Osteoarthritis is one of the most frequent causes of pain and disability in the elderly. Traditional medical treatments focus primarily on the relief of symptoms, using analgesics and/or various nonsteroidal antiinflammatory drugs (NSAIDs). Longterm use of these drugs carries potentially serious side effects. It is estimated that NSAID use in the United States results in >100,000 hospitalizations and 16,500 deaths annually.1 In addition to failing to prevent continued cartilage degeneration, numerous NSAIDs are now known to actually accelerate joint deterioration, resulting from their inhibition of prostaglandin synthesis.2,3
Individuals with osteoarthritis are known to have elevated levels of damaging free radicals being produced in the affected joints.4 It also has been determined that these free radicals produce cytokines and various other biochemical factors that are involved in cartilage degradation and joint inflammation.5
Results from small studies have shown that the antioxidant nutrients vitamins C and E can reduce inflammation and pain and slow the progression of osteoarthritis. In the Framingham Osteoarthritis Cohort Study, individuals with higher intakes of vitamin C had a 3-fold reduced risk for the progression of osteoarthritis.6 Studies with vitamin E have produced conflicting results. Although some studies report no significant benefits, several trials utilizing 400 to 600 international units per day resulted in significant pain relief and/or improved mobility.7-9
Glucosamine sulfate is now widely used to relieve symptoms from osteoarthritis. Although the mechanisms of action are not totally clear, in vitro studies indicate that glucosamine stimulates the synthesis of glycosaminoglycans, proteoglycans, and hyaluronic acid.10
Numerous human trials have reported that glucosamine provides greater symptom relief than placebo.11,12
Four short-term (4-8 weeks), double- blind, placebo-controlled human trials have compared glucosamine with NSAIDs. In each study, patients responded better to ibuprofen in the first week, but during final weeks glucosamine was as effective as ibuprofen. Side effects were much more frequent and severe in the patients treated with ibuprofen.13-16
In addition to symptomatic relief, results from two 3-year studies indicate that treatment with glucosamine slows down the progression of osteoarthritis. In one trial, the placebo patients experienced an additional 0.33 mm narrowing of joint space, whereas glucosamine-treated patients experienced no significant advancement of joint space narrowing.17 The second trial reported an additional 0.19 mm of joint space narrowing after 3 years.18 The most common dose of glucosamine sulfate is 500 mg taken 3 times daily.
Chondroitin sulfate (CS) is another compound the body needs to make cartilage and various other connective tissues in the body. Structurally, CS consists of repeating chains of molecules called glycosaminoglycans. Like glucosamine, studies reveal that chondroitin reduces pain, improves flexibility and mobility, and slows the progression of osteoarthritis. Pooled data from a meta-analysis of 7 clinical trials revealed that CS performed significantly better than placebo, producing at least a 50% improvement.19 Daily dosages of CS range from 800 to 1600 mg.
S-adenosylmethionine, or SAM-e, is another natural agent that is gaining in popularity. Studies indicate that SAM-e may reduce pain and inflammation in the joints as well as promoting cartilage repair. Although large clinical trials have not been conducted, results from smaller trials suggest that SAM-e provides pain relief similar to that from NSAIDs, but with far fewer side effects. For example, in a 16-week, randomized, double-blind, crossover study, SAM-e (1200 mg/day) was compared with celecoxib (200 mg/day) in patients with osteoarthritis of the knee. During the first month, celecoxib provided significantly more pain reduction than SAM-e, but by the second month there was no significant difference between the 2 agents.20 Because SAM-e is a metabolite of methionine, many health professionals recommend taking additional B vitamins to avoid elevating levels of homocysteine. Other double-blind clinical trials have reported that SAMe works as well as or better than ibuprofen, with far fewer side effects.21,22 The primary problem with SAM-e therapy is its price.
In the 1990s, studies reported that the mineral boron was a safe and effective supplement that could alleviate arthritic pain and discomfort. Countries with lower soil boron levels are known to have higher rates of arthritis, and it was suggested that the increasing use of chemical fertilizers might be a contributing factor.23 In one 8-week double-blind trial, 50% of the people taking boron (6 mg/day) improved, compared with 10% of the placebo patients. Individuals with severe osteoarthritis experienced the greatest benefit.24
Dr. Pelton is director of education at Integrative Health Resources Inc.
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