies do suggest they help minimize pain, which is what’s most important to those patients suffering from the pain of arthritis.
Among the group of patients in the NIH study with moderate to severe pain, 79 percent reported some relief when taking the glucosamine-chondroitin combination. However, among the entire group (including patients with varying degrees of pain), only celecoxib provided significantly more relief than the placebo.
Although additional studies are needed to confirm or refute the results, some experts suggest osteoarthritis sufferers should try glucosamine-chondroitin. This combination supplement doesn’t appear to have severe side effects, with the following few exceptions:
• Individuals who have shellfish allergies should avoid glucosamine.
• Diabetics should closely monitor their blood sugar, as experts are still unsure whether or not glucosamine raises blood sugar levels.
• People who have clotting disorders or take an anticlotting drug such as warfarin (Coumadin) shouldn’t take any herbal supplement without consulting a physician.
Store brand or generic?
According to Consumer Reports, there are significant differences among various brands of supplements. Here are its recommendations:
• Select the lowest-price brand that includes 1,500 mg of glucosamine and 1,200 mg of chondroitin per day, as clinical trials suggest these are the optimum doses. When measuring price, keep in mind the cost-per-day, rather than the cost-per-pill. Some brands have smaller pills (for those people have difficulty swallowing larger ones); these brands require three pills-per-day rather than the two pills-per-day regimen for other labels.
• Don’t choose products that include other ingredients along with the glucosamine and chondroitin. As of this point, there haven’t been any studies to determine the safety of “fillers” commonly used in complex compounds. In addition, some fillers may negatively impact the absorption of the glucosamine-chondroitin.
• Whenever possible, purchase mainstream brands. Although both brand-name and generic formulas may contain equivalent levels of glucosamine and chondroitin, generic supplements often use binding agents that affect the absorption of the main ingredients.
What works
Although further clinical trials are needed to evaluate the effectiveness of supplements, there are some things we know do work in the management of osteoarthritis pain. They include:
• Weight management. Heavier people put more stress on their joints than do those at their ideal weights. Interestingly, for every one pound you lose, the pressure on your joints is reduced three to five pounds.
• Exercise. Although too little exercise can have a negative impact on your joint pain (as it relates to both your weight and your flexibility), too much exercise can also have a negative impact. Determining this level of “moderate and appropriate” exercise is different for each person. In nearly every situation, walking is a safe and effective exercise option.
What we don’t know yet
Studies on glucosamine-chondroitin appear to demonstrate safety and probable effectiveness. Yet, there are many other supplements being touted as the answer to your joint problems. Although the following substances may be useful for some situations, they haven’t been thoroughly evaluated as treatment for osteoarthritis or for possible side effects.
• Avocado/soybean oils
• Ginger
• MSM (methylsulfonylmethane)
• SAM-e
• Vitamin D (although this is important to take as part of your diet to aid in calcium absorption, it isn’t recommended to treat osteoarthritis).
Sometimes patients wonder why we don’t automatically recommend products that appear to offer a miracle cure. The reason is our patients’ safety. That’s why we don’t recommend products until repeatable double-blind studies are done to demonstrate safety and effectiveness. Therefore, although we can’t say that the above products don’t work, we also don’t have proof they do work, and we’d rather err on the side of caution. tpw
Arthritis defined
Osteoarthritis is often referred to as a “wear and tear” type of disease. It’s also known as degenerative joint disease, degenerative arthritis, ostoearthrosis, and hypertrophic arthritis. Osteoarthritis occurs when the cartilage loses elasticity and becomes more prone to damage as caused by age, injury, excess body weight, or other factors. This is the most common type of arthritis, with approximately 21 million Americans suffering today.
Study protocol
Just about any research statistic can be made to sound promising. To ascertain the validity of a study’s outcome, it’s important to determine the research method. A doubleblind study with a significant sampling (test group size) will produce the most accurate results. In a double-blind study, some patients are given the substance (medicine or supplement) being measured, while others are given a placebo (sugar pill). Neither group knows what they’re taking—hence the name double-blind.
