Osteoarthritis, which affects an estimated 27 million Americans, is a leading cause of disability in older adults. Because the general population is aging and obesity, a major risk factor, is increasing in prevalence, the occurrence of osteoarthritis is on the rise. Clinical practice guidelines issued by the American College of Rheumatology recommend aerobic exercise and/or strength training, weight loss (if overweight), and a number of pharmacological and non-pharmacological modalities for treating OA of the knee, hip, or hand.
Many people with OA report trying various dietary supplements in an effort to relieve pain and improve function. However, there is no convincing evidence that any dietary supplement helps with OA symptoms or the underlying course of the disease. This issue of the digest summarizes current scientific evidence about several dietary supplements most often used by people with OA, including glucosamine and chondroitin sulfate, Dimethyl Sulfoxide (DMSO) and Methylsulfonylmethane (MSM), S-Adenosyl-L-methionine (SAMe), and herbal remedies.
Glucosamine, Chondroitin Sulfate, or the Combination: Glucosamine and chondroitin sulfate—taken separately or together—are marketed for supporting joint health. They have also been widely used for treating OA. The preponderance of evidence indicates little or no meaningful effect on pain or function. Independent clinical practice guidelines published in 2012 by the American College of Rheumatology (ACR) [95KB PDF], and in 2010 by the American Academy of Orthopaedic Surgeons (AAOS) recommend not using glucosamine or chondroitin for OA. Recommendations from Osteoarthritis Research Society International (OARSI) published in 2014 conclude that current evidence does not support use of glucosamine or chondroitin in knee OA for disease-modifying effects, but leave unsettled the question of whether either may provide symptomatic relief.
- A 2009 Cochrane systematic review of 25 studies found evidence of improvement in pain and function in studies using one manufacturer’s preparation of glucosamine, not in studies using preparations from other companies.
- Three reports from the NIH-funded Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), compared glucosamine, chondroitin sulfate, the two in combination, celecoxib, and placebo. There were no clinically significant differences in pain or function following 6 months and 2 years of treatment. There was also no evidence that glucosamine, chondroitin, or the combination could prevent the progression of OA, based on joint space width measurements.
- A 2007 meta-analysis considered 20 controlled clinical trials comparing chondroitin with placebo or n treatment in 3846 patients with OA of the hip or knee. The investigators concluded that “large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged.”
- A 2010 network meta-analysis analyzed 10 glucosamine and chondroitin trials involving 3,803 patients with knee or hip OA published similar results. The investigators concluded that glucosamine, chondroitin, or a combination did not significantly reduce pain or change joint space compared to placebo.
- A 2014 double-blind randomized placebo-controlled trial compared glucosamine, chondroitin, the combination, or placebo in 605 patients with knee osteoarthritis. While symptomatic improvement was seen in all four groups over the study period, there were no differences in symptomatic improvement. A very small but statistically significant reduction in joint space narrowing was seen in the glucosamine–chondroitin combination group at 2 years.
Glucosamine and chondroitin appear to be relatively safe and well tolerated when used in suggested doses over a 2-year period. In a few specific situations, however, possible side effects or drug interactions should be considered:
- No serious side effects have been reported in large, well-conducted studies of people taking glucosamine, chondroitin, or both for up to 3 years.
- However, glucosamine or chondroitin may interact with warfarin.
- Although recent studies conducted by the U.S. Food and Drug Administration show that high doses of glucosamine hydrochloride taken by mouth in rats may promote cartilage regeneration and repair, this dose was also found to cause severe kidney problems in the rats—a serious side effect of the treatment.
Dimethyl Sulfoxide (DMSO) and Methylsulfonylmethane (MSM): DMSO and MSM are two chemically related dietary supplements that have been used for arthritic conditions. However, evidence does not suggest that DMSO and MSM are helpful for OA symptoms.
- A 2011 meta-analysis of a small number of studies looked at topical (applied to skin) DMSO and oral (taken by mouth) MSM as potential products for OA of the knee. There was no evidence of significant reductions in pain compared to placebo.
- Although there are limited safety data available, some side effects from topical DMSO have been reported, including upset stomach, skin irritation, and garlic taste, breath, and body odor.
