Are NSAIDS Really The Best Treatment Option for Osteoarthritis?
The standard pharmacotherapy for people suffering with osteoarthritis includes NSAIDS (no-steroidal anti-inflammatories). Given that some of the effects associated with NSIADS include gastrointestinal bleeding, increasing risk of heart failure, stroke and
Osteoarthritis is a degenerative joint disease where wear and tear damage occurs with in the joint over time. OA more common than rheumatoid arthritis where by the joints are attacked by the bodies own immune system, which causes damage, inflammation and pain but the symptoms are similar in many ways. The Centre for Disease Control and Prevention estimates that over 25% of the US population will have been diagnosed with osteoarthritis with two thirds of those cases being women (1).
How does OA develop and what are the symptoms?
There is cartilage that covers the ends of bones that articulate or come together with other bones, creating a joint. The most common sites where OA occurs includes the hands, hips and knee joints, where the cartilage on these touching surfaces will break down and slowly start to expose the bone underneath. This leaves the joint with limited cushioning and leads to pain, stiffness, inflammation and reduced range of motion and overall function.
This process happens overtime and usually starts when the supporting structures and muscles of a joint are weakened by injury or underuse and more stress is placed on the cartilage as the space in the joint begins to narrow. The bone underneath the cartilage begins to change as the physical stress and can develop osteophytes or bone spurs.
If early osteoarthritis is suspected or diagnosed in the mild to moderate stage there are several natural supplements that have been shown to help stop the progression of the degeneration and alleviate pain.
Glucosamine and Chondroitin
Glucosamine is a sugar molecule that is produced in the body and used in the cartilage and other connective tissue. It has shown in several studies to be effective on relieving stiffness associated with osteoarthritis (2).
Chondroitin is also a complex sugar molecule that helps cartilage retain water and thus helps keep the cartilage resistant and pliable, allowing it to better withstand physical stresses placed on the cartilage. Chondroitin was seen to be more effective in relieving pain than placebo in several clinical trials (2)
Glucosamine and chondroitin have no or minimal side effects and thus is a good option for people to try if they are suffering from OA (3).
Methylsulfonylmethane (MSM) has been reported to slow progression of osteoarthritis and while there has been limited studies on its use, one double blind placebo controlled trial demonstrated that its combination with glucosamine and chondroitin was significantly better in reducing pain than placebo or using glucosamine and chondroitin on its own (4).
Collagen is a protein that is found in your skin, tendons, organs and bones. There are several types of collagen in your body but it is specifically type 2 collagen that is found in the cartilage of your joints. Taking supplemental collagen has been of interested as it is thought that your body will use the amino acids from the supplemental collagen as fuel its own collagen to repair and protect itself from damage. While longer and larger studies are currently needed, most studies done to date have shown beneficial effects in reducing cartilage destruction or promoting cartilage repair and improving quality of life for OA patients (5).
Omega-3 fatty acids are well known to help decrease inflammation in the body and thus fish oil would be an excellent addition to supplemental treatment for OA patients as increased inflammation can exacerbate the pain felt around the joints.
The standard pharmacotherapy for people suffering with osteoarthritis includes NSAIDS (no-steroidal anti-inflammatories). Given that some of the effects associated with NSIADS include gastrointestinal bleeding, increasing risk of heart failure, stroke and vascular events like heart attack, it would be prudent that using some natural supplements that have minimal to no harmful side effects would be a better first choice (6).
1. Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040. Arthritis Rheumatol. 2016;68(7):1582–1587. doi: 10.1002/art.39692. PubMed PMID: 27015600.
2. Zhu X, Sang L, Wu D, Rong J, Jiang L. Effectiveness and safety of glucosamine and chondroitin for the treatment of osteoarthritis: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2018 Jul 6;13(1):170. doi: 10.1186/s13018-018-0871-5. PMID: 29980200; PMCID: PMC6035477.
3. Harrison-Muñoz S, Rojas-Briones V, Irarrázaval S. Is glucosamine effective for osteoarthritis? Medwave. 2017 Mar 15;17(Suppl1):e6867. Spanish, English. doi: 10.5867/medwave.2017.6867. PMID: 28306711.
4. Lubis AMT, Siagian C, Wonggokusuma E, Marsetyo AF, Setyohadi B. Comparison of Glucosamine-Chondroitin Sulfate with and without Methylsulfonylmethane in Grade I-II Knee Osteoarthritis: A Double Blind Randomized Controlled Trial. Acta Med Indones. 2017 Apr;49(2):105-111. PMID: 28790224.
5. Honvo G, Lengelé L, Charles A, Reginster JY, Bruyère O. Role of Collagen Derivatives in Osteoarthritis and Cartilage Repair: A Systematic Scoping Review With Evidence Mapping. Rheumatol Ther. 2020 Dec;7(4):703-740. doi: 10.1007/s40744-020-00240-5. Epub 2020 Oct 17. PMID: 33068290; PMCID: PMC7695755.
6. Schjerning AM, McGettigan P, Gislason G. Cardiovascular effects and safety of (non-aspirin) NSAIDs. Nat Rev Cardiol. 2020 Sep;17(9):574-584. doi: 10.1038/s41569-020-0366-z. Epub 2020 Apr 22. PMID: 32322101.