Osteoarthritis is a common rheumatologic disorder. It is estimated that 40 million Americans and 80 percent of persons older than 75 years are affected by osteoarthritis pain. Although symptoms of osteoarthritis occur earlier in women, the prevalence of osteoarthritis among men and women is equal. The diagnosis of osteoarthritis is largely clinical because radiographic findings do not always correlate with symptoms.

Common risk factors for Osteoarthritis - Cause of Osteoarthritis
Age older than 50

Obesity (weight-bearing joints)

History of immobilization

Injury to the joint

Joint hypermobility or instability

Prolonged occupational or sports stress
Diet (see study below)

Natural osteoarthritis treatment
Adults who suffer from knee osteoarthritis may want to go without shoes when they can. Walking in shoes increases loads on knee and hip joints in patients with osteoarthritis of the knee. The most commonly used alternative or complementary nutrients for osteoarthritis are glucosamine and chondroitin. Several other nutrients and herbs may potentially help reduce symptoms of osteoarthritis. A healthy diet throughout life that includes lots of antioxidant rich fruits and vegetables reduces the risk for osteoarthritis.

Joint Power Rx for Osteoarthritis - A formula with powerful herbs and nutrients
Physician Formulas -- Formulated by Ray Sahelian, M.D.

Because osteoarthritis is so debilitating, Glucosamine and Chondroitin alone are often not enough. This powerful osteoarthritis formula includes several additional herbal extracts and nutrients that play a role in joint health.  

Joint Power Rx Supplement Facts:
Serving Size: 4 Capsules
Servings Per Container: 30 (1 month supply)

Glucosamine sulfate (from shellfish) Glucosamine is helpful in osteoarthritis particularly if combined with other nutrients.
Chondroitin sulfate - Chondroitin is a major constituent of cartilage providing structure, holding water and nutrients, and allowing other molecules to move through cartilage.
MSM -  MSM appears to be a promising nutrient in osteoarthritis and possibly certain types of allergies. A new study finds the combination of MSM and glucosamine to having synergistic effects in osteoarthritis.
CMO complex - also known as cetyl myristoleate
Boswellia serrata extract -  Boswellia serrata has been found helpful in knee osteoarthritis
Curcumin
Cat's claw extract
Devil's claw extract
Grape seed extract
Sea Cucumber extract

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Subscribe to a FREE Supplement Research Update newsletter by Ray Sahelian, M.D.. Twice a month you will receive an email with abstracts of several studies on various supplements and natural medicine topics, including osteoarthritis treatment with natural herbs and supplements.

Causes of osteoarthritis
The exact cause of osteoarthritis is not fully understood. Multiple factors (e.g., heredity, trauma, and obesity) interact to cause this disorder. Obesity is a growing cause of osteoarthritis. Any event that changes the environment of the chondrocyte has the potential to cause osteoarthritis. Although usually occurring as a primary disorder, osteoarthritis can occur secondary to other processes. The pathophysiology of osteoarthritis involves a combination of mechanical, cellular, and biochemical processes. The interaction of these processes leads to changes in the composition and mechanical properties of the articular cartilage. Cartilage is composed of water, collagen, and proteoglycans. In healthy cartilage, continual internal remodeling occurs as the chondrocytes replace macromolecules lost through degradation. This process becomes disrupted in osteoarthritis, leading to increased degenerative changes and an abnormal repair response.
     For overweight people hobbled by knee osteoarthritis, losing even one pound can diminish the stress the knees take with every step.

Osteoarthritis symptom
The following are some osteoarthritis symptoms:
     Aching pain, stiffness, or difficulty moving the joint. The pain often gets worse with overuse and may occur in the evening. In late stages of osteoarthritis, the pain can occur at rest.
     Osteoarthritis of Fingers : Bone enlargements in the fingertips (first joint) are common. These are called Heberden nodes. They are usually not painful.
     Hip osteoarthritis : The hips are major weight-bearing joints. Involvement of the hips may be seen more in men. Farmers, construction workers, and firefighters have been found to have an increased incidence of hip osteoarthritis. Heavy physical workload contributes to osteoarthritis of the hip and knee. Repetitive squatting and kneeling may promote knee osteoarthritis.
     Spine Osteoarthritis : this can cause bone spurs or osteophytes, which can pinch nerves and cause pain and potentially weakness in the arms or legs.

