We try not to use this word often in our clinic. It tends to cause a whole flurry of negative reactions. It’s easier to write about than discuss with a patient. We’re talking arthritis. In this case, Osteoarthritis (OA), the type of arthritis that is often thought of as “wear and tear”.

Captain obvious statement: as we age, our joints deteriorate. So instead of thinking of OA as a disease with a label, we prefer to look at it as a part of our natural aging process. But just because we all eventually get arthritis, what if we could slow it down? Or minimize some of the unpleasant symptoms (achy, sore joints anyone??). If there is a magic pill…we certainly need to know about it…

So when we see a systematic review in the British Journal of Sports Medicine come along assessing the value of supplements for osteoarthritis we take notice. This review looked at the short term, medium term and long term role for supplements in managing the pain associated with osteoarthritis (henceforce here known as OA) and improving function.

Let’s get the bad news out of the way. Overall there is a lack of unbiased research out there that supports the use of any individual supplement to combat pain and improve performance in the medium and long term. However, this is NOT surprising as longer term studies are much more complex and costly to conduct.

On a more positive note, there are some supplements out there worth trying. But it might not be the ones that you think.

For decades Glucosamine and Chondroitin have been regarded as the golden boys/girls of supplements for OA. When I first graduated (back in 2008…aiiieeee) I remember prescribing 1500mg of Glucosamine 3x/day for a month. The research, at that time, seemed to support that this approach had significant positive results in 50% of cases. And while some patients still strongly believe in their Glucosamine regimen, the evidence now seems to be less promising than we initially thought. So much that this recent systematic review concluded Glucosamine and Chondroitin were either ineffective or had clinically unimportant effects. Wow…maybe it’s time for that bottle of Glucosamine and Chondroitin to make room on your supplement shelf for something else??

When it comes to PAIN reduction these supplements were shown to have a moderate effect in reducing pain in the short term: carnitine, pycnogenol, curcumin, Boswellia, passion fruit peel extract and collagen hydrolysate. (Don’t feel bad if you haven’t even heard of some of these…because a couple of them are new to us too!!). These same supplements above were shown to have moderate improvement in physical FUNCTION in the short term, with one change: swap out collagen hydrolysate for MSM. Boswellia was the only supplement that demonstrated clinically meaningful improvements in STIFFNESS.

A couple key points:

1. All these supplements appear to be safe. Save from the financial investment (and some mild GI bloating/distress), there doesn’t appear to be a significant risk.
2. I would argue the biggest advantage if you find one of these supplements helpful in the short term is to keep you away from excessive, prolonged use of Tylenol and NSAIDs which don’t have a clear safety record.
3. The effects of these supplements appear to be modest at best. These are not miracle cures. We know there is strong evidence to support that exercise reduces pain and improves quality of life in patients with OA. Weight management is also valuable to decrease the loads experienced by joints with OA (especially for hip and knee OA). Exercise + weight loss + supplementation…now you’re making some big moves.

Ok, so get to the point already…what should I take?

Full disclosure…of the supplements listed above above we only have clinical experience with Curcumin, Boswellia and MSM. Since we opened our doors in 2010 we have recommended a product called OA Matrix (www.cyto-matrix.com/p_oa_matrix.php) which is a combination product including Boswellia, Curcumin and MSM (as well as Glucosamine and Chondroitin).

You may have heard of Curcumin as an anti-inflammatory, you might even have that at home already. However, a recent study (2018) tested curcumin versus curcumin and boswellia combined and found a synergistic beneficial effect when combined. Although it is important to note that curcumin alone out performed the placebo group…so it is better than nothing if you don’t have a good combo product option.

We are not saying OA Matrix is the only effective combo product out there, it just happens to be the one we have experience with. And what’s that saying if it aint broke, don’t fix it? Well let me add…if it aint broke, and the evidence supports it, don’t fix it.

But just so you don’t think we are undercover CytoMatrix sales reps, here are a couple other Curcumin/Boswellia combo options to consider:

https://organika.com/product/boswellia-curcumin-complex/

https://www.douglaslabs.com/boswellia-turmeric-complex.html

References:

Liu X, Machado GC, Eyles JP, et al

Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis

Br J Sports Med 2018;52:167-175.

Haroyan A, Mukuchyan V, Mkrtchyan N, et al. Efficacy and safety of curcumin and its combination with boswellic acid in osteoarthritis: a comparative, randomized, double-blind, placebo-controlled study. BMC complementary and alternative medicine. 2018;18(1):7.