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Health
News Archive 9 - Osteoarthritis
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to structure/function index
Glucosamine And MSM Synergistic for Arthritis
Glucosamine
and MSM (methylsulfonylmethane) combined are more effective against
osteoarthritis than either agent alone, according to Indian researchers.
In the journal Clinical Drug Investigations, Drs. P. R. Usha and M. U. R.
Naidu report that although the individual agents did improve pain and
swelling in patients' affected joints, the combined therapy was more
effective than the single agents in reducing these symptoms and improving
the function of joints.
In a clinical trial conducted at Nizam's Institute of Medical Sciences in
Hyderabad, 118 patients with mild to moderate osteoarthritis were treated
three times daily with either 500 milligrams of glucosamine, 500
milligrams of MSM, a combination of both, or an inactive placebo.
After 12 weeks of treatment, the average pain score had fallen from 1.74
to 0.65 in the glucosamine-only group. In MSM-only participants, it fell
from 1.53 to 0.74. However, in the combination group, it fell from 1.7 to
0.36.
The researchers also found that the combination treatment had a faster
effect on pain and inflammation compared to glucosamine alone. All of the
treatments were well tolerated. "It can be concluded," they observe, "that
the combination of MSM with glucosamine provides better and more rapid
improvement in patients with osteoarthritis."
SOURCE: Clinical Drug Investigations, June 2004.
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Glucosamine
Reduces Progression of Osteoarthritis
Glucosamine stops
the progression of osteoarthritis in postmenopausal women, according to a
study published in the 2004 journal Menopause.
Researchers conducted two, three-year, randomized, placebo-controlled
studies evaluating the effect of glucosamine sulfate on symptoms and the
modification of joint structure in women with knee osteoarthritis. Of the
414 subjects in the two studies, 319 were postmenopausal women.
After 3 years, postmenopausal participants in the glucosamine sulfate
group showed no joint space narrowing, whereas participants in the placebo
group did experience joint narrowing. Joint space narrowing is an
indication of osteoarthritis disease progression. In addition, symptoms
improved in the glucosamine-treated group, whereas the placebo group
experienced a trend toward worsening of symptoms.
The researchers concluded that the study demonstrated for the first time
that glucosamine has a disease-modifying effect in knee osteoarthritis,
meaning that glucosamine treated the osteoarthritis disease itself, rather
than just the symptoms. This was particularly true in postmenopausal
women, a group of the population who are the most frequently affected by
this disease.
According to the study authors, 'Glucosamine sulfate, therefore, is the
first agent that meets the current requirements to be classified as a
symptom- and structure-modifying drug in women with knee osteoarthritis.'
Source: Bruyere O, Pavelka K, Rovati LC, Deroisy R, Olejarova M, Gatterova
J, Giacovelli G, Reginster JY. Glucosamine sulfate reduces osteoarthritis
progression in postmenopausal women with knee osteoarthritis: evidence
from two 3-year studies. Menopause. 2004;11(2):138-143.
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Clinical Study Shows Biocell Collagen II® Effective for Osteoarthritis
A novel dietary
supplement derived from sternum collagen improves the pain, stiffness, and
quality of life in persons with osteoarthritis (OA), researchers announced
in April 2003.
The findings of Dr.
Eric Sheldon, a clinical research investigator at Miami Research
Associates, are derived from a placebo-controlled pilot study in sixteen
men and women with OA who received the supplement for an eight-week
period. The supplement tested is a unique, patented extract of naturally
occurring type II Collagen, Chondroitin Sulfate, and
Hyaluronic Acid named BioCell Collagen II™.
“This preliminary
study suggests that BioCell Collagen II has promise in the management of
chronic osteoarthritis symptoms,” said Sheldon, a rheumatologist and
voluntary rheumatology instructor at the University of Miami School of
Medicine. “We used a symptom assessment tool that is used routinely in OA
drug studies and the results are encouraging.”
Sheldon said the
data reveal that daily consumption of BioCell Collagen II led to
clinically meaningful improvements that were significantly superior to the
group receiving placebo supplements. Additionally, the BioCell Collagen
II group had no greater incidence of adverse events or side effects.
Osteoarthritis, also
known as degenerative joint diseases, is the most common form of
arthritis. “We believe BioCell Collagen II is a viable alternative to
glucosamine and chondroitin products, especially among those that have a
concern or allergy associated with shellfish and cow-derived ingredients,”
offered Suhail Ishaq, vice president of BioCell Technology in Newport
Beach, CA. Glucosamine is derived from shellfish and chondroitin is
typically derived from cow cartilage.