What is the standard medical Osteoarthritis treatment?
Acetaminophen and nonsteroidal anti-inflammatory drugs, such as ibuprofen, remain first-line traditional medications for the treatment of osteoarthritis. Naproxen, also sold as Aleve, might increase risk of heart attack or stroke. Osteoarthritis medications such as cyclooxygenase-2 inhibitors (COX-2) with the brand name Vioxx and Celebrex were thought to offer a safe alternative, but now we realize that they can be dangerous. Salsalate (Disalcid) or choline magnesium trisalicylate (Trilisate) are good osteoarthritis medicine alternatives. Complementary medication for osteoarthritis use has increased.
     Recent studies indicate that common osteoarthritis medications such as acetaminophen may not be effective after all.      
     Approximately one third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or nonsteroidal anti-inflammatory agents (NSAIDs) painkillers like ibuprofen. Moreover, up to one third of these painkiller-related incidents may be due to low-dose aspirin.

Joint Cracking and Osteoarthritis
Your mother always said, "Don't crack your knuckles - you'll get arthritis." Well, she was off the mark. Cracking joints is not detrimental to bone health. On the contrary, it may actually help ward off joint trouble. Dr. Tyler Cymet and colleagues from Johns Hopkins University in Baltimore determined the incidence of osteoarthritis in 100 men and women whose average age was 59. They compared the incidence in those who cracked their joints and those who didn't. Osteoarthritis occurred significantly more often in those who said they never cracked their joints. People who said they cracked their neck, or their back, hips or knees, had less osteoarthritis than those who didn't.

Diagnosis and Lab Tests for Osteoarthritis
The principal disease hallmarks for assessment of osteoarthritis are still clinical observation and x-ray findings. However, the efficacy of therapeutic interventions is complicated by the time required to observe radiographic signs, useful for both diagnosis and assessment. Thus, laboratory markers have received growing attention in recent years, in an attempt to improve diagnosis, assessment of disease activity and severity, and evaluation of therapeutic effects. Many biomarkers have been proposed, in particular those reflecting cartilage and bone turnover and synovitis. Among these, COMP, antigenic keratan sulphate, hyaluronan, YKL-40, type III collagen N-propeptide, and urinary glucosyl-galactosyl pyridinoline appear to be the most promising. However, serum or urinary determinations of these molecules are difficult to interpret adequately due to their complex metabolism. New ultrasensitive methods for C-reactive protein have improved the usefulness of this marker, especially in the assessment of disease activity. Routine examination of synovial fluid is still essential for diagnosis and includes leukocyte count and crystal detection; specialized testing includes the evaluation of the levels of markers of local inflammation such as metalloproteinases and cytokines, which appear to be crucial to the pathogenesis of osteoarthritis.

Osteoarthritis treatment and prevention is different than rheumatoid arthritis.

Osteoarthritis and Meniscus Damage
The meniscus performs an important function in the joint and removing it (either in part or whole) enhances the rate of structural change within the joint leading to osteoarthritis. During knee surgery, keeping the meniscus is better for patients with osteoarthritis. In the absence of symptoms such as a locked knee, it is preferable to keep as much of the meniscus as possible.

Rock Climbers and Osteoarthritis
Rock climbers may stress their hands and fingers more certain other athletes, but they don't seem to boost their arthritis risk in the process. In a comparison of 27 recreational rock climbers and 35 non-climbers, researchers found that climbers actually had a lower-than-expected rate of hand osteoarthritis on X-ray. When sports contribute to osteoarthritis, it seems to stem largely from frequent, heavy impacts or twisting motions on the joint. Though rock climbing is a workout for the hands, the stress placed on the fingers is "static," and not high-impact.

Weather influences osteoarthritis pain
Osteoarthritis pain usually worsens when the temperature drops or when the barometric pressure increases. Some osteoarthritis sufferers say their pain is better in climates that are warm and sunny. It's not fully clear why temperature and barometric pressure might influence osteoarthritis pain. Cold temperatures may, for instance, affect joint range of motion, or the flow of the synovial fluid that lubricates the joints. American Journal of Medicine, May 2007.

