Supplemental Relief
2. Glucosamine and Chondroitin Sulfate
What they are:
Glucosamine and chondroitin sulfate are a widely touted supplement duo for relieving symptoms of OA. Glucosamine, a major component of joint cartilage, is made naturally in the human body when it combines glucose, a simple sugar, and glutamine, an amino acid. With age, the body's ability to make glucosamine is reduced. Supplemental glucosamine is made from the shells of shrimp, lobster, and crabs. (Shellfish-free forms are available.)
Glucosamine products are often combined with chondroitin sulfate, a chain of repeating molecules that add elasticity to cartilage and help it retain water. Chondroitin is not made in the human body. Supplements are derived from cow, sharke or pig cartilage.
What they do:
Some experts say that taking glucosamine can slow the deterioration of joint cartilage and relieve joint cartilage and relieve OA pain.
Supplemental chondroitin is said to increase collagen’s ability to absorb shocks, lubricate joints and block enzymes that destroy cartilage.
What we know about them:
James McKoy, MD, chief of rheumatology and pain medicine at Kaiser Permanente Medical Center, in Honolulu, says, “Throughout the past 10 years, there are studies that show the combination of glucosamine and chondroitin slows deterioration of cartilage, relieves OA pain and improves joint mobility; and other sutdies that say they don't."
First-stage results from the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), a 16-center, double-blind study of 1,583 people age 40 and older with OA knee pain were released in 2006. Overall, the study found that 67 percent of those who took the glucosamine-chondroitin treatment combo had reduced pain.
"Some experts," says Dr. McKoy, "don't accept those overall study findings due to the very high placebo response rate of about 60 percent."
A subset of patients, however showed a more positive, but less publicized finding--79 percent of participants with moderate-to-severe pain who took the combined treatment reported significant pain relief versus about 54 percent response for those taking a placebo.
According to Dr. McKoy, the contradictory findings could be due to participants' use of different products, which can vary in quality and potency, and discrepancies in the severity of subjects' pain at study onset.
In 2007, researchers from the University of Bern, in Switzerland, released results of their analysis of large-scale, methodologically sound studies of chondroitin's effectiveness for knee OA pain--specifically when not used in combination with glucosamine. The concluded chondroitin provides minimal or no symptomatic relief. They did not study its effect on cartilage.
Dr. McKoy says that he still recommends all people with early OA take the combo. However, he says, "patients with the most severe OA, showing complete loss of cartilage on X-rays, aren't going to get much benefit from anything except total joint replacement."
Watch for:
People with allergies to shellfish should choose shellfish-free glucosamine. Potential side effects include indigestion, nausea, and heartburn. People with diabetes or who have high cholesterol, triglycerides or blood pressure should exercise caution. Chondroitin has blood-thinning properties, so if you take blood thinners, such as Coumadin, aspirin or Heparin, talk to your physician before taking it. Chondroitin may increase the risk of bleeding when taken with non-steroidal anti-inflammatory drugs like naproxen (Aleve) or ibuprofen (Advil).
Take oral versions of glucosamine, says Dr. McKoy. "There is no evidence that topical glucosamine can be absorbed through the skin."
"Look for products that contain only glucosamine hydrochloride or glucosamine sulfate," he says, and "steer clear of chondroitin complex or compounds, because some manufacturers use low-grade materials or bulk up the pill with superfluous ingredients."
How much you need:
Glucosamine daily doses are 1500 mg to 2000 mg per day with 800 mg per day of chondroitin. Dr. McKoy always recommends the maximum dosing for arthritis.
Bottom line:
The jury is out on the ultimate effectiveness of glucosamine. And evidence is starting to show that chondroitin, when not combined with glucosamine, at least, may confer minimal, if any, benefits for pain. However, both substances are considered generally safe and may be worth a four- to six-month trial. If you don't feel a reduction in pain or stiffness by that time, you aren't likely to benefit and should stop taking them.
3. Pycnogenol
What it is:
Pycnogenol is the trade name for pine bark extract derived from French maritime pine, which is grown in coastal southwest France.
What it does:
Pycnogenol contains antioxidants called OPCs (oligomeric proanthocyanidins) that have anti-inflammatory properties and seem to inhibit enzymes that break down collagen and hylauronic acid--a substance that gives joint fluid its viscosity. Recent research suggests that pycnogenol may reduce OA symptoms. A double-blinded, placebo-controlled study of 100 people with mild to moderate OA was released this summer of the Comenius University School of Medicine in Bratislava, Slovakia. It found that participants taking the supplement were able to decrease analgesic use after about three months.
Another study earlier this year from Italy's G. d'Annunzio University, in Chieti and Pescara, found similar results. Participants who took 100 mg of pycnogenol daily for three months experienced a 55 percent reduction in OA pain compared with those who took a placebo. The scores for stiffness went down by 53 percent, and usage of NSAIDs dropped by 58 percent among the pycnogenol group. A study from Iran found that after taking pycnogenol for three months, participants reported a 43 percent reduction in pain and were able to reduce their use of NSAIDs.
What we know about it:
Pycnogenol may cause minor stomach upset and may alter blood sugar levels. People with diabetes or hypoglycemia, and those taking blood thinners, such as clopidogrel (Plavix), wafarin (Coumadin), aspirin or heparin, should use caution and talk to a doctor to determine if pycnogenol is right for them.
How much you need:
Aim for a total of 100 to 250 mg per day (in two daily doses). Allow at least one month for benefits.Because of pycnogenol’s aftertaste and potential for minor stomach discomfort, take it with meals.
Bottom line:
Evidence from small studies suggest that pycnogenol can reduce pain and inflammation.