- Only minor side effects are associated with MSM in humans including allergy, upset stomach, and skin rashes.
S-Adenosyl-L-methionine (SAMe): SAMe is a molecule that is naturally produced in the body and is often taken as a dietary supplement. There is not enough evidence to support the use of SAMe for OA of the knee or hip.
- A 2009 systematic review concluded that there was not enough evidence to use SAMe for OA of the knee or hip. The reviewers did indicate that small improvements in pain and function were seen in some but not all studies.
- SAMe is generally considered safe.
- Common side effects include gastrointestinal problems, dry mouth, headache, sweating, dizziness, and nervousness.
Herbal Remedies: Although some results suggest that a few herbs may be beneficial for OA symptoms, the overall evidence is weak. In addition, not all herbs have been studied or prepared in a consistent way, and conclusions among reviews of the literature provide conflicting interpretations. There is also a general lack of safety data available for many herbal medicines.
Avocado/Soybean Unsaponifiables: Avocado/soybean unsaponifiables (ASU) are supplements made from avocado oil and soybean oil extracts and have been studied, mostly in Europe, for their effects on osteoarthritis.
- A 2009 Cochrane review of two combined studies of ASU showed beneficial effects on functional index, pain, intake of NSAIDs, and global evaluation.
- There are limited safety data available.
Other Herbal Remedies: The current evidence base on efficacy of other herbal therapies for osteoarthritis, such as willow bark and tipi tea, is limited to clinical trials reports and a systematic review.
- Authors of a 2009 Cochrane review concluded that evidence for willow bark, topical capsaicin, and tipi tea is insufficient to support their use.
- There are limited safety data available.
6 Things You Should Know About Dietary Supplements for Osteoarthritis
Osteoarthritis is the most common type of arthritis—affecting 27 million Americans—and is an increasing problem among older adults. Treatments for osteoarthritis address the symptoms, such as pain, swelling, and reduced function in the joints. Nonmedicinal approaches involve lifestyle changes such as exercise, weight control, and rest. Conventional medicinal treatments for OA include nonsteroidal anti-inflammatory drugs (NSAIDS), acetaminophen (a class of pain reliever), and injections of corticosteroids (anti-inflammatory hormones). Many people with OA report trying various dietary supplements, including glucosamine and chondroitin, alone or in combination, in an effort to relieve pain and improve function. However, there is no convincing evidence that any dietary supplement helps with OA symptoms or the course of the underlying disease. Here are 6 things you should know about dietary supplements for osteoarthritis:
1). The majority of research has found little effect of glucosamine or chondroitin on symptoms or joint damage associated with osteoarthritis of the knee or hip. Studies have found that glucosamine and chondroitin supplements may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin). But overall, studies have not shown any other serious side effects.
2). Dimethyl Sulfoxide (DMSO) and Methylsulfonylmethane (MSM) are two chemically related dietary supplements that have been used for arthritic conditions; however, evidence does not suggest that DMSO and MSM are helpful for osteoarthritis symptoms. Although there are limited safety data available, some side effects from topical DMSO have been reported, including upset stomach, skin irritation, and garlic taste, breath, and body odor. Only minor side effects are associated with MSM in humans including allergy, upset stomach, and skin rashes.
3). S-Adenosyl-L-methionine (SAMe) is a molecule that is naturally produced in the body and is often taken as a dietary supplement; however, there is not enough evidence to support the use of SAMe for osteoarthritis of the knee or hip. SAMe is generally considered safe, but common side effects include gastrointestinal problems, dry mouth, headache, sweating, dizziness, and nervousness.
4). There is preliminary evidence that avocado/soybean unsaponifiables (ASU), supplements made from avocado oil and soybean oil extracts, may have modest beneficial effects on symptoms of osteoarthritis. Safety information has not been sufficiently available.
5). Although some results suggest that a few herbs may be beneficial for OA symptoms, the overall evidence is weak, and conclusions among reviews of the literature provide conflicting interpretations. In general, herbs have not been studied or prepared in a consistent way. There is also a general lack of safety data available.
6). If you take, or are considering taking, dietary supplements for osteoarthritis, tell your health care providers. They can do a better job caring for you if they know what dietary supplements you use.
Source: National Center for Complementary and Alternative Medicine
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