Which Supplements Work Best for Osteoarthritis?

The October issue of Nutrition Action Newsletter looked at pills that claim to reduce pain associated with osteoarthritis. As I’ve said before, I like Nutrition Action Newsletter for its level-headed, science-based analysis (its bias, if it has one, is for sensible eating and exercise and weight reduction -- and what’s not to like there?)

First, obesity was identified by an assistant research professor at University of Michigan’s School of Public Health as “the number-one risk factor for osteoarthritis.”

What’s so bad about excess weight, according to this article:

(1) Each extra pound increases the load across the joint “three to five times,” says an arthritis expert.

(2) The heavier you are, the higher your risk of injuring your joints, which can lead to osteoarthritis.

(3) Heavier people have higher levels of inflammatory chemicals circulating in their body, which can break down cartilage.

Now, what about their verdict on those “pills for pain”?

* Glucosamine

“Glucosamine doesn’t work, period,” David Felson of the Boston University School of Medicine says. Nine trials that found a benefit for glucosamine were run by the supplement industry. Still, despite the lack of evidence, Felson says if patients “think something is working and it’s not dangerous, I don’t discourage its use.”

That’s a wise stance for a doctor to take, I think.

* Chondroitin

Like glucosamine, chondroitin is an essential element in cartilage. Taken as a supplement, however, it is no more effective at relieving pain than a placebo, rigorous trials have found.

* Glucosamine and chondroitin

The combination didn’t work better than a placebo in the National Institute of Health’s large GAIT trial. At first it appeared to benefit a subset of subjects with moderate to severe pain. But, as I wrote in Saving My Knees, “this may just be a statistical anomaly.”

Yup. That’s exactly what it was. When researchers monitored the patients for two more years, they saw no benefit.

* MSM (methylsulfonylmethane)

MSM is sometimes substituted for chondroitin (which is more expensive) in supplements. In three trials, researchers question whether MSM would make much of a difference, if any, for treating arthritis.

* Avocado and soybean unsaponifiables (ASU)

The one good study from the last 11 years found no benefits for pain, stiffness or joint function.

* Vitamin D

A two-year study showed vitamin D was no better at reducing pain and slowing cartilage loss than a placebo.

* SAM-e

In half a dozen trials, 1,200 mg of SAM-e (S-adenosylmethionine) provided as much pain relief as anti-inflammatory drugs such as Celebrex or ibuprofen. However, a rheumatology professor cautions that the trials were small and characterizes the results as showing only a “small pain relieving effect.”

Then there’s the price: $80 to $110 for a month’s supply of 1,200 mg a day. That’ll put a dent in your household budget.

So, all in all, a fairly dismal showing for supplements that aim to reduce knee pain. SAM-e looks the most promising. Of course, if something seems to work for you, even if medical science says it’s useless, you might as well keep taking it.