Good News for People with Osteoarthritis
People who experience pain and poor joint function in the knees due to osteoarthritis (OA) may reduce symptoms by intermittently taking oral chondroitin sulfate (CS), according to a study in Osteoarthritis and Cartilage (2004;12:269–76). While previous studies have shown a beneficial effect of CS, this is the first to demonstrate that it does not have to be taken continuously in order to be effective.
OA is a disease of the cartilage that lines joint surfaces. It is the most common form of arthritis, often affecting the knees, hips, neck, lower spine, hands, and feet. Repetitive trauma or overuse of joints may promote the development of OA by causing changes in the cartilage that can eventually lead to bone-on-bone contact. OA is characterized by joint pain, tenderness, inflammation, limitation of movement, and creaking of the joints upon movement (crepitus). When located in the knees, OA is associated with a narrowing of the space between the bones that results from the loss of cartilage. This space can be measured on an X-ray to determine the severity of the disease, and comparisons can be made between X-rays to determine disease progression.
Drug treatments for OA include pain relievers (analgesics) such as acetaminophen (Tylenol™) and non-steroidal anti-inflammatory drugs such as naproxen (Aleve™). These drugs act quickly to reduce pain and inflammation; however, they do not address the underlying disease process, and may be associated with side effects including liver damage from long-term use (acetaminophen) and gastrointestinal damage (naproxen). Other agents including glucosamine sulfate and CS have been used to treat OA, as they provide some of the building blocks for the formation of cartilage.
The new study investigated the intermittent use of CS for the treatment of OA of the knees. Eighty-four people over the age of 40 with OA of one or both knees completed the one-year study. The participants were randomly assigned to receive either (1) 800 mg (purified to contain at least 95%) of oral CS per day for the first 3 months of the study, and from months 7 to 9; or (2) placebo according to the same schedule. Neither group received treatment between months 4 and 6 and months 10 and 12. Participants were allowed to take acetaminophen as needed for pain (up to 4 grams per day). To assess the response to treatment, the following parameters were measured: level of pain and joint function, walking time (how long it took for the participant to walk 20 meters), participant and physician evaluations of effectiveness, analgesic consumption, and changes in the joint space as seen on X-ray.
Knee pain decreased and function improved significantly in the CS group compared with the placebo group. By the end of the study, the CS group experienced a 36% decrease in symptoms, whereas the placebo group had a 23% decrease. Walking time also improved significantly among the CS group participants compared with the placebo group. Eighty-nine percent of the physicians and participants rated the effectiveness of CS as “good” or “very good”; 49% rated the placebo as “good” or “very good.” The average intake of analgesics was significantly higher throughout the study period in the placebo group than in the CS group. Among the placebo-group participants, X-rays showed joint space narrowing consistent with progression of OA. No progression was seen on X-ray among those people receiving CS.
Other studies have confirmed the benefit of CS for the treatment of OA. Well-absorbed and associated with only minor side effects, CS appears to decrease pain and slow the rate of cartilage loss in people with OA. This study demonstrates that CS has a delayed onset of action and is effective when given intermittently.
Kimberly Beauchamp, ND, received her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. She is a co-founder and practicing physician at South County Naturopaths, Inc., in Wakefield, RI. Dr. Beauchamp teaches holistic medicine classes and provides consultations focusing on detoxification and whole-foods nutrition.
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