Helpful, Healthy Supplements?

Glucosamine and chondroitin are nutritional supplements that are being studied for their effectiveness in treating arthritis. While significant evidence in the past has shown the supplements work, a newer study has stirred debate in the medical community.

Could these supplements offer nothing more than a placebo for people with mild arthritis? Are they best for those with moderate to severe pain, as the new research suggests?

Jason Theodosakis, MD, says that "first-line therapies" for the treatment of arthritis should always be improving biomechanics, injury prevention, weight control, and low-impact exercise. Theodosakis is an assistant clinical professor at the University of Arizona College of Medicine; he serves on the oversight committee for a $16 million NIH trial on glucosamine and chondroitin.

"But there is also enough scientific evidence -- 42 human clinical trials to date -- to recommend the use of glucosamine and chondroitin," says Theodosakis, also the author of The Arthritis Cure.

In 2003, an analysis of 15 studies of glucosamine and chondroitin was published in Archives of Internal Medicine. The studies involved a total of 1,775 patients 1,020 taking glucosamine and 755 taking chondroitin.

Researchers found "significant changes" in the symptoms of patients taking them pain, stiffness, physical functioning, and joint mobility; no placebo group showed that kind of improvement. Glucosamine significantly improved joint space narrowing; it also helped slow the progression of osteoarthritis, researchers found.

Taking at least 1,500 milligrams of oral glucosamine sulfate for at least three years was the most effective in slowing the degenerative process, they reported. While there were similar findings on chondroitin, those findings were not as clear-cut. Overall safety of both glucosamine and chondroitin can be considered "excellent," according to researchers.

More recently, a study funded by the National Institutes of Health looked only at pain reduction from glucosamine-chondroitin supplements. The study was conducted at 16 sites across the country -- and was the most rigorous examination of the widely used supplements ever done, according to researchers, whose study appeared in the New England Journal of Medicine.

Called the Glucosamine/Chondroitin Arthritis Intervention (GAIT) trial, it involved 1,583 people with osteoarthritis of the knee. They were randomly placed into five different groups -- each group taking either glucosamine, chondroitin sulfate, both the supplements, the Cox-2 anti-inflammatory pain reliever Celebrex, or a placebo.

Overall, researchers found no significant pain reduction in the patients taking either supplement alone or combined, or in those patients taking a placebo. The patients with mild pain got no greater pain relief -- whether they took the combination of supplements, just one supplement, or Celebrex -- compared with those taking a placebo.

However, those with moderate to severe knee pain -- who took a combination of the two supplements -- reported significantly greater pain relief, compared with patients taking either Celebrex or a placebo. This group of 354 patients was too small to prove the findings, researchers said.

What should you do? health2008.net asked an arthritis expert. "It seems that researchers are having a difficult time confirming the beneficial effects of [glucosamine and chondroitin]," says Robert Hoffman, DO, chief of rheumatology at the University of Miami Miller School of Medicine.

"The good news is the supplements seem to be safe [at the standard dosage], but it's not clear that they're beneficial. I don't feel compelled to highly recommend them. But if patients don't mind taking another pill -- and paying for a pill that may or may not help them -- it seems quite reasonable. And really, there isn't anything else that helps slow the progression of osteoarthritis."

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