In the last 15 years or so, several new over-the-counter (OTC) treatment compounds for arthritic joints have become available. These new products are a huge potential benefit to a lot of people. In my medical practice, I have observed that in about 50 to 60% of my patients have begun to show signs of osteoarthritis (also called DJD, meaning degenerative joint disease) by the time they are middle-aged. I have also noted that there is a general lack of understanding about how to effectively use these products. In this article, I will share what I have learned over the last decade using these products extensively with my patients.
Normal Joint Function
For joints to function well without stiffness or pain, they need very efficient lubrication between the bone surfaces that are touching each other. The human body, like all animal bodies with a bony skeleton, provides this by coating the bone surfaces that are in contact with other bones with a very strong, slippery material called the synovial membrane. This membrane works very closely with a lubricating fluid, called the synovial fluid, to provide an incredible amount of lubrication when bones must move against each other. In healthy joints, this is a superb system.
When Things Go Wrong in DJD
To understand how degenerative arthritis can begin, you must consider that the joint capsule, like every organ and tissue in the body is undergoing constant turnover. The materials in the system are constantly being broken down and the system’s cells are actively regenerating new components. The higher the load you put on a joint, or the more damage you do to it in some way, the faster this breakdown occurs. Usually, the regenerative cells can keep up with the damage and wear, but if damage exceeds repair, degenerative joint disease develops. Healthy tissues are lost faster than they are replaced and the lubrication begins to be lost. Joint function becomes progressively more compromised as pain and stiffness develop, often further complicated by muscle weakness as a reaction to the pain. If the situation gets bad enough, about the only effective option is to remove the damaged joint and replace it with an implanted joint prosthesis.
Treatment of DJD with NSAIDs and Pain Medications
What about non-steroidal anti-inflammatory drugs, like ibuprofen, and pain relievers, like acetaminophen? Can they restore effective function? Well, sort of. They do block pain and inflammation somewhat and allow more joint function with less pain for a while, but they do not repair the damage. In fact, using them in certain circumstances can encourage you to ignore the accelerated damage that too vigorous activity can bring about. To my way of thinking, they are best used to decrease pain occurring at rest or interfering with sleep. Unfortunately, even though these medications can help the joints feel better, this is not a true indicator that the joints are actually improved.
The New OTC Compounds that are the Point of this Article
The reason these new OTC preparations are so useful is that can actually help the body repair the damaged joints! In addition, as they repair the damage, they also prevent other joints from developing the same problems. This has been very well documented in the first two of these preparations to appear on the scene: glucosamine and chrondroitin. Two newer compounds, MSM (methylsuhphonylmethane) and HLA (hyaluronic acid) are not as well researched, but appear to behave just like glucosamine and chrondrioitin.
These compounds do not directly relieve pain like NSAIDs and other pain medications. They act by stimulating the body’s natural joint regeneration, which is a relatively slow process. While pain relievers take hours to days to work, these new OTC compounds take weeks to months. When I am having a patient try a new regenerative compound, I usually ask them to take it for two months before deciding how well it works. A given compound can sometimes make a noticeable difference in two or three weeks, but not always. Using the compounds, when your joints begin to feel better, they actually are better. In a manner of speaking, they turn back the clock and make your joints younger!
Combining these OTC Compounds
Will it be advantageous to take more than one of these compounds at the same time? My experience is that this is definitely possible. If after an adequate trial, there is no improvement, I stop that compound and try another. If there is improvement, I continue it for several months or until the improvement has clearly reached a plateau. When improvement plateaus with some pain and/or stiffness remaining, I often add another compound to the earlier one. I have occasionally used three or four with some apparent additive benefit from each.
Long Term Outlook
It is not at all unusual for these compounds (sometimes just one), properly used, to completely eliminate pain and stiffness, especially when the disease is mild and in its early stages. In cases of severe arthritis, they are still worth a try, but sometimes they don’t help much. In these more severe cases, there is no problem using these new OTC compounds along with more traditional drugs. These compounds have been a tremendous benefit to a lot of people.
An Important Note about Quality Control of OTC Preparations
I would be remiss if I did not warn you about a significant problem with all OTC preparations in the U. S. (and probably most everywhere). Several studies have been completed taking manufacturer’s products off the store shelves and analyzing them for the accuracy of the labeled ingredient amounts. Some studies have found less than half the products studied had unacceptable amounts compared to the label (a few were near zero!). You can’t tell by how nice the bottle looks or how reputable the store is where you purchase the compound. There is very little regulation of these kinds of products. They are pretty safe, but just because a given brand isn’t working does not mean a better brand wouldn’t. To solve this problem, when I am trying my patients on these OTC products, I use a manufacturer’s products whose quality control I have investigated. We carry these very reliable products in our office for this reason. Once I know what works, people can switch to any other brand. If it stops working, they know why.
As always, never stop your physician prescribed medications without discussing it with him or her first. If you have arthritis, these compounds are relatively inexpensive, they have very few side effects and can be wonderfully effective. (Unfortunately, they are usually not on insurance formularies.) Good health to you!