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Millions of Americans who traditionally have reached for painkillers for relief of osteoarthritis pain can now choose between a host of alternative therapies, which, though not entirely proven by science, are catching on in doctors' offices.
Nutritional supplements, heat and cold treatments, injections made from rooster combs, and magnets all make the list of alternative osteoarthritis treatments. Experts say each has been tried with varying degrees of success. However, they caution that most of the evidence that these therapies work is anecdotal, rather than scientific.
W. Hayes Wilson, M.D., chief of rheumatology at Piedmont Hospital in Atlanta, says he doesn't discount these therapies. However, he says patients should not rule out traditional painkillers as a way of relief.
"What works for the patient is what counts," Wilson says. "That is our final goal."
Nearly 30 million Americans suffer from osteoarthritis, a degenerative disease that causes the breakdown of cartilage in the joints and leads to stiffness or pain. Osteoarthritis, which typically comes with age (older than 45), often occurs in the knees and hips and can so debilitating that it affects your ability to walk.
A new wave of treatments
Newer alternative therapies are welcomed particularly by people who dislike taking medication for an extended period. Painkillers and anti-inflammatory drugs often are indicated for long-term use because osteoarthritis is a chronic disease.
"I have patients who say, under no circumstance do they want to use medication," Wilson says. "I say, 'That's fine.'"
Two nutritional supplements glucosamine and chondroitin sulfate have become the biggest rage. Both are normal constituents of the cartilage in the joints. Many people take them, believing that they either slow down the breakdown of cartilage or restore cartilage.
While some benefit has been documented in animal studies, so far it has not been proven in the short-term studies in humans. Still, from what Wilson says he has observed, glucosamine and chondroitin do have some anti-inflammatory effect and they may actually help the body to heal. Another plus is that the supplements really don't have any side effects.
The downside, according to Wilson, is that the U.S. Food and Drug Administration does not regulate them, so patients can't be sure they are getting what they think they are getting. Supplements may be contaminated or have less of the active ingredient that the label claims. Be careful when taking supplements because they may interfere with other medications you take or may worsen existing medical conditions. Talk with your doctor before taking any supplement.
Omega-3 oils
There are a host of other nutritional supplements that are believed to have anti-inflammatory qualities, such as omega-3 oils, particularly salmon, cod liver oil, oil of evening primrose and flaxseed oil.
"People have to be careful of cod liver oil because it has vitamin A in it," Wilson says. Vitamin A is fat-soluble and stored in the body, so there is a danger of taking too much. (The daily adult requirement is 900 micrograms.)
Another option for treating osteoarthritis is a natural substance called hyaluronic acid, which is present in the connective tissue and joint fluid in humans and animals, and gives elasticity to the joints. Preparations of hyaluronic acid for relief of osteoarthritis pain are extracted from roosters' combs. Hyaluronic acid is injected into the joint for five weeks once a week and provides relief for up to six months afterward.
"When it works, it works great," Wilson says. "But it doesn't work for everyone." Hyaluronic acid is expensive, however, and it is unclear whether it provides any real protection against joint deterioration.
Still, it is a natural substance, and some doctors prefer it to traditional cortisone shots, which also can be used to provide pain relief for a severely inflamed joint. Frequent injections of corticosteroids, however, can lead to the destruction of cartilage and bone.
Magnetic therapy
Some people with osteoarthritis also are turning to magnetic therapy for relief. Those who believe in magnets' healing qualities say that when a magnet is applied to the body, magnetic waves pass through the tissues, creating secondary currents. The theory is these currents clash with magnetic waves, producing impacting heat, which is effective to reduce pain and swelling.
Wilson says the use of magnetic fields hasn't been studied at all, but it's not invasive and some patients like that.
Still other patients also swear by hot showers or cold packs for occasional osteoarthritis flare-ups. Applying a cold pack first to an inflamed area can help reduce the inflammation and heat afterward can help relax the muscles, he says.
These alternative therapies may be in the limelight, but experts say patients shouldn't shun painkillers, which have been the drugs of choice for treating osteoarthritis.
"The least expensive, effective therapy for osteoarthritis is still acetaminophen," says Eric G. Boyce, Pharm. D., professor of clinical pharmacy at the University of the Sciences in Philadelphia. Boyce adds that acetaminophen, the active ingredient in Tylenol®, is a safe drug providing people stay within the recommended doses and don't abuse alcohol, which can lead to acetaminophen-induced liver damage.
These drugs, which include aspirin and ibuprofen, reduce pain and inflammation and may be used for both short- and long-term pain relief for people with osteoarthritis or rheumatoid arthritis. Your doctor may prescribe them if you have problems with joint inflammation, or if you are not receiving enough pain relief from acetaminophen alone.
One disadvantage, though, is that they have been known to cause an assortment of side effects, including irritation and bleeding in the stomach and a decrease in kidney function.
Concerns have been raised regarding the NSAID naproxen. The Food and Drug Administration (FDA) is working with the National Institutes of Health to review the available scientific information on naproxen following the decision of the National Institute on Aging to stop a clinical trial studying NSAIDs in people at risk of developing Alzheimer's disease. Early information from the study showed some evidence of a higher risk of heart problems when compared to a dummy pill.
The FDA advises patients who take over-the-counter naproxen products to carefully follow the instructions on the label. Do not take more than the recommended doses for naproxen (220 milligrams twice daily), and you should not take naproxen for longer than 10 days unless a physician tells you otherwise. NSAIDs also should be used with caution by anyone who drinks alcohol.
A newer generation of NSAIDs called COX-2 inhibitors, or "super aspirins," are as effective as the older NSAIDs. These compounds don't cause the gastrointestinal irritation of the older anti-inflammatory drugs. But there have been concerns that they raise the risk of heart problems. Vioxx® was pulled by its manufacturer, Merck, in 2004 because a study on how it can work against colon cancer showed a small increased risk of cardiovascular problems.
Now researchers say the COX-2 inhibitor Celebrex® may also increase the risk of heart attack at high doses or with long-term use. Like Vioxx, Celebrex was being studied to see if it helped prevent colon cancer in certain people. Results of that study showed the rate of heart attack was two-and-a-half times higher in those taking 400 milligrams (mg) of Celebrex and more than three times higher in people taking the 800-mg dose than in those taking a dummy pill. The study was stopped immediately. However, another study did not show an increase in heart attacks. More research is being done.
Bextra®, another COX-2 inhibitor, and Celebrex remain on the market. However, the FDA issued an advisory for anyone taking these two drugs, saying that they may be associated with an increased risk of serious cardiovascular events such as heart attack and stroke especially when they are used for a long time or in very high risk settings (immediately after heart surgery).
Don't stop taking your medication regimen without talking to your doctor first.
Patients can take acetaminophen or anti-inflammatory drugs for decades, providing they tolerate them well and only under a doctor's direction.
"Never take anything longer than needed, and never take more than you need," Wilson advises, providing one yardstick for use of those drugs.
Prevention first
Wilson and Boyce say you control your weight control and exercise to help manage osteoarthritis. Federal studies have shown that a moderate amount of weight loss - 10 pounds - can decrease the pressure on your knees.
"One of the first things I recommend to a patient is get as close to your ideal body weight as possible," Wilson says. "If you lose 10 pounds, it's like taking 30 pounds off the knee."
This article was reviewed and updated
June 2007.
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