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Do arthritis supplements work? Don't bet your joints on it.

Osteoarthritis supplements are more baffling than ever, as manufacturers mix and match ingredients to create new formulas to entice customers. If you want to try one, remember:

None slow the disease. At best, you can hope to relieve pain or stiffness or walk or climb stairs a bit better. Claims like "supports healthy joints" or "helps rebuild cartilage & lubricate joints" require little or no proof.

Evidence is skimpy. Most supplements are backed by a few small studies, at most. That's far too little evidence to know if they really work.

The placebo effect is strong. Studies show that a sugar pill relieves arthritis pain in up to 60 percent of patients. So you may feel better after you take a supplement simply because you expect to or because your joints don't happen to ache that day.

Relief may be minor. Even if studies find a statistically significant difference between the supplement and a placebo, the pill may not relieve pain nearly as effectively as non-steroidal anti-inflammatory medications (like aspirin and ibuprofen), weight loss, exercise, or other well-established treatments.

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Here's what we know about the ingredients in most major arthritis supplements.

Glucosamine & Chondroitin

The glucosamine that our bodies make helps synthesize glycosaminoglycans, which bind with water to cushion, lubricate, and protect cartilage in the joints. Chondroitin, a chain of sugars that forms naturally in the body, helps keep joints stable by helping cartilage resist being compressed.

* Glucosamine plus chondroitin.

In one study, 39 people with mild-to-moderate arthritis symptoms who took 2,000 mg of glucosamine hydrochloride plus 1,600 mg of chondroitin every day for six months reported less knee pain than 33 similar people who took a placebo. (1) People with severe symptoms reported no improvement.

In a second study, 21 U.S. Navy SEALs with mild-to-moderate arthritis reported less pain when they took 1,500 mg of glucosamine hydrochloride plus 1,200 mg of chondroitin every day for four months than when they took a placebo. (2)

Both studies used the Cosamin brand and were funded by Cosamin's manufacturer.

In the much larger government-funded GAIT trial, 67 percent of the 317 people who took glucosamine hydrochloride (1,500 mg a day) plus chondroitin (1,200 mg a day) reported less knee pain. But so did 60 percent of the 313 people who were given a placebo. (3) Statistically, glucosamine plus chondroitin was no better than a sugar pill.

There was a hint that the combination helped those with moderate-to-severe-but not mild-to-moderate--osteoarthritis, but the study wasn't designed to look at those groups separately, so it's not clear whether there was any benefit.

Bottom line: Results are inconclusive.

* Glucosamine hydrochloride alone. In three trials, glucosamine hydrochloride was no better than a placebo in relieving osteoarthritis pain. (4) By itself, "glucosamine hydrochloride is not effective," concludes rheumatologist Steven Vlad of the Boston University Medical Center.

Bottom line: Doesn't work.

* Glucosamine sulfate alone. Ten good studies have tested 1,500 mg a day of glucosamine sulfate for one month to three years in people with arthritis of the hip or knee. (4) In four of the 10, patients reported less pain when they took glucosamine than when they took a placebo. Supplement manufacturers paid for all four studies (as well as four of the six studies in which glucosamine sulfate came up empty).

Bottom line: Results are inconclusive.

* Chondroitin alone. When researchers looked at the three largest and best studies that tested 800 mg to 1,200 mg a day of chondroitin by itself for 6 months to 2 1/2 years, the supplement had little or no benefit. (5) To cut costs, some companies use a "chondroitin complex" that contains less than 800 mg of chondroitin, without specifying how much less.

Bottom line: Doesn't work.

MSM (Methylsulfonylmethane)

Companies like to add MSM to their supplements because it's cheap and they can use it to replace more-expensive chondroitin.

In the best study done so far, researchers at a naturopathic college in Arizona gave 21 men and women a megadose (6,000 mg) of MSM every day for three months. The people reported slightly less pain in their arthritic knees than 19 people who took a placebo. (6) The study was funded by the MSM manufacturer.

Bottom line: Too little evidence.

Ginger

In test-tube studies, ginger inhibited the COX-2 enzyme, which is how the arthritis drug Celebrex works. But in two of three studies on people with arthritis, it didn't work (and it barely worked in the third). (7-9)

Bottom line: Too little evidence.

Hyaluronic Acid

Hyaluronic acid enables synovial fluid to lubricate the joints. In more than three dozen studies, when hyaluronic acid was injected into arthritic knees, it relieved pain and improved function better than a placebo. (10) But in the only published (industry-funded) study of an oral supplement, eight middle-aged men and women who took hyaluronic acid for two months reported no less pain in their knees than when they took a placebo. (11)

Bottom line: Too little evidence.

