Ask the Doctors

Dear Doctor: I love to go for long walks and lately have noticed that I'm developing pain in my hip joints. I think that's just part of aging, but my daughter is urging me to try a glucosamine supplement. Can this really be helpful?

Dear Reader: Glucosamine is a compound that is naturally produced within your body. It plays a key role in building and maintaining healthy cartilage, the connective tissue between your joints. Tough and flexible, cartilage provides a smooth, lubricated surface over which bones can easily move and glide without friction or pain.

But cartilage has a limited ability to repair itself. When it is damaged, or when it wears away over time as we age, the resulting joint pain and stiffness can turn even the simplest tasks into an ordeal. Loss of cartilage, which leads to degeneration of the underlying bone, is what makes osteoarthritis so painful.

The use of glucosamine, a supplement sold in capsule and tablet form, became popular in the 1990s after several best-selling books touted it as a hedge against osteoarthritis. Several studies had suggested that glucosamine has anti-inflammatory properties and might even aid in the regeneration of cartilage. Sales of the dietary supplement spiked.

However, subsequent research has offered conflicting medical data about the benefits of glucosamine. In the largest study thus far, which looked at more than 1,500 adults with osteoarthritis of the knee, glucosamine proved to be no more effective than a placebo. Only the participants who were given acetaminophen for pain reported ongoing relief.

In several other studies, meanwhile, participants with osteoarthritis of the knee and hip who took glucosamine reported reduced pain and swelling, as well as increased range of motion. Little wonder that the glucosamine debate is lively and occasionally contentious.

If you do decide to give glucosamine a try, the National Institutes of Health report that glucosamine appears to be safe and well tolerated when taken in suggested doses over a two-year period of time. Although infrequent, reported side effects are headache, indigestion, heartburn and constipation. Since glucosamine is made from shellfish, including shrimp and crab, individuals with shellfish allergies or who are sensitive to iodine are warned to avoid it.

It's also an excellent idea to also follow recommendations put forth by the American College of Rheumatology. Their panel of experts -- primary care physicians, rheumatologists, geriatricians, surgeons, physical therapists and other health care professionals -- suggests the following:

-- Exercise: Thanks to increased muscle strength and toning, individuals with arthritis who exercise regularly have more energy, report less pain, sleep better and are better able to carry out daily tasks.

-- Lose weight: Every extra pound that you carry puts additional stress on your knees, hips and spine.

-- Medication: Check with your primary care physician whether oral or topical pain relievers might be helpful. Acetaminophen is a common first treatment for osteoarthritis. Nonsteroidal anti-inflammatory drugs, also known as NSAIDs, can also help with pain and swelling.

As with any treatment plan, make your primary care physician your partner. Whether it's giving your daughter's idea about glucosamine a try, or following through with the American College of Rheumatology's recommendations, your doctor is there to help, encourage and guide you.

(Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.)

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

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