Natural vs. Surgical Remedies for Osteoarthritis

Arthroscopic surgery for osteoarthritis (OA) of the knee, a frequently performed and expensive procedure, is ineffective, according to a report in the New England Journal of Medicine (2002;347:81–8). This new study, combined with ongoing concerns about the safety and efficacy of drug therapy for OA, should lead to increased interest in natural remedies for this common arthritic condition.

Researchers randomly assigned 180 individuals with OA of the knee to receive arthroscopic surgery or “placebo” surgery and then observed them for two years. The arthroscopic surgery consisted of inserting a scope into the knee and cleaning out degenerated tissue and debris. Participants assigned to placebo surgery were subjected to skin incisions over the knee, but the arthroscope was not inserted. Both groups experienced a reduction in pain and an improvement in function during the two years following the procedure. However, at no time did the group receiving arthroscopic surgery fare better than the placebo group. In fact, at some points during the study, the placebo group actually showed greater improvement than the surgery group.

The results of this study suggest that this $5,000 procedure is a waste of money for individuals with OA, though it did not address the value of arthroscopic surgery for torn cartilage and other indications for which this procedure is considered to be effective.

Other research suggests that long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), which are commonly used to treat OA, may actually accelerate the progression of the disease, even though they help relieve symptoms temporarily.

Fortunately, a number of natural remedies are available that are both safe and effective. The most widely used product is glucosamine sulfate. Numerous studies have shown that this substance, which helps rebuild damaged cartilage, relieves pain at least as effectively as NSAIDs, and is relatively free of side effects. Even more importantly, continued use of glucosamine sulfate appears to slow or halt joint degeneration. The amount of glucosamine sulfate used in most studies was 500 mg 3 times per day.

Chondroitin sulfate, a component of the connective tissue that makes up joint cartilage, has also been studied extensively. When taken in the amount of 800 to 1,200 mg per day, it appears to produce results similar to those seen with glucosamine sulfate, and has not been associated with any significant side effects. It is not known whether a combination of glucosamine sulfate and chondroitin sulfate would be more effective than either compound alone.

Some doctors recommend niacinamide (vitamin B3) as a treatment for OA. Although comparative studies have not been done, it appears to be as effective as glucosamine sulfate. Moreover, a number of positive "side effects" may occur with the use of niacinamide, such as better mood, less anxiety, and improved overall well-being. However, the large amounts of niacinamide that are needed to improve joint health (such as 500 mg, 4 to 6 times per day) have the potential to damage the liver on rare occasions. Therefore, niacinamide therapy should be monitored by a physician familiar with its use.

Other natural substances that have been reported to relieve the symptoms of OA include vitamin E (600 to 1,200 IU per day), Devil's claw, cat's claw, and ginger root.

Alan R. Gaby, MD, an expert in nutritional therapies, served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the Medical Editor for Clinical Essentials Alert, is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Prima, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Prima, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). Currently he is the Endowed Professor of Nutrition at Bastyr University of Natural Health Sciences, Kenmore, WA.

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