The People's Perspective on Medicine

What Can You Do for Your Knee Arthritis?

A major review of research on knee arthritis found just one treatment, glucosamine sulfate, with a modest effect on pain and function long term.

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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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
Alternatives for Arthritis
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This eGuide describes nondrug alternatives for arthritis with the latest scientific studies to document anti-inflammatory activity. This comprehensive online guide (too long to print) adds the science behind ancient healing traditions.

Alternatives for Arthritis
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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.

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.

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/

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

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.

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.

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.

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.

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

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/

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

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.

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.

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.

Why is there no answers to these questions?

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

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

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?

I’ve had multiple massive sports injuries and have broken both knees, right across the ball and socket joint. I’ve also ripped, torn and stretched every bit of soft tissue around each knee and hardly ever seen a doctor for any of it (except the breaks) because of lack of medical benefits, lack of $$, etc.

When I was a kid, my knees had bad “crepitus” (crackling upon flexion/extension) and I had to hobble painfully and use pain pills when backpacking.

NOW, at 71 yo this month, I finally have no pain at all in my knees although I ski really really hard and always push my limits. I often don’t even take a Tylenol!

WHAT’S MADE THE DIFFERENCE? HYALURONIC ACID! And TURMERIC! Also, I take good ol’ GIN-SOAKED RAISINS every night. The pain was much improved last ski season, though still there. This ski season, it’s simply gone, for the first time in my life. Unbelievable but true.

I’ve had two arthroscopies on each knee, the last in 1992. I had a hard time recovering from the last one and when I did recover mobility it was due to specific exercises for the quad muscles of the thighs. I do leg extensions — building over time to a maximum weight, and leg presses — one leg at a time. These have stabilized and built the muscles around my knees and I can squat down and rise again, my legs are powerful and my knees only hurt if I skip more than 2 weks of exercise. You can’t expect to exercise for just a few weeks and build any real strength, and you will have your best luck learning exercises from a physical therapist — not a physical trainer — their goals are different. Glucosamine Hcl 1500 mg combined with chondroitin sulfate at 1200 mg has been the best supplement regimen for my knees. Some brands have worked, and some have not. To see if a supplement will help you, you should try one for over a month before deciding it hasn’t helped. The brand that works for me doesn’t work for my husband and the brand that works for him doesn’t work for me.
Don’t just give up until you have given exercises a chance. You don’t always have to just live with the pain. You should educate yourself on what NOT to do on a regular basis. For aerobic work, according to my orthopedist, the bicycle is best. I have personally learned that both the stairmaster and the various eliptical machines are a bad idea if you have arthritis or osteo-arthritis in your knees.

I had prolozone therapy on both knees around 5 years ago, and my knee problems went away and never returned. My internist offers this service in his office. It is an injection of vitamins, ozone, and forgot what else. At first I didn’t think it did anything for me, as I was expecting a quick fix. But 3 months later I woke up one morning and realized my knees didn’t hurt anymore. The pain has never come back.

I agree with Charles W. S. ‘I have found that hyaluronic acid helps my knee pain better than anything I have tried.’

My greatest success has been with knee supports. But Hyaluronic acid is a recovery tool. Glucosamine has not been particularly helpful but not harmful when I take plant steroids to reduce cholesterol. But co-enzyme Q just does not work for me.

I have been suffering from arthritis for years. Have tried glucosamine and many other things. Haven taken turmeric with black pepper and ginger. Worked for a while. But something else I have, and has worked for me, is carrot juice sometimes mixed with celery. It really worked.

Several years ago I was getting a cortisone shot for pain every 5 months in my left knee, which was diagnosed as having “advanced arthritis.” After 4 or 5 shots, I started taking a good quality capsule of curcumin, the active ingredient in turmeric. It started helping in a few weeks and is still working years later if I don’t overdo being on my feet. What a blessing! I hope I’ll never need a knee replacement. I’m 80.

My knee started to hurt pretty badly last summer (age 74); all kinds of ordinary movements had become painful. My doctor diagnosed arthrosis. I had 6 sessions of physical therapy, and the pain has almost disappeared. I faithfully did the prescribed exercises and intend to keep doing them as long as physically possible. It’s all about strengthening the large thigh muscles that support the knees. (First I tried pectin in grape juice; it didn’t seem to have any effect.)

I take high dose curcumin to try to avoid early onset AD, which is in my family. I noticed after a while my knee and hip pain had virtually disappeared along with my Dupuytren’s contracture. And yes I feel I have gained a few IQ points back. I’m 62. Maybe this will also help others.

