Glucosamine, chondroitin and MSM don't put a dent in osteoarthritis

In the past decade, glucosamine and chondroitin have been among the nation's bestselling supplements as aging baby boomers seek natural remedies for their aging joints. • 

Sales boomed after New York Times health columnist Jane Brody wrote in a 1997 column that the combination helped her arthritic dog and relieved her own knee pain by about 30 percent. • But Brody went on to have a double knee replacement, and recent studies have found little or no benefit from glucosamine and chondroitin, either separately or in combination, for treating osteoarthritis. • And what about MSM, the supplement often found in combination with glucosamine and chondroitin?

A 2006 study of MSM (methylsulfonylmethane), found some improvement in terms of pain and physical function, but the study involved only 50 patients.

Does all this mean that people with arthritis should stop taking these supplements?

"One thing about glucosamine and chondroitin is that they're very, very safe," said Dr. John Murray of Pasadena Family Medical Associates in St. Petersburg. "So if a patient is taking them, I won't tell them to stop, or if they suggest to me that they'd like to try (taking) it, I don't object. Some patients tell me they've felt an improvement, but there might be a strong placebo component to that."

Early studies suggested that glucosamine might stimulate the production of healthy cartilage and that chondroitin might help fight the inflammation that contributes to cartilage destruction in osteoarthritis.

The two supplements also seemed to help relieve the pain of arthritis.

But the best study to date, known as the Glucosamine/Chondroitin Arthritis Intervention Trial, or GAIT, has found few such benefits.

The GAIT study investigated the two supplements on pain relief and to see if they could control the underlying cause of osteoarthritis — the deterioration of the cartilage between the bones in the joints.

One part of the study followed 1,583 patients who received glucosamine, chondroitin, both, a pain reliever, or a placebo. People taking the supplements reported no greater reduction in pain than did those receiving a placebo.

Last year new GAIT results showed that the supplements did not slow the deterioration of joint cartilage either.

Supplement makers argue that the results of the GAIT study are not conclusive.

"What they did was study people too early in the arthritic process," Luke Bucci, vice president of research at Schiff Nutrition International, a maker of glucosamine and chondroitin, told WebMD after the first GAIT results were announced. "They were starting to see some small advantages for the glucosamine group."

A closer examination of the results shows that a small subgroup of people with moderate to severe pain did gain significant pain relief, according to Arthritis Today.

Also, the GAIT study used glucosamine hydrochloride instead of glucosamine sulfate, which controlled arthritic knee pain among participants in a European study of the supplement, according to the magazine. And the dosage — once a day instead of three times a day — may have been inadequate.

Such ambiguity, combined with the apparent harmlessness of glucosamine and chondroitin, has prompted many physicians such as Murray to tolerate, if not actually recommend, the use of the supplements.

Popping pills?

For most people, glucosamine, chondroitin and MSM supplements cause no apparent harm. Not so for high doses of ibuprofen and other nonsteroidal anti-inflammatory drugs, or NSAIDs, according to a recent study in Neurology. Among people 65 and older, heavy users of NSAIDs were 66 percent more likely to develop dementia, and 57 percent more likely to develop Alzheimer's, than non-users.

The American Geriatrics Society just recommended that older patients should never use NSAIDs due to increased risk of heart and gastrointestinal problems. NSAIDs and COX-2 inhibitors, such as Celebrex, should be used "with extreme caution," according to the group, which advises acetaminophen (Tylenol, Excedrin) instead, except in heavy drinkers.

"Acetaminophen is the initial drug of choice for osteoarthritis for the majority of patients," said St. Petersburg physician John Murray. "It has a good safety record, and it's been around for long time.

"The only problem is that for a lot of patients, it doesn't work very well."

Outside the bottle

Here are non-drug and non-supplement measures frequently recommended to relieve osteoarthritis. 

• If you're overweight, lose a few pounds to ease the load on joints.
• Exercise moderately (walking, swimming, cycling, light weight training, yoga) to strengthen muscles around joints and keep them limber.
• Therapies such as acupuncture, physical therapy and heat therapy may help.
• Try support devices such as splints, canes, walkers and braces.

Painkillers pose problems for people with heart disease

(Harvard Health Publications) As if people with the combination of high blood pressure and heart disease don’t already have enough to worry about, a new study suggests that common painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) pose special problems for them.

Among participants of an international trial called INVEST, those who often used NSAIDs such as ibuprofen (Advil, Motrin and others), naproxen (Aleve, Naprosyn, and others), or celecoxib (Celebrex) were 47% more likely to have had a heart attack or stroke or to have died for any reason over three years of follow-up than those who used the drugs less, or not at all. The results were published in the July issue of the American Journal of Medicine.

Millions of people take NSAIDs to relieve pain and inflammation. They are generally safe and effective. The main worry with NSAIDs has always been upset stomach or gastrointestinal bleeding. During the last few years, researchers have raised concerns that their use may be hard on the heart as well.

This one study, and the handful that have come before it, don’t mean that people with high blood pressure and heart disease or other cardiovascular conditions should stop taking NSAIDs, especially if they are used to ease pain from a chronic condition like arthritis. But it may make sense to try an alternative first.

Talk with your doctor about taking aspirin instead of ibuprofen, naproxen, or other traditional NSAID. Aspirin eases pain and inflammation and also offers protection against myocardial infarction (heart attack) and the most common kind of stroke.

Try acetaminophen (Tylenol and many generic versions) instead of an NSAID. Be careful not to take more than 3,250 milligrams in a 24-hour period, and read medication labels—many combination over-the-counter products contain acetaminophen.

If aspirin or acetaminophen doesn’t give you enough relief, try a low-dose NSAID. Early studies suggested that naproxen it may be safer than ibuprofen, although this has been challenged.

If you take ibuprofen and aspirin, take the aspirin at least 30 minutes before the ibuprofen or eight hours afterward. Aspirin’s ability to protect the heart depends on its fitting snugly into the pocket of an enzyme known as cyclooxygenase. Ibuprofen can block aspirin’s entry into this pocket.