SAMe (S-adenosyl-methionine) for osteoarthritis

We’ve discussed SAMe’s use as an anti-depressant on this Blog, as well as its potential to support liver health. But over the past twenty years there has also been much research into SAMe to counter osteoarthritis pain. In a number of trials in Europe and in the US, SAMe has equalled the effect of nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen in decreasing pain and improving function. Furthermore, it is better tolerated than NSAIDS, which cause clinical concern about side effects especially when taken at high doses over long periods of time.

Here’s one drawback to SAMe for osteoarthritis: trials have shown this supplement to have a slower onset of action than NSAIDs–an initial starting use of about 4 weeks is needed for full effectivesness. In the meantime, some patients may continue to take NSAIDS, gradually reducing the dose.

See the NYBC description of SAMe for additional information, including our recommendation to take adequate B-complex along with this supplement.

For further reading and references on SAMe for osteoarthritis, we recommend Natural Products: A Case-Based Approach for Health Professionals (American Pharmacists’ Assoc., Washington, DC: 2006), pp. 37-49

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Arthritis Supplements reviewed in the journal “American Family Physician”

Our local paper, The New York Times, has just brought us a piece on “Making Sense of Arthritis Supplements” in its Jan. 21, 2008 issue.  It’s motivated by a recent medical journal review, and has already attracted a long string of reader comments.
No surprise, given that arthritis is the leading condition for which Americans use alternative therapies, including dietary supplements. At this point there has been a lot of scientific research on supplements for osteoarthritis; the review in the journal “American Family Physician,” which is the starting point for the NYT piece,  attempts to help people sort through the studies and come to some conclusions about what the best bets are.
Some of our own thoughts on the topic:
Glucosamine sulfate is the acknowledged front-runner, both for symptom relief and on account of evidence that it may have disease-modifying effects. Especially when side effects of ibuprofen or prescription medications cause concern, there’s reason to think about glucosamine sulfate as an alternative.
In 2005, results were made available for the NIH-sponsored “Glucosamine-Chondroitin Arthritis Intervention Trial” (GAIT), which looked at almost 1600 US patients with moderate-to-severe knee osteoarthritis pain. In the glucosamine-chondroitin combination group, 79.2% had pain relief, as opposed to 69.4% in the celecoxib (tradename you might know: Celebrex) group. The competition to interpret this trial to favor supplements or prescription drugs still rages pretty fiercely–see the comment from Dr Jason Theodosakis following the NYT review. (He was on oversight committee of the GAIT study, and is a well-known proponent of glucosamine.)
There is another supplement, more expensive than glucosamine, that has been extensively researched for osteoarthritis: SAM-e (S-Adenosyl-methionine). Below we simply reproduce the abstract of a frequently-cited review of this supplement, with Conclusion highlighted. (BTW, the caution raised in the NYT review about the stability of this product on the shelf is a point well taken.)
Safety and efficacy of S-adenosylmethionine (SAMe) for osteoarthritis
Soeken KL, Lee WL, Bausell RB, Agelli M, Berman BM.
University of Maryland, School of Nursing, Baltimore, MD.
OBJECTIVE: We assessed the efficacy of S-adenosylmethionine (SAMe), a dietary supplement now available in the Unites States, compared with that of placebo or nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis (OA). STUDY DESIGN: This was a meta-analysis of randomized controlled trials. DATA SOURCES: We identified randomized controlled trials of SAMe versus placebo or NSAIDS for the treatment of OA through computerized database searches and reference lists. OUTCOMES MEASURED: The outcomes considered were pain, functional limitation, and adverse effects. RESULTS: Eleven studies that met the inclusion criteria were weighted on the basis of precision and were combined for each outcome variable. When compared with placebo, SAMe is more effective in reducing functional limitation in patients with OA (effect size [ES] =.31; 95% confidence interval [CI],.099-.520), but not in reducing pain (ES =.22; 95% CI, -.247 to.693). This result, however, is based on only 2 studies. SAMe seems to be comparable with NSAIDs (pain: ES =.12; 95% CI, -.029 to.273; functional limitation: ES =.025; 95% CI, -.127 to.176). However, those treated with SAMe were less likely to report adverse effects than those receiving NSAIDs. CONCLUSIONS: SAMe appears to be as effective as NSAIDs in reducing pain and improving functional limitation in patients with OA without the adverse effects often associated with NSAID therapies.
Citation: J Fam Pract. 2002 May;51(5):425-30.