With help of supplements, some arthritic people report less pain

By JANE E. BRODY
New York Times / 1998

NEW YORK -- The two questions I was asked most often in 1997 were, "Is that dietary supplement still helping your arthritic knees?" and, "Are there results yet from the studies being done on this side of the Atlantic?"

Fourteen months ago, following my arthritic spaniel's dramatic improvement upon taking a supplement containing two substances that play a role in the formation of cartilage, glucosamine and chondroitin sulfate, I decided to try the stuff myself. Two months later -- ignoring amused queries such as "Are you barking yet?" -- I reported about a 30 percent improvement: less pain and stiffness and little or no swelling after activities that gave my knees a workout, such as tennis and ice-skating.

A year later, my dog and I are still taking the supplement, though at lower daily doses. My dog, who will be 13 in June, appears to be free of pain and stiffness. He walks two hours a day, goes up and down stairs easily and regularly climbs a mountain road with me. I continue to play singles tennis two to four times a week and skate four or five times a week, and I have added a daily 3½-mile brisk walk to my activities.

Despite recent X-rays showing advanced arthritis in one knee and moderately advanced arthritis in the other, my knees do not swell anymore and are no longer stiff after prolonged sitting. I do not have pain-free knees, but I no longer have disabling discomfort, a chronic limp or difficulty going down stairs, and I have greatly reduced my use of ibuprofen, which while relieving pain and swelling may contribute to joint deterioration.

Anecdotes abound

My dog and I are not alone. My mailbox has been stuffed with testimonials from others who have ventured into this form of alternative medicine to cope with their arthritis.

One elderly Brooklyn man said that after three years of crippling pain, he has thrown away his cane and now walks a mile a day. An Arizona woman in her 70s who could hardly walk now walks a mile and a half every morning with her once equally crippled 13-year-old dog. A 67-year-old man in North Carolina reports that after being sidelined by arthritis, he has resumed square dancing.

An orthopedic surgeon in Rochester, N.Y., told of a patient who canceled knee-replacement surgery after improving on the supplements.

And Jason Theodosakis, the Arizona doctor who last January turned glucosamine and chondroitin into a national craze, said he was among thousands of patients helped by one or both substances, which are not covered by medical insurance because they are sold as dietary supplements rather than drugs.

Theodosakis, author with Brenda Adderly and Barry Fox of The Arthritis Cure (St. Martin's Press, $22.95 hardcover and $6.50 paperback), includes additional testimonials in a follow-up work, Maximizing the Arthritis Cure, to be published this month by St. Martin's Press ($22.95). Among them are the stories of a 70-year-old man who was able to dance for the first time in 10 years and a priest who was no longer stiff getting off his knees in church.

No dietary supplement alone can be expected to cure osteoarthritis, the wear-and-tear degeneration of the cartilage that cushions the ends of bones in each body joint.

Theodosakis devotes the bulk of his new book to exercises that foster aerobic conditioning, muscular strength and flexibility and a diet that counters overweight. I can testify to the value of both. My knees hurt when I carry just 10 extra pounds in my arms for any distance. If those pounds were on my frame, they would be carried by my knees as well.

Not everyone improves on the supplements. If cartilage has completely worn away, it cannot be rebuilt. On average, about half of those who try the supplements report reduced pain and stiffness.

What studies show

But anecdotes do not establish facts. Well-designed studies are needed to prove or disprove the value of a remedy. Patients must be randomly assigned to take either the substance in question or a look-alike inactive or comparison remedy, and neither patients nor evaluating physicians can know who is on what until the study is completed.

While positive results from good studies continue to be published in Europe, there are still no published results of such studies in people on this side of the Atlantic. Two unpublished American studies, good but less than perfect, have been completed using the combination treatment. A third, more exacting study in Canada is nearly finished; it enlisted 100 patients in a 16-week trial of glucosamine alone.

The Canadian researcher, Dr. Joseph B. Houpt, a rheumatologist at the University of Toronto, maintains that there is little point in testing the combination regimen before defining the benefits of the individual components. Others, pointing to extensive studies in Europe of glucosamine alone and a few studies of chondroitin, believe the combination is synergistic, meaning that the two together produce greater benefits than would be expected simply from adding their individual effects.

Dr. Amal K. Das Jr., an orthopedic surgeon in Hendersonville, N.C., has completed a study of nearly 100 patients treated for six months with both glucosamine and chondroitin sulfate.

"We found the combination of 1,500 milligrams glucosamine and 1,200 milligrams of chondroitin daily to be effective for treating the pain of mild to moderate arthritis confirmed by X-ray," he said.

Patients were evaluated using numerous measures of pain, including their discomfort when walking and climbing stairs. Das and others report that the supplements caused no adverse reactions.

Another study, of 34 Navy divers by Dr. Alan Philippi and Dr. Christopher Leffler at the Portsmouth Naval Medical Center in Virginia, is said by other researchers to have found significant relief of knee pain but no improvement in function after eight weeks on the supplements.

Several new university-based studies of arthritic horses and dogs as well as basic laboratory studies continue to point to functional benefits and healthy changes in joint cartilage associated with the supplements. For example, Dr. Louis Lippiello, a biochemist at Medical Professional Associates of Arizona, found in cell cultures and in dogs that each substance independently increased synthesis of cartilage components and that the two together did even better.

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