Remedies That May Help Ease Arthritis

My friend Paul is a retired air traffic controller. A former B-24 bomber pilot in World War II, he has kept himself fit and healthy. Now in his 70s, he regularly works out, swims, bikes, hikes and works as a volunteer maintaining a section of the Appalachian Trail in his spare time. A few years ago, his knees started hurting. Sometimes they were so painful, he couldn’t walk.

Paul is one of the more than 6 million older Americans with osteoarthritis. Years ago, he experienced pain from what appeared to be arthritis in the neck and spine, for which his physician prescribed nonsteroidal anti-inflammatory drugs (aspirin is the most common), or NSAIDs. The NSAIDs produced moderate relief of the neck and spine pain, but the knee problem did not respond to this standard treatment.

He heard about the over-the-counter food supplements glucosamine and chondroitin, which promised to relieve the pain and help improve his mobility. He started with a product containing 500 milligrams of glucosamine and 400 milligrams of chondroitin daily. It cost him about $25 for a two-month supply. Now, after more than a year, the knee pain is almost completely gone, and he’s back to his old “lean, mean hiking machine” self.

If you are among those who suffer the sometimes agonizing pain of osteoarthritis, you have probably been frustrated by the lack of accepted effective treatments. There is no cure for the disease. You too may have contemplated trying glucosamine and chondroitin. The two typically are packaged together. These supplements gained broad attention when a book extolling them, “The Arthritis Cure,” was published in 1997.

Glucosamine and chondroitin are natural body compounds that help build and maintain cartilage. Supplementing these naturally occurring sulfates (or salts of sulfur) with synthetic counterparts frequently reduces arthritis pain and may slow the progression of cartilage loss in arthritic joints. The supplements also may stimulate the production of new joint cartilage components, thus helping repair cartilage damaged by the arthritis.

Chondroitin also may block the destructive effect of certain enzymes in joint tissue. Commercially available glucosamine is made from the shells of shrimp, crabs or lobsters, and chondroitin comes from cattle windpipes. Studies of glucosamine and chondroitin have uncovered no harmful side effects and at least some benefit, typically among those who use the supplements for weeks or a few months.

Researchers at Boston University this year published the results of controlled studies of these supplements in the Journal of the American Medical Assn. They concluded that glucosamine has a moderate effect, and chondroitin a somewhat greater effect, against the pain of arthritis. However, the number and scope of studies have been limited, and the medical community generally wants to see more solid evidence before wholeheartedly recommending these supplements to arthritis patients.

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At your local health food store, you’ll find numerous products containing glucosamine and/or chondroitin that vary in their strength and dosage recommendations. Because there is little government regulation of dietary supplements, there is limited assurance of purity, potency or accuracy of stated strengths. At least one physician suggests starting with 500 milligrams of glucosamine three times a day. If pain persists after a month, he recommends doubling the amount of glucosamine to 1000 milligrams. If pain persists another month later, he says to switch to 500 milligrams of chondroitin three times a day.

While we await further research, it is not hard to find anecdotal evidence that glucosamine and chondroitin help many people.

There are other complementary therapies that also may work well. Sam-E, an over-the-counter dietary supplement sold primarily to treat depression, is also said to benefit arthritis, although only limited research backs that claim. Many patients find acupuncture an effective therapy for arthritis pain. Other strategies, such as the application of heat to aching joints and mild exercise such as swimming and walking, are also therapeutic.

What is osteoarthritis and why is it so difficult to treat? It occurs predominantly in older adults and results from a wearing away of the cartilage cushions between the bones of our skeletal joints from continued use (and aging), or overuse (as in basketball or football players) or injury. How the process begins or how it can be stopped is not yet known.

Rheumatoid arthritis is an autoimmune form of arthritis affecting people of all ages. It is often accompanied by other symptoms such as fever, weight loss and anemia. The medical community continues to search for effective treatments for arthritis, and several major pharmaceutical companies recently have introduced new medications.

Unlike many of the “natural” products hawked over the Internet, in magazines and on radio and TV, however, glucosamine and chondroitin seem to offer real promise. Even though many Americans don’t tell their doctor when they try over-the-counter complementary remedies, we still believe that it’s a good idea to be open with your physician.

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Barrie Cassileth is chief of integrative medicine at Memorial Sloan-Kettering Cancer Center in New York and the author of “The Alternative Medicine Handbook” (Norton, 1998). She can be reached at cassileth@mskcc.org. Her column appears the first Monday of the month.