Clinical Briefs: An OK for MSM for Osteoarthritis
With Comments from Russell H. Greenfield, MD. Dr. Greenfield is Medical Director, Carolinas Integrative Health, Carolinas HealthCare System, Charlotte, NC, and Clinical Assistant Professor, School of Medicine, University of North Carolina, Chapel Hill, NC.
Source: Usha PR, Naidu MUR. Randomised, double-blind, parallel, placebo-controlled study of oral glucosamine, methylsulfonylmethane and their combination in osteoarthritis. Clin Drug Invest 2004;24:353-363.
Goal: To judge the safety and efficacy of glucosamine (Glu), methylsulfonylmethane (MSM), and combination therapy using Glu and MSM as compared with placebo in the treatment of knee osteoarthritis (OA).
Study Design: Randomized, double-blind, parallel, placebo-controlled trial performed over 12 weeks in India.
Subjects: Patients with mild-to-moderate OA of the knee (n = 118) as determined by both clinical and radiographic data.
Methods: Subjects were randomized to one of four groups, receiving three times daily either 1) glucosamine 500 mg with placebo MSM, 2) MSM 500 mg with placebo Glu, 3) Glu 500 mg and MSM 500 mg, or 4) Glu placebo and MSM placebo. Measures included degree of pain (4-point pain scale and visual analogue scale), swelling, joint mobility, 15-meter walking time, Lequesne index, and use of rescue medications. Participant evaluation took place at baseline and two, four, eight, and 12 weeks, and a global evaluation was performed at trial's end.
Results: All three active interventions improved signs and symptoms of OA significantly as compared with placebo. Combination therapy produced the greatest improvements in mean pain index, mean swelling index, and overall functional ability, as well as more rapid attainment of symptom relief. Less rescue medication was required by those in receipt of combination therapy than in any of the other three groups.
Conclusion: For the treatment of knee OA, combination therapy with Glu and MSM is more effective than treatment with either agent alone, either of which is more effective than placebo.
Study strengths: Degree and intensity of follow-up; dosages employed.
Study weaknesses: Compliance assessed by pill counting.
Of note: MSM is the oxidized form of dimethyl-sulfoxide (DMSO); topical DMSO has been used for the treatment of OA but is associated with a bad smell and the potential for skin irritation; Glu has been shown to possess mild anti-inflammatory activity through means other than inhibition of prostaglandin production; the optimal dosing schedule for MSM is as yet undetermined, though those who employ the agent often recommend 1-2 g twice daily; subjects were excluded from participation if they were using anti-inflammatory drugs, supplements, or physiotherapy (acetaminophen was permitted as rescue medicine); approximately 5% of participants who received Glu alone developed diarrhea.
We knew that: OA represents a degenerative joint disorder with associated secondary bony changes; Glu is an amino monosaccharide and an intermediate substrate for the production of glycosaminoglycan and proteoglycans by articular cartilage, as well as a provider of sulfate ions important to the production of chondroitin and keratin sulfate; sulfur concentration within arthritic joints is markedly less than that typically found in otherwise healthy joints; the Lequesne index is a functional index comprised of three parameterspain, maximum distance walked, and activities of daily living, with higher values associated with more severe disease.
Comments: While many people use MSM in association with glucosamine, or glucosamine and chondroitin, for the treatment of OA, there exists a paucity of human data to support such action. This study begins to remedy that situation. It is understood that nonsteroidal anti-inflammatory agents produce symptomatic relief in OA but without modifying the underlying disease process, and are associated with potential development of significant side effects. Glu, on the other hand, has been shown not only to provide significant pain relief in the setting of OA, but seemingly also impedes further disease progression. The rationale for consistently adding MSM to Glu is not yet compelling, but data such as those presented in this paper are intriguing and warrant further investigation.
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Greenfield RH. An OK for MSM for osteoarthritis. Altern Med Alert 2005;8(10):118-119.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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