Relieving ARTHRITIS PAIN Can Supplements Help?

"I can stay on the dance floor all night."

For years, 67-year-old William Stewart of Hendersonville, North Carolina, was hobbled by arthritis. Eighteen months ago, he began taking a dietary supplement called glucosamine for the pain in his right knee. The avid square dancer doesn't have to sit on the sidelines any longer.

"It's really been an improvement for me," says Stewart. "I don't know whether glucosamine has stopped the deterioration, but there has been no change in the condition of that cartilage for over a year."

Stewart isn't alone. Thousands of other arthritis sufferers are singing the praises of glucosamine and another over-the-counter supplement, chondroitin.

They may not be imagining the relief. Evidence is mounting that both may help ease the aches and stiffness caused by arthritis. But before you rush out and buy them, make sure you understand what the research does--and doesn't--show.

Bone on Bone

When the cartilage that cushions the joints in your hands, hips, knees, or back breaks down faster than your body can replace it, you've got osteoarthritis. Without the protective tissue, bone rubs against bone and you feel pain, tenderness, swelling, and stiffness.

Sixteen million Americans--about two-thirds of them women--suffer from the degenerative disease. And their ranks are expected to swell as millions of baby boomers wheeze and creak their way into their late 40s, when arthritis typically sets in.

Doctors usually recommend nonsteroidal anti-inflammatory drugs (NSAIDS) like aspirin or ibuprofen to soothe the pain. But these--and stronger prescription drugs--can cause serious side effects like gastrointestinal bleeding. In fact, NSAIDS account for an estimated 7,600 deaths and 76,000 hospitalizations each year.[1]

"You're dealing with a disease that's very common, for which there is no terrific therapy available from traditional medicine," says David Felson, an arthritis expert at Boston University. "A lot of people are looking for something to help them with their arthritis, grasping at stuff that's been publicized as being effective."

And there's plenty of "stuff" to grasp at.

Books touting arthritis "cures" crowd bookstore shelves, arthritis supplements are popping up at pharmacy counters, and supermarkets carry special beverage powders to improve "flexibility."

But when you wade through the scientific evidence, only two products stand out: glucosamine and chondroitin. In the studies done so far, both help relieve the pain of arthritis in many people.

Glucosamine

Glucosamine (glue-COSE-uh-mean) is a simple molecule that the body makes from sugar and uses as a major building block of cartilage. In test tubes, it stimulates cartilage cells to synthesize the ingredients for more cartilage.

In a handful of good studies in Europe, osteoarthritis sufferers who took 1,500 mg of glucosamine each day for one to three months reported less pain, swelling, or tenderness than those who took a (inactive but look-alike) placebo. Many experienced as much relief as those who took painkilling drugs.

In one study of 200 people with arthritis of the knees, glucosamine matched the popular painkiller ibuprofen, the active ingredient in Advil and Motrin.[2] Each relieved symptoms in about half of the 100 people who took it. But after four weeks, those in the ibuprofen group were six times more likely than those on glucosamine to report side effects like heartburn, stomach pain, and nausea or to stop taking their medication.

"The good studies show that glucosamine relieves the pain of osteoarthritis as effectively as the other things we're using now," concludes Felson. Which is why many doctors tell their patients that glucosamine is worth a try.

Rheumatologist Marc C. Hochberg of the University of Maryland School of Medicine in Baltimore, an expert on how to gauge the effectiveness of osteoarthritis treatments, is one of them.

"If patients are interested, I suggest that they try 500 mg three times a day for a month," he says. "If they notice an improvement in symptoms they can continue for as long as it seems to work and there are no uncomfortable side effects."

If there's no relief after four weeks--and studies report that from 20 to 50 percent of people get none--Hochberg recommends that his patients stop taking glucosamine.

Chondroitin

Chondroitin (conn-DROY-tin) sulfate is another one of the molecules that make up cartilage. One of its functions: to draw fluid into the tissue, which gives the cartilage resistance and elasticity.

Like glucosamine, chondroitin stimulates cartilage cells to form the components of new cartilage, at least in test tubes. It may also slow the breakdown of cartilage.

In one of four published well-designed studies, Pietro Morreale and colleagues in Italy and Switzerland tested 1,200 mg a day of chondroitin sulfate for three months against either 150 mg of the popular prescription pain reliever diclofenac sodium (Voltaren) or a placebo.[3] Among the 146 volunteers, who all had arthritis of the knees, those taking chondroitin reported as much pain relief as those taking the drug. Both got more relief than people who were given a placebo.

Chondroitin also came out ahead of a placebo in the three other studies.[4,5]

"The research on chondroitin is looking better and better," says Felson.

Glucosamine and Chondroitin

If glucosamine and chondroitin make life more bearable for people with arthritis, will glucosamine plus chondroitin lead to double relief? No one knows.

So far, just one study has tested the two supplements together, but it didn't compare their impact to either one alone.