Osteoarthritis Research Update
 In a study published in the New England Journal of Medicine, glucosamine plus chondroitin sulfate did not provide significant relief from osteoarthritis pain among all participants. However, a smaller subgroup of study participants with moderate-to-severe pain showed significant relief with the combined supplements. Researchers led by rheumatologist Daniel O. Clegg, MD, of the University of Utah, School of Medicine, Salt Lake City, conducted the 4-year study known as the Glucosamine / chondroitin Arthritis Intervention Trial (GAIT) at 16 sites across the United States.GAIT enrolled nearly 1,600 participants with documented osteoarthritis of the knee. Participants were randomly assigned to receive one of five treatments daily for 24 weeks: glucosamine alone (1,500 mg), chondroitin sulfate alone (1,200 mg), glucosamine and chondroitin sulfate combined (same doses), a placebo, or celecoxib (200 mg). Celecoxib is an FDA-approved drug for the management of osteoarthritis pain and served as a positive control for the study. (A positive control is a treatment that investigators expect participants to respond to in a predictable way; it helps validate study results.) A positive response to treatment was defined as a 20 percent or greater reduction in pain at week 24 compared to the start of the study. The researchers found that participants taking celecoxib experienced statistically significant pain relief, as expected, versus placebo -- about 70 percent of those taking celecoxib versus 60% taking placebo had a 20% or greater pain reduction. For all participants, there were no significant differences between the other treatments tested and placebo. However, for participants in the moderate-to-severe pain subgroup, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared to placebo -- about 79% in this group had a 20% or greater pain reduction compared to 54% for placebo. In the subgroup of participants with mild pain, glucosamine and chondroitin sulfate together or alone did not provide statistically significant relief compared to placebo. On entering the study, a participant's level of pain was assessed as either mild or moderate to severe using standard pain assessment tools and scales, such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Of the 1,583 study participants, 78% were in the mild pain subgroup and the other 22% were in the moderate-to-severe pain subgroup. Level of pain was evaluated at weeks 4, 8, 16, and 24 using the WOMAC scale and other tools. In addition to taking their daily study treatment, participants could take up to 4,000 mg of acetaminophen daily for pain, except for the 24 hours before they were assessed by study staff. Few side effects from any of the treatments were reported. Those reported were generally mild, such as upset stomach, and distributed evenly across the treatment groups. The GAIT team continues their research with a smaller study to see whether glucosamine and chondroitin sulfate can alter the progression of osteoarthritis, such as delaying the narrowing of the joint spaces. About one-half of the participants in the larger GAIT study were eligible to enroll in this ancillary study. The results are expected in about a year.

Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis.
N Engl J Med. 2006 Feb 23;354(8):795-808. Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ. Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT
Glucosamine and chondroitin sulfate are used to treat osteoarthritis. The multicenter, double-blind, placebo- and celecoxib-controlled Glucosamine / chondroitin Arthritis Intervention Trial (GAIT) evaluated their efficacy and safety as a treatment for knee pain from osteoarthritis. We randomly assigned 1583 patients with symptomatic knee osteoarthritis to receive 1500 mg of glucosamine daily, 1200 mg of chondroitin sulfate daily, both glucosamine and chondroitin sulfate, 200 mg of celecoxib daily, or placebo for 24 weeks. Up to 4000 mg of acetaminophen daily was allowed as rescue analgesia. Assignment was stratified according to the severity of knee pain (mild [N=1229] vs. moderate to severe [N=354]). The primary outcome measure was a 20 percent decrease in knee pain from baseline to week 24. RESULTS: The mean age of the patients was 59 years, and 64 percent were women. Overall, glucosamine and chondroitin sulfate were not significantly better than placebo in reducing knee pain by 20 percent. As compared with the rate of response to placebo (60.1 percent), the rate of response to glucosamine was 3.9 percentage points higher, the rate of response to chondroitin sulfate was 5.3 percentage points higher, and the rate of response to combined treatment was 6.5 percentage points higher. The rate of response in the celecoxib control group was 10.0 percentage points higher than that in the placebo control group (P=0.008). For patients with moderate-to-severe pain at baseline, the rate of response was significantly higher with combined therapy than with placebo (79.2 percent vs. 54.3 percent, P=0.002). Adverse events were mild, infrequent, and evenly distributed among the groups. CONCLUSIONS: Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee. Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain.

Pomegranate fruit extracts can block enzymes that contribute to osteoarthritis according to a Case Western Reserve University School of Medicine study published in the September 2005 issue of the Journal of Nutrition. The study looked at the ability of an extract of pomegranate fruit against Interleukin-1b (IL-1b), a pro-inflammatory protein molecule that plays a key role in cartilage degradation in osteoarthritis.

Pomegranate extract may prevent prostate cancer or slow its growth, if results of lab experiments conducted at the University of Wisconsin in Madison translate to real-world benefits. Pomegranates are high in polyphenolic compounds, making its juice higher in antioxidant activity than red wine and green tea. When they incubated prostate cancer cells with low concentrations of pomegranate extract, they observed a dose-related inhibition of cell growth. In prostate cancer cells driven by male hormones (androgens) and expressing prostate specific antigen (PSA), treatment with pomegranate extract decreased androgen receptors and PSA expression. When human prostate cancer cells were injected into mice, feeding the animals pomegranate extract delayed the appearance of tumors. Tumor growth was significantly inhibited and survival was prolonged.

The arthritis drug Bextra, made by Pfizer Inc., has shown a high incidence of heart attacks and strokes among patients.

Australian scientists have identified an enzyme that destroys cartilage in mice and believe the find may lead to new drugs that stop cartilage joint deterioration and painful osteoarthritis in humans. The same enzyme, ADAMTS5, would be involved with breaking down cartilage in humans.

