Page 9 - SMU Winter 2020

TEAM PHYSICIAN’S CORNER
NUTRACEUTICALS FOR
JOINT INFLAMMATION & PAIN
BY LEE DIEHL, MD
TEN TO 15 YEARS AGO it was common for physicians to recommend
glucosamine and chondroitin sulfate supplements for the management
of pain and stiffness related to early knee arthritis. In fact, many of us
took them ourselves.
A review article published in 2007, from the WHO Collaborating
Center for Public Health Aspect of Osteoarticular Disorders, University
of Liege Belgium, stated guidelines from EULAR (the European League
Against Rheumatism) and the United States, which included “Glucosamine
sulfate has efficacy in treatment of OA.” It was given a “Strength A”
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recommendation, which indicated per their guidelines, the “highest
level of evidence” due to high quality studies.
They also referenced a 2006 article presenting findings from a
multicenter randomized, blinded, placebo controlled, study which found
statistically significant differences in pain VAS and WOMAC in favor of oral
chondroitin sulfate supplements. Their conclusion was “oral chondroitin
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sulfate is a valuable symptomatic treatment for OA disease.” The US
National Institute of Health published the results of a glucosamine treatment
trial in 2008. Overall, they did not find significant differences except in a
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small subset of patients with moderate
to severe pain, where 79 percent showed
a 20 percent or greater reduction in pain
versus 54 percent in the placebo group.
Fast forward to 2013, and presumably
an updated review of published evidence,
the American Academy of Orthopaedic
Surgeons (AAOS) 2013 Osteoarthritis
Treatment Guidelines says, “We cannot
recommend using glucosamine and
chondroitin for patients with symptomatic
osteoarthritis of the knee.” The strength
of that recommendation is “Strong,” which
indicates the quality of the supporting
evidence is “High,” based on at least two or
more “High” strength studies showing no
benefit. The stated implication of a “Strong”
recommendation is that practitioners
should follow it, “unless there is compelling
rational for an alternative approach.”
They stated that no “harm analysis” was
performed, so this change seems unrelated
to a rash of unexpected injury, but
more likely due to a failure of purported
efficacy. Glucosamine and chondroitin
sulfate are still listed on many common
arthritis treatment websites and combined
in many multi-ingredient oral supplements
available in stores and online, advertised
to help symptoms of osteoarthritis.
of Nutrition described nutraceuticals
In 2009 the International Journal
as “Functional foods, natural products,
or parts of food that provide medicinal,
therapeutic, or health benefits, including
prevention and treatment of disease.”
Nutrition supplements in the U.S. is big
business. The perennial knock on the
multi-billion dollar supplement industry
is typically related to quality control.
Non-FDA regulated, there are recurring
questions regarding the purity, quantity/
quality, and effectiveness of widely
available supplements. Are you getting
what you think you are getting and is
it doing what you’ve been told it will?
Despite these realistic concerns, people
continue to seek nutraceuticals to help
manage the symptoms of osteoarthritis.
Three examples of available OTC
supplements with current literature
supporting their use are Turmeric,
Avocado Soybean Unsaponifiables,
and Undenatured Type II Collagen.
Winter 2020, Issue 1 | sportsmed.org 7 