My right knee has had no cartilage (no meniscus) for at least ten years, and now I’m 74. I have very little and infrequent pain – not enough to bother about. My secret comes from a physical therapist (PT) who had also had knee trouble as a teenager, and here’s what she said: “Keep the quads (the big muscles on the front of your thighs) strong. The quads support the knees. Do this exercise three times a week for the rest of your life, and your knee will be fine.” “Why not every day?” I asked. “Because,” she said, “you won’t do it every day, and then you’ll give up. Three times a week is fine.” I’m not going to describe the exercise here; I suggest you ask a PT. Just to be sure to get it right the first time without straining.

What exercises are you talking about to strengthen the quads? I’d love to try something that doesn’t include adding chemicals to my body!

Any information related to the local injection of stem cells to rebuild arthritic joints?

HI David,
I have been looking into this for my knees. One has already been replaced at age 57 and did NOT go well. I had this done in 2014 and have had stiffness and cramps ever since. It only bends to 85 degrees now, and bend was 115 BEFORE the surgery!

My right knee is getting bad also, and I am fearful. I do not want another knee replacement on this now-achy knee since the other replacement went so badly. I went to three different PTs for help and did ALL the PT, and things did not get better. I have looked into STEM CELLS, and it all sounds good except the $3800 price tag—for one knee–and no guarantees that it will work. And of course, insurance companies will not pay one dime for something safe like stem cells. I take nothing for pain but Advil and worry that it is dangerous. Not sure WHAT the “baby boomers” are going to do—(I’m only 62, and the future does NOT look good for me). Have always been active but now have to use a cane.

I did stem cell treatment on both knees a year and a half ago, at the age of 60. I experienced remarkable relief for the first year. It was like magic!

I am now feeling quite a lot of pain again, but that may be because I’ve been rather too cavalier with my knees, since they felt so good. I stopped doing any PT exercises, and I played Pickleball outside on concrete courts about 12 hours a week most of the summer. The game involves a great deal of torquing on the knees, with sudden stops and starts.

I am being diligent with the PT exercises now, as well as daily riding on a stationary bike and am playing Pickleball on wooden gym courts. I want to see if I can get back to my pre-summer knees before I contact the doctor (in Seattle) for a follow-up treatment.

I have been taking Black Seed Oil for knee pain, and I find that it is effective. This was initiated by a report about one year ago in People’s Pharmacy by a lady who experienced such relief from using Black Seed Oil that a planned knee replacement was halted.

I developed knee pain for the first time this summer in my left knee and tried a knee brace. That helped some but made my ankle swell. I tried several variations of knee brace, and they helped for a while but were not a solution. I had an x-ray that determined I had arthritis. Tylenol Arthritis had minimal effect. I asked to see a physical therapist who used heat, massage, exercise bike, and a number of different exercises, and I am now free of pain. Primarily, she believed that strengthening the muscles and tendons around the knee and even up to the hip would relieve the pressure between the bones, and exercise allowed the knee to produce lubrication that was important to relieve pain.

How about the rooster injections into the knees? Many doctors recommend this, as it helps the cartridge. Also, the CBD oil really helps with the pain orally and in gel form to put on the knees. You can try the coated aspirin or turmeric, one or the other because together they thin the blood. Check all out with your Dr. first.

As for the rooster comb, it is my understanding that if you are on medicare usually cortisone injections are first before advancing to the rooster comb

One concern about glucosamine products is that for some people it can raise LDL Cholesterol!

I suffer extreme arthritis in both knees (bone on bone). Injections no longer work. To relieve pain I take 300 mg of boswellia and hyaluronic acid daily. I can walk and exercise without pain although when active. I wear soft braces.

My knee pain is helped by three things: (1) cycling a few miles every week, (2) stretching exercises recommended by a physical therapist, and (3) taking 400 mg of ibuprofen every morning.

The combination of Glucosamine, Chondrointin, and MSM sure has taken pain out for me.

Years ago, at age 59, my right knee hurt so badly I could hardly walk. Then I read an article by a sports doctor who said that some people get knee pain from walking crooked. The solution is to use orthotics. Orthotics are simple heel inserts that somehow straighten out your feet as you walk. Since I have walked crooked all my life (my feet roll to the outside), I decided to try this. I went to the drugstore and bought a pair of popular brand-name orthotics for $15, and popped them into my shoes. The knee pain went away instantly. Since then, I’ve had very little knee or hip pain.

Since taking a spoonful of hydrolyzed gelatin (from grass-fed cows) each morning, dissolved in our morning coffee or tea, my husband and I have no joint issues. Hydrolyzed gelatin is more bioavailable than regular gelatin, and dissolves readily in either hot or cold liquid. My knees were starting to cause pain when walking downhill or down stairs, but that is no longer an issue since taking gelatin daily. We have been doing this for several years. I am 72, and my husband is 87.

