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.


Glucosamine Chondroitin: interpreting the research

When interpreting research on dietary supplements, it sometimes pays to look between the lines and recognize that pharmaceutical companies don’t have much interest in letting people know that over-the-counter dietary supplements are at times a reasonable option for addressing a medical condition. Yes, it’s true, the pharmaceutical companies and their researchers can display, shall we say, bias in assessing the relative merits of prescrpiton drugs and supplements.

Here’s a brief case study from the NYBC archives:

…a good illustration of the dangers of the influence of The Media and Big Business on our healthcare system was recently discussed by New York Buyers’ Club’s Treatment Director, George M. Carter: this past year, the National Institutes of Health released the results of a study that the popular media interpreted as decrying the effectiveness of the popular supplement, glucosamine-chondroitin. However, read in its entirety, the study found that the combination didn’t work well specifically for mild arthritis of the knee but neither did the prescription drug Celebrex, also included in the study. It is interesting to note that many of the researchers involved had received monies from Pfizerthe makers of Celebrex. It is also worth noting that for moderate to severe arthritic pain, the glucosamine-chondroitin combination actually worked much better than Celebrex – and that the researchers didn’t even use its most potent form (glucosamine sulfate) in the study.

For more on this issue, see the NYBC website:

Interpreting the research on glucosamine chondroitin

When FDA-Approved Drugs Stumble, Shouldn’t Patients and Healthcare Providers Consider Dietary Supplements Instead?

Our friends at the FDA have come under a lot of criticism lately.

It seems that every time you open a newspaper (OK, we actually open our browser these days), there’s a new revelation about problems with an FDA-approved drug:

• Vioxx: approved by the FDA in 1999 to treat arthritis pain; withdrawn by manufacturer Merck in 2004 because of concerns about increased risk of heart attack and stroke associated with long-term, high-dosage use

• Statins: a class of FDA-approved drugs to lower cholesterol, including such well-known names as Lipitor; studies have found statin therapy may be associated with heart problems and myopathy (muscle weakness)

• Procrit: one of several drugs for anemia that now carry FDA-mandated “black-box” warnings indicating that they can increase risk of death or serious medical complication, especially when used at high dosage. Procrit and other red blood cell-stimulating drugs had been advertised as “improving quality of life,” but can worsen cancer and increase the risk of blod clots

• Avandia: in May, 2007 the New England Journal of Medicine published a report concluding that this FDA-approved diabetes drug is associated with increased heart attack risk; federal drug reviewers agreed, and said that Avandia is particularly dangerous for people also taking insulin

These and other revelations led Congress to pass legislation this year aimed at improving the FDA’s ability to force follow-up studies on approved drugs, so that serious problems could be detected earlier. (There’s a lot to say about how the FDA approval process has been corrupted by its dependence on funding from pharmaceutical companies, but for the moment we’ll pass by that topic!)

Here we’d just like to ask whether it doesn’t make sense–given such issues as these with prescription drugs—-for patients and their healthcare providers to consider dietary supplements and nutritional strategies as an alternative whenever possible.

Some specific alternatives to the drugs above:

• Glucosamine and chondroitin for osteoarthritis pain; SAMe also effective for this purpose in some trials.

• Niacin and/or fish oil to manage cholesterol; CoQ 10 to offset statin-related side effects. (See the studies on CoQ 10 in this Blog for evidence about how this supplement can counter statin-related muscle pain and diastolic function impairment.) 

• Marrow Plus to counter anemia; may be useful for chemotherapy-associated anemia. See this comment on Marrow Plus from one NYBC member who used it to maintain blood counts during six months of Pegasys/Ribavirin combination therapy for Hep C.

• Chromium supplementation may improve insulin function in diabetics; dietary supplements such as Glycemic Balance may also be useful.