Glucosamine

Inconsistent evidence hints that glucosamine can reduce symptoms of mild to moderate arthritis; a small amount of evidence indicates that regular use can slow down the gradual worsening of arthritis that normally occurs with time.

Chondroitin Sulfate

As described in the previous section, the supplement chondroitin is often combined with glucosamine. Several studies have evaluated chondroitin used alone, as well, with some positive results, both for improving symptoms and slowing the progression of the disease. On balance, however, the evidence for chondroitin’s effectiveness for osteoroarthritis remains inconsistent. 197

S-adenosylmethionine (SAMe)

A substantial body of scientific evidence indicates that S-adenosylmethionine (SAMe) can relieve symptoms of arthritis. 50,203 Numerous double-blind studies involving more than a thousand participants in total suggest that it is approximately as effective for this purpose as standard anti-inflammatory drugs.

One of the best double-blind studies enrolled 732 patients and followed them for 4 weeks. 205 Over this period, 235 of the participants received 1,200 mg of SAMe per day, while a similar number took either placebo or 750 mg daily of the standard drug naproxen. The majority of these patients had experienced moderate symptoms of osteoarthritis of either the knee or of the hip for an average of 6 years.

The results indicate that SAMe provided as much pain-relieving effect as naproxen and that both treatments were significantly better than placebo. However, differences did exist between the two treatments. Naproxen worked more quickly, producing readily apparent benefits at the 2-week follow-up, whereas the full effect of SAMe was not apparent until 4 weeks. By the end of the study, both treatments were producing the same level of benefit.

In a double-blind study that compared SAMe against the new anti-inflammatory drug Celebrex (celecoxib), once more, the drug worked faster than the supplement, but in time both were providing equal benefits. 123

Evidence regarding slowing the progression of arthritis is, at present, limited to studies involving animals rather than people. 52,53

For more information, including dosage and safety issues, see the full SAMe article.

Avocado/Soybean Unsaponifiables (ASUs)

Special extracts of avocado and soybeans called avocado/soybean unsaponifiables (ASUs) have been investigated as a treatment for osteoarthritis with very promising results in studies enrolling a total of several hundred people. 85-92,125

For example, in a double-blind trial, 260 individuals with arthritis of the knee were given either placebo or ASU at 300 or 600 mg daily. 93 The results over 3 months showed that use of ASU significantly improved arthritis symptoms as compared to placebo. There was no significant difference seen between the two doses tested.

Thus far, however, it does not appear that ASU can slow the progression of osteoarthritis. 126

Cetylated Fatty Acids

A type of naturally occurring fatty acid called cetylated fatty acids have shown growing promise for osteoarthritis. It is used both as a topical cream and as an oral supplement.

Three double-blind placebo-controlled studies have found cetylated fatty acids helpful for osteoarthritis . Two involved a topical product, and one used an oral formulation.

In one of the studies using the cream, 40 people with osteoarthritis of the knee applied either cetylated fatty acid or placebo to the affected joint. 128 The results over 30 days showed greater improvements in range of motion and functional ability among people using the real cream than those using the placebo cream. In another 30-day study, also enrolling 40 people with knee arthritis, use of cetylated fatty acid cream improved postural stability, presumably due to decreased pain levels. 145 In addition, a 68-day, double-blind, placebo-controlled study of 64 people with knee arthritis tested an oral cetylated fatty acid supplement (the supplement also contained lesser amounts of lecithin and fish oil .) 147 Participants in the treatment group experienced improvements in swelling, mobility and pain level as compared to those in the placebo group. Inexplicably, the study report does not discuss whether or not side effects occurred. While this is a promising body of research, it is far from definitive. Current advertising claims for cetylated fatty acids go far beyond the existing evidence. For example, a number of websites claim that cetylated fatty acids are more effective than glucosamine or chondroitin . However, no comparison studies have been performed upon which such a claim could be rationally based.

For more information, including dosage and safety issues, see the full Cetylated Fatty Acid article.

Acupuncture

Acupuncture has shown inconsistent benefit as a treatment for osteoarthritis. 72,102,108,109,148,154,169,171,179,191,192,200,206

A 2006 meta-analysis (systematic statistical review) of studies on acupuncture for osteoarthritis found 8 trials that were similar enough to be considered together. 192 A total of 2,362 people were enrolled in these studies. The authors of the meta-analysis concluded that acupuncture should be regarded as an effective treatment for osteoarthritis.

