The early report from a long-awaited study of glucosamine/chondroitin supplements found no benefit for most people with arthritis, and the possibility of reduction in pain for people with moderate to severe arthritis. So what does this mean for you?
1. If you have mild arthritis, you're unlikely to benefit.
In the study, the supplements, taken separately or together, were not effective in reducing pain for people with mild arthritis. So there's no need to try it for this condition.
Whether the supplements relieve pain in people with more advanced disease is still an open question: In a secondary analysis, a combination of glucosamine and chondroitin sulfate appeared somewhat more effective for people with moderate to severe arthritis. But more research is needed to confirm those findings.
Research exploring whether glucosamine/chondroitin might slow cartilage damage in osteoarthritis patients continues.
2. Watch your wallet.
For an unproven treatment, glucosamine/chondroitin is expensive -- $25 to $50 a month.
3. Safety doesn't appear to be an issue.
Studies have found few dangerous side effects to glucosamine/chondroitin, though it's always smart to consult your doctor before starting a new treatment. In the latest study, principal investigator Daniel Clegg said safety data were reassuring. There were no deaths or heart attacks. Gastrointestinal events and blood sugar problems were no greater in the supplement group than in the placebo or Celebrex group.
The most common problems associated with glucosamine/chondroitin are increased gas and softened stools, according to the Arthritis Foundation. Because animal research has suggested that glucosamine may exacerbate insulin resistance, a cause of diabetes, the organization advises people with diabetes to check their blood sugar levels more frequently when taking the supplement.
The group also advises extra caution for people who take a blood-thinning medication or are allergic to shellfish. Patients on blood thinners were excluded from the latest trial, which was funded by the National Institutes of Health (NIH).
4. Product quality is nearly impossible to determine.
Because dietary supplements are lightly regulated, the quality and content of ingredients in supplements can vary widely. The exact formulation used in the NIH study is not sold commercially.
The Arthritis Foundation recommends reading product labels carefully and choosing products sold by large, well-established companies. However, the group receives funding from some of those companies.
Consumerlab.com, a for-profit company, has conducted tests on several glucosamine products. Company president Tod Cooperman advises sticking with products that have been tested by a credible group and that have the right dosage; he urges caution on patented combinations of products and products that uses the word "complex." He said one recent test found a product that had only 18 percent of the chondroitin claimed on the label.
5. If you take it, consider matching your dose to that used in the study.
The daily doses used in the NIH study were 1,500 milligrams of glucosamine HCI (hydrochloride) and 1,200 milligrams of chondroitin sulfate. Previous studies have found that people needed to take the supplements for six to eight weeks before feeling a difference in symptoms.
6. Consider other methods for relieving arthritis pain.
Marc Hochberg, head of the division of rheumatology and clinical immunology at the University of Maryland School of Medicine, recommends that patients focus on losing weight to reduce pain and exercising to maintain strength and flexibility.
A recent study of 48 adults found that even modest weight loss can help reduce pain and stiffness and improve day-to-day functioning in patients with mild to moderate knee osteoarthritis. Education, physical therapy and both prescription and over-the-counter pain medications have also been shown to help.
Two prescription pain medications -- Vioxx and Bextra -- were pulled from the market in the past year because of safety risks. Similar concerns have also been raised about some other pain relievers, including Celebrex and naproxen, but experts advise patients to evaluate risks individually with their doctors. If you try glucosamine/chondroitin, experts advise you take it as an adjunct to regular treatments, not as a replacement.
More information on arthritis and glucosamine/chondroitin is available through these groups:
* The Arthritis Foundation, www.arthritis.org, offers information on the new NIH study as well as tips on how to buy and use supplements. The foundation accepts industry funding.
* Quackwatch, www.quackwatch.org, offers a skeptical, well-researched look at the supplements.
* Consumer Lab, www.consumerlab.com, a fee-for-service site, can help you assess products.
* The National Center for Complementary and Alternative Medicine, http://nccam.nih.gov, has a Q&A on the recent trial, which the center partially funded.
* The American College of Rheumatology, www.rheumatology.org, has abstracts of recent studies as well as patient information on osteoarthritis and supplement use.
-- Elizabeth Agnvall