Arthritis Supplements in Question

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Arthritis Supplements in Question: Glucosamine and Chondroitin No

Better Than Placebo for Mild Pain By Salynn Boyles

WebMD Medical News Reviewed By Louise Chang, MD

Feb. 22, 2006 -- The popular dietary supplements glucosamine and

chondroitin sulfate are no better than placebo for treating knee

pain in most people with osteoarthritis, according to findings from

a large study funded by the National Institutes of Health.

Osteoarthritis is the most common type of arthritis that is often

associated with the knee, hip, spine, and fingers. It is also known

as degenerative joint disease.

The trial was conducted at 16 sites around the country and is the

most rigorous examination of the widely-used supplements ever done,

researchers say. It appears in tomorrow's issue of the New England

Journal of Medicine.

Osteoarthritis patients with mild pain treated for six months with

the glucosamine and chondroitin sulfate, either alone or in

combination, experienced no greater pain relief than patients

randomly assigned to take a placebo.

Those with moderate to severe knee pain who took a combination of

the two supplements did report significantly greater pain relief

than patients with the same degree of pain who took a placebo.

But this subgroup of around 20% of the total study population was

too small to prove the findings, researchers say.

Millions Take the Supplements

Twenty one million Americans suffer from chronic joint pain due to

osteoarthritis, and that number is expected to double within the

next two decades as the population ages. The condition is caused by

the breakdown and eventual loss of cartilage, the rubbery substance

that serves as a cushion between the bones of the joints.

According to a 2002 survey conducted by the CDC, 5.2 million people

reported using glucosamine, either alone or in combination with

chondroitin, and most used the supplements for arthritis pain. Both

substances, which are found naturally in the body, help make and

maintain cartilage.

" Since both [glucosamine and chondroitin] are important components

of cartilage, it is tempting to believe that ingestion of the agents

would somehow provide beneficial help to the cartilage, " researcher

and rheumatologist O. Clegg, MD, said in a news

conference. " However, it must be stressed that there is very little

understanding of any potential biologic action of either of these

agents in the treatment of osteoarthritis. "

Supplements vs. Placebo

Supplements vs. Placebo

The Glucosamine/chondroitin Arthritis Intervention (GAIT) trial was

designed to determine if the supplements effectively treat the pain

associated with osteoarthritis of the knee.

A total of 1,583 people over the age of 40 with confirmed

osteoarthritis were randomly placed into five different groups. Each

group took either glucosamine, chondroitin sulfate, both the

supplements, the -2 anti-inflammatory pain reliever Celebrex, or

a placebo.

The study endpoint was a 20% or greater reduction in pain, as

determined by a standardized questionnaire, after six months of

treatment.

Overall, there was no significant difference in pain reduction

between the people using supplements either alone or combined or

those taking placebo. There was a greater improved response in the

people taking Celebrex.

In the 354 patients with moderate to severe pain, however, the

supplement combination appeared to be more effective than either

Celebrex or placebo. The researchers say a larger study of patients

with moderate to severe pain is needed to better understand the

findings.

Unanswered Questions

Another important unanswered question is whether the supplements can

slow progression of knee osteoarthritis. Clegg and colleagues will

attempt to answer this question by following about half of the

original study participants who will continue taking the treatments

for two years. Results from that trial are expected in about a year.

In the meantime, Clegg says that patients who want to take the

supplements should probably take them in combination for just long

enough to determine if they help relieve the pain.

Although few side effects were reported in the six-month study,

National Center for Complementary and Alternative Medicine director

Straus, MD, says the long-term safety of the supplements is

unknown.

" We've learned from past studies that much longer exposures to

certain medications are needed to reveal their true safety profile, "

he says.

Clegg also warned that the unregulated glucosamine and chondroitin

products available commercially may be very different from the

supplements used in the study.

Marc C. Hochberg, MD, MPH, who heads the division of rheumatology at

the University of land School of Medicine, says the findings

also raise interesting questions about the placebo effect.

No fewer than half of the patients in the placebo arm of the study

experienced significant reductions in pain, and responses in some

placebo subgroups were as high as 62%.

Hochberg says the large placebo effect shows that the mind-body

connection is very important in the treatment of arthritis pain.

He adds that physicians should consider treating these patients with

minimal dosages of the safest pain medications available early on,

graduating to stronger doses and drugs if pain persists.

SOURCES: Clegg, D.O. The New England Journal of Medicine, Feb. 23,

2006; vol 354: pp 795-808. O. Clegg, MD, chief of

rheumatology, University of Utah School of Medicine, Salt Lake City.

Marc C. Hochberg, MD, MPH, Center for Integrative Medicine,

University of land School of Medicine. Straus, MD,

director National Center for Complementary and Alternative Medicine.