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Joint remedies vary

3 min read

DEAR DOCTOR K: I have osteoarthritis. It’s improved some with physical therapy and weight loss, but not entirely. Should I give “joint support” supplements a try? Which ones?

DEAR READER: Your question reminds me of two of my patients. “John” was a man in his 50s whose pain from arthritis in his knees made it hard for him to play pickup basketball. Physical therapy and pain medicines helped, but not completely.

“Helen” was a woman in her 60s who loved gardening. Arthritis in her knees caused pain every time she knelt to dig up or plant something. Conventional treatments helped a lot, but she still was in pain.

Many of my patients with osteoarthritis are like these two. They benefit from physical therapy, weight loss and medications to reduce pain and inflammation. But some, despite trying these treatments, still end up with pain, stiffness and limits on their day-to-day functioning. So I understand when they ask about joint support supplements.

Here are some of the more popular osteoarthritis supplements on the market and the evidence for — or against — giving them a try:

GLUCOSAMINE and CHONDROITIN

A major study of these supplements in The New England Journal of Medicine concluded that they may help relieve pain in people with moderate to severe osteoarthritis pain. If you fall into this category, try the glucosamine-chondroitin combination for two to three months. If you find it eases your pain, it’s reasonable to keep using it. If not, save your money.

DIMETHYL SULFOXIDE (DMSO) and METHYL SULFONYL METHANE (MSM)

The handful of clinical trials on these substances show that they are no better than a placebo (sugar pill) when it comes to pain reduction.

S-ADENOSYL-METHIONINE (SAMe)

A 2009 review looked at four clinical trials that compared SAMe against a placebo. The difference between the supplement and sugar pill was small and possibly due to chance.

BOSWELLIA SERRATA

In one review of this herbal remedy, people who took 100 milligrams (mg) of B. serrata daily for three months said their pain was moderately lower and their functioning slightly better, compared with those who took the placebo.

AVOCADO SOYBEAN UNSAPONIFIABLES (ASU)

Results from six studies of ASU, another herbal remedy, found that taking 300 mg daily for three to 12 months slightly improved pain and functioning.

I usually support my patients’ decisions to try glucosamine and chondroitin. But I warn them that just because a supplement is natural doesn’t mean it’s safe. And that supplements, like medications, can cause side effects such as stomach upset, nausea, skin rashes and allergic reactions.

More worrisome are potential drug interactions. For example, glucosamine and chondroitin could interfere with the widely used blood thinner warfarin (Coumadin). Also, the FDA does not monitor the dose and purity of supplements, as it does for conventional drugs.

My patient “John” was on warfarin for an irregular heartbeat. Even though I monitored his dose, he had a bad nosebleed, stopped glucosamine and chondroitin and switched from basketball to swimming. “Helen” was luckier. The same supplements nearly eliminated her knee pain and produced no adverse effects.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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