An Unproven Arthritus Cure

A doctor once told me that my back xrays look like they are of a man twice my age. This explains the endless aches and pains, despite frequent chiropractic visits and constant exercise. So, when a friend of mine (who is quite familiar with my constant ache-and-pain-whining) stumbled across an article about some success using a combination of glucosamine and chondroitin sulfates, he brought it to my attention. Never too quick to act, it sat on my desk so long that I scanned it into my computer for future reference.

Sept, 1999: since my posting the article below, I have used glucosamine and chondroitin sulfates; however, I have done this in combination with a better diet, intake of other supplements (Calcium, Magnesium, C, E, B, Knox Nutra-Joint), moderate excercise, and weekly chiropractic with massage. I feel a bunch better, able to play volleyball a couple times a month again, but it is hard to say what has contributed most. And, I am by no means cured. At any rate, the info is here, just in case someone else finds it of use. Should you learn something then please let me know (

Please note that glucosamine and chondroitin sulfate are not FDA approved. This means that the quality and purity of the supplements is questionable.

There is also a good article at the Arthritus Foundation here.

Along with the article was the following drawing of the knee (by John Papasian), the arthritic drawing is all too familiar to me after having seen my own back xrays many times.

The following article scanned without permission from:

New York Times, Jan 15, 1997
Section/Page B10
Personal Health
Jane E. Brody

I have been asked repeatedly in the last two months about my knees and whether the arthritis remedy I mentioned in a column on alternative medicine was actually working. It is a combination of glucosamine and chondroitin sulfates, natural substances that are centrally involved in the formation of the cartilage that caps the ends of bones.

Deterioration of this articular cartilage and resulting abnormalities in the surrounding bone cause the stiffness, pain, crackling sounds and sometimes swelling of joints that are the hallmarks of osteoarthritis, the wear-and-tear form of arthritis that afflicts 16 million Americans.

The product had seemed to be so effective in countering the arthritic lameness of my 11-year-old spaniel that I decided to try it myself. After two months on this remedy, I am about 30 percent better. I am not pain-free and I still tend to get a little stiff after prolonged sitting, but I have stopped limping, I am playing tennis and ice skating with less pain and my knees have stopped swelling after strenuous activity. But please understand that I am only an anecdote of one, not a study that proves anything. Without a careful scientific study, any personal account of benefit leaves open to question what actually caused the improvement.

The starting dose of three capsules a day costs about $1.67. Since it is sold as a "nutritional supplement" rather than a drug, it is not covered by health insurance.

The usual treatments for osteoarthritis are anti-inflammatory drugs, combined with muscle-strengthening activities and judicious exercise. This approach may relieve discomfort and slow deterioration of the joint, but it does not restore the health of damaged cartilage and can cause serious drug reactions.

Might Something Work?

Rebuilding damaged cartilage has long been the holy Grail of orthopedics and rheumatology, and supporters of the glucosamine-chondroitin combination hope it will be the first remedy to achieve this. The individual ingredients have already been shown to improve arthritic symptoms in more than a dozen studies in Europe, some of which were well designed. European researchers have shown, using radio actively labeled substances, that glucosamine and chondroitin taken by mouth do indeed find their way to articular cartilage, and biopsies of some treated patients have shown structural improvements in damaged cartilage.

Dr. Marc Hochberg, chief of rheumatology at the University of Maryland School of Medicine, said that early studies of glucosamine and chondroitin sulfates when taken orally for osteoarthritis "appear to demonstrate that they are effective and warrant examination in a placebo-controlled, randomized trial."

The American College of Rheumatology also noted the promise of early studies but cautioned that "what looks promising at first doesn't always pan out to be effective or safe. "The Arthritis Foundation also cited European reports indicating that the two nutrients are safe and "may be helpful in controlling pain and improving function" but added that "good, controlled, long-term studies are needed to see if the products are indeed helpful and safe."

The combination of glucosamine and chondroitin is now being tested in well-designed human trials by a few clinical researchers in the United States. Dr. Amal Das, an orthopedic surgeon in Hendersonville, N.C., is assessing its effectiveness in 100 patients with mild to moderate osteoarthritis of the knee (results here). For six months, the patients will receive either a dummy medication&emdash;a placebo or a combination of glucosamine and chondroitin, and each will be thoroughly evaluated before and after the treatment for pain and disability.

Dr. Das is financing the study but Nutramax, a Baltimore company that produces a product that combines relatively large doses of glucosamine and chondroitin, is donating the product. The same product is also being evaluated by American military doctors in Norfolk, Va., for its ability to relieve arthritic back and knee pain in United States Navy Seals.

