Reaching for relief from arthritis

Glucosamine and chondroitin — two dietary supplements whose names are difficult to pronounce and whose benefits, for some people, often are difficult to comprehend.

Believed by many laymen and health professionals to alleviate moderate to severe joint pain, they also have been shown in some studies to inhibit the progress of osteoarthritis, the most common form of arthritis, which involves the degeneration of cartilage, the buffer material found at the ends of bones. In its worst phase, the disease can lead to a permanent loss of motion.

About 20 million Americans have osteoarthritis, with obesity one of the prime causes, says Dr. Lee Ann Rhodes, director of pain management at Washington Hospital Center. Extreme weight puts pressure on the joints, she says, and with age, the condition can worsen.

“Despite that,” she says, “two-thirds of people suffering from osteoarthritis are under 65 years of age.”

Because cartilage has no nerve endings, “some people can have osteoarthritis without pain but have problems with motion and movement.”

Under the Alternative Therapies section on its Web site (www.arthritis.org/conditions/alttherapies/), the Arthritis Foundation defines glucosamine as “a form of amino sugar that is believed to play a role in cartilage formation and repair. Chondroitin sulfate is part of a large protein molecule (proteoglycan) that gives cartilage elasticity.” Both substances are found naturally in the body. In a complex and expensive process, glucosamine for supplements is extracted from animal tissue such as crab, lobster or shrimp shells, and chondroitin sulfate is extracted from animal cartilage.

The difficulty of determining the supplements’ benefit — as pills taken once, twice or three times daily — stems from several factors, one of which is frequently confusing advice given about amounts needed and length of time required to show any effect. Another obvious factor is that individuals, with their different medical histories, will react to the supplements in different ways.

“You start from the patient’s perspective. Medical care is the person and not just the disease,” says Dr. Kathy Brennaman, a geriatrician at Providence Hospital, who says she may use supplements in combination with medications such as ibuprofen, Tylenol or the prescription drug Celebrex.

“I tend to do one drug at a time,” she says. “I tell people to give [glucosamine and chondroitin] a try, to do it for a month and then evaluate matters to be sure there are no side effects.”

She says the only issues she knows about are when the supplements are used alongside anticoagulants because “they can mess up timings.” She also has heard of the possibility of gastric upset when several medicines are taken. She notes, however, that her patients are the very old — “people with multiple disease processes for whom function and ability to get around is top of the list.”

The largest federal study done to date on the popular supplements was nicknamed GAIT, for Glucosamine/chondroitin Arthritis Intervention Trial, and was conducted at several medical centers in the United States under the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health.

Reaction to results, first published last year, were mixed, to judge by a panel of joint health experts speaking at this month’s annual meeting of the American College of Rheumatology in the Washington Convention Center. Billed as the “Great Debate,” the session raised doubts about the numbers involved in the study, recruitment and control of participants, and the amount and time of the dosages used. Further work is planned.

Dr. Jason Theodosakis, a member of the NIH study’s steering committee and author of the book “The Arthritis Cure”— a misleading title, he agrees — is an avid proponent of glucosamine and chondroitin, especially when used in combination with another supplement known as ASU, avocado soybean unsaponifiables, a vegetable extract.

He is, however, concerned about the composition of many commercial brands of glucosamine and chondroitin. As dietary aids sold over the counter, they are not regulated by the Food and Drug Administration and, hence, as the Arthritis Foundation warns, “quality and content may vary widely.”

The use of inferior ingredients, introduced to lessen overall cost, can lessen their palliative and curative impact, Dr. Theodosakis says. For this reason, he says, he decided some years ago to produce his own version (www.drtheo.com). Among brands that have held up in independent testing, he says, are Osteo Bi-Flex from Rexall, Cosamin DS from Netramax Labs and TripleFlex from NatureMade.

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