Where is this glucosamine sulfate crystallized made? No doubt it is uninspected and contaminated. I have stopped all supplements. I only take one multiple vitamin a day, and I think that is all the mystery ingredients I dare put in my body. I will depend on diet and exercise. My knees are crippled, and I have limited mobility, but I don’t see taking supplements of unknown origin and manufacture to add to the problem.

Jesse, negative outlook and attitude can make one miserable,
you are doing a fine job at it. If you had read the PP article
carefully, you would have read that it was developed in
Germany not a third world country! I appreciate PP for
bringing us ALL remedies and info about the latest developments. Thank you, People’s Pharmacy!

I took Celebrex with only modest results. However, 1500 mg of Turmeric twice daily has had remarkable results. I know that it may not work for everyone but I have had 3 years of almost total relief. Purchased at a big chain pharmacy, it costs less than 5 cents per capsule or less than 30 cents per day.

I am 65 and use glucosamine sulfate. It helps my knee’s and joints. If I miss a few days, I notice it.

I have found that hyaluronic acid helps my knee pain better than anything I have tried.

I have found, on the internet, a tablet with 300 mg. I take one every day.

When the pain still shows up, occasionally, I take two tablets a day until the pain subsides.

I have a question:
I noted with interest the part of your article that said that “This product (crystalized glucosamine sulfate) is available by prescription in Europe, where the authors are based, but not in the U.S.”. I have been taking Glucosamine and Chondroitin with MSM capsules from that has a statement on the label explaining that each serving contains 1,100 mg of Glucosamine Sulfate (from 1,500 mg Glucosamine Potassium Sulfate Complex).

I also noted that the description on the bottle does not use the word “crystalized”. So, my question is, does the particular capsule (from Now Foods) provide the form of glucosamine that your article says we need or not. Thanks, in advance, for any clarification you can provide.

Not sure what causes my knee pain. Before I started taking the liquid hyaluronic acid, if I sat in one position where I could not straighten my legs the knees would hurt, like when I was in the movies or in a car. Taking the acid seems to fix this issue. I take a table spoon each morning, and it did take a few days for this to work.

I used to take Meloxicam as prescribed by an orthopedic surgeon. It did not eliminate the pain but it helped. I switched to grape juice and pectin. It is as good as Meloxicam. It helps but does not eliminate the pain.

I know you’re talking about arthritis keeping people from being active, but that’s what they need. Both of my knees have arthritis, and one even sits at a slight angle from an old fracture. Neither knee has much, if any, cushioning. However, I have relatively little pain. I can still squat down to the ground and get back up, provided I’m not down for very long. Otherwise I need to give myself a little push, and I will admit that I can’t tolerate being in that position for too long. I walk or use the treadmill at least 5 times a week, and the only time I ran into problems was when I tried using a program that simulated walking uphill. I saw my X-rays of both knees, and I’m amazed I have so few problems, but my doctors have told me that staying active is really important. I should also add that I am not overweight, and I’m in my 60s.

My mom used glucosamine, and it helped her knee pain. But there was a price to pay. She had a heart arrhythmia for years (after having scarlet fever), but it wasn’t too bad. After using glucosamine for a month or so, her arrhythmia got quite a bit worse. Her cardiologist said it was the glucosamine causing it. So she had to stop using it, even though she had to put up with bone-on-bone knee pain for the rest of her life. She had hoped for knee replacement, but her doctor said her heart wasn’t strong enough. Just thought I should mention this. Hope it serves as a warning if people have heart rhythm issues.

I was able to get some powdered glucosamine by mail many years ago , perhaps 25 years, and it worked for me so much that I told several people about it. It cured my pain completely. Years went by, and I didn’t have a need for this for years. Then I had another flare-up and tried to get some and never was able to. I remember seeing a panel of celebrities on a TV talk show that said they owed their mobility to this powdered glucosamine.

Where can we get it?

I have osteoarthritis for the pasf 40 years , knees shoulders back and ankle . Had one knee replaced 7 years ago and sorry I did it.
Went to a orthopedic hospital 2 years ago and was advised to have fusion done right away but I declined. My ankle is doing better now and also the rest of my joints but I know for sure that taking drugs is not the best way to go. I use quite a lot of turmeric with black pepper, boswellia, devils claw, ginger, fish oil, and viamin C (1500 mg per day). I go to the gym, sauna, and pool three days a week, and at 74 years of age I feel great most of the time. Drugs do not kill pain. They can kill you. Keep moving fast. The hospital said 7 years ago that they could do no more for me, so do it for yourself. It works.

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