Medicine Talk

Arthritis – Life Beyond Vioxx

Glucosamine sulfate is now well-known to decrease pain in people with leg osteoarthritis by assisting the growth of joint cartilage. Doses of 1500mg are needed, usually split 500mg three times a day. Some of my patients mistakenly under-dose themselves and wonder why it does not work for them. Of course, it does not work for all people, but a 3-4 month trial is reasonable. It can elevate blood sugar, so diabetics must monitor their sugars carefully and be aware they may need to alter their diabetes regimen to compensate. Despite the fact that glucosamine is often combined with chondroitin, studies do not show any convincing advantage of this. In fact, this combination can make the supplement more expensive, and chondroitin is hard for the body to absorb fully, unlike glucosamine.

Gamma linoleic acid, or GLA, is a natural oil present in a variety of plants such as evening primrose, borage, and black currant. At high doses of 1.4 to 2.8 grams per day, it acts as a natural anti-inflammatory (and at lower doses in some persons). It has modest positive effects for rheumatoid arthritis and Sjogren's syndrome, and is well-tolerated.

Finally, there is convincing evidence of benefit of pain reduction and improved overall function for hip osteoarthritis sufferers with avocado-soybean unsaponifiables (ASU). This product is 1/3 avocado and 2/3 soybean derivatives. The dose studied is 300 mg a day for 3 months, with some lasting effects once stopped. This product is difficult to find in the United States, even here on the West Coast, but may be worth the effort.

Hmmm... seems that after typing this column, my own hands and wrist arthritis is kicking in. Time to rest - and maybe eat some more soy products, with my flaxseed microwaveable warming pillow by my side. Here's hoping we all move forward into spring gently with more spring in our steps (and hands)!

Terry Maresca, MD (Mohawk) is a board-certified physician in family medicine. She is the former president of the Association of American Indian Physicians, and a clinical assistant professor teaching at the University of Washington School of Medicine in Seattle. Her medical practice with the Snoqualmie Tribe of Washington combines her Western and herbal medicine approaches. She maintains a medicinal herb garden at the clinic, and is a frequent speaker on the subject of combining Western and traditional approaches to health.