As a community pharmacist, you will get questions about supplements for osteoarthritis. Guidelines don’t recommend any oral supplements for most patients with osteoarthritis, due to limited evidence. But some people swear by them or want to give them a try, especially if topical or oral NSAIDs aren’t an option.
- Help sort through the plethora of products. Studies have mixed results and often use different ingredients, doses, or forms.
- Explain that out of all the supplements, glucosamine SULFATE 1500 mg/day or S-adenosyl-L-methionine (SAMe) up to 1200 mg/day has the best evidence, and is usually a good place to start.
- Advise that some glucosamine products (Dorofen, Jointace, etc) may contain shellfish, and to avoid if patients have a history of a severe reaction. If patients take warfarin, monitor INR more frequently when starting glucosamine, it may increase bleeding risk. Tell patients starting SAMe that it may cause anxiety, insomnia, or mania and to report any mood changes.
- Educate that it’s also okay to try chondroitin, collagen, methylsulfonylmethane (MSM), turmeric or combos including these. But counsel that any of these oral supplements can cause GI upset, may take at least a month to see any benefit and should be stopped if there’s no improvement after a few months. If patients prefer a “natural” topical, explain that arnica or capsaicin might help. Don’t rely on cannabidiol (CBD).
References
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Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020 Feb;72(2):220-233. Available at: https://onlinelibrary.wiley.com/doi/10.1002/art.41142
Beaudart C, Lengelé L, Leclercq V, Geerinck A, Sanchez-Rodriguez D, Bruyère O, Reginster JY. Symptomatic Efficacy of Pharmacological Treatments for Knee Osteoarthritis: A Systematic Review and a Network Meta-Analysis with a 6-Month Time Horizon. Drugs. 2020 Dec;80(18):1947-1959. Available at: https://link.springer.com/article/10.1007/s40265-020-01423-8
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