However, as it happens, one study comprised almost half of all the people considered in this meta-analysis, and it failed to find real acupuncture more effective than sham acupuncture. In this study, published in 2006, 1,007 people with knee osteoarthritis were given either real acupuncture, fake acupuncture, or standard therapy over 6 weeks. 169 Though both real acupuncture and fake acupuncture were more effective than no acupuncture, there was no significant difference in benefits between the two acupuncture groups. In general, larger studies are more reliable than small ones. For this reason, it is always somewhat questionable when meta-analysis combines one very large negative study and a number of smaller positive ones to come up with a positive outcome.

Another review, published in 2007, nuanced its conclusions differently. 189 It concluded that real acupuncture produces distinct benefits in osteoarthritis as compared to no treatment, but that fake acupuncture is very effective for osteoarthritis too. When comparing real acupuncture to fake acupuncture, the difference in outcome—while it might possibly be statistically significant—is so trivial as to make no difference in real life. In other words, virtually all of the benefit of acupuncture for osteoarthritis is a placebo effect.

A similar effect was found in another review of 11 randomized trials. Acupuncture decreased pain in people with osteoarthritis pain compared to those who had sham acupuncture or no treatment. Follow-up ranged from 1-12 months. 207

For more information, see the full Acupuncture article.

Other Treatments

A 6-week, double-blind, placebo-controlled study of 247 individuals with osteoarthritis of the knee evaluated a combination herbal product containing ginger and the Asian spice galanga ( Alpinia galanga ). 94  The results showed that participants in the ginger/galanga group improved to a significantly greater extent than those receiving placebo.  However, despite news reports claiming that this study proves ginger effective for osteoarthritis, it only provides information on the effectiveness of the herbal combination. The two double-blind studies performed on ginger alone were small and produced contradictory results. 95,127 Furthermore, another study found that massage combined with the topical application of essential oils made from ginger and orange was no better than massage plus olive oil in patients with osteoarthritis of the knee. 199

A 3-week double-blind study of 220 people with osteoarthritis of the knee found that use of a cream containing the herb comfrey reduced symptoms significantly more than a placebo cream. 181

The herb white willow contains the aspirin-like substance salicin. A 2-week, double-blind, placebo-controlled trial of 78 individuals with arthritis found evidence that willow extracts can relieve osteoarthritis pain. 69 However, another double-blind study enrolling 127 people with osteoarthritis found white willow less effective than a standard anti-inflammatory drug and no more effective than placebo. 142 Again, the likely explanation for these contradictory results is that white willow at usual doses provides relatively modest benefits.

As noted above, the supplement methyl sulfonyl methane (MSM) has shown promise for osteoarthritis when taken along with glucosamine. 138 Besides that study, benefits were also seen in a 12-week, double-blind, placebo-controlled trial of 50 people with osteoarthritis, utilizing MSM at a dose of 3 g twice daily. 155 However, in a comprehensive review of 6 studies involving 681 patients with osteoarthritis of knee, researchers concluded it is not yet possible to convincingly determine whether or not either DSMO or MSM is beneficial. 197

A randomized trial with 200 patients found collagen hydrolysate significantly reduced joint pain when compared to placebo. Patients, who were followed for 6 months, were over 50 years old with hip, knee, elbow, shoulder or lumbar spine pain.208

Other treatments with incomplete supporting evidence from double-blind trials include Ayurvedic herbal combination therapy , 81,174boswellia , 107cat’s claw , 100 a proprietary complex of minerals with or without cat's claw, 156devil's claw , 65,66,157-158proteolytic enzymes , 97,98,159,160rose hips , 143,161-162,188soy protein, 150 and vitamin B 3 . 64

Traditional Chinese herbal medicine has also shown some promise for osteoarthritis. However, one study that compared a commonly used Chinese herbal product (Duhuo Jisheng Wan) to the drug diclofenac found that the herb worked more slowly than the drug, yet produced about an equal rate of side effects.

