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Today's blog is written by Dr Xiaoqian Liu from the Institute of Bone and Joint Research. Dr Liu is a rheumatologist from China and is a current PhD student working with Professor David Hunter. Dr Liu's research centres around supplements and OA.

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What do you need to know about supplements?
Dietary supplements are defined as a product taken orally intended to supplement the diet and this includes: vitamins, minerals, and herbs. They can come in a variety of forms such as tablets or capsules, liquids, or powders. Given the favorable safety profile in recent times, nutritional supplements for osteoarthritis (OA) are currently riding the crest of public enthusiasm with up to 69% of patients with OA taking some form of supplements for their disease!

However, before you buy any supplements for OA, you need to know that not all supplements are created equally. They are often marketed under different names/brands, with different strengths and levels of purity. Unfortunately at this time, there are no rigorous manufacturing and regulatory processes to ensure how well the supplement work, how consistent the products are, and what these products are made of.

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What are the potential benefits of supplements?
1. Ease pain and improve function or disability

Supplements may help with osteoarthritis pain through curbing inflammation around the joint and give you better joint movement.

2. Protect cartilage

Some of supplements are part of what makes up the cartilage in the body such as glucosamine and chondroitin. While they are believed to be nutritional “ingredients” for the bodies cartilage that can protect it from damage, the research in the area is mixed.

3. Safer than anti-inflammatory drugs

Generally supplements are quite safe to use as they are derived from natural products. They are unlikely to cause potential stomach and kidney related side effects which are common if you take anti-inflammatory drugs. So, you can take supplements for a longer time without worrying about side effects.

What is the evidence available for the use of supplements on OA?

1. Glucosamine, Chondroitin, Willow bark extract, Vitamin E, Vitamin D, and Bromelain

These supplements are widely used by patients with OA especially glucosamine and chondroitin but demonstrated little or doubtful effects for pain reduction. As a result, these supplements are not recommended for use. However, patients are recommended to continue use of these supplements ONLY if are currently using them AND have found benefits.
Furthermore, there is no evidence that glucosamine and chondroitin has any effect on cartilage rebuilding or structural changes.

2. Diacerein, Methylsulfonylmethane, Avocado/soybean unsaponifiables

There is a small amount of evidence that showed that these supplements had moderate effects for OA pain, however, we are not quite sure at the moment if the effects reach clinical importance. These supplements are not used as commonly as glucosamine and chondroitin by patients . This is especially true for diacerein for which there is a common unpleasant side effect: diarrhea!

3. Pycnogenol, Curcumin, Boswellia serrata extract

There is some evidence that these supplements have large effects for osteoarthritis but the evidence to support this claim is limited. We still need more trials that are well designed and provide more conclusive evidence to confirm their effectiveness.

What if I want to start taking supplements?

Before starting any new treatments, it is always important to consult with your doctor (either your GP or rheumatologist) who can help review your medical history to help you decide which supplement is right for you.

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