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Popular supplements fail to ease arthritis pain

/ Source: The Associated Press

For many arthritis sufferers, there has been a long and frustrating search for the best and safest pain relief. For some, the quest seemed to lead to a health store for supplements.

But the largest and most rigorous study so far suggests the salve for mildly aching knees doesn’t lie there. The popular supplements, glucosamine and chondroitin sulfate — once used even by President Bush — were no better than dummy pills at pain relief, government researchers concluded.

At the same time, the supplements did seem to help people with more severe arthritis, although more research is needed.

“We still have a bit of a conundrum,” said Dr. Tim McAlindon, a Tufts University rheumatologist who had no role in the new study.

The long-awaited research, funded by the National Institutes of Health, is the latest effort by the government to scrutinize these untested health remedies.

Lead researcher Dr. Daniel Clegg of the University of Utah suggested people with severe arthritis talk to their doctors about trying the supplements short-term to see if they work.

Dr. John Klippel, president of the Arthritis Foundation, said arthritis sufferers should not necessarily abandon glucosamine and chondroitin.

“Supplements continue to be an important option for some people,” he said. “We’re reminding people there are lots of choices that people need to make and supplements are one of them.”

More than 20 million Americans suffer from osteoarthritis, the most common form of arthritis. That number is expected to double in the next two decades as baby boomers age. Osteoarthritis is a degenerative joint disease that affects the knees, hips, back and the small joints in the fingers.

The search for pain relief helped boost worldwide sales of glucosamine and chondroitin to $1.7 billion last year, according to the Nutrition Business Journal, which tracks supplements. The supplements — made from animal cartilage and shellfish — have had even wider appeal amid safety concerns over certain painkillers, including the arthritis medicine Vioxx, which was yanked from the market in 2004.

At least 5 million Americans use the two supplements either alone or together, government figures show. President Bush has acknowledged taking the combination supplements to ease stiffness in his joints from running, but he no longer uses them.

The supplements showed no known side effects during the government’s six-month study, but the scientists didn’t address the safety of longer-term use.

The arthritis research, published in Thursday’s New England Journal of Medicine, is the third major study in a year to find no overall benefit from some of the most popular nutritional supplements. Recently, research showed the herb saw palmetto didn’t reduce symptoms of an enlarged prostate, and last year a study indicated echinacea didn’t prevent or treat colds.

Lax regulations

Unlike drugs, such supplements are only loosely regulated by the U.S. Food and Drug Administration and their makers don’t have to prove the products are safe or effective.

One consumer who plans to keep using the supplements is 72-year-old Irene Schwartzburt. She said the remedies relieved the “sticking pain” in her right knee when painkillers failed.

“I want to stay active,” said the retired teacher from Plainview, N.Y. “The supplements work for me so why not continue with them?”

In the government study, 1,583 patients with arthritis knee pain received one of five treatments: either glucosamine or chondroitin, a combination of both, the painkiller Celebrex or dummy pills. Neither the doctors nor patients knew which treatment was given.

After six months, patients filled out a questionnaire to determine how many felt a 20 percent reduction in pain. Researchers found the supplements when taken alone or together were no more effective than dummy pills at pain relief.

Sixty percent who took the dummy medication had reduced pain compared with 64 percent who took glucosamine, 65 percent who took chondroitin and 67 percent who took the combo pills. These differences were so small that they could have occurred by chance alone.

The drug Celebrex did reduce pain — 70 percent reported improvement — affirming the study’s validity. However, the drug is being studied to see if it’s safe for people at risk of heart problems.

Of the 354 people with moderate to severe pain, 79 percent who took both supplements reported relief compared with 54 percent who took the dummy pills and 69 percent who took Celebrex.

In a journal editorial, Dr. Marc Hochberg of the University of Maryland noted the study’s limitations: a high dropout rate (20 percent) and a whopping 60 percent who said the dummy pills made them feel better — double the usual placebo effect. Hochberg has received consulting fees from Pfizer Inc., which makes Celebrex, and Merck & Co., which made Vioxx.

Clegg, the lead researcher, and 10 other scientists who worked on the study reported receiving fees or grant support from Pfizer or McNeil Consumer & Specialty Pharmaceuticals, which makes Tylenol.

The Council for Responsible Nutrition, which represents dietary supplement makers, said it was pleased about the positive findings in the severe arthritis group.