Growing but definitive evidence suggests that the natural substance hyaluronic acid may help reduce osteoarthritis symptoms when it is injected directly into an affected joint. 163-166,173,195 However, there is absolutely no reason to believe that oral hyaluronic acid should help, and one study failed to show any significant benefit. 194

Incomplete and inconsistent evidence from human and animal studies only weakly suggests that green-lipped mussel might alleviate osteoarthritis symptoms. 82-84,130-136,167 A badly designed human study hints that krill oil might be helpful as well. 184

One double blind study involving dogs found some evidence of benefit with elk velvet antler . 137

Numerous other herbs and supplements sometimes recommended for osteoarthritis include: beta-carotene , boron , cartilage , chamomile , copper , dandelion , D-phenylalanine , feverfew , molybdenum , selenium , turmeric , and yucca . However, there is little to no evidence as yet that these treatments are effective.

Other studies provide limited evidence that certain supplements proposed for osteoarthritis do not work. For example, a 2-year, double-blind study of 136 people with knee arthritis found vitamin E ineffective for either reducing symptoms or slowing the progression of the disease. 118 In addition, a 6-month, double-blind, placebo-controlled trial of 77 people with osteoarthritis failed to find any symptomatic benefit with vitamin E. 96 Similarly, in a large (almost 400-participant) 5-year, double-blind, placebo-controlled study, use of injected mesoglycan failed to slow the progression of osteoarthritis. 119 A fairly small study failed to find the enzyme bromelain helpful for reducing symptoms. 175

Prolotherapy is a special form of injection therapy that is popular among some alternative practitioners. A double-blind, placebo-controlled study evaluated the effects of 3 prolotherapy injections (using a 10% dextrose solution) at 2-month intervals in 68 people with osteoarthritis of the knee. 110 At 6-month follow-up, participants who had received prolotherapy showed significant improvements in pain at rest and while walking, reduction in swelling, episodes of "buckling," and range of flexion, as compared to those who had received placebo treatment. The same research group performed a similar double-blind trial of 27 individuals with osteoarthritis in the hands. 111 The results at 6-month follow-up showed that range of motion and pain with movement improved significantly in the treated group as compared to the placebo group.

Several double-blind, placebo-controlled studies suggest that pulsed electromagnetic field therapy, a special form of magnet therapy , can improve symptoms of osteoarthritis. 112-115 One small study provides extremely weak supporting evidence for the more ordinary form of magnet therapy: static magnets. 124 A subsequent much larger study of static magnets failed to find real magnets more effective than placebo magnets, but a manufacturing error may have obscured genuine benefits (some people in the placebo group were accidentally given active magnets). 149 In yet another placebo-controlled trial, the use of a magnetic knee wrap for 12 weeks was associated with a significant increase in quadriceps (thigh muscle) strength in patients with knee osteoarthritis. 201

Limited evidence supports the use of bee venom injections for osteoarthritis. 168 Hot water therapy ( balneotherapy ), 176-180, 186relaxation therapies , 172 and various forms of exercise , including hatha yoga and tai chi , have also all shown some promise. 117,173,183,193 However, for none of these therapies is the supporting evidence convincing.

In a 2011 review of the literature, researchers analyzed 4 studies investigating the benefits of manual therapy (including massage therapy, joint mobilization, and manipulation ) for osteoarthritis of the hip or knee. 204 The results were inconclusive. Although one of the studies (involving 68 people) did find that massage therapy helped to improve pain and function, it was compared to no intervention rather than another treatment or a placebo.

Oligomeric proanthocyanidins (OPCs) are chemicals derived from pine bark extract. Three trials, which were part of a larger systematic review, hinted at the possible effectiveness of OPCs in treating osteoarthritis of the knee. 205

Leech saliva has anesthetizing, anti-inflammatory, and vasodilating properties. In a randomized crossover trial of 52 patients with knee osteoarthritis, one application of leech therapy was associated with improvements in pain, function and overall symptoms compared to one-time transcutaneous electrical nerve stimulation. Patients switched therapies after 42 days and were followed for an additional 21 days after the second treatment. Only about three-quarters of the patients completed the study. 209

For a discussion of homeopathic approaches to osteoarthritis, see the Homeopathy Database .