Natural combo helps in severe arthritis

As painkilling arthritis drugs prove increasingly unsafe, the largest study ever done of popular, natural alternatives - glucosamine and chondroitin - shows they can significantly reduce moderate to severe joint pain.

Used widely in recent years to battle osteoarthritis - the "wear and tear" form of arthritis afflicting more than 20 million Americans - the glucosamine-chondroitin combination of over-the-counter nutritional supplements is coming under heavy scientific scrutiny.

However, this latest study - involving patients at the University of Arizona - is proving highly controversial, with some evidence suggesting the supplements actually did no better than inactive placebos for arthritis sufferers.

"The primary outcome of the study was negative - it was not a ringing endorsement of glucosamine and chondroitin," said Dr. Jeffrey Lisse, interim director of the Arizona Arthritis Center, where some 30 patients were enrolled in the nationwide study.

"But when you look only at those patients with the worst pain, in the moderate to severe range, then glucosamine and chondroitin did better than placebo, or even Celebrex. So it's a confusing trial, depending on how you spin it."

But because glucosamine and chondroitin - dietary supplements containing natural substances found in the cells of joint cartilage - are known to be safe, with very few side effects, Lisse will continue to advise his arthritis patients to give them a try.

"It takes awhile, two to three months, for them to work, and the response is varied," he said. "But you can take them without the fear now linked to many arthritis drugs, and you may get a good response."

Glucosamine-chondroitin therapy burst on the medical scene in the late 1990s, when a Tucson-based sports medicine physician, Dr. Jason Theodosakis, wrote the best seller "The Arthritis Cure." In it, he argued that these easily obtained supplements were far more effective, and safe, than prescription painkillers for osteoarthritis.

Taken together, they not only ease pain, but actually repair damaged, thinning cartilage that causes the pain, according to Theodosakis.

At first, most physicians derided these claims as unproven "snake oil." But as a series of scientific studies began to demonstrate effectiveness, doctors gradually joined the glucosamine-chondroitin bandwagon, with many - including specialists at the Arizona Arthritis Center - now routinely recommending them.

The supplements have become increasingly popular as prescription painkillers known as nonsteroidal anti-inflammatory drugs (NSAIDs) - most notably Vioxx - were yanked off the market, blamed for causing heart attacks, strokes and death in regular users.

Those left on the market - mainly prescription Celebrex, also over-the-counter pain relievers such as Advil and Motrin - must all now carry "black box" warnings of dangerous side effects.

That is why the results of the largest study ever done of glucosamine and chondroitin - the nationwide Glucosamine/ Chondroitin Arthritis Intervention Trial - have been so eagerly awaited by patients and physicians wanting to know what really works on this painful disease that affects so many.

Launched two years ago, the trial tested the effects of the two supplements alone and in combination, comparing them to Celebrex and inactive placebo, when used for six months in nearly 1,600 patients suffering arthritis of the knee with various levels of pain.

Funded by the National Institutes of Health, the $16 million study was conducted at 16 U.S. medical centers, including the UA, where some 30 arthritis patients were tested.

Across the whole spectrum of arthritis patients, glucosamine and chondroitin, either alone or together, did no better at relieving pain than placebo pills, while Celebrex did show a response.

But in what some say is the study's key finding, those results changed dramatically among patients with greater pain. In that smaller group - about 20 percent of patients - nearly 80 percent of those taking the glucosamine/chondroitin combination experienced significant pain relief, compared with 69 percent who took Celebrex, and 54 percent taking placebo.

"Given the fact that the combination of supplements blew away Celebrex in those people who actually needed intervention (the high-pain group), it's clear that it may become malpractice to use anti-inflammatory drugs as first-line therapy, unless the patient has failed six months of (glucosamine-chondroitin) therapy," said Theodosakis in a statement on the trial results.

Considerably more cautious, the American College of Rheumatology - where the results were announced this month - said only that the supplements "may be an effective combination in reducing pain associated with osteoarthritis of the knee," in a statement.

The group pointed out that the glucosamine and chondroitin used in the NIH study was specially formulated, and is not the same as what is available to consumers in drugstores.

Also, the study findings are considered preliminary at this point, because they have not yet been reviewed and published in a medical journal, said the NIH, refusing to comment on the results until they are.