Because accurate results are based upon statistical probabilities, the study should also be repeated. In addition, the clinical trial should be reviewed by other physicians in order to ensure there are no flaws in the trial’s design. All of these study criteria are especially important for conditions like arthritis because symptoms can come and go. In a clinical study that isn’t repeated, some patients may believe they’re getting better, when in reality it’s just the waxing and waning of their pain.
OTC supplements
Several over-the-counter (OTC) joint-pain-relief supplements have been evaluated by the National Institutes of Health (NIH) in a recent clinical trial. According to the June 2006 issue of Consumer Reports, this study measured the effectiveness of treating with glucosamine, chondroitin, and celecoxib (Celebrex) in reducing the pain of osteoarthritis and slowing the disease’s progression in almost 1,600 patients with knee osteoarthritis.
It’s hypothesized that glucosamine helps prevent cartilage breakdown by stimulating the production of cartilage-building proteins, while chondroitin may fight inflammation and inhibit the production of cartilagedestroying enzymes. Because there haven’t been repeated studies, the NIH couldn’t confirm that these substances modify the disease itself. Studies do suggest they help minimize pain, which is what’s most important to those patients suffering from the pain of arthritis.
Among the group of patients in the NIH study with moderate to severe pain, 79 percent reported some relief when taking the glucosamine-chondroitin combination. However, among the entire group (including patients with varying degrees of pain), only celecoxib provided significantly more relief than the placebo.
Although additional studies are needed to confirm or refute the results, some experts suggest osteoarthritis sufferers should try glucosamine-chondroitin. This combination supplement doesn’t appear to have severe side effects, with the following few exceptions:
• Individuals who have shellfish allergies should avoid glucosamine.
• Diabetics should closely monitor their blood sugar, as experts are still unsure whether or not glucosamine raises blood sugar levels.
• People who have clotting disorders or take an anticlotting drug such as warfarin (Coumadin) shouldn’t take any herbal supplement without consulting a physician.
Store brand or generic?
According to Consumer Reports, there are significant differences among various brands of supplements. Here are its recommendations:
• Select the lowest-price brand that includes 1,500 mg of glucosamine and 1,200 mg of chondroitin per day, as clinical trials suggest these are the optimum doses. When measuring price, keep in mind the cost-per-day, rather than the cost-per-pill. Some brands have smaller pills (for those people have difficulty swallowing larger ones); these brands require three pills-per-day rather than the two pills-per-day regimen for other labels.
• Don’t choose products that include other ingredients along with the glucosamine and chondroitin. As of this point, there haven’t been any studies to determine the safety of “fillers” commonly used in complex compounds. In addition, some fillers may negatively impact the absorption of the glucosamine-chondroitin.
• Whenever possible, purchase mainstream brands. Although both brand-name and generic formulas may contain equivalent levels of glucosamine and chondroitin, generic supplements often use binding agents that affect the absorption of the main ingredients.
What works
Although further clinical trials are needed to evaluate the effectiveness of supplements, there are some things we know do work in the management of osteoarthritis pain. They include:
• Weight management. Heavier people put more stress on their joints than do those at their ideal weights. Interestingly, for every one pound you lose, the pressure on your joints is reduced three to five pounds.
• Exercise. Although too little exercise can have a negative impact on your joint pain (as it relates to both your weight and your flexibility), too much exercise can also have a negative impact. Determining this level of “moderate and appropriate” exercise is different for each person. In nearly every situation, walking is a safe and effective exercise option.
What we don’t know yet
Studies on glucosamine-chondroitin appear to demonstrate safety and probable effectiveness. Yet, there are many other supplements being touted as the answer to your joint problems. Although the following substances may be useful for some situations, they haven’t been thoroughly evaluated as treatment for osteoarthritis or for possible side effects.
• Avocado/soybean oils
• Ginger
• MSM (methylsulfonylmethane)
• SAM-e
• Vitamin D (although this is important to take as part of your diet to aid in calcium absorption, it isn’t recommended to treat osteoarthritis).
Sometimes patients wonder why we don’t automatically recommend products that appear to offer a miracle cure. The reason is our patients’ safety. That’s why we don’t recommend products until repeatable double-blind studies are done to demonstrate safety and effectiveness. Therefore, although we can’t say that the above products don’t work, we also don’t have proof they do work, and we’d rather err on the side of caution. tpw