In osteoarthritis, the cartilage in joints has become damaged, disrupting the smooth gliding motion of the joint surfaces. The result is pain, swelling, and deformity.
The pain of osteoarthritis typically increases with joint use and improves at rest. For reasons that aren't clear, although x-rays can find evidence of arthritis, the level of pain and stiffness experienced by people does not match the extent of injury noticed on x-rays.
Many theories exist about the causes of osteoarthritis, but we don't really know what causes the disease. Osteoarthritis is often described as "wear and tear" arthritis. However, evidence suggests that this simple explanation is not correct. For example, osteoarthritis frequently develops in many joints at the same time, often symmetrically on both sides of the body, even when there is no reason to believe that equal amounts of wear and tear are present. Another intriguing finding is that osteoarthritis of the knee is commonly (and mysteriously) associated with osteoarthritis of the hand. These factors, as well as others, have led to the suggestion that osteoarthritis may actually be a body-wide disease of the cartilage.
During one's lifetime, cartilage is constantly being turned over by a balance of forces that both break down and rebuild it. One prevailing theory suggests that osteoarthritis may represent a situation in which the degrading forces get out of hand. Some of the proposed natural treatments for osteoarthritis described later may inhibit enzymes that damage cartilage.
When the cartilage damage in osteoarthritis begins, the body responds by building new cartilage. For several years, this compensating effort can keep the joint functioning well. Some of the natural treatments described below appear to work by assisting the body in repairing cartilage. Eventually, however, building forces cannot keep up with destructive ones, and what is called end-stage osteoarthritis develops. This is the familiar picture of pain and impaired joint function.
The conventional medical treatment for osteoarthritis consists mainly of anti-inflammatory drugs, such as naproxen and Celebrex. The main problem with anti-inflammatory drugs is that they can cause ulcers. Another possible problem is that they may actually speed the progression of osteoarthritis by interfering with cartilage repair and promoting cartilage destruction.
Several natural treatments for osteoarthritis have a meaningful, though not definitive, body of supporting evidence indicating that they can reduce pain and improve function. In addition, there is some evidence that glucosamine and chondroitin might offer the additional benefit of helping to prevent progressive joint damage.
Inconsistent evidence hints that glucosamine can reduce symptoms of mild to moderate arthritis; a small amount of evidence indicates that regular use can slow down the gradual worsening of arthritis that normally occurs with time.
Glucosamine is widely accepted as a treatment for osteoarthritis. However, the supporting evidence that it works is somewhat inconsistent, with several of the most recent studies failing to find benefit. Two types of studies have been performed: those that compared glucosamine against placebo and those that compared it against standard medications.
In the placebo-controlled category, one of the best trials was a 3-year, double-blind study of 212 people with osteoarthritis of the knee. 21 Participants receiving glucosamine showed reduced symptoms as compared to those receiving placebo.
Benefits were also seen in other double-blind, placebo-controlled studies, enrolling a total of more than 800 people and ranging in length from 4 weeks to 3 years.
Other double-blind studies enrolling a total of more than 400 people compared glucosamine against ibuprofen and found glucosamine equally effective as the drug.
However, most recent studies have not shown benefit. In four studies involving a total of almost 500 people, use of glucosamine failed to improve symptoms to any greater extent than placebo.
It appears that most of the positive studies were funded by manufacturers of glucosamine products, and most of the studies performed by neutral researchers failed to find benefit.
Many popular glucosamine products combine this supplement with
Two studies reported that glucosamine can slow the progression of osteoarthritis. However, as with the positive studies of glucosamine for reducing symptoms, both of these studies were funded by a major glucosamine manufacturer.
A 3-year, double-blind, placebo-controlled study of 212 individuals found indications that glucosamine may protect joints from further damage.
A separate 3-year study enrolling 202 people found similar results.
Furthermore, a follow-up analysis 5 years after the conclusion of the above two studies found suggestive evidence that use of glucosamine reduced the need for knee replacement surgery.
However, the aforementioned study involving 222 patients with osteoarthritis of the hip failed to show any significant change on x-ray findings following 2 years of glucosamine treatment compared to placebo.
Glucosamine appears to stimulate cartilage cells in the joints to make proteoglycans and collagen, two proteins essential for the proper function of joints.
For more information, including dosage and safety issues, see the full
As described in the previous section, the supplement chondroitin is often combined with glucosamine. Several studies have evaluated chondroitin used alone, as well, with some positive results, both for improving symptoms and slowing the progression of the disease. On balance, however, the evidence for chondroitin’s effectiveness for osteoroarthritis remains inconsistent.
According to some but not all double-blind, placebo-controlled studies chondroitin may relieve symptoms of osteoarthritis.
One study enrolled 85 people with osteoarthritis of the knee and followed them for 6 months.
Another way of comparing the results is to look at maximum walking speed among participants. Whereas individuals in the chondroitin group were able to improve their walking speed gradually over the course of the trial, walking speed did not improve at all in the placebo group. Additionally, there were improvements in other measures of osteoarthritis, such as pain level, with benefits seen as early as 1 month. This suggests that chondroitin was able to stop the arthritis from gradually getting worse.
