RESEARCH - Supplements fail to stop arthritis pain, study says

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Supplements Fail to Stop Arthritis Pain, Study Says

By GINA KOLATA

Published: February 23, 2006

Two widely used nutritional supplements for arthritis pain do not

effectively soothe patients' aching arthritic knees, a large federal study

has found.

The study of the two drugs, glucosamine and chondroitin sulfate, was

published today in The New England Journal of Medicine. The study was meant

to provide a definitive answer to a question that has baffled doctors and

patients alike: do these supplements work?

Americans spent an estimated $734 million on glucosamine and chondroitin in

2004, according to The Nutrition Business Journal, making them among the

most widely used dietary supplements in the nation. The two, which are

produced by numerous companies, are often sold in combination as a treatment

for arthritis.

In the 24-week study, 1,583 patients with osteoarthritis of the knee were

randomly assigned to one of five groups. Some patients took glucosamine,

some took chondroitin and some took both. Others, serving as comparison

subjects, took a placebo or celecoxib, sold as Celebrex, a prescription drug

that is approved for osteoarthritis.

No effect was found for glucosamine, chondroitin or a combination of the

two. But the study found that the patients who took celecoxib had a

statistically significant improvement in their symptoms.

Although the new study found no overall effect for the supplements, the

authors and some other medical researchers said that an analysis of a

subgroup of patients provided hope - although not definitive evidence - that

the supplements taken together might help some people with more severe pain.

" Patients who had more pain did seem to be helped by the combination, " said

Dr. O. Clegg, a researcher at the University of Utah School of

Medicine who was the lead author of the study.

But Dr. Clegg hastened to add that this observation would have to be

confirmed in later studies.

Dr. Marc C. Hochberg, the head of the division of rheumatology and clinical

immunology at the University of land, said it was also possible that

another type of glucosamine might be effective.

The study used glucosamine hydrochloride because it was the only type that

could be manufactured at the time in a sufficiently pure form. In Europe,

where glucosamine and chondroitin are sold as drugs, glucosamine comes in

the form of glucosamine sulfate, Dr. Hochberg said, and some

industry-supported studies have indicated that this form helps.

But others said there was no reason to expect that glucosamine sulfate would

be any different from glucosamine hydrochloride. They said they viewed the

study's finding that the supplements had no benefit as persuasive.

" It's a null trial, " said Dr. Felson, a rheumatologist at Boston

University. " It doesn't work any better than placebo. "

Because the supplements are so popular, the results of the trial had been

eagerly awaited.

" We've been talking about the importance of this study for the last two or

three years, " said Dr. Klippel, president and chief executive of the

Arthritis Foundation.

" When people have been asking about glucosamine and chondroitin, we tell

them this is the most important study ever done, " Dr. Klippel said. " It has

a very large number of patients and it is scientifically rigorous. "

Previous studies had methodological flaws, and their results were

contradictory. A handful of publicly financed trials showed no effect, Dr.

Felson and others said. Other studies, financed by supplement makers, " were

impressively positive, " Dr. Felson said.

Dr. Clegg said the new study, financed by the National Center for

Complementary and Alternative Medicine and the National Institute of

Arthritis and Musculoskeletal and Skin Diseases, arose after an expert panel

in 1998 concluded that " there is a real and urgent public health need to

test these agents in a rigorous way. "

Glucosamine and chondroitin are substances found naturally in joints,

leading some to suggest that they might be helpful for arthritis patients.

Glucosamine is a modified sugar that is thought to play a role in the

formation and repair of cartilage, and chondroitin is part of a large

protein, proteoglycan, that provides elasticity to cartilage.

But, arthritis researchers say, they know of no biological reason why eating

those compounds would help people with arthritis.

Dr. Tim McAlindon, chief of rheumatology at Tufts-New England Medical Center

in Boston, said that glucosamine traveled to the liver, which then broke it

down. Almost no glucosamine that is eaten actually gets into the blood,

where it can travel to the joints, Dr. McAlindon said, adding, " The amount

that gets beyond the liver is minuscule. "

Chondroitin, a large molecule, is digested, Dr. McAlindon said, but it is

broken into pieces in the intestines and none of it gets through intact to

the joints.

Still, many arthritis patients swear by the supplements, which cost $30 to

$50 a month, said Dr. Shao, vice president for scientific and

regulatory affairs at the Council for Responsible Nutrition, a trade

association for the dietary supplement industry.

Dr. E. Straus, director of the National Center for Complementary and

Alternative Medicine, a sponsor of the new study, said a national survey in

2002 found that about 5.2 million Americans had used one or both supplements

in the preceding year. Dr. Straus noted that arthritis joint pain and

stiffness were among the leading reasons for seeking alternative medical

treatments.

Glucosamine and chondroitin are also marketed for pets - dogs and horses in

particular - and veterinarians routinely prescribe them for arthritic

animals.

MacLeod, 65, an administrative assistant who works in Manhattan, said

that as far as she was concerned, the supplements worked.

" The difference is like walking on a spike and having padding in your knee, "

Ms. MacLeod said. " The medical profession says that can't happen, but I'm

not in pain and I take no other drugs. "

Despite the study's findings, she said, " I'm going to continue doing it. "

The study found that in a subgroup, consisting of patients with

moderate-to-severe knee pain, 79 percent of those who took the supplements

together improved compared with 54 percent of those who took a placebo.

Such findings are viewed by most researchers as fodder for further studies

but not as rigorous evidence in themselves, because they can be caused by

random fluctuations in data and tend not to be confirmed in subsequent

studies.

Some experts, however, said they thought the finding in the subgroup was

likely to be real.

" Our take on this study is that it did find that the combination relieved

pain in people who have moderate-to-severe pain, " said Dr. Klippel of the

Arthritis Foundation.

M. Halloran, a biostatistics professor at the Fred Hutchinson

Cancer Research Center and the University of Washington in Seattle, who had

no association with the study, also thought there was an effect.

Dr. Halloran said she was swayed not only by the data but also by her

sister's experience giving the supplements to her arthritic dog.

" If I had severe pain from osteoarthritis of the knee, based on this study,

I would try glucosamine and chondroitin sulfate, " Dr. Halloran said.

But Berry, chairman of the department of biostatistics at M. D.

Cancer Center, in Houston, who had no association with the study,

said he was completely unconvinced by the subgroup finding.

" This is a spurious subset result if I've ever seen one, " Dr. Berry said. " I

wouldn't spend a nickel trying to confirm it. "

http://www.nytimes.com/2006/02/23/health/23arthritis.html?pagewanted=1 & _r=1 & ei=5\

094 & en=5b999c1cff93f0dc & hp & ex=1140670800 & partner=homepage

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org