Dr. Das, who specializes in hip and knee replacement, said he had been searching for a "biological alternative to joint replacement" when he stumbled upon the European data on glucosamine and chondroitin. Glucosamine was described as reducing the pain and disability associated with osteoarthritis and chondroitin appeared to slow progression of the disease. He said he started using the treatment in patients who could not tolerate anti-inflammatory drugs. The compounds are not toxic and, in safety studies at Cornell University's College of Veterinary Medicine, the combination product lacked side effects beyond occasional loose stools in dogs.

"If the compounds are proved to be as effective as the European studies say they are, they should be used in the United States and they should replace the anti-inflammatory medications," Dr. Das said.

A preventive medicine specialist in Arizona who is himself using this remedy and has prescribed it for about 600 patients, including his mother and grandmother, has decided not to await results of these studies and instead summarized the European findings in a book that promotes the combination as part of a nine-point program for combating osteoarthritis. The book, despite its injudicious title, "The Arthritis Cure," by Dr. Jason Theodosakis with Brenda Adderly and Barry Fox (St. Martin's Press, $22.95), makes no wild claims.

Needed: Healthy Skepticism

Dr. Theodosakis emphasizes that not every patient responds to the remedy and not everyone who does respond ends up free of pain or restricted movement. But he cites a number of placebo-controlled studies of the individual ingredients that showed improvements in significantly more patients given either glucosamine or chondroitin than in those who received a look-alike inactive capsule. And he recounts the histories of patients who experienced significant improvement after taking the substances, some of whom began feeling better within a week or two.

Dr. Theodosakis also insists that improvement depends not only on taking the substances but also on following the eight other steps in his program, which include a regular regime of physical exercise, a diet rich in fish high in omega-3 fatty acids and losing excess weight.

Although glucosamine with or without chondroitin has been used for years by veterinarians, mainly in horses and dogs, most American doctors, who tend not to act on the basis of European studies, have kept their distance.

The substances cannot be patented, which is why drug companies have not supported research. Neither have rheumatologists, who have seen scores of quack remedies for arthritis, pushed for government-sponsored studies.

Dr. Joseph B. Houpt, a rheumatologist at Mount Siani Hospital in Toronto, said his review of the medical literature, the dramatic response of his arthritic Labrador to glucosamine and anecdotal reports from patients who had taken glucosamine had revealed "enough smoke" to prompt him to begin a controlled clinical trial. He will study its effects in 100 patients, half of whom will unknowingly receive a placebo. Dr. Houpt insists glucosamine alone should be studied first and, if found effective, then followed by a study of the glucosamine-chondroitin combination.

Study by Dr. Amal Das (original here)

American Academy of Orthopaedic Surgeons
1999 Annual Meeting
Scientific Program

Efficacy of a New Class of Agents (Glucosamine and Chondroitin Sulfate) in the Treatment of a Osteoarthritis of the Knee A Randomized Double-Blind Placebo-Controlled Clinical Trial

Paper No: 180

Saturday, February 6, 1999
02:20 PM

Location: A9-A10

Amal Kumar Das Jr, MD, Hendersonville, NC
Tarek Hammad, MD, Baltimore, MD (a - Nutramax Labs)
Jennifer Eitel, Hendersonville, NC

Background: Anti-inflammatory medications are the mainstay for treatment of osteoarthritis. However, they have significant side effects and some of them may negatively influence the progression of the disease. We evaluated the oral combination of glucosamine hydrochloride, sodium chondroitin sulfate and manganese ascorbate for the treatment of osteoarthritis of the knee. These compounds have a well-known safety profile. Methods: A randomized placebo-controlled study design was implemented. We recruited 93 patients with osteoarthritis of the knee from a single center. The intervention group received 1000mg glucosamine hydrochloride, 800mg sodium chondroitin sulfate and 152mg manganese ascorbate twice daily (CosamineDS). Patients were evaluated initially and then every two months for six months. The primary outcome was the Lesquene Index of Severity of Osteoarthritis of the knee (ISK). Results: Patients with mild or moderate osteoarthritis (n = 72) in the intervention group showed significant improvement in the ISK at four and six months (p = 0.003 and p = 0.04). There was a 17% incidence of adverse events in the intervention group and 19% in the placebo group. Conclusions: A combination of glucosamine hydrochloride, sodium chondroitin sulfate and manganese ascorbate was found to be effective for the treatment of radiographically mild to moderate osteoarthritis of the knee as measured by the ISK.

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