Alternative and Experimental Therapies
reprinted from Primer on the Rheumatic Diseases, edition 12

An estimated 23 percent of people with osteoarthritis (OA) regularly use alternative and complementary therapies (9). Most patients using unconventional remedies are willing to discuss these therapies with their physician when asked (9). Understanding these alternative therapies can allow the physician to  educate the patient with the information available about their use in OA and possible risks of treatment. These discussions can help patients use judgement when considering  alternative treatments and avoid potentially harmful interventions.

Glucosamine and Chrondroitin
Glucosamine and chrondroitin preparations are used commonly by people with OA and are widely advocated in lay publications. Multiple sources distribute these compounds. Because they are not classified as medications, but rather regulated as nutritional supplements,  the quality and constitution of the different preparations varies. Fortunately, only minimal adverse events with glucosamine and chondroitin sulfate have been described.

Although several studies of these therapies have been published, the quality of these investigations is not optimal. Limitations in these investigations include methodologic weaknesses, proprietary sponsorship, and possible publication bias (10). Despite these limitations, there is a possibility that these compounds may improve OA symptoms and even reduce the radiographic progression of OA.  Large-scale, ongoing investigations of these agents may answer important questions.

Cartilage Repair and Transplantation
Extensive work has attempted to promote cartilage repair and restore normal cartilage tissue (11). Experimental procedures used to promote cartilage repair include penetration of the subchondral bone, osteotomy, joint distraction, soft-tissue graft of her periosteum or perichrondrium, cell transplantation, and use of growth factors. Unfortunately, these procedures generally are not successful in promoting cartilage repair. Results of early clinical experience with cartilage transplantation of autografts and allografts suggest that these procedures may benefit selected patient populations with focal cartilage defects. Currently, these procedures are not sufficiently successful for general application in people with OA.