Alternative Therapies for Arthritis
Nutritional Supplements & NSAID’s
Today we're going to take a few minutes to talk about alternative therapies for Arthritis, including nutritional supplements and anti-inflammatories. Using these alternative methods to surgery can help ease the pain if you are arthritic. Let's dive right in!
Anti-Inflammatory medicines can be taken for 2 different reasons. Their anti-inflammatory effect takes more than a day to act, however often they are useful as acute non-narcotic pain killers. Once we decide whether we are taking them as a pain reliever or as an anti-inflammatory, the rest is easy.
- As a painkiller we take them for a very short period of time (often several days) intermittently for pain.
- As an anti-inflammatory it is necessary to stay on them consistently for the prescribed period of time to break a cycle of inflammation, which causes pain, which causes more inflammation, which causes more pain.
Traditional medicines include Motrin, Ibuprofen, Advil, Aleve, Naprosyn, etc. Newer ones include Vioxx or Celebrex.
What’s The Difference?
Typically these medicines inhibit a pathway called “cyclo-oxygenase” which has two arms. COX-2 is the arm which promotes inflammation. COX-1 prevents formation of stomach ulcer forming enzymes.
Most NSAID’s inhibit both COX-1 (a bad thing to do) and COX-2 (a good thing to do). Vioxx and Celebrex inhibit only COX-2. Although safer, Vioxx or Celebrex are more expensive and may not be covered by insurance except under certain circumstances.
All NSAID’s inhibit inflammation in a similar fashion (COX-2 inhibition) but may be more or less effective on an individual basis based on additives, genetics etc. It may require trying different ones to see which works best for you.
The most common side effect of NSAID’s is GI upset. If you have a history of stomach problems, do not take any NSAID without consulting your physician.
Chondroitin sulfate exists naturally in your cartilage. It’s thought to draw fluid into the tissue to give cartilage elasticity and to slow cartilage breakdown by protecting it from destructive enzymes.
Although it hasn’t been proven to reverse cartilage loss, in some studies it appeared to help stop joint degeneration, improve function, and ease pain. In one placebo-controlled study, joint narrowing in the knee was stabilized in some of those who took chondroitin (Uebelhart).
Another controlled study looked at osteoarthritis of the finger joints for a period of three years. Among the group that took chondroitin, there was a significant decrease in the number of patients with new erosions in their finger joints (Verbruggen).
Chondroitin is a slow-acting supplement: It takes two months or more for the effects to show up. Some have questioned whether chondroitin can be easily absorbed when taken orally. However, studies show it relieves arthritis symptoms.
How It’s Used
The recommended dosage of chondroitin is 1,200mg a day divided into two doses. It’s most often taken in combination with glucosamine although there are no studies that show the two together are any more effective than either taken alone.
Expert Opinion on Chondroitin Sulfate
Because there are no serious side effects, it’s worth a try. It doesn’t seem to help everyone: If you have severe cartilage loss, you probably won’t see any improvement. If you don’t see any progress after two or three months, it may not work for you.
- Occasional side effects include nausea and indigestion. However, it hasn’t been studied over time, so effects of long-term use aren’t known.
- It is molecularly quite similar to the blood thinner heparin, so be aware that it may increase your chances of bleeding if you are taking other drugs or herbs that are blood thinners.
- Some chondroitin supplements are made from shark cartilage, but this is not recommended as a source. The quality and amount of active ingredients varies, and some experts are concerned about possible heavy metal contamination.
3 products are licensed to have both Glucosamine and Chondroitin in one capsule. These are the ones that have consistently found to test well for purity. Some other brands contain as little as 1% of what they claim to contain on their labels. A bad brand is the most common reason not to notice pain relief.
- Osteo Bi-Flex Found in Wal-Mart, K-Mart, and Walgreen’s.
- GlucoPro Found in many Health Food Stores
- Cosamin DS Found in Pharmacies and with some Doctors
This supplement has been touted as an arthritis “cure,” and although that’s an overstatement, it does appear to help ease the pain and stiffness of osteoarthritis.
There’s growing bodies of evidence that shows glucosamine eases osteoarthritis pain as well as NSAIDs. A 1998 double-blind study of 178 patients with osteoarthritis of the knee compared a daily dose of 1,500mg of glucosamine sulfate with 1,200mg of ibuprofen for four weeks.
Both treatments relieved osteoarthritis symptoms, but the glucosamine group had significantly fewer side effects (Qiu). An analysis of English language studies from 1975-1997 came to the same conclusion (da Camara), saying in some cases glucosamine performs as well as ibuprofen.
There’s speculation it may rebuild cartilage, but no evidence yet. The National Institutes of Heath is sponsoring a large study that should give some better answers in a few years.
You have to take glucosamine for about two months before you see any effects. It doesn’t help everyone, so if you don’t notice any changes after two months, it probably isn’t working for you. It’s not inexpensive: A day’s dosage costs $0.80-$1.30, so comparison-shop for the best value.
How It’s Used
Glucosamine comes in capsules, as a drink and also as a cream. The usual dosage is 1,500 mg per day taken in two doses (2,000mg for those who weigh 200 pounds or more). It’s often combined with chondroitin, another supplement believed to nourish cartilage.
Look carefully at the labels. Some glucosamine products have added ingredients, such as vitamins or minerals that you may not want. There’s no evidence that cream or any other topical application of glucosamine has any effect on osteoarthritis.
Some doctors are recommending this supplement, and even taking it themselves for osteoarthritis. Because it has no known serious side effects, it’s worth a try. Some have found it can help reduce the need for painkillers.
Side effects include occasional cases of indigestion or nausea. If this happens, you may want to try a different brand. It is important to know, however, that long-term effects of this supplement haven’t been studied. Some vendors say not to take glucosamine if you have a shellfish allergy.
This Article is Adapted From: The Arthritis Foundation’s Guide to Alternative Therapies
William Sterett, MD, is an orthopaedic surgeon residing in Vail, Colorado. Dr. Sterett is the head team physician for the U.S. Women's Alpine Ski Team and the Medical Director for the Vail Valley Surgery Centers.
For more resources and to contact Dr. Sterett, please visit www.drsterett.com.