Good results were seen in a 12-month, double-blind trial that compared chondroitin against placebo in 104 individuals with arthritis of the knee,
Another interesting study evaluated intermittent or “on and off” use of chondroitin.
Benefits were also seen in two short-term trials involving a total of about 240 individuals.
Generally positive results were also seen in other studies, including one that found chondroitin about as effective as the anti-inflammatory drug diclofenac.
However, a very large (1,583-participants) and well-designed study failed to find either chondroitin or glucosamine plus chondroitin more effective than placebo.
Some evidence suggests that, like glucosamine, chondroitin might slow the progression of arthritis.
An important feature of the study of 42 individuals mentioned previously was that the individuals taking a placebo showed progressive joint damage over the year, but among those taking chondroitin sulfate no worsening of the joints was seen.
A longer and larger double-blind, placebo-controlled trial also found evidence that chondroitin sulfate can slow the progression of osteoarthritis.
During the 3 years of the study, only 8.8% of those who took chondroitin sulfate developed severely damaged joints, whereas almost 30% of those who took placebo progressed to this extent.
Similar long-term benefits were seen in two other studies, enrolling a total of more than 200 people.
Additional evidence comes from animal studies. Researchers measured the effects of chondroitin sulfate (administered both orally and via injection directly into the muscle) in rabbits, in which cartilage damage had been induced in one knee by the injection of an enzyme.
Looking at the sum of the evidence, it does appear that chondroitin sulfate may actually protect joints from damage in osteoarthritis. However, the scientific record suffers from a paucity of truly independent researchers.
For more information, including dosage and safety issues, see the full
A substantial body of scientific evidence indicates that S-adenosylmethionine (SAMe) can relieve symptoms of arthritis.
One of the best double-blind studies enrolled 732 patients and followed them for 4 weeks.
The results indicate that SAMe provided as much pain-relieving effect as naproxen and that both treatments were significantly better than placebo. However, differences did exist between the two treatments. Naproxen worked more quickly, producing readily apparent benefits at the 2-week follow-up, whereas the full effect of SAMe was not apparent until 4 weeks. By the end of the study, both treatments were producing the same level of benefit.
In a double-blind study that compared SAMe against the new anti-inflammatory drug Celebrex (celecoxib), once more, the drug worked faster than the supplement, but in time both were providing equal benefits.
Evidence regarding slowing the progression of arthritis is, at present, limited to studies involving animals rather than people.
For more information, including dosage and safety issues, see the full
Special extracts of avocado and soybeans called avocado/soybean unsaponifiables (ASUs) have been investigated as a treatment for osteoarthritis with very promising results in studies enrolling a total of several hundred people.
For example, in a double-blind trial, 260 individuals with arthritis of the knee were given either placebo or ASU at 300 or 600 mg daily.
Thus far, however, it does not appear that ASU can slow the progression of osteoarthritis.
A type of naturally occurring fatty acid called cetylated fatty acids have shown growing promise for osteoarthritis. It is used both as a topical cream and as an oral supplement.
Three double-blind placebo-controlled studies have found cetylated fatty acids helpful for
In one of the studies using the cream, 40 people with osteoarthritis of the knee applied either cetylated fatty acid or placebo to the affected joint.
For more information, including dosage and safety issues, see the full
A 2006 meta-analysis (systematic statistical review) of studies on acupuncture for osteoarthritis found 8 trials that were similar enough to be considered together.
However, as it happens, one study comprised almost half of all the people considered in this meta-analysis, and it failed to find real acupuncture more effective than sham acupuncture. In this study, published in 2006, 1,007 people with knee osteoarthritis were given either real acupuncture, fake acupuncture, or standard therapy over 6 weeks.
Another review, published in 2007, nuanced its conclusions differently.
For more information, see the full
A 6-week, double-blind, placebo-controlled study of 247 individuals with osteoarthritis of the knee evaluated a combination herbal product containing
and the Asian spice galanga (
As noted above, the supplement
Other treatments with incomplete supporting evidence from double-blind trials include
Growing but definitive evidence suggests that the natural substance hyaluronic acid may help reduce osteoarthritis symptoms when it is injected directly into an affected joint.
Incomplete and inconsistent evidence from human and animal studies only weakly suggests that
Numerous other herbs and supplements sometimes recommended for osteoarthritis include:
Other studies provide limited evidence that certain supplements proposed for osteoarthritis do
work. For example, a 2-year, double-blind study of 136 people with knee arthritis found
Several double-blind, placebo-controlled studies suggest that pulsed electromagnetic field therapy, a special form of
Limited evidence supports the use of bee venom injections for osteoarthritis.
For a discussion of homeopathic approaches to osteoarthritis, see the
Various herbs and supplements may interact adversely with drugs used to treat osteoarthritis. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.
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