Oh, my aching knee! Oh, my aching back! Oh, my aching (Fill in the blank with YOUR aching joint—fingers, toes, elbows, wrists, or hips)! Probably most everyone ever on the planet has said something similar, because whether due to injury, overuse, or disease, at one point or another, everyone experiences some joint pain somewhere!
Joint disorders can be due to overuse and/or aging, injury, or disease. These disorders can be acute (sudden) or chronic (long-term). They can affect the bones or soft tissues of the joint—or both. The soft tissues that can be damaged include cartilage, tendons, and ligaments and can extend to the muscles attached to the joints. Before we get into what supplements can help support the joints, let’s get into some term definitions and general descriptions of some of the more common joint disorders.
Basic Joint Facts
There are 4 types of joints:
- Ball and socket:Examples are the shoulders and hips. These joints allow rotation, backwards, forwards, and sideways motion.
- Hinge: Hinge joints are found in the knees, fingers, elbows, and toes and allow bending (flexion) and straightening (extension) movement.
- Pivot: Examples are the neck vertebrae. The pivot joints allow for limited rotation (e.g. Shaking or nodding)
- Ellipsoid: Ellipsoid joints, as found in the wrists, allow some rotation, backwards, forwards and sideways motion.
Joints consist of bone and softer tissue which have various functions in joint health and in movement. The soft or connective tissues are:
- Tendonsconnect muscle to bone and help control joint movement.
- Ligaments connect bone to bone and both support and limit joint movement.
Cartilage covers the surface of the bone at the joint, reducing friction when the joint is moving. Friction is also reduced by synovial fluid found within the synovial membrane. Joints may also have bursae, or fluid-filled sacs to help cushion the joint.
Joint Injuries, Disorders, and Diseases Which Affect the Joints
Acute or sudden injuries include sprains (stretched or torn ligaments) and strains (stretched or torn muscles or tendons). Acute injuries also include dislocated joints.
Chronic disorders generally caused by overuse are:
- Bursitisis an inflammation of the bursa, the fluid-filled sacs cushioning the joint. The shoulder, hip, and knee are most commonly affected by bursitis.
- Tendonitisis an inflammation of the tendons and can occur at any tendon—though the most common occur at the shoulder, elbow, knee, and ankle.
There are many joint disorders—the most common are osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and reactive arthritis. Ankylosing spondylitis is a less common joint disorder that affects the spine and larger joints.
We’ll focus on the two most common forms of joint disease—osteoarthritis and rheumatoid arthritis.
Osteoarthritis
Osteoarthritis is considered a degenerative joint disease and is associated with aging. Symptoms include:
- Pain often triggered by the use of the joint
- Stiffness in the morning that usually lasts less than 30 minutes. Stiffness can also occur after periods of inactivity.
Osteoarthritis (OA) affects about 12% of the world’s population and is characterized by the disruption and eventual loss of cartilage and changes in joint structure.(1) The joints most often affected are the joints of the fingers, upper and lower back, the joint of the big toe, the hips, and the knee. Diagnosis is either by clinical history, the appearance of nodes on the fingers, or by X-ray. Lab studies may be done to rule out other conditions, but there is no specific lab test for osteoarthritis. NSAIDs and other anti-inflammatory drugs, along with some modification of daily activities, are usually recommended. Muscle relaxants are sometimes used along with massage therapy, weight loss recommendations, acupuncture, chiropractic care, and transcutaneous electrical nerve stimulation (TENS).
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune disease where antibodies against components of the joint are produced. These antibodies include rheumatoid factor (RF), anti-carbamylated protein (anti-CarP) antibodies, and anti-cyclic citrullinated peptide (anti-CCP) antibodies. When these antibodies bind to joint components, they initiate a cascade of inflammatory substances (pro-inflammatory cytokines) and enzymes that can damage the joints.
RA commonly affects the wrists, index and middle fingers, knuckles, shoulders, elbows, hips, knees, and ankles but just about any other joint can be affected except for the end-of-finger joints. Signs and symptoms include morning stiffness, joint pain and swelling, general weakness, and general fatigue. Diagnosis is by lab testing for RA-type antibodies or signs of inflammation. X-rays and/or MRIs are also often taken. Other tests may be needed to rule out other disorders.
Treatment may include some lifestyle modifications (i.e. losing weight, quitting smoking), NSAIDs and other anti-inflammatory agents, including steroids, a class of drugs known as Disease-modifying antirheumatic drugs (DMARDs), and biologics or monoclonal antibodies. These drugs may be used alone or in combination with other classes. Other therapies can include physical or occupational therapy and surgery.
