Methylsulfonylmethane (MSM) offers relief in knee OA

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Methylsulfonylmethane offers relief in knee OA

Aug 29, 2005 Janis

Phoenix, AZ - The popular dietary supplement methylsulfonylmethane

(MSM) modestly improves pain and function in patients' knee

osteoarthritis (OA) and might be considered for short-term pain

relief when other treatments are ineffective, according to Dr

Kim (Southwest College of Naturopathic Medicine, Tempe, AZ). Kim and

colleagues reported a randomized, placebo-controlled trial of MSM at

the American Association Naturopathic Physicians (AANP) 20th annual

meeting [1].

If the COX-2 inhibitors are contraindicated, a patient might give

MSM a try.

" If the COX-2 inhibitors are contraindicated, a patient might give

MSM a try, " Kim tells rheumawire. " This provides only symptomatic

relief, but MSM was associated with no problems or adverse effects in

our study. "

Modest but significant benefits seen with MSM

The study, which was presented at the AANP meeting by coauthor Dr

Axelrod (Southwest College of Naturopathic Medicine, Tempe,

AZ), randomized 50 patients to 12 weeks of MSM (n=25) or placebo

(n=25). Eligible patients had documented knee OA (Kellgren-Lawrence

grade 2 or 3) and significant pain (at least 40 mm on a 0-100 mm

visual analog scale [VAS]). Other types of arthritis or chronic pain

were excluded.

Patients had a washout of seven days for NSAIDs or other OA

treatments and then were randomized to 3 g bid of MSM (OptiMSM,

Cardinal Nutrition) or to an identical-appearing placebo capsule. MSM

patients took 1 g bid for the first two days, then increased to 3 g

bid by the end of the first week of treatment.

The primary study end points were the WOMAC Index, the patient and

physician global assessments of overall arthritis disease status and

response to therapy, and laboratory measures including serum

homocysteine, C-reactive protein, erythrocyte sedimentation rate,

urine malondialdehyde (MDA), complete blood count/chemistry panel,

fasting lipids, urinalysis, and stool occult blood test, all measured

at baseline and again at 12 weeks.

Axelrod reported data for 21 MSM patients and 19 placebo patients who

completed the trial. At week 12, WOMAC pain scores dropped by 14.6 mm

in MSM patients vs 7.3 mm with placebo (12% difference, p=0.041).

Function scores improved by 15.7 mm in MSM patients vs 8.8 mm in

placebo patients (13.7% difference, p=0.045).

MSM improves pain, function in knee OA

Outcome measure

MSM

Placebo

p

WOMAC pain baseline

58.0

55.1

NS

Pain change at 12 weeks

-14.6

-7.3

0.041

WOMAC function baseline

51.5

52.9

NS

Function change at 12 weeks

-15.7

-8.8

0.045

To download table as a slide, click on slide logo below

Homocysteine at 12 weeks decreased from 8.0 to 7.2 µmol/L in the MSM

group (p=0.004 vs placebo). Urine MDA, a measure of lipid

peroxidation, decreased from 16.7 to 14.3 µmol/L with MSM treatment

(p=0.010).

" This pilot study showed that MSM 3 g bid for 12 weeks improved pain

and physical function in patients with knee OA pain without major

adverse events, " the researchers concluded.

Similar benefits have been reported earlier by Usha and Naidu, who

concluded in a study of 118 patients that MSM significantly decreased

pain in knee OA and that combined MSM/glucosamine was even more

effective [2].

Although MSM proponents and marketers unfailingly emphasize that MSM

is a naturally occurring compound, the formulation used in this trial

(as in all other human trials and case series reports) is not the

least bit " natural. " All of the marketed and tested MSM products are

industrially produced by processing of dimethyl sulfoxide (DMSO), of

which MSM is a metabolite. The resulting MSM retains many DMSO

therapeutic effects but without DMSO's unfortunate tendency to make

those who use it smell like garlic and oysters.

Sources

Kim L, Axelrod L, P, et al. Efficacy of methylsulfonylmethane

(MSM) in knee osteoarthritis pain: a pilot clinical trial. American

Association of Naturopathic Physicians 20th annual meeting; August

24-27, 2005; Phoenix, AZ.

Usha PR, Naidu MUR. Randomized, double-blind, parallel, placebo-

controlled study of oral glucosamine, methylsulfonylmethane and their

combination in osteoarthritis. Clin Drug Invest 2004; 24:353-363.

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