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Health News Archive 9 - Osteoarthritis
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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 .

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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