Researchers Alan Philippi and Christopher Leffler gave 34 Navy SEALs and divers--who are at high risk for arthritis--either a daily combination of 1,500 mg of glucosamine and 1,200 mg of chondroitin or a placebo for two months. While details haven't been published yet, Philippi said that the results for the glucosamine-chondroitin combination were promising.

Gelatin 

Collagen forms the interlocking strands that help give cartilage its strength. It's a protein made up mainly of the amino acids glycine, proline, and hydroxyproline.

Gelatin is a cheap animal protein that's rich in those same amino acids. Which is why cookie giant Nabisco has dusted off its old Knox Gelatine, added some vitamin C and calcium, and is selling it as a new dietary supplement called NutraJoint.

What evidence does the maker of Oreos and Ritz crackers have to back up its claim that NutraJoint is "for everybody who wants to maintain flexible joints and healthy bones"?

The only good published study of gelatin in humans was completed in Czechoslovakia in 1985.[6] Of 51 men and women with arthritis of the hips and knees who were given a daily dose of a gelatin similar to that in NutraJoint for two months, about half reported less pain (but no increase in mobility) compared to people who took a placebo.

Nabisco says that it has done its own study on 372 people taking NutraJoint or a placebo, but there's no word yet on the results.

"Until there is more evidence that NutraJoint works," says arthritis expert David Felson, "I would discourage people from taking it."

[1] Annals of Internal Medicine 127: 429, 1997.

[2] Osteoarthritis and Cartilage 2: 61, 1994.

[3] Journal of Rheumatology 23: 1385, 1996.

[4] Rev. Rhum. Mal. Osteoartic. 59: 466, 1992.

[5] Litera Rheumatologica 14: 69 & 77, 1992.

[6] Therapiewoche 38: 2456, 1991.

RELATED ARTICLE: HOW TO AVOID OSTEOARTHRITIS

Experts recommend that you keep your weight down and your muscles strong and in good condition, and that you stay physically active but try to avoid joint injury as much as possible.

"Jobs involving kneeling, squatting, and climbing stairs increase the risk of getting osteoarthritis of the knees," says University of Maryland arthritis expert Marc C. Hochberg, "while jobs that require heavy lifting increase the risk of osteoarthritis of the hip."

But that's not a license to avoid strenuous exercise.

"Recreational physical activity, such as swimming, jogging, or using a StairMaster, does not appear to increase the risk, as long as the joints being subjected to repetitive stress are not already damaged," says Hochberg.

If you're overweight, losing 10 to 15 pounds could have a powerful impact on reducing your chances of getting arthritis, especially in the knees.

RELATED ARTICLE: THE BOTTOM LINE

* Glucosamine and chondroitin relieve the symptoms of osteoarthritis in many people. Both appear to be safe, but their long-term safety has never been studied.

* Glucosamine (50 [cts.] to $1.50 a day for 1,500 mg) is somewhat cheaper than chondroitin (75 [cts.] to $2.00 a day for 800 to 1,200 mg), and is less prone to quality control problems.

* Researchers have never looked at whether a glucosamine plus chondroiton combination is more effective than taking either one separately.

* The evidence is scanty that a gelatin mix like NutraJoint can help "maintain healthy joints and bones," as its ads promise.

RELATED ARTICLE: THE FINE PRINT

* Long-term safety. While there are no reports of serious side effects for either glucosamine or chondroitin, studies typically last just a few months. That means there's little information about how safe they are for arthritis sufferers, who could end up taking them for decades.

* Not everybody benefits. Many people don't respond to glucosamine or chondroitin. And studies show that up to 40 percent of patients feel better when they're given a (inactive) placebo.

* Rheumatoid arthritis. "There's no scientific evidence that glucosamine or chondroitin is mine helpful for rheumatoid arthritis," cautions expert Joseph Houpt of Mount Sinai Hospital in Toronto. In rheumatoid arthritis--which affects more than two million Americans and can strike people in their 20s or 30s--the body's immune system attacks the joints, often in the hands, feet, and hips, but also in the wrists, elbows, shoulders, and neck.

* Quality. "Some of the products being sold are below acceptable standards," says Natalie Eddington of the University of Maryland School of Pharmacy in Baltimore.

In 1996, she and her colleagues analyzed 27 popular brands of glucosamine and chondroitin. Nineteen contained less than the amount listed on the label--though the book publisher that commissioned her analysis won't let her say which brands or how much less. A few had none at all.

Eddington is now testing all of the glucosamine and chondroitin she can lay her hands on--90 to 100 brands. Her results--which she plans to make public--should be available later this year.

Another wrinkle: Some chondroitin--you can't tell which--is poor quality and may not be well-absorbed.

* Shark cartilage. Most chondroitin sulfate is extracted from cow tracheas. Shark cartilage is a cheaper source. "If people want to use shark cartilage, they should know that we have no idea how much chondroitin they're getting from some brands," advises Houpt. They should also know that no one's done a good study to see if any brand of shark cartilage is effective in treating osteoarthritis.