Pills for your ills: but do they do any good?

    Pills for your ills: but do they do any good?

    Do joint supplements really help with the pain of arthritis?

    18 February 2016

    Joint health supplements are big business in the UK. Millions of pounds are spent over the counter every year, and most buyers are seeking relief from the symptoms of arthritis — a group of painful long-term conditions thought to affect around 10 million Britons.

    Osteoarthritis is the most common form, affecting around eight million people. It usually comes on as you age, with joint pain and stiffness developing as the cartilage between the bones gradually wears away. Rheumatoid arthritis tends to affect a younger section of the population and is caused by the body’s immune system attacking the joints.

    NHS guidelines recommend that sufferers maintain a healthy weight and stay physically active, strengthening their muscles while protecting any damaged joints during daily life. First-choice prescription drugs for osteoarthritis are topical non-steroidal anti–inflammatories (NSAIDs) and paracetamol; for Rheumatoid arthritis, drugs that suppress the immune system are usually recommended.

    So why do people with arthritis turn to joint supplements when they can be treated on prescription? And do any of the supplements really work? In my experience, patients try these products as an alternative to their prescription drugs, or to supplement them. The most popular include omega-3 fatty acids, glucosamine and chondroitin, and rosehip extracts. So let’s look at the evidence for their use and effectiveness…

    Omega-3 fatty acids

    These are found in fish oils and are usually sold as capsules or liquids. They have anti-inflammatory properties and some evidence suggests that, when taken regularly at a high enough dose, they reduce cholesterol and may benefit heart health. UK diet guidelines recommend eating at least one portion a week of oily fish such as sardines or mackerel. This works out at about 0.45 grams per day of omega-3 fatty acids.

    However, a daily dose of at least 2.7 grams is thought necessary to get the anti-inflammatory effect, and this means taking a lot of standard fish-oil capsules every day. There is reasonably good evidence — although the studies are quite old — that fish oil provides effective pain relief for some people with rheumatoid arthritis, reducing their symptoms and their need to take NSAIDs. However, these benefits may not appear for up to three months, so perseverance is vital. Very little evidence exists to suggest that fish-oil supplements benefit people with osteoarthritis.

    Glucosamine and chondroitin

    Many people with osteoarthritis try glucosamine, sometimes in combination with chondroitin. Both occur naturally in the body and help to keep our joints healthy. Some early studies reported positive findings with glucosamine, but more recent and better–designed research found no consistent benefits. Of the two types available (glucosamine sulphate and glucosamine hydrochloride), the sulphate appears to be more effective, and a daily dose of 1500mg is generally recommended. Treatment should stop if there is no improvement after a three-month trial.

    Rosehip extracts

    Roses and rosehip extracts have a long history of medicinal use but their potential for treating both types of arthritis has come to light only recently. The most consistent and robust research used extracts from a specific species of rosehip called w, which was found to contain a potent anti-inflammatory ingredient called galactolipid (or Gopo for short). Several well-designed studies in Scandinavia and Germany found that Gopo can rapidly reduce joint pain, stiffness and swelling, improve joint mobility and reduce the need for standard painkillers. In one combined analysis of all Gopo studies, the researchers said it may be more effective than either paracetamol or glucosamine in treating osteoarthritis. As with all the supplements reviewed here, a three-month trial at the manufacturer’s recommended dose may be considered.

    Though a variety of rosehip supplements are on sale, it’s not clear whether they contain the same amount of Gopo as the product used in all the studies (called Gopo Joint Health). No research has been carried out with other preparations so it’s unwise to presume that all rosehip products offer the same benefits.

    So where do the supplements fit in?

    Many people with painful joint conditions feel they benefit from taking supplements alongside or instead of their prescribed medication. All those reviewed here are generally well tolerated and I would not dissuade anyone from starting a three-month trial if they wish.

    Fish oils have many potential benefits, but you need a least nine standard capsules a day to achieve a clinically effective dose. This may be too expensive for many people. Glucosamine and chondroitin may work for some, but it seems likely that there’s an equal number of patients who feel no improvement. Gopo has been well studied and appears to have multiple benefits for a range of painful joint conditions — but do beware of the copycat products that may not contain the active ingredient.