arthritic knee pain, advantages of Voltaren gel, knee arthritis

You don’t have to be a baby boomer to suffer from knee pain. Plenty of younger people have pain that they can trace to overuse or to a specific injury. Older people also may be afflicted with arthritis that can cause knee or hip pain. But as increasing numbers of boomers move into their 60s and 70s, knee arthritis is becoming a common complaint. Moreover, the pain it produces can interfere with patients being able to run or even walk as they would wish. Understandably, many people are looking for the best medication to ease the pain. Here, the research has failed us all.

No Clarity on Long-Term Pain Control for Knee Arthritis:

A recent article in JAMA (Dec. 25, 2018) reviewed 47 randomized controlled trials of medications or supplements for knee pain. In all of them, the pharmacological intervention was compared to placebo or to another treatment. Importantly, all of the studies lasted for at least a year. (Short-term pain relief studies may not tell us enough about how well the treatment works in the long run.) This is exactly the type of study that should reveal how well medications work over the long term for controlling knee pain.

The Envelope Is Nearly Empty:

As a result, we are disappointed that this meta-analysis that included more than 22,000 patients did not demonstrate a clear winner. Two of the interventions did show a decrease in pain attributed to knee arthritis. They were celecoxib (Celebrex), a specialized COX-2 inhibitor in the NSAID category and crystalline glucosamine sulfate. (This product is available by prescription in Europe, where the authors are based, but not in the US.) Glucosamine sulfate had the best showing but the effect was small to moderate.

As the investigators state:

“Among the high-quality trials, glucosamine sulfate had the highest probability of being the best long-term treatment…”

In addition, the scientists found that glucosamine sulfate was most likely to be associated with improvements in joint structure. However, the authors noted significant uncertainty regarding how much this product is likely to help. Importantly, they found even more uncertainty with respect to celecoxib, the only NSAID (nonsteroidal anti-inflammatory drug) to do well in this set of long-term clinical trials. NSAIDs like ibuprofen and naproxen are far and away the most popular medications used to treat knee arthritis despite a lack of evidence that they help over the long term.

Consequently, the researchers conclude:

“Larger RCTs are needed to resolve the uncertainty around efficacy of medications for knee osteoarthritis.”

What Can You Do About Knee Arthritis?

Given this research, a person suffering the pain of osteoarthritis of the knee might well decide to explore glucosamine sulfate as a treatment option. People in the US might have trouble finding crystalline glucosamine sulfate, however, and other forms of glucosamine do not appear to be useful.

Will home remedies help? Few scientists have studied home remedies or dietary supplements for knee arthritis. If you would like to learn more about them, you may be interested in our Guide to Alternatives for Arthritis. It is available as a printed book or as an online resource (not a pdf). In addition, you may wish to listen to our recent interview with Dr. Beth Jonas. It is Show 1140: How Can You Manage Arthritis Pain?

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  1. Dr Richard
    West Palm Beach
    Reply

    As a healthcare professional, who has had both knees ” cleaned” o the medial and lateral meniscus, I would have surgery as the last resort.
    First I would lose weight. This is the least popular answer but those who lose 20% of excess body weight will also lose 80% of the symptoms, Based on the Worthington study
    Second is to go cycling, it is easy on the joints but very good for range of motion and strengthening the joint.
    Third is to reduce all inflammatory foods, ie fried, or packaged foods, sugared or salted. Most single ingredient food is fine ie, an apple, an orange.
    Fourth I would seek acupuncture treatments from a real acupuncturist.

  2. Cecilia
    Cary, NC
    Reply

    Physical therapy is the key for my knees. I do water aeroebic 5 days a week in class. Then i add more to build up my muscle around the knees. I now feel no joint pain or discomfort at all after one year. I can squad down and up in my garden for hours at a time. I intend to keep up my erercise regime forever.

  3. jeannniesue
    PA
    Reply

    Joe and Terry – I think it is crystalline, not crystallized, glucosamine sulfate that has been shown to be effective in knee osteoarthritis. It is available in the US under the brand name Dona, which is mentioned along with several others in this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400104/

    • Terry Graedon
      Reply

      You are right! I’ve made the correction. Thank you.

