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Big Boost for Pain Remedy: Dietary Supplements Aid Achy Knees, a Study Says

Posted on: Tuesday, 15 November 2005, 06:00 CST

PHILADELPHIA _ It's official: Two dietary supplements that millions of senior citizens and baby boomers already swear by for creaky knees finally have some real science behind them.

Glucosamine and chondroitin sulfate, taken together, may help reduce moderate to severe knee pain caused by osteoarthritis, the leading cause of disability in the United States, according to research to be presented this week at the American College of Rheumatology's annual meeting in San Diego.

Supplement makers, who sold $734 million worth of glucosamine/chondroitin last year in this country, have been eagerly awaiting the results of the research. It comprises the first large-scale, rigorously designed clinical trial of the popular supplements to be funded by the federal government rather than private industry.

"This study offers us another alternative and that's what it's really all about _ alternatives in treatment," said Crystal S. Wright, vice president of Leiner Health Products of Carson, Calif., supplier of 43 percent of the nation's glucosamine/chondroitin store brands.

Wright, who takes the stuff herself, embraces the study's findings as further evidence that with scientific scrutiny, dietary supplements increasingly will be found safe and effective. Many consumers and mainstream physicians likely will agree, at least for glucosamine/chondroitin, hyped as "The Arthritis Cure" in Jason Theodosakis' 1997 best-seller.

Havertown, Pa., orthopedic surgeon Nicholas A. DiNubile, a knee specialist, insists there is no cure for arthritis. But he takes glucosamine/chondroitin for a stubborn teenage football injury and recommends it for 1,000 of his patients. The typical daily dose is 1,500 milligrams of glucosamine and 1,200 milligrams of chondroitin sulfate.

DiNubile has long thought the combination can improve both pain and function in arthritic knees, calling it "a no-brainer for people to try."

A bit more cautious is rheumatologist H. Ralph Schumacher, who supervised 98 patients for the study at the Philadelphia Veterans Affairs Medical Center and the Hospital of the University of Pennsylvania. Altogether, 16 research sites across the country were involved.

Schumacher, too, takes glucosamine/chondroitin _ for knees battered by decades of playing basketball. But he warns it's not the magic bullet consumers are looking for.

"You can buy the combo and it might have some effect but it's not miraculous," he said. "It's minor."

The NIH study, based at the University of Utah, recruited almost 1,600 osteoarthritis patients ages 40 to 80. For six months, they were given either glucosamine or chondroitin, a combination of the two, 200 milligrams of the common prescription pain medication celecoxib (sold as Celebrex) or a placebo. No one knew who was getting what and no patient suffered serious side effects.

The best results were reported in patients with moderate to severe pain who took the combo: almost 80 percent said they had about 20 percent less pain.

"It did provide some benefit to a subset of people but they were still left with pretty significant pain," said Schumacher, who adds exercise, good diet and weight loss to the list of strategies to combat osteoarthritis.

The study showed that celecoxib also reduced knee pain, to a lesser extent, but Schumacher recommends the supplements over Celebrex, which carries warnings about possible cardiovascular and gastrointestinal-bleeding.

"Less risk," he said.

One somewhat surprising study result was that 60 percent of patients given a placebo reported pain relief, twice the typical placebo rate in most clinical trials. Researchers interpret that as a measure of arthritis sufferers' intense desire for relief.

Osteoarthritis, also called degenerative joint disease, affects 21 million people in this country, more women than men and especially women over 65. More men are developing severe cases, and doing so in their 50's as opposed to later, which may be attributed to greater participation in strenuous sports.

Other risk factors include family history and obesity.

The disease is caused by the progressive breakdown of cartilage, the body's shock absorber, a slippery connective tissue that cushions the ends of bones within the joints. Osteoarthritis most often affects the hands and large weight-bearing joints, commonly knees, by limiting movement and causing pain and swelling.

Knee pain persuaded Marshall Phillips, 72, a biochemist from Thornton, Pa., to volunteer for the Penn arm of the study a few years ago. He learned only last week that he'd been given glucosamine alone during the six-month trial.

In an interview, Phillips said he'd not noticed any difference in his knee pain during that time but that, given the study's results, he might start taking glucosamine/chondroitin now.

"Some days my knees hurt, some days they don't," he said.

Since the study, Phillips has lost a little weight and hired a personal trainer who comes to his house twice a week. He calls the sessions "paid torture," but credits them with transforming him from a "sedentary, mopey guy" to someone who's reasonably fit and active.

"I'm not going to win the contest, but I feel better," he said.

Glucosamine and chondroitin are natural substances found in and around cartilege cells. They're thought to inhibit inflammation and help in cartilege repair and maintenance. The supplements use extracts from animal products _ glucosamine from crab and shrimp shells, chondroitin from cow windpipes.

In addition to their human application, glucosamine/chondroitin has been used for years to help arthritic horses, dogs, performing elephants and seals.

But the federal government doesn't regulate supplements the way it does prescription drugs, and what's inside the bottle doesn't always match what the label promises.

Andrew Schao, a vice president of the Council for Responsible Nutrition, a supplement industry trade association, recommends consumers go with a trusted brand and then decide how much they can spend.

Consult with a physician and be wary of what's on the internet, he added. "There are a lot of bottom-feeders out there telling people what they want to hear."

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Source: The Philadelphia Inquirer

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