Supplements Used for Joint Disorders
There are several different natural products used to help support joints. Among the most common are Glucosamine, Chondroitin and methylsulfonylmethane (MSM). Other natural substances often used are curcumin, Boswellia serrata, and pycnogenol. All have been studied to some degree—but, as with everything, some studies are better than others. Let’s take a look at some of the more common natural substances—that also have some of the most evidence and data behind them.
Glucosamine
Glucosamine is increasingly used to support OA, especially OA of the knee, to reduce pain.(2) Glucosamine has also been shown to confer some joint protection in athletes who experience intense joint stress.(3) Glucosamine also provides some pain relief in RA while helping to support improved joint function.(4)
Glucosamine is used by the body to make glycoproteins and glycosaminoglycans—both substances highly concentrated in cartilage and other connective tissues in the joints. The exact way that glucosamine appears to support joint health is not clear, but it may involve both protection against connective tissue damage and degradation(5) and anti-inflammatory actions.(6)
Glucosamine, whether taken alone or in combination with other supplements, generally takes a few weeks to start showing its effects—so it is important to keep taking the supplement. This may be due to the time it takes to begin to repair connective tissues.
Chondroitin Sulfate
Chondroitin sulfate is a sulfated glycosaminoglycan—more simply put, a large molecule made up of sugars, amino acids, and sulfur. It is a major part of what is known as the extracellular matrix (ECM) of connective tissues such as cartilage, ligaments, and tendons. The ECM is not a tissue or organ, as such—it is the “mortar” that helps hold connective tissue in place. Numerous studies have shown that chondroitin sulfate can be safely recommended for osteoarthritis of the knee and hip, especially when combined with glucosamine.(7) Chondroitin sulfate has also been shown to be beneficial in rheumatoid arthritis, likely because of its anti-inflammatory and other immune-modulating characteristics.(8) Chondroitin sulfate also appears to “home-in” on the joints somewhat specifically, allowing it to work more effectively on the affected joints.(9)
Combined Glucosamine and Chondroitin Sulfate
The combination of glucosamine and chondroitin sulfate has been widely studied, and they appear to work better together, especially in slowing AND helping to prevent further joint damage. Also importantly, they appear to be safe to use at doses of up to 2000 mg per day (glucosamine) and 1200 mg per day (chondroitin sulfate).(10)
Methylsulfonylmethane (MSM)
Methylsulfonylmethane or MSM is a Generally Recognized As Safe (GRAS) substance with few side effects and is well-tolerated by most people.
MSM is a naturally occurring organosulfur compound. You may have noticed that both Chondroitin sulfate and MSM contain sulfur. Sulfur compounds tend to form “bridges” between molecules, and in this case, between components of the ECM. These “bridges” tend to strengthen the ECM, potentially providing a stronger matrix for the joints.
MSM has anti-inflammatory, antioxidant, and immune modulation properties.(11) Clinical studies indicate MSM can reduce pain in arthritic joints.(12) The use of MSM was also associated with reduced swelling and stiffness in the joints.(13)
MSM is considered very safe and very well tolerated.
Combination Products
Most supplements are not clinically tested on their own—for the most part, much of the clinical evidence for supplements is based on combination products.
MSM is also often tested in combination with glucosamine and chondroitin sulfate. In these studies, supplements whose main ingredients were Glucosamine, Chondroitin sulfate, and MSM also showed improved joint mobility (improved range of motion) and improved physical functions along with decreased pain and stiffness.(14)
A Cochrane review – one of the “gold standards” of the evidence-based medical reviews—concluded that combinations of glucosamine and chondroitin sulfate were safe to use and provided some improvement in pain levels, range of motion, and function of affected joints.(15) Another broad meta-analysis concluded that chondroitin sulfate appeared to be most effective for pain and joint function, while glucosamine appeared to be most effective for reducing stiffness.(16)
Takeaways
Combinations of glucosamine, chondroitin sulfate, and MSM appear to be effective in reducing pain, stiffness, and swelling in both OA and RA. These natural supplements also can improve the function of the joints and may help prevent further joint damage. They are safe to use over a wide dose range and have a very low incidence of adverse effects, mostly mild and temporary gastric upset.
If you are one of those people who cry out about your aching joints, consider using a supplement containing these natural and effective ingredients.