  4. Jim
    Winchester, VA
    Reply

    I only find glucosamine hydrochloride in local pharmacies and big-box stores, so I order glucosamine sulfate from the internet. I use the recommendations of ConsumerLab.com (subscription required) to order the most cost-effective glucosamine sulfate. Following PP over the years, various studies generally have found some benefit from sulfate and little benefit from hydrochloride.

  5. jeanniesue
    PA
    Reply

    Crystalline (not crystallized) glucosamine sulphate is available through Amazon under the brand name Dona. It is not cheap – about $1/day for the 1500 mg. recommended dose. I found an article in PubMed entitled “Crystalline glucosamine sulfate in the management of knee osteoarthritis” which mentions this brand (and others) specifically, and indicates that “crystalline” means stabilized. This formulation uses sodium chloride to stabilize it, not potassium chloride, which seems to be more common. I plan to try the “stabilized” glucosamine sulfate offered by Integrative Therapeutics, which lists chloride and sodium, not potassium, separately on the label, and is about half the cost/day as the Dona crystalline product. Another quite different approach that I have found helpful is a few minutes of gentle bouncing daily on the mini-tramp, which is low-impact on the knees and gives you some of the benefits of walking. My right knee is so severely affected that I have a Baker’s cyst there. The lower leg has some edema as a reault, and the mini-tramp has reduced it.

  6. Barbara
    Mississippi
    Reply

    I am 82 years old and have been very healthy; take no meds but a year ago knee arthritis had just about done me in. Refuse meds but wear a compressed knee sleeve or compressed knee highs socks all day and take 2 Tylenol for Arthritis in mid-morning. Haven’t needed a cane since.

  7. Betsy
    Cary,NC
    Reply

    I use your home remedy of golden raisins soaked in gin. Eat 9 each day. Along with water aerobics and water walking knee pain, arthritis, is not bad. Cannot do
    much regular walking, however, but that is partially because of neuropathy in
    feet.

  8. Barbara Neuberger
    Texas
    Reply

    I see that amazon has crystalline glucosamine sulfate. Is that the same as crystallized glucosamine sulfate?

    • jeanniesue
      PA
      Reply

      Check this out if you don’t mind reading scientific papers. It specifically references Dona, the brand of crystalline glucosamine sulfate available on Amazon. I think that “crystallized” was a typo. I am going to try the Integrative Therapeutics brand of stabilized GS, since the NIH article says that “crystalline” is the same as “stabilized” – as long as it is stabilized with sodium chloride, not potassium chloride – and it is half the price per daily dose.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400104/

  9. nancy
    decorah iowa
    Reply

    Tumeric with curcumin does it for us. And tai chi every day 20 min.

  10. Bob
    Spokane
    Reply

    I take turmeric and glucosamine as well as “drunken raisins”. But what seems to work well is taking
    Type 2 collagen.
    Another possible cause of knee pain is too tight of your IT band. See a PT for stretches.

  11. Ken
    SC
    Reply

    Glucosamine chondroitin has helped my knees tremendously for over 25 years, and I am still using it at 80 and walking several miles each day.

  12. Wanda
    United States
    Reply

    CAUTION: Webmd has a warning that Turmeric should not be taken if you are on a blood thinner or antiplatelet medication. Research and ask your doctor before taking supplements.

  13. William Nair
    Ca.
    Reply

    Why is there no answers to these questions?

  14. ANANT
    HOUSTON,TEXAS
    Reply

    One small addition to my comment. I cannot take Aspirin or Nsaids and Tylenol does not help.

    • Nancylee
      suburban Chicago
      Reply

      I, too, have noted that there are seldom any answers to these comments/questions.

  15. ANANT
    HOUSTON,TEXAS
    Reply

    I am a physician 86 , and had surgery done on right knee which did not help and was advised to have repeat surgery done as the screws plcaed were in wrong position.I do not want another surgery now because of complications which dropped my hemoglobin to 7 grams needing blood transfusion, my glucose went up to 384 mgms and now I need to take Metformin etc.I have taken many differant suppliments which did not help and injection of stemcells in left knee also did not help. I do regular PT ,massage etc but still need a walker as my knees have no strength or stabily, I cannot bear my weight and stand without support.I weigh 130 pounds. Any suggestions?

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