Dietary Supplements For Treatment of Arthritis From the Cleveland Clinic

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Many people with arthritis -- especially osteoarthritis -- use supplements to ease the pain of arthritis. Glucosamine and chondroitin are the most well known and best tested. Methyl sulfonylmethane, or 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, a smaller subgroup of study participants with moderate to severe pain did show significant relief. Due to the small size of this subgroup, these findings should be confirmed in larger studies.

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. 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 the treatment.

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.

These arthritis supplements may also have a blood-thinning effect so people taking these supplements in addition to an anticoagulant (blood-thinner) 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.

What Are the Side Effects of Glucosamine and Chondroitin?

These arthritis supplements are generally well tolerated. However, side effects can occur. The most commonly reported side effects of glucosamine and chondroitin include:

• Nausea
• Diarrhea or constipation
• Heartburn
• Increased intestinal gas

MSM, or methyl sulfonylmethane, is a supplement said to help a wide range of conditions, including arthritis, allergies and even snoring.

MSM is an odorless and tasteless natural sulfur compound found in all living things. Sulfur is needed by the body for healthy connective tissue and joint function and has purported pain-quashing and anti-inflammatory properties.

While MSM is found in many foods -- including meat, fish, certain fruit, vegetables and grains -- it is destroyed when foods are processed. MSM supplements have become increasingly popular in recent years and many people feel they have had some pain relief since taking MSM. Although some studies have reported improvement in pain with MSM, very little or no rigorous scientific research has been done to support its use as an arthritis supplement.

Those patients with multiple other health conditions should be aware that current prescription medication may interact with dietary supplements, and you should consult your doctor so that side effects can be best monitored. Moreover, as with many supplements that have not been studied, the long-term benefits and safety of the chemical are unknown.

Talk to your doctor before taking MSM.

What Are the Side Effects of MSM?

MSM is considered very safe, and side effects are very rare. Side effects that have been reported include:

• Diarrhea
• Skin rash
• Headache
• Fatigue

Other Dietary Supplements

There are many other supplements available that claim to help reduce the pain of arthritis. Before starting any new dietary supplement, remember that there may or may not be scientifc evidence to back these claims. It is also importatnt to know that dietary supplements do not require FDA approval. Always check with your doctor before taking any new supplement to see if it is appropriate (and safe) for you.

Dietary Approaches to Treating Pain

Some people believe that changing dietary fat intake and/or consuming foods that contain anti-inflammatory agents can help ease pain by limiting inflammation. Further research is needed to determine the effectiveness of dietary modifications as an arthritis treatment.

However, certain diet modifications (such as limiting red meat and alcohol) can be helpful for preventing gout attacks, and weight loss achieved by a combination of dietary changes and increased physical activity has been shown to be helpful for people suffering from osteoarthritis. Check with your doctor before starting any new diet and/or exercise program.

Edited by Cynthia Haines, MD, WebMD, June 2006.

SOURCE: National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health.