Soy protein may alleviate osteoarthritis symptoms.
Phytomedicine. 2004 Nov;11(7-8):567-75.
Alternative and complementary therapeutic approaches, such as the use of a wide array of herbal, nutritional, and physical manipulations, are becoming popular for relieving symptoms of osteoarthritis. The present study evaluated the efficacy of soy protein supplementation in relieving the pain and discomfort associated with osteoarthritis. One hundred and thirty-five free-living individuals (64 men and 71 women) with diagnosed osteoarthritis or with self-reported chronic knee joint pain not attributed to injury or rheumatoid arthritis were recruited for this double-blind, placebo-controlled, parallel design study. Study participants were assigned randomly to consume 40 g of either supplemental soy protein or milk-based protein (MP) daily for 3 months. Overall, soy protein improved osteoarthritis -associated symptoms such as range of motion and several factors associated with pain and quality of life in comparison to MP. However, these beneficial effects were mainly due to the effect of soy protein in men rather than women. This study is the first to provide evidence of possible beneficial effects of soy protein in the management of osteoarthritis. Examining and verifying the long-term effects of soy protein on improving symptoms of osteoarthritis, particularly in men, is warranted.

More than 70 percent of patients who took painkillers such as ibuprofen for more than three months suffered damage to their small intestines. The study is yet another blow to patients trying to find ways to treat osteoarthritis pain, after reports that the most advanced drugs, called COX-2 inhibitors, can raise the risk of heart death. Baylor College of Medicine researchers in Houston studied 21 patients taking a range of drugs called non-steroidal anti-inflammatory drugs, or NSAIDS. They compared them to 20 osteoarthritis patients taking acetaminophen, an unrelated painkiller, or nothing. Small-bowel injury was seen in 71 percent of NSAID users compared with 10 percent of controls. "We have always known that NSAIDs can cause potentially deadly stomach complications, but the extent of the impact on the small intestine was largely unknown until now, " they say.

The pathobiology of osteoarthritis and the rationale for using the chondroitin sulfate for its treatment.
Curr Drug Targets Immune Endocr Metabol Disord. 2004 Jun;4(2):119-27.
Structure-modifying osteoarthritis drugs are agents that reverse, retard, or stabilize the pathology of osteoarthritis, thereby providing symptomatic relief in the long-term treatment. The objective of this review is to evaluate the literature on chondroitin sulfate with respect to the pathobiology of osteoarthritis to ascertain whether this agent should be classified as a symptomatic slow-acting drug, a compound that has a slow onset of action and improve osteoarthritis symptoms after a couple of weeks. Chondroitin sulfate exhibits a wide range of biological activities and from a pharmacological point of view it produces a slow but gradual decrease of the clinical symptoms of osteoarthritis and these benefits last for a long period after the end of treatment. Many literature data show that chondroitin sulfate could have an anti-inflammatory activity and a chondroprotective action by modifying the structure of cartilage. These properties are also related to the oral adsorption of chondroitin sulfate as high-molecular mass compounds having clusters of sulfate groups and high charge density capable of exert their chondroprotective activity in vivo.

Boston researchers report a link between low serum levels of vitamin D and decreased knee function in patients with osteoarthritis of the knee. At the annual meeting of the American College of Rheumatology in San Antonio, researchers presented findings from 221 subjects recruited from the Boston VA Medical Center. All had knee arthritis and reported knee pain on most days in the month before they joined the study. The investigators measured blood levels of vitamin D at the start and again after 15 and 30 months. They compared change in vitamin D levels with changes in knee pain, physical function and muscle strength during the 30-month study period. Low levels were associated with higher levels of pain and disability and to a lesser extent muscle weakness. The researchers also found that about 50 percent of the population were deficient in vitamin D.

Though it's widely used as an alternative pain remedy, willow bark extract may not bring much relief to people with osteoarthritis. German researchers found that six weeks of treatment with the botanical failed to ease painful symptoms among patients with either osteoarthritis or rheumatoid arthritis. Osteoarthritis is the common form of arthritis associated with aging, while rheumatoid arthritis (RA) is an autoimmune disorder in which the immune system mistakenly attacks the lining of the joints, leading to inflammation, pain and stiffness. Willow bark has been used for centuries as an analgesic. Its principle active ingredient is salicin, a precursor to aspirin. In Germany, preparations containing willow bark extract have been licensed by federal health officials for the treatment of arthritis. However, the effectiveness of the alternative pain reliever has been less than clear. Two recent studies have suggested that willow bark extract may ease lower-back pain, while a two-week trial, by the same authors of the new study, found a modest benefit for osteoarthritis. In this latest, longer study, Dