Complimentary treatments for Osteoarthritis - How effective are they?

Osteoarthritis is a common cause of joint stiffness and pain, that progresses over time often leading to degeneration of the affected joint or joints decreased mobility, and disability. Sadly, there are very few conventional treatments for osteoarthritis.

Initial treatment usually includes the nonsteroidal anti-inflammatory drug (NSAID). Unfortunately, these drugs are associated with side effects when taken chronically, such as gastrointestinal upset and bleeding and kidney problems and often osteoarthritis pain is too severe for NSAIDs to be effective. NSAIDs do not stop joint destruction or improve long-term ability. Patients who fail to find relief with NSAIDs may require injections into the affected joint or even joint replacement surgery. The former may only work for one to three months, if at all. The latter is extremely expensive and permanently limits range of motion compared to a natural joint. In other words, osteoarthritis is a disease without a cure.

Complementary treatments for osteoarthritis

What medical science fails to provide sufficient treatment for a disease or condition, many turn to unconventional treatments. Unfortunately, the claims made about complementary and alternative therapies are often less rigorously tested than those suggested by your physician. Therefore, people must be careful and even more critical of complementary therapies. We review the science behind some of the more common complementary treatments for osteoarthritis.

Glucosamine and Chondroitin

Glucosamine and chondroitin are dietary supplements commonly used by people with osteoarthritis. They are often mentioned together because they are marketed, sold, and tested in a dual supplement. In addition, there is some evidence to suggest that the two compounds work together or synergistically. The typical dose of glucosamine is 500 mg taken three times a day. For chondroitin, a dose of 400 mg is standard, also taken three times a day.

Some trials show benefit, others no benefit. The clinical trials of glucosamine and chondroitin have been mixed, meaning that some trials have shown a significant benefit while others have not. When a number of clinical trials show conflicting results, scientists compare them in a process called a meta-analysis. In a 2010 meta-analysis, researchers compared 10 clinical trials comprising nearly 4000 patients with osteoarthritis of the knee or the hip. Patients received glucosamine, chondroitin, or a dual supplement containing both or placebo. Neither glucosamine nor chondroitin taken alone resulted in any clinically meaningful benefit for patients. Another important finding of this meta-analysis was that clinical trials subsidised by makers and retailers of the dietary supplements showed larger effects than those of independent researchers, suggesting the possibility of bias. 

Not statistically significant, but not dangerous, either. There are two important things to note from these trials. One is that the combination of glucosamine and chondroitin appears to have a small beneficial effect, especially in some people, but is not necessarily rise to the level of statistical significance. In other words, some people may find modest relief from these dietary supplements. Others may not. The other important issue is that across studies, these dietary supplements were very safe. Adverse events were no more likely to occur than in those taking placebo. Therefore, for people who wish to try these dietary supplements, there is very little risk, other than the cost of the supplements. They may or may not be effective for the individual. Sadly, there is no way to find out except to try them.

Fish Oil, Krill Oil, Green-Lipped Mussel Oil

Marine oils (fish, krill, green-lipped mussel) are perhaps best known for their ability to improve blood cholesterol and reduce the risk of atherosclerosis and coronary artery disease. However, these oils have also been proposed as a treatment for osteoarthritis. The property common among marine oils is that they are rich in omega-3 fatty acids. Omega-3 fatty acids may work by reducing pain, inflammation, and cartilage degeneration. 

Helpful for dogs, maybe also for humans? Omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been tested rather extensively in dogs with osteoarthritis, where they have been effective. There have been fewer trials in humans, though those that exist appear promising. Omega-3 fatty acids apparently reduce inflammation, reduce pain, and improve joint mobility in people with osteoarthritis in clinical trials.

With high dosages comes additional risk. Unfortunately, the dose is required to achieve these beneficial effects are relatively high, higher than what is normally recommended on over-the-counter dietary supplements. Some studies have included doses as high as 20 g per day. By exceeding recommended dosages, there is a concern for increased risk of side effects. For example, high doses of omega-3 fatty acids are associated with diarrhoea, nausea, stomach irritation, and increased blood pressure. Omega-3 fatty acids may increase the risk for bleeding, which is especially concerning in people who take NSAIDs each day. In general, however, omega-3 fatty acids are well tolerated.

Is there any difference between marine oils? There may be benefits to individual types of marine oils beyond their content of omega-3 fatty acids. Omega-6 fatty acids such as gamma-linolenic acid also found in fish oils, may also be helpful in osteoarthritis, for example. Oils from specific aquatic sources may have unidentified constituents that enhance their effect in osteoarthritis. Evidence for this comes from trials in which fish oil was compared in head-to-head with krill oil and green-lipped mussel oil. For instance, Krill oil seems to be more potent than simple fish oil it contains lower concentrations of omega-3 fatty acids. At least one clinical trial showed green-lipped mussel oil was more effective than fish oil in treating symptoms of osteoarthritis.

Curcumin

Curcumin is isolated from a root called turmeric. Curcumin and turmeric are commonly used in eastern foods (i.e., curry); however, curcumin appears to have potent anti-inflammatory and antioxidant properties. Thus, there is significant interest in testing curcumin for its ability to treat inflammatory conditions.

Impressive in lab studies. So far, the most impressive data for the use of curcumin inflammatory conditions has come from laboratory studies rather than clinical trials.

Curcumin blocks cytokines that increased inflammation and pro-inflammatory genes. The supplement may also help prevent the breakdown of joint components that are effective in osteoarthritis. Curcumin may also improve the survival of chondrocytes, which are cartilage cells.

Limited clinical data. There have only been a few clinical trials of curcumin in people with osteoarthritis, unfortunately. In one small study, 42 patients treated for one month with curcumin reported less pain and improve mobility compared to placebo. One other trial tested a proprietary blend of curcumin with other ingredients and showed that the substance improved joint pain and function and reduced markers of inflammation when taken for at least eight months. 

A highly concentrated preparation of curcumin (high bioavailability) given for eight weeks improved pain and reduced the amount of pain medication patients required. 

Beyond these studies, little is known about the effect of curcumin in people with osteoarthritis.

Incredibly safe. Since it is a food product and has been routinely consumed an extremely high quantities for thousands of years, curcumin is safe. At worst, the supplement may cause mild stomach upset. In fact, when a highly concentrated preparation of curcumin was given to people with cancer, was no observable adverse effects.

References

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