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Broadly speaking, ‘nutraceuticals’ are nutrients, supplements or other dietary products that are considered to have potential medicinal or physiological effects but do not fall within standard drug classifications. The term is loosely derived from ‘nutrition’ and ‘pharmaceutical’, and does not have a clear definition in the medical literature. However, it represents a series of approaches that have either established or potential benefits in the treatment of a wide range of conditions.

For arthritis (inflammation of the joints), and other conditions of the joints, cartilage or related areas, there are several nutraceuticals that can help alleviate pain and discomfort. These have the potential to replace, or at least help reduce, the use of more aggressive drug therapies. They are known for their extremely safe action, and in most cases are relatively inexpensive.

In some cases, there is now some data in the literature that suggests that several different nutraceutical approaches are beneficial in the treatment of cartilage and joint disorders. However, there remains some conflicting opinions on the efficacy of certain products, and this makes it imperative to discuss any products you are considering with your physician who will be able to offer you advice based on the current evidence available.

Nutraceuticals have the potential to compliment the other treatment options available in the toolbox for treating a broad range of cartilage and joint problems. It has the potential to be combined with non-operative intervention such as mainstream drug therapies, physical therapy, lifestyle changes (weight, diet) and management of other co-existing conditions, as well as with surgical procedures.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about nutraceuticals, as well as anyone interested in cartilage problems.

What are the common neutraceuticals for arthritis, joint and cartilage problems?

Of the neutraceuticals currently available, glucosamine, chondroitin, S-adenosylmethionine (SAMe) and Avocado Soybean Unsaponifiables (ASU) have been the most carefully assessed with considerable amount of scientific and clinical usage data, as well as safety profile.

Glucosamine and chondroitin

Glucosamine and chondroitin are found naturally in the body and serve as important building blocks for the extracellular matrix (ECM), which is a spongy foundation that cells in the body attach to and form different tissues. Dietary supplementation for cartilage and joint disorders has therefore attracted a great deal of attention in recent years.

Glucosamine supplements themselves are usually derived from various compound forms of glucosamine (sulfate, hydrochloride, etc.) found in shellfish, which should be taken into account if you are allergic to shellfish or have other dietary restrictions. However, shellfish-free varieties have recently become available. Chondroitin is currently only derived from animal or fish products; again, it is important to consider your own dietary restrictions.

A number of studies have examined the potential benefits of both supplements, taken either individually or in combination, in reducing pain and inflammation in the joints. These studies have also tried to determine if these products provide any short- or long-term benefits in terms of pain, function and also the structural integrity of the joint. Thus far the literature has been inconsistent in terms of reported effects. Some systematic reviews and meta-analyses of high quality studies have shown that glucosamine and chondroitin, taken either individually or combined, provided significant improvements in terms of pain, function and disease modification as compared to placebo. While other studies have found no significant differences. Furthermore, one of the best studies on the effects of these neutraceuticals on people with knee osteoarthritis, “the multicenter, double-blind, placebo- and celecoxib-controlled glucosamine/chondroitin Arthritis Intervention Trial (GAIT) “ that was published in the well respected New England Journal of Medicine showed that glucosamine and chondroitin sulfate, taken alone or in combination, did not significantly reduce pain. However, subgroup analysis did show that the combination of glucosamine and chondroitin sulfate might be effective in treating patients with moderate-to-severe knee pain. The recent OARSI guidelines provided the following recommendations for glucosamine: “uncertain” for symptomatic pain relief and the “not appropriate” for diseases modification. Similarly, the guidelines for chondroitin were “uncertain” for symptomatic pain relief and “not appropriate” for disease modification.

Our understanding of these neutraceuticals continues to evolve and it is recommended that you discuss the efficacy of their use with your health care provider who will be able to provide you with individualized recommendations based of your disease process.

S-adenosylmethionine (SAMe)

Although naturally occurring in the body, dietary supplements of SAMe have been available since 1999 in the USA. Before that, SAMe was used as a prescription drug in many countries in Europe from the 1970s. Originally tested as an antidepressant, researchers noticed positive effects in osteoarthritis sufferers.

Oral supplementation with SAMe for prolonged periods of time has the potential to provide pain relief. Some, reports suggest it is as effective as NSAIDS in the treatment of osteoarthritis and similar conditions, with fewer side effects. The mechanism of action is slower than NSAIDS and it can take an extended period of time prior to it having an effect. A Cochran systematic review of its use in knee or hip osteoarthritis was inconclusive due to the lack of large trials studying its use. However, they found that SAMe may have some clinically relevant effects in terms of pain and function, but that more studies were needed due to the heterogeneity of the currently available literature.

It is important to be cognizant of the potential side effects of its use, especially if taken alongside other antidepressants. Therefore it is strongly recommended that you consult your healthcare provider prior to starting a course treatment.

Avocado Soybean Unsaponifiables (ASUs)

While derived from avocados and soybeans, ASUs are not naturally found at high enough levels to have an effect simply from eating them. However, as a concentrated dietary supplement, there is a growing body of evidence in the literature that shows that ASUs are potentially safe and effective as anti-inflammatory that can be used to treat hip and knee arthritis. A meta-analysis of the available randomized controlled trials studying ASU’s showed that its use did provide some benefit in terms of pain relief, especially in knee arthritis. Similar to the other neutraceuticals the ORADSI guidelines have also give the use of ASUs an uncertain recommendation.

It should be noted that similar to some of the other neutraceuticals, ASUs have a relatively slow onset versus NSAIDS. A dose of approximately 300 mg of ASU has been reported to provide significant pain relief and anti-inflammatory properties in osteoarthritis sufferers after 30–60 days. It is possible that the use of this and/or some of the other neutraceuticals may allow patients to reduce their use of NSAIDs and also has the potential to delay the need for early operative intervention.

As previously mentioned, the use of intra-articular corticosteroid, over the counter anti-inflammatory (such as Ibuprofen) and prescribed anti-inflammatory pain medications (such as Meloxicam, Celebrex, Naprosyn, etc.) all still play a major role in the treatment of joint pain. Some of these can even be used to have a synergistic effect with the neutraceuticals that you may use. However, it is important for you to talk to your healthcare provider about the risk and benefits of this treatment and its appropriateness for your specific condition.

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