The study findings
are being submitted for presentation at a national biomedical research
conference scheduled for later in 2003. The study was sponsored by BioCell
Technology, LLC, Newport Beach, CA. It was conducted at Miami Research
Associates, a private clinical research center with over 25 years of
experience in conducting clinical trial for pharmaceutical companies.
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Glucosamine Relieves Knee and Osteoarthritis Pains
People suffering from knee pain caused by articular cartilage damage
and/or osteoarthritis may find significant benefit from
Glucosamine
supplements, according to a study published in the British Journal of
Sports Medicine in February 2003.
PROCEDURE: In the 12-week study, researchers randomly divided subjects
into two groups. One group of 24 subjects received 2,000 mg daily of
glucosamine. Another group of 22 subjects received a placebo. During the
course of the study, the investigators conducted four testing sessions
where they noted changes in knee pain and function. The tests included a
"duck walk" and a repeated, walking stair climb. They also relied on two
questionnaires to determine glucosamine's effect on knee injury and
osteoarthritis symptoms.
RESULTS: After 12 weeks the researchers found that the glucosamine-treated
group had an improved quality of life in regards to osteoarthritis
symptoms and lower levels of knee pain compared to the placebo-treated
subjects. On self-reported evaluations of knee pain, 88% (21 subjects) of
the glucosamine group reported some degree of improvement compared to only
17% (3 subjects) in the placebo group.
CONCLUSION: According to the study authors, "These results suggest that
glucosamine supplementation can provide some degree of pain relief and
improved function in persons who experience regular knee pain, which may
be caused by prior cartilage injury and/or osteoarthritis. The trends in
the results also suggest that, at a dosage of 2,000 mg per day, the
majority of improvements are present after eight weeks."
This
study was unique in that it administered glucosamine over a three-month
period, compared to other studies lasting four or eight weeks, and the
amount of glucosamine, intended to provide 168 grams to each participant
over the study's course, was greater than most earlier studies. This may
explain why an earlier study supplementing 500 milligrams glucosamine for
a two-month period failed to show improvement. Since the knee pain
experienced by participants in the current study was probably due to
cartilage damage or osteoarthritis, glucosamine's proposed mechanism of
action of improvement of cartilage integrity was likely the reason for the
benefits seen in this study.
SOURCE: Br J Sports Med. 2003 Feb;37(1):45-9.
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Government
Report Concludes: Dietary Supplement SAM-e Equally Effective as
Prescription Drugs for Depression and Osteoarthritis
October,
2002
The
popular, over-the-counter dietary supplement SAM-e (pronounced SAMMY)
shows promise as an equivalent treatment to prescription drugs for
depression and osteoarthritis and may help some chronic liver conditions.
This information comes from a just-released Evidence Report Summary on the
supplement sponsored by the U.S. Department of Health and Human Services'
(HHS) Agency for Healthcare Research and Quality (AHRQ).
"The Department of Health and Human Services hired an impeccable
group of researchers to examine 102 clinical studies to determine whether
or not SAM-e works ... their results are quite compelling," said Hyla
Cass, M.D., a Los Angeles-based clinical psychiatrist and UCLA assistant
professor.
The Evidence Report on SAM-e was prepared for the HHS by Rand Corporation,
a Southern Calif.-based think tank. A 16-person team of medical
professionals worked for more than three years to conduct a literature
review and synthesis of evidence on 102 different human clinical studies
of SAM-e to determine its efficacy for treatment of depression,
osteoarthritis and intrahepatic cholestasis associated with liver disease.
According to the Evidence Report's summary, the team's key findings
include evidence that SAM-e:
-
Is
as effective as prescription antidepressants
-
Fights
osteoarthritis pain as well as non-steroidal anti-inflammatory drugs
(NSAIDS)
-
Helps
some liver conditions
Also
according to the summary, the objective of the Evidence Report "was
to conduct a search of the published literature on the use of S-adenosyl-L-methionine
(SAM-e) for the treatment of osteoarthritis, depression and liver
disease." The summary refers to the high annual costs -- $43.7 to
$52.9 billion -- associated with treatment and lost wages for depression.
It also states that an estimated 15 percent of Americans suffer from
arthritis and the annual cost to society is estimated at $95 billion.
Osteoarthritis is the most common form of arthritis.
