Study Finds Chondroitin Sulfate Helps Hand OA
The supplement is worth a try, but benefits may be modest.
Chondroitin sulfate is a popular supplement used treat the pain and loss of function associated with osteoarthritis, or OA, but studies assessing its effectiveness have been mixed. A study published online in Arthritis & Rheumatism adds one more piece to the chondroitin puzzle, finding that the supplement appears to safely relieve some symptoms of hand OA.
“Hand osteoarthritis is a frequent form of arthritis that can be very painful and is also associated with a significant impact on quality of life,” explains lead author Cem Gabay, MD, professor of medicine at the University of Geneva School of Medicine and head of the division of rheumatology at the University Hospitals of Geneva, Switzerland. Hand arthritis affects 20 to 30 percent of adults, and more than 50 percent of those age 60 and older.
The body naturally makes chondroitin, a molecule that is a major component of cartilage and helps cartilage retain water. It also can be manufactured from the cartilage of animals – like cows, pigs or sharks – or made synthetically. The supplement is sold as chondroitin sulfate. In many European countries it is approved as a prescription treatment for OA. In the U.S., it is often combined with a glucosamine supplement. Like chondroitin, glucosamine is a natural compound found in healthy cartilage.
The new study – a randomized, placebo-controlled, double-blinded trial – involved 162 patients older than age 40 with hand OA. Eighty participants were given a daily 800 mg dose of chondroitin sulfate (derived from fish) for six months; 82 patients received a placebo.
Compared with those taking a placebo, participants taking the supplement had a statistically significant decrease in hand pain and improvement in hand function at the end of the study. The researchers write that these improvements “started to become evident after 3 months of treatment.” Chondroitin-takers also experienced significantly shorter duration of morning stiffness. There were no differences in grip strength, the use of pain rescue medication (acetaminophen) or side effects.
Dr. Gabay says the findings show that chondroitin’s effect is similar in magnitude to that of nonsteroidal anti-inflammatory drugs, or NSAIDs, but has fewer risks. As the researchers wrote, chondroitin has not been compared head-to-head to NSAIDs, but three other studies of NSAIDs’ effects on hand OA measured a similar improvement in hand pain and function scores.
“The positive effects of NSAIDs appear more rapidly than those observed with chondroitin sulfate,” says Dr. Gabay. “However, NSAIDs are associated with significant side effects, in particular in elderly patients.”
In 2009, the American Geriatrics Society took NSAIDs off the list of medicines recommended to treat persistent pain in older patients because of an increased risk of gastrointestinal bleeding, heart attack or stroke. NSAIDs also don’t interact well with many of the drugs taken for conditions commonly associated with aging, such as heart failure medication.
Because chondroitin sulfate was well tolerated, Dr. Gabay says it offers “an interesting alternative to NSAIDs in patients who are susceptible to develop side effects with NSAIDs and in the case of long-term treatment.”
This study adds to a growing – and often conflicting – body of research on chondroitin. Before 2001, many studies showed that chondroitin sulfate did help relieve OA pain and improve function. But newer studies haven’t all agreed. For example, a study published last year in the Annals of the Rheumatic Diseases showed no difference when hundreds of knee OA patients took the supplement compared to a placebo.
But Dr. Gabay stresses that previous research looked almost entirely at knee OA patients. He says this is the first randomized clinical trial looking at the supplement’s effects on hand OA. “Thus the results cannot be compared to those of studies on other joints,” Dr. Gabay says.
Natural Medicines Comprehensive Database, which has rated and evaluated more than 80,000 natural drug ingredients and commercial dietary supplements, classified chondroitin as “possibly effective” for knee OA, but hasn’t assessed it for hand OA. Philip J. Gregory, a pharmacist and editor of the site, says this is a small, short-term study, but he agrees with its conclusion although he finds it a bit sweeping.
“The benefit observed is fairly modest. It’s about 10 percent different from placebo, so that’s small,” Gregory explains. “So people taking this should not expect a huge impact. They should expect modest benefit.”
He stresses the chondroitin in this study was derived from fish – a fact he thinks is important. “Some [chondroitin supplements] are from bovine or other animal sources. I’m generally leery of those because you don’t know what conditions they are manufactured under,” he says. “We generally advise people to stay away from supplements from cows and pigs – animals that might be slaughtered. The risk [of contamination] of anything is probably miniscule. But why risk it at all?”
He says the bottom line for patients is: If you’re searching for something that can help, this might be a supplement to consider.
“It’s something that I think probably would be worth trying. As a pharmacist, I wouldn’t jump out of my chair to recommend it for everyone. But for someone with severe OA like patients in this trial who aren’t getting relief, they have to try something,” Gregory says. “If you don’t feel a benefit in [about] three months, then stop taking it.”
This clinical trial was sponsored by IBSA, a pharmaceutical company in Switzerland that produces chondroitin sulfate. Dr. Gabay says the study was performed independently from the company and Gregory says he sees no evidence of bias in the research.