Vitamin C

The body needs vitamin C to make collagen and proteoglycan, two components of cartilage. Only one published study (in 2003 in Denmark) tested vitamin C on osteoarthritis. (12) According to a summary in English, when 133 men and women with osteoarthritis of the knees or hips took 1,000 mg of vitamin C every day for two weeks, they reported modestly less pain than when they took a placebo.

Bottom line: Too little evidence.

Vitamin D

Vitamin D helps build bones (by increasing calcium absorption) and may shore up the cells that produce cartilage. "At least three good trials are in progress, trying to ascertain if supplementing with vitamin D is likely to be helpful in osteoarthritis," says Tufts University Medical Center rheumatologist David Hunter. Bottom line: Too little evidence.

Collagen & Gelatin

Collagen is a protein that's a component of cartilage and bone. The collagen in supplements typically comes from gelatin extract ed from the skin and bones of animals.

In an unpublished study funded by Nabisco, collagen from gelatin (10 grams a day for 14 weeks) had no impact on osteoarthritis symptoms. At the time, Nabisco was touting the gelatin in its NutraJoint arthritis supplement. It later sold NutraJoint to another company. In an unpublished study sponsored by a German gelatin company, 10 grams of collagen a day for 24 weeks appeared to work in German, but not U.S. or British patients.

Bottom line: Doesn't work.

RELATED ARTICLE: Joint jive?

You may have seen ads touting one arthritis supplement over another. Here's what's in some of the top brands, and the evidence that does (or doesn't) support them.

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Move Free Advanced Triple Strength contains glucosamine hydrochloride, a small amount of chondroitin, "Joint Fluid" (hyaluronic acid), and "Uniflex" (a patented extract of two botanical compounds). The manufacturer says that Move Free is "clinically proven."

The proof? A similar product worked in a small, "preliminary," company-funded study conducted five years ago but never published. Schiff says that it has other unpublished studies in which Joint Fluid and Uniflex also work.

Bottom line: Too little evidence.

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Cosamin ASU contains glucosamine hydrochloride, chondroitin, and a vegetable oil extract called ASU (avocado and soybean unsaponifiables).

While Cosamin's glucosamine and chondroitin helped people with mild-to-moderate arthritis pain in two small company-funded studies, the two compounds did nothing for similar people in the larger government-funded GAIT trial.

As for ASU, in four well-designed industry-funded studies, a total of 336 men and women who took 300 mg a day for three to 12 months reported less pain and more movement than 328 people given a placebo. (1)

"ASU appears to be particularly beneficial, both for osteoarthritis symptoms and for the structure of joints, at least based on early research," says rheumatologist David Hunter.

Bottom line: Promising, but more research is needed.

(1) Osteoarthritis Cartilage 16: 399, 2008.

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Osteo Bi-Flex Joint Shield Formula contains glucosamine hydrochloride, chondroitin, MSM, collagen, vitamin C, hyaluronic acid, and 5-LOXIN (a concentrated extract of the herb Boswellia).

The collagen is useless, there isn't enough evidence to say that the MSM, glucosamine, chondroitin, hyaluronic acid, or vitamin C relieves arthritis pain, and 5-LOXlN has only been tested in one small study in India. (People reported less pain than when they took a placebo.)

Bottom line: Too little evidence.

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Joint Juice contains glucosamine hydrochloride, which doesn't work when taken alone.

Bottom line: Doesn't work.

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NatureMade Triple Flex contains glucosamine hydrochloride, hyaluronic acid, and a small amount of chondroitin in a "Chondroitin Complex" that also contains white willow bark extract.

The evidence on glucosamine plus chondroitin is inconclusive, there isn't enough evidence to say anything about hyaluronic acid, and in the largest, longest study of willow bark, it was no better than a placebo. (1)

Bottom line: Too little evidence.

(1) J. Rheumatol. 31: 2121, 2004.

(1) Osteoarthritis Cartilage 8: 343, 2000.

(2) Mil. Med. 164: 85,1999.

(3) N. Engl. J. Med. 354: 795, 2006.

(4) Arthritis Rheum. 56: 2267, 2007.

(5) Annals Intern. Med. 146: 580, 2007.

(6) Osteoarthritis Cartilage 14: 286, 2006.

(7) Osteoarthritis Cartilage 11: 783, 2003.

(8) Arthritis Rheum. 44: 2531, 2001.

(9) Osteoarthritis Cartilage 8: 9, 2000.

(10) Cochrane Database Syst. Rev. (2): CD005321, 2006.

(11) Nutr. J. 7: 3, 2008.

(12) Ugeskr Laeger 165: 2563, 2003.
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Title Annotation:SPECIAL FEATURE
Author:Schardt, David
Publication:Nutrition Action Healthletter
Article Type:Clinical report
Geographic Code:1USA
Date:Oct 1, 2009
Words:1550
Previous Article:Aching joints: dodging arthritis pain.
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