SAM-e and Depression
Among the findings culled from 47 studies on the treatment of depression,
the summary concludes that "compared to the use of conventional
antidepressant pharmacology, treatment with SAM-e was not associated with
a statistically significant difference in outcomes."
"These new findings suggest that SAM-e works as effectively as
prescription drugs and it does it without the side effects," added
Dr. Cass.
"This is big news for patients who suffer side effects from
prescription antidepressants such as headaches, weight gain and the most
significant -- sexual dysfunction."
SAM-e and Joint Health
The team also examined 14 studies of osteoarthritis, which causes pain in
the joints. The Evidence Report summary concludes that SAM-e appears to
work as effectively as non-steroidal anti-inflammatory drugs (NSAIDS) in
treating osteoarthritis.
SAM-e and Liver Disease
More than 40 studies of liver disease were analyzed for the Evidence
Report. The summary states promise that SAM-e may have an effect on
intrahepatic cholestasis of pregnancy. This condition, caused by elevated
levels of bilirubin in the liver, occurs in 1 in 500 to 1,000 pregnancies.
The report's summary recommends more studies on SAM-e in the area of liver
disease as well as depression and osteoarthritis to understand "the
risk benefit ratio of SAM-e compared to conventional therapy, especially
for depression and osteoarthritis."
Consumers interested in learning more may view the SAM-e Evidence Report
Summary by logging onto the Department of Health and Human Services'
Agency for Healthcare Research Quality web site at http://www.ahrq.gov/clinic/epcsums/samesum.htm
.
The entire SAM-e Evidence Report is expected to be available to the public
at the same web address in late 2002.
About SAM-e
SAM-e is an acronym for S-adenosyl-L-methionine, a natural compound found
in every human cell and involved in over 35 biochemical processes in the
body. Low levels of SAM-e in the body have been correlated with
depression. In addition, clinical research findings as demonstrated in
this Report Executive Summary support SAM-e's ability to promote joint and
liver health.
SAM-e
has been touted for its fast acting mood elevating benefits and lack of
side effects (such as weight gain and sexual problems) commonly found in
prescription anti-depressants. It was officially introduced into the U.S.
as a dietary supplement in 1998.
Reprinted with permission of
Medline plus Health Information: a service of the National Library of Medicine
More info on SAM-e
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Long-term
effects of glucosamine on osteoarthritis progression: a
randomized,
placebo-controlled clinical trial
BACKGROUND:
Treatment of osteoarthritis is usually limited to short-term symptom control.
We assessed the effects of the specific drug
Glucosamine sulphate on the
long-term progression of osteoarthritis joint structure changes and symptoms.
METHODS: We
did a randomized, double-blind placebo controlled trial, in which 212
patients with knee osteoarthritis were randomly assigned 1500 mg sulphate
oral glucosamine or placebo once daily for 3 years. Weightbearing, anteroposterior
radiographs of each knee in full extension were taken at enrolment and
after 1 and 3 years. Mean joint-space width of the medial compartment
of the tibiofemoral joint was assessed by digital image analysis, whereas
minimum joint-space width--ie, at the narrowest point--was measured by
visual inspection with a magnifying lens. Symptoms were scored by the
Western Ontario and McMaster Universities (WOMAC) osteoarthritis index.
FINDINGS: The
106 patients on placebo had a progressive joint-space narrowing, with
a mean joint-space loss after 3 years of -0.31 mm (95% CI -0.48 to -0.13).
There was no significant joint-space loss in the 106 patients on glucosamine
sulphate: -0.06 mm (-0.22 to 0.09). Similar results were reported with
minimum joint-space narrowing. As assessed by WOMAC scores, symptoms worsened
slightly in patients on placebo compared with the improvement observed
after treatment with glucosamine sulphate. There were no differences in
safety or reasons for early withdrawal between the treatment and placebo
groups.
INTERPRETATION:
The long-term combined structure-modifying and symptom-modifying effects
of glucosamine sulphate suggest that it could be a disease modifying agent
in osteoarthritis.
Excerpt from: National
Library of Medicine: Comment in: Lancet. 2001 Jan 27;357(9252):247-8
Reginster JY, Deroisy
R, Rovati LC, Lee RL, Lejeune E, Bruyere O, Giacovelli G, Henrotin Y,
Dacre JE, Gossett C.
Bone and Cartilage
Metabolism Research Unit (WHO Collaborating Center for Public Aspects
of Osteoarticular Disorders), University of Liege, Belgium.
More info on Glucosamine
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