Osteoarthritis, which is the most common form of arthritis in many countries, is a condition characterized by functional impairment and pain in the joints.
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This joint pain may affect one’s daily recreational and occupational activities and is as a result of a panoply of biological processes that involve periarticular structures, synovium and subchondral bone, in addition to other non-cartilaginous structures.
Several avenues may be employed with regards to the management of osteoarthritis.
While interventions that target the affected joints may include pharmacologic and nonpharmacologic therapy, surgery may also be considered. Furthermore, management typically involves dealing with osteoarthritis-associated conditions such as sleep disturbances and depression.
The primary goal of treatment is to reduce the pain and functional impairment that accompanies this fairly prevalent condition.
To date, there is no convincing evidence to support the notion that supplements can lessen osteoarthritis-related symptoms or augment the body’s natural defense against the pathogenesis of osteoarthritis.
Nonetheless, many people with osteoarthritis report trying different supplements in efforts to lessen the burden of their disease. These supplements include chondroitin sulfate, glucosamine, methylsulfonylmethane (MSM), dimethyl sulfoxide (DMSO), and an array of herbs.
Chondroitin sulfate and glucosamine
Chondroitin sulfate and glucosamine are frequently taken together and are marketed as agents that support healthy joints. This is despite the preponderance of findings, which illustrate that these two agents do not have any significant effects on improving joint functionality or reducing joint pain.
Furthermore, reputable bodies, such as the Osteoarthritis Research Society International, which is dedicated to advancing osteoarthritis research, has not found contemporary evidence to support the use of either agent against osteoarthritis.
Three reports that were published from the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), which was funded by the US National Institutes of Health (NIH), found that there were no clinically meaningful differences between glucosamine and chondroitin sulfate when compared to celecoxib and placebo.
These reports were made gauging for differences in joint functionality or pain reduction after 6 and 24 months of study. Nonetheless, despite the non-clinically significant effects, these two agents, appear to be well tolerated and reasonably safe when used in their suggested doses over 2 years.
MSM and DMSO
Like chondroitin sulfate and glucosamine, DMSO and MSM are two other supplements reportedly taken by those who suffer from osteoarthritis. Likewise, there is no contemporary evidence to support their use in disease-modifying effects.
Furthermore, DMSO has been associated with minor side effects such as skin irritation and bad breath, while MSM has also had reports of minor skin irritation and upset stomach.
The use of herbs, such as avocado, willow bark, soybean, and topical capsaicin, to counter the effects of osteoarthritis has only been weakly supported by the very few scientific studies conducted.
Moreover, a limited number of herbs were taken into consideration in these studies, and the conclusions drawn by systematic reviews of the literature were contradictory. Many of these investigations are limited to small clinical trial reports and case studies.
Thus, it is uncertain whether these remedies truly affect patients with osteoarthritis.
Management of osteoarthritis
The mainstay of therapy for osteoarthritis is nonpharmacologic in the first instance, and pharmacotherapy is added as needed.
Weight loss of at least 10% of body weight over time (for those who carry excess weight), diet control, exercise, and lifestyle modifications are the main pillars of nonpharmacologic intervention for patients with osteoarthritis.
Carrying excessive weight puts extra stress on the joints, whereas exercise can improve joint health. Where necessary, foot orthoses and braces may be employed. Pharmacologic therapy is considered when the first line of defense fails to result in appreciable effect and is only used when symptoms flare.
The agent used for pharmacotherapy is joint-specific and also depends on the number of joints involved, as well as any comorbidities that the patient may have.
Topical NSAIDs are generally considered in patients with osteoarthritis of the hand and knee joints. Patients who respond poorly to topical NSAIDs and/ or those who have multiple joints involved or the hip joint may be candidates for oral NSAIDs.
In patients who have contraindications to NSAIDs or present with several comorbidities, then antidepressants or serotonin/norepinephrine reuptake inhibitors may be considered.
When all else fails, surgical intervention may be considered as a last resort, especially in patients who present with advanced osteoarthritis of the knee or hip.
- Osteoarthritis. Available at: https://www.nhs.uk/conditions/osteoarthritis/
- Osteoarthritis supplement study. Available at: https://www.nhs.uk/news/food-and-diet/osteoarthritis-supplement-study/
- Brien, S., Prescott, P., Bashir, N., Lewith, H. and Lewith, G., 2008. A systematic review of the nutritional supplements dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM) in the treatment of osteoarthritis. Osteoarthritis and Cartilage, 16(11), pp.1277-1288.
- Wandel Simon, Jüni Peter, Tendal Britta, Nüesch Eveline, Villiger Peter M, Welton Nicky J et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis BMJ 2010; 341:c4675