Resources:
- Liu X, Machado GC, Eyles JP, et al. Dietary supplements for treating osteoarthritis: a systematic review and meta-analysisBritish Journal of Sports Medicine 2018;52:167-175. https://bjsm.bmj.com/content/52/3/167.long
- Ogata, T., Ideno, Y., Akai, M. et al. Effects of glucosamine in patients with osteoarthritis of the knee: a systematic review and meta-analysis. Clin Rheumatol 37, 2479–2487 (2018). https://doi.org/10.1007/s10067-018-4106-2
https://link.springer.com/article/10.1007/s10067-018-4106-2 - Nagaoka I, Tsuruta A, Yoshimura M. Chondroprotective action of glucosamine, a chitosan monomer, on the joint health of athletes. International journal of biological macromolecules. 2019 Jul 1;132:795-800.
https://www.sciencedirect.com/science/article/pii/S014181301836536X - M, Sampoorna, Ortholord Tablets: Nutritional Support for Rheumatoid Arthritis (October 17, 2020). Mediterranean Journal of Basic and Applied Sciences (MJBAS), Volume 4, Issue 2, Pages 29-40, April-June 2020, Available at SSRN: https://ssrn.com/abstract=3714000
- Dahmer, S, Schiller, RM, Glucosamine, Am Fam Physician. 2008 Aug 15;78(4):471-476. https://www.aafp.org/afp/2008/0815/p471.html
- Jerosch J. Effects of Glucosamine and Chondroitin Sulfate on Cartilage Metabolism in OA: Outlook on Other Nutrient Partners Especially Omega-3 Fatty Acids. Int J Rheumatol. 2011;2011:969012. doi: 10.1155/2011/969012. Epub 2011 Aug 2. PMID: 21826146; PMCID: PMC3150191. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150191/
- Henrotin Y, Mathy M, Sanchez C, Lambert C. Chondroitin sulfate in the treatment of osteoarthritis: from in vitro studies to clinical recommendations. Ther Adv Musculoskelet Dis. 2010 Dec;2(6):335-48. doi: 10.1177/1759720X10383076. PMID: 22870459; PMCID: PMC3383492. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383492/
- Du Souich P., García A.G., Vergés J., Montell E. Immunomodulatory and anti-inflammatory effects of chondroitin sulphate. J. Cell. Mol. Med. 2009;13:1451–1463. doi: 10.1111/j.1582-4934.2009.00826.x. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828858/
- Zewail M., Nafee N., Helmy M.W., Boraie N. Coated nanostructured lipid carriers targeting the joints—An effective and safe approach for the oral management of rheumatoid arthritis. Int. J. Pharm. 2019;567:118447. doi: 10.1016/j.ijpharm.2019.118447.
https://www.ncbi.nlm.nih.gov/pubmed/31226475 - Hathcock JN, Shao A. Risk assessment for glucosamine and chondroitin sulfate. Regul Toxicol Pharmacol. 2007 Feb;47(1):78-83. doi: 10.1016/j.yrtph.2006.07.004. Epub 2006 Aug 30. PMID: 16942821. https://pubmed.ncbi.nlm.nih.gov/16942821/
- Butawan M, Benjamin RL, Bloomer RJ. Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement. Nutrients. 2017 Mar 16;9(3):290. doi: 10.3390/nu9030290. PMID: 28300758; PMCID: PMC5372953.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372953/ - Debbi E.M., Agar G., Fichman G., Ziv Y.B., Kardosh R., Halperin N., Elbaz A., Beer Y., Debi R. Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: A randomized controlled study. BMC Complement. Altern. Med. 2011;11:50. doi: 10.1186/1472-6882-11-50. https://www.ncbi.nlm.nih.gov/pubmed/21708034
- Butawan M, Benjamin RL, Bloomer RJ. Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement. Nutrients. 2017 Mar 16;9(3):290. doi: 10.3390/nu9030290. PMID: 28300758; PMCID: PMC5372953.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372953/ - Vidyasagar S., Mukhyaprana P., Shashikiran U., Sachidananda A., Rao S., Bairy K.L., Adiga S., Jayaprakash B. Efficacy and tolerability of glucosamine chondroitin sulphate-methyl sulfonyl methane (MSM) in osteoarthritis of knee in indian patients. Iran. J. Pharmacol. Ther. 2004;3:61–65. https://www.ncbi.nlm.nih.gov/pubmed/22977594
- Singh JA, Noorbaloochi S, MacDonald R, Maxwell LJ. Chondroitin for osteoarthritis. Cochrane Database Syst Rev. 2015 Jan 28;1:CD005614. doi: 10.1002/14651858.CD005614.pub2. PMID: 25629804; PMCID: PMC4881293.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881293/ - Zhu X, Sang L, Wu D, Rong J, Jiang L. Effectiveness and safety of glucosamine and chondroitin for the treatment of osteoarthritis: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2018 Jul 6;13(1):170. doi: 10.1186/s13018-018-0871-5. PMID: 29980200; PMCID: PMC6035477. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035477/