اللغة
الخدمات الطبية
الاطباء
نصائح صحة المجتمع
Arthritis and Rheumatism (Rheumatology)

Dietary Supplements for Treatment of Arthritis

Does green tea prevent cancer? Can consuming fish oils prevent heart disease? Is zinc a remedy for the common cold? Do soy products diminish the uncomfortable symptoms of menopause? Can Glucosamine and Chondroitin halt the progression of arthritis? These questions are asked commonly by persons seeking a "natural" way to prevent disease.


Yet, a great deal of ambiguity exists regarding the effectiveness of many types of alternative medicine. Consumers seek authoritative information and credible research regarding the efficacy and safety of herbal and "natural" remedies. An increasing number of studies provide information regarding the beneficial health effects, possible side effects, toxicity, and drug interactions of herbs and "natural" dietary products, yet many unanswered questions persist.


Since the passage in 1994 of the Dietary Supplement Health and Education Act (DSHEA), which allows natural products to be marketed with minimal FDA scrutiny, dietary supplement sales have grown from $8.8 billion (in 1994) to an estimated $15.7 billion in 2000. In a recent survey of medication use in the United States, 40% of respondents reported taking herbal supplements or vitamins on a daily basis, with higher rates among women, whites, and urban dwellers. The DSHEA does not require manufacturers to demonstrate the safety or efficacy of natural products in human trials before marketing.


The myth that natural products are completely safe is constantly promoted in advertising and creates a need for responsible public education. Although most clinicians can quickly debunk advertising myths with examples of toxic natural products, such as hemlock and cyanide, knowledge of the interactions of natural products with drugs may not be as prevalent.


One supplement is Glucosamine, derived from the shells of crabs and lobsters. The other is Chondroitin, usually derived from animal cartilage. These supplements are said to help relieve arthritis pain. They are also said to prevent the arthritic joint narrowing that causes one bone to grind against another. Of note, Glucosamine sulfate and Chondroitin sulfate are components of normal cartilage. In the body, they are the building blocks for cartilage.


Do these supplements really work?


There are at least 50 published clinical trials on either one of these supplements or the combination, with various relevant health outcomes, such as improved joint pain, function and improved joint space, however, some studies failed to show any significant benefit. Above studies done on Osteoarthritis patients. There is no evidence that these supplements are useful for inflammatory arthritis such as Rheumatoid.


If patients choose to take dietary supplements to control their symptoms, they should be advised to take Chondroitin sulfate with Glucosamine sulfate which may have an additive effect. Three months of treatment is a sufficient period for the evaluation of efficacy; if there is no clinically significant decrease in symptoms by this time, the supplements should be discontinued. Furthermore, there is no evidence that these agents prevent osteoarthritis in healthy persons or in persons with knee pain but normal radiographs. Also of note, these supplements will not cure arthritis -- and that they are only a part of a multiprong treatment.


Some physicians advise patients to use it in three-month-on, two-month-off cycles. Some patients who use these supplements have been able to use [fewer] anti-inflammatory and pain medications. One should always keeps in mind that there are things may work for certain patients and not work for others.


Both treatments appeared to be very well-tolerated.


Which brand of supplement should I use?


According to the results of some studies, Glucosamine sulfate is more effective than other forms of Glucosamine such as Glucosamine hydrochloride.


There are many different brands of Glucosamine and Chondroitin, which are usually sold together in one supplement. Unfortunately at this time, there is no government monitoring to ensure the purity of these products.

In order to assure that you get a consistent dose of the supplements, stick with a reputable manufacturer; choose products sold by large and well-established companies. If you don’t recognize a brand name, ask about the company’s reputation, how long it has been in business and how long the store has stocked the brand.

 

Who should NOT take these supplements?


The supplements, which are available in pharmacies and health food stores without a prescription, are well tolerated and appear to be safe however these supplements may have a blood-thinning effect so people taking these supplements in addition to an anticoagulant may have to have their blood tested more often. People who are allergic to shellfish also should consult their doctors before using Glucosamine and Chondroitin.


People with diabetes should use caution when taking Glucosamine because of concern that it might raise blood sugar, an issue which is not confirmed yet.


The effects of these supplements on a growing child or developing baby are not yet known. For that reason, Glucosamine and Chondroitin are not recommended for children, women who are pregnant and women who could become pregnant.


What are the side effects of Glucosamine and Chondroitin?

These supplements are generally well tolerated. However, side effects can occur. The most commonly reported side effects of Glucosamine and Chondroitin include:


• Nausea 
• Diarrhea or constipation 
• Heartburn 
• Increased intestinal gas


It is important to check with your doctor before starting any new treatments. Your doctor can review the other medications you are taking and help you decide whether or not these supplements are right for you. Do not take more of the supplements than is recommended.

 

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