Arthritis help or hype? Controversial supplements examined.

It is sometimes said that if you live long enough just about everyone will get arthritis. For some, it brings mild pain and joint stiffness. For others, it brings intense pain and crippling disability. Active people are not immune, because the risk of arthritis rises after injuries involving cartilage damage, especially where surgery is required. Since arthritis is widespread it is small wonder that a book called The Arthritis Cure (by Jason Theodosakis, M.D., et. al., 1997, St. Martins Press, Griffin, 224pp., $22.95) has persuaded many people to try the authors' recommendations, including the use of two nutritional supplements called glucosamine sulfate and chondroitin sulfate. Not surprisingly, sales of these supplements have soared, and although they used to be available only in health food stores, more recently they have appeared on the shelf of every drug store, and are widely promoted. Many among the medical establishment have dismissed the book as hype, and are skeptical about the scientific evidence t hat glucosamine and chondroitin sulfates are effective. What is the real story? The facts suggest that these compounds should not be dismissed out of hand.

What Are They?

Glucosamine sulfate is a simple carbohydrate derivative that is a precursor of a main joint cartilage component. Chondroitin sulfate is one of a group of compounds called glycosaminoglycans, and is a complex carbohydrate derivative found in cartilage. These compounds are part of the nutrient system used to grow cartilage in tissue cultures in the laboratory. They are found in small quantities in our food, and occur naturally in our bodies. They are natural compounds that promote cartilage growth. But can they do this in the human body? Although there is no evidence to support this speculation, it is undoubtedly the reason behind their use in arthritis treatment.

The Evidence

Those who say there is no evidence that glucosamine sulfate and chondroitin sulfate relieve arthritis symptoms may have not done their homework. If you enter the Medline Web site (igm.nlm.nih.gov) and search the current file (1995-present) for 'glucosamine sulfate and arthritis', and 'chondroitin sulfate and arthritis,' you will recover nine references. Some are reviews of research and refer mostly to studies published in the 1980s. Others report the use of one of the supplements in the treatment of various types of arthritis. They all report positive results. Another approach is to search for the word, chondroprotective (glucosamine and chondroitin sulfates are sometimes called chondroprotective agents). This tactic brings 130 hits. These also report positive results. As in any subject in clinical research, the quality of the research varies. Some studies are very well designed double-blind, placebo-controlled, randomized studies, and in some cases large enough to be multi-center trials. The most striking th ing about the studies in general is that they all report positive results. Glucosamine sulfate and chondroitin sulfate both decrease the pain and stiffness associated with a variety of arthritic conditions. In some cases, the effect is found to be similar to that provided by anti-inflammatory drugs.

Also, no significant side effects have been reported. The other striking thing about the studies on these compounds is that they all come from Europe and Asia. Amazingly there has not been a significant study in the United States. This may account for the skepticism expressed by the medical community in this country.

The mechanism of action that produces the improvements reported is not known. There is no evidence that they produce cartilage regrowth, as is sometimes claimed by promoters of these supplements. But the appropriate studies have not been done. Some people with cartilage injuries wonder if taking the supplements could reduce their risk of developing arthritis in the future, but there is also no evidence on this point.

What To Do?

Critics who say there is no evidence that glucosamine and chondroitin sulfates are effective are wrong. Although there is no evidence to support the claim that these carbohydrate derivatives help repair or replace cartilage, they do appear to relieve pain and stiffness. Some doctors who are aware of the significance of glucosamine and chondroitin sulfates take the attitude "They might help, and they can't do any harm." These doctors encourage their patients to try the supplements, in addition to traditional treatment. This seems to be a practical approach. There may continue to be a swirling storm of controversy around these supplements, but if you are developing arthritis and want to try this approach, let your doctor know. Although no side effects have been reported, studies are usually short term. Even over-the-counter products should be used with medical supervision over the long term. Many people have gained benefits from the supplements and you may, too.

(Trevor Smith is a retired research scientist, for editor of "Running & FitNews," and current assist editor of "AMAA Quarterly.")

RELATED ARTICLE: Steps to Reduce Risk of Arthritis

The Arthritis Cure is not as bad as it's critics claim. The worst thing about it is its title In an introductory note we find; "We use the word cure to mean the partial or complete relief of symptoms." There will be few who agree with this definition, and dictionaries and medical encyclopedias certainly do not support it. When you recognize that the book is really about relief of symptoms it becomes more reasonable.

The authors promote a nine-step plan for arthritis treatment:

1. A thorough consultation with a physician.

2. Take glucosamine and chondroitin sulfates.

3. Improve biomechanics to counteract stress on joints.

4. Exercise regularly.

5. Eat a healthy diet.

6. Maintain ideal body weight.

7. Fight depression.

8. Use traditional medicine as needed.

9. Maintain a positive attitude.

Only the second point is controversial. Just about everyone would agree with the other eight. The text of the book comprises a discussion of the nature of arthritis. Then there is a description evidence that glucosamine and chondroitin sulfates relieve arthritis symptoms. Finally there is a detailed discussion of each of the nine points in the treatment program. If the authors had kept clear of the word cure, the book would have been more widely accepted.