Joint Care : Dr Rod Hughes sets out how pharmacists can play a pivotal role in steering people with joint pain towards a prevention programme…
Joint health supplements are big business in the UK, with millions of pounds spent over the counter every year. People turn to these supplements for various reasons, but most are seeking relief from the symptoms of arthritis, a group of painful long-term conditions thought to affect around 10 million people in this country.
Osteoarthritis (OA) is the most common form of arthritis, affecting around eight million people in the UK. The condition is generally age-related, with joint pain and stiffness developing as the cartilage between the bones gradually wears away.
OA changes and the inflammation involved causes difficulty moving and considerable pain. Rheumatoid arthritis (RA) tends to affect younger people and is caused by the body’s immune system attacking the joints. As a nation we tend to ignore our joints until they cause us problems, resulting in an increasing number of people taking long-term analgesics to control the pain or needing surgery to repair knees and hips.
Treatment guidelines followed by doctors in the UK recommend that people with arthritis are advised to maintain a healthy weight and keep physically active, while strengthening their muscles and protecting any damaged joints during daily activities.
Simple pain-killers are not without risk and the potential long-term side-effects of some of the most popular analgesics was recently highlighted by the UK’s National Institute for Health and Care Excellence (NICE).
While use of simple analgesics and non-steroidal anti-inflammatories (NSAIDs) can be reassuring and effective for those with muscular and joint pain, both groups of medicines may have side effects. For example, constipation and headache can occur with some analgesics, and indigestion and peptic ulceration with NSAIDs.
These side-effects can result in medicines not being taken correctly, limitation of dose or duration and, in some cases, lead to overt harm. Pharmacists can play a pivotal role in steering people with joint pain towards a prevention programme, promoting lifestyle and diet changes, including recommendation of clinically proven joint specific supplements.
In my experience, people often try these products as an alternative to, or to supplement, their prescription drugs. It’s important to be aware of the evidence, as the most popular may not be the most effective.
Omega-3 fatty acids
Omega-3 fatty acids have anti-inflammatory properties and are found in fish oils or formulated and sold as capsules or liquids. Studies assessing the benefits of fish oil, although quite old, have pro-vided reasonably good evidence that it is effective for some people with RA, providing pain relief, reducing the need for NSAIDs, and leading to symptom remission in some individuals.
It is important to bear in mind, however, that the benefits of fish oil supplementation in RA may not be apparent for up to three months – so perseverance is key. Very little evidence exists to suggest that fish oil supplements benefit people with OA.
Glucosamine & chondroitin
Glucosamine and chondroitin are popular joint health supplements that are available individually or in combination products. The clinical evidence supporting the use of glucosamine and chondroitin is mixed with only marginal benefits observed in clinical trials. GP’s have therefore been advised not to prescribe these supplements on the NHS; some people however do feel they see benefits.
Rosehip extracts
Roses and rosehip extracts have a long history of medicinal use and their potential benefits in the treatment of OA and RA have relatively recently come to light. The most consistent and robust re-search has been undertaken on extracts from a specific species of rosehip called Rosa canina, which has been found to contain a potent anti-inflammatory ingredient called galactolipid (or GOPO® for short).
GOPO® has been investigated in a number of well-designed studies conducted in Scandinavia and Germany involving people with either OA or RA. These studies found that GOPO® can rapidly reduce joint pain, stiffness and swelling, improve joint mobility and reduce the need for standard painkillers. In one combined analysis of all GOPO® studies, the researchers concluded that GOPO® may be more effective than either paracetamol or glu-cosamine in the treatment of OA.
In conclusion
Fish oils undoubtedly have many potential health benefits, however, a large number of standard capsules (around nine a day) are required to achieve a clinically-effective dose, which may be expensive and, ultimately, too heavy a treatment burden.
Glucosamine and chondroitin may benefit some individuals, however, it seems likely that the number of people who benefit will be matched by the number who don’t. GOPO® has been well studied and appears to have multiple benefits across a range of painful joint conditions, but beware of the ‘copy-cat’ products that may not necessarily contain the active ingredient.
Given the growing popularity of natural alternatives to conventional analgesics for joint pain, together with evidence to support their benefits, it would appear advisable for such options to be available via pharmacies. I would urge that customers look for evidence-based options and that if something is not working for them they should try something different with the advice of pharmacy staff.
(Dr Rod Hughes MD, FRCP is a consultant rheumatologist based in Surrey.)
