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Supplements still an option for knee arthritis: based on new data, glucosamine and chondroitin are safe and still worth trying, Cleveland Clinic experts say.

Little about the use of glucosamine and chondroitin for easing knee osteoarthritis (OA) pain is absolute. By and large, experts disagree on whether the supplements are of value, and although Americans spend millions of dollars on glucosamine and chondroitin products each year, evidence supporting their use has been conflicting.

However, a study published online Jan. 14 in Annals of the Rheumatic Diseases suggests the supplement combination may be as effective as a common prescription painkiller for patients with more severe knee OA. Based on these results and others, there's little risk, and some potential benefit, to trying glucosamine and chondroitin, say two Cleveland Clinic physicians.

"Studies support that these are supplements we should consider recommending to patients with knee arthritis," says Evan Peck, MD, a Cleveland Clinic Florida sports medicine specialist. "Some people see benefit; some don't. Perhaps most importantly, they are relatively safe."

MIXED EVIDENCE

In the Annals study, European researchers assigned 606 patients with moderate-to-severe knee OA to receive glucosamine/chondroitin or celecoxib (Celebrex[R]) daily for six months. They found that both treatment groups experienced, on average, a 50 percent improvement in pain and similar improvements in stiffness, function and joint swelling.

In 2006, a major study found that, overall, the supplements provided no significant improvements compared to a placebo. However, a subgroup of patients with more severe knee OA did benefit from the supplements.

"The evidence is not definitive that the supplements prevent arthritis or improve symptoms," says Apostolos Kontzias, MD, with Cleveland Clinic's Department of Rheumatic and Immunological Diseases. "It's sort of a flip of a coin whether they help or not."

Based on the medical literature, glucosamine and chondroitin are most likely to be helpful if you have moderate-to-severe knee OA pain.

"I have had a few patients who were using other treatments, and when we added glucosamine and chondroitin to their regimen, it made a significant difference," Dr. Peck says. "I have some confidence in at least trying them for certain patients. And I feel comfortable telling patients that if you're already taking it, you can keep taking it."

USING GLUCOSAMINE/CHONDROITIN

Glucosamine and chondroitin are compounds found in healthy human cartilage. The supplements are sold as beverages and topical gels, but most studies have used tablets, capsules or softgels--recommended daily doses are 1,500 mg glucosamine and 1,200 mg chondroitin. It may take two to three months to see improvements with the supplements.

"I usually recommend my patients try glucosamine and chondroitin for three months," Dr. Kontzias says. "If it does help after three months of use, great, but if by the end of three months they don't see any efficacy, I advise them to stop taking it."

The supplements are generally safe, although they may cause some stomach upset or bloating. Since glucosamine supplements contain materials harvested from shellfish, avoid taking them if you have a shellfish allergy. And, glucosamine may increase blood sugar, so if you have diabetes, talk to your doctor before trying the supplement.

Use the supplements to complement, not replace, other treatments for OA, especially exercise and weight control. If you're overweight, work with your doctor to shed pounds and reduce stress on your knees, hips, ankles, and feet.

"The best evidence for helping knee arthritis pain is to improve strength and decrease body weight," Dr. Peck says. "If you're overweight and deconditioned and you continue to put your joint through wear and tear and just take something for the pain, you're not putting that joint in a more favorable environment."

A note on supplements

Glucosamine, chondroitin and other dietary supplements are not subjected to the same review process as conventional pharmaceuticals. So, there's no guarantee of the purity, quality and efficacy of the product you buy.

"You don't know how much of the active ingredient these pills have," Dr. Kontzias says. "In cases where the results aren't great, it could be that the supplements don't have enough of the active ingredient to exert an effect."

Your best bet is to carefully examine the supplement label--the active ingredient should be listed first or second--and also look for products bearing the symbol of independent organizations such as the U.S. Pharmacopeia or ConsumerLab.com, which test supplements for quality. Most importantly, tell your doctor if you're taking glucosamine, chondroitin, or any supplements.

"Do some research and look for a reputable, well established brand that has been around a long time," Dr. Peck adds.
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Title Annotation:Bones & joints
Publication:Men's Health Advisor
Date:Aug 1, 2015
Words:736
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