A look at nontraditional therapies for treating arthritis

Dear GeezerJock Doc:

I am an active runner/triathlete in the 65-69 age group. I had knee surgery in October for a meniscus tear and debris removal. I also had a series of Orthovisc injections to help the cartilage. I have been taking chondroitin/glucosamine supplements but recently
changed to a liquid because it includes MSM and collagen. Could you write about these supplements and if they are helpful in the long run?

-- Judy in Pennsylvania

I will use your question as an opportunity to discuss some of the various nontraditional therapies for osteoarthritis. Osteoarthritis is a disease of the lining cartilage of the joints. As the disease progresses, the cartilage is less able to bear weight and will cause pain, swelling and limited mobility.

An often overlooked factor in arthritis is weight. If you are overweight, weight reduction is crucial. It will ease the load transferred to the cartilage, decreasing the pain and the wear on the joint. This applies mostly to lower extremity joints -- your hips, knees and ankles.

There are many over the counter supplements advertised for the treatment of arthritis. I will discuss some of the more common ones, most of which are not regulated. Glucosamine is a derivative of a sugar that is widely distributed in the body. It is a major of component of cartilage. The theory is that supplemental glucosamine will help rebuild cartilage. The normal daily dosage is 1,500 milligrams. It is well tolerated and has few side effects. In the United States, it is sold as a dietary supplement and poorly regulated as to the quality of each brand. In Europe, it is more closely regulated and is approved as a medical drug.

Chondroitin is a complex carbohydrate that is also a major component of cartilage. It helps the cartilage retain water, increasing its resilience and elasticity. A typical daily dose is 1,200 millgrams, often in combination with glucosamine. Clinical trials on the efficacy of glucosamine-chondroitin in treating arthritis have been all over the place. Some are positive; others show no change. For example, a recent study published in the New England Journal of Medicine found that those with more severe knee pain benefited from the treatment; those with mild pain showed no benefit.

MSM is an organic sulfur compound. Sulfur is an important part of cartilage. MSM has been shown to be safe at the recommended daily dosage of 1,500 milligrams. Like the other over the counter remedies, some studies support its usage, and others found it had no effect.

SAM-e was originally used in Europe. It is said that the product helps build cartilage; it is also touted as a treatment for depression as a mood elevator. Trials of SAM-e have produced varying clinical results regarding its effect on arthritis. The usual daily dosage ranges from 800 milligrams to 1,600 milligrams.

The orthopedic community is undecided as to the efficacy of most of these compounds. Many orthopedic surgeons will recommend their patients to try a combination of glucosamine and chondroitin. We counsel these people to not expect any significant pain relief for a few months. People should also make an effort to try and investigate the quality of the supplement they are taking because of the poor regulation of the industry.

I also wanted to mention visco supplementation, which is a relatively new approach to treating arthritis. At this time it is only approved by the Food and Drug Administration for the knee. This treatment consists of a series of three to five injections of hyaluronic acid directly into the knee joint over a three- to five-week period. This substance is an important component of articular cartilage. It coats the cartilage cells and keeps the cartilage strong by helping it to hold water molecules.

Over time and with arthritis the hyaluron in the knee loses water and becomes thinner. The result is more pain. The injections increase the viscosity of the joint, resulting in better lubrication and a possible pain-relieving effect. Synvisc, Euflexxa, Orthovisc, Hyalgan and Supartz are a few of the brand name hyaluronic acids on the market.

In summary, these are some of the alternative treatments for arthritis. They are not that well studied, and some are poorly regulated. The upside is that most are very well tolerated with minimal side effects. In my practice I often recommend these treatments. I often use visco supplementation for arthritic knees. These injections are usually covered by insurance and can be repeated at six-month intervals if you have relief.

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Written by orthopedic surgeon and Masters sprinter Allan Tissenbaum, M.D., GeezerJock Doc is a forum for your questions about injuries, exercise and getting older. Submit questions to geezerjockdoc@geezerjock.com or mail to GeezerJock Doc, 2033 W. Hutchinson St., Chicago, IL 60618.