Many people with arthritis -- especially osteoarthritis -- use supplements in their diet to ease the pain of arthritis. Glucosamine and chondroitin are the most well-known and best tested. Methyl sulfonylmethane (MSM) is another supplement used to ease the pain of arthritis, but it has not been through as much rigorous scientific testing.

What Are Glucosamine and Chondroitin?

Glucosamine and chondroitin sulfate are components of normal cartilage. In the body, they are the building blocks for cartilage and appear to stimulate the body to make more cartilage.

There are conflicting studies on glucosamine and chondroitin, some demonstrating a beneficial effect on osteoarthritis pain. Others, including the NIH-sponsored multicenter Glucosamine/Chrondroitin Arthritis Intervention Trial (GAIT), did not show benefit for the primary outcome measure of osteoarthritis pain measured by WOMAC (Western Ontario and McMacster Universities).

However, there are no long-term studies to confirm their long-term safety and effectiveness. Many physicians may still recommend a trial of glucosamine at this point, and if there is not apparent improvement by 3 months, it would reasonable to stop glucosamine. More definitive conclusions will be made available once the full results are published in the peer-reviewed literature.

The supplements, which are available in pharmacies and health food stores without a prescription, are well tolerated and appear to be safe. However, there are no long-term studies to confirm their long-term safety and effectiveness.

It is important to check with your doctor before starting any new treatments. Your doctor can review the other medications you are taking and help you decide whether or not these arthritis supplements are right for you. In addition, always follow the instructions on the medication label. Do not take more of the supplements than is recommended.

Which Brand of Arthritis Supplement Should I Use?

There are many different brands of glucosamine and chondroitin, which are usually sold together in one arthritis supplement. Unfortunately at this time, there is no government monitoring to ensure the purity of these products.

In order to assure that you get a consistent dose of the supplements, stick with a reputable manufacturer; choose products sold by large and well-established companies. If you don't recognize a brand name, ask about the company's reputation, how long it has been in business and how long the store has stocked the brand.

Who Should Not Take These Arthritis Supplements?

People with diabetes should use caution when taking glucosamine because it may raise blood sugar. People taking blood-thinning medication (anticoagulants) should check with their doctors before taking glucosamine and chondroitin.

These arthritis supplements may also have a blood-thinning effect so people taking these supplements in addition to an anticoagulant may have to have their blood tested more often. People who are allergic to shellfish also should consult their doctors before using glucosamine and chondroitin. Glucosamine is extracted from a substance in shellfish.

The effects of these supplements on a growing child or developing baby are not yet known. For that reason, glucosamine and chondroitin are not recommended for children, women who are pregnant and women who could become pregnant.

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Do You Have Fibromyalgia Pain?

Cymbalta is approved for the management of fibromyalgia.

Important Safety Information

Cymbalta^® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.

What should I talk about with my healthcare provider?

Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.

You should also know that:

Suicide is a known risk of depression and some other psychiatric disorders.
Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
Cymbalta^® is not approved for use in patients under age 18.

Who should NOT take Cymbalta?
You should not take Cymbalta if:

You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
You have uncontrolled narrow-angle glaucoma (an eye disease)
You are taking Mellaril^® (thioridazine)

What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:

about all of your medical conditions, including kidney problems, glaucoma, or diabetes
about your alcohol use
if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant

While taking Cymbalta, tell your healthcare provider:

if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
before stopping Cymbalta or changing your dose
if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta

If you have any questions, talk to your healthcare provider before taking Cymbalta.

What are the possible side effects of Cymbalta?

The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.

Safety Information and Boxed Warning | Prescribing Information | Medication Guide