Which Joint Cocktail Should I Choose?

As Physical Therapists we often find ourselves on the forefront of many new modalities and treatments to alleviate or cure some form of dysfunction. In the realm of holistic medicine joint supplements have, in recent years, exponentially grown in popularity.  As a result patients with osteoarthritis (OA) often ask us what supplement works best or works at all.  The increased popularity with joint supplements has opened the door for much more quackery in promising cures for joint disease and dysfunction.  Doctors with unknown credentials promise relief in pain and swelling if the patient will just commit to a monthly supply of supplements.  As a result, as the musculoskeletal specialists that we are, Physical Therapists, with the intent of achieving more a primary care role, owe it to their patients to be educated on these holistic medicines to sift through the quackery and find a cocktail that works best for each individual patient.

To date, there has been a significant number of studies pushing for the efficacy or denying the efficacy of joint supplements.  Consistently three substances appear in the literature: glucosamine, chondroitin, and hyaluronic acid.  Under scrutiny and a microscope, glucosamine and chondroitin have been studied together in the joint cocktails.  To date, the research tends to suggest that these two do not have significant effect in relieving joint pain from OA. Some articles have reported a slowing down of joint OA, but no improvements in patient function or pain.  The overwhelming consensus leads towards exercise prescription and the psychological effects of the supplements that show an overall improvement in patient function.  With hyaluronic acid, little research has been down to the effectiveness of supplements, but it is widely used in injection therapy for pain relief and synovial joint fluid.  Common sense would hold that oral supplement could achieve similar effects as the injections, but not a lot of research in this realm.

Additional studies through a meta-analysis have found potential benefits of vitamin suplements in treating OA.  Vitamin D has been found to be of potential use in preserving the integrity of the joint space.  Also, the extract called avocado-soybean unsaponifiables has been speculated to have similar effects as glucosamine and chondroitin.  Again, the research is inconclusive that any symptomatic relief can be achieved, but that structural changes can be delayed.  Some patients' joints may be too far progressed with OA for any structural difference to be achieved, but working these supplements into a vitamin or daily pill at an early stage may be effective.

The main theme taken from these articles combined is that there is still not enough evidence to support insurance based reimbursement for these supplements.  However, patients can choose to take the pills and pay out of pocket for them.  Based on the above research a supplement with glucosamine and chondroitin only would be a waste of money.  The positive effects a person is experiencing could simply be the placed effect.  Putting these together with hyaluronic acid, the ASU extract and a vitamin cocktail may prove more effective, but remember, not fully validated.  

To put it simply, a patient should be educated based upon the condition of the OA.  If they are young enough and active enough, then maybe these joint supplements would be effective, but if the patient has been dealing with OA on a chronic basis, degenerative changes that have occurred with be difficult, if not impossible, to reverse.  As with the article headed by Wandel et al., the if the supplements pose no health risks to the patient and they are able to cover the costs themselves, then even the placebo effect can be of a positive outcome.  As physical Therapists we can educate our patients on the effects of certain supplements while giving the full needed detail of the nature of the disease process so the the patient can make an informed and educated decision.  Another avenue we can take is to find the supplements that have the proper cocktail ahead of time to better prepare the patient to make a decision he can be satisfied with.  At the end of the day what matters most is a patient's safety and satisfaction with the care he has received.

 References:

1. Baron and Rubin. Managing Osteoarthritic Knee Pain. JAOA. Vol:107. 2007.

2..  Wandels S. et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knees: a meta-analysis. BMJ. 2010;34:c4675.

3. Yuanyuan W. The effects of nutritional supplements on osteoarthritis. Alternative Medicine Review. Vol. 9; 2004: 275-296.

4. Sawitzke AD, et al. Clinical efficacy and safety over two years use of glucosamine, chondroitin sulfate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: a GAIT report. Ann Rheum Dis. 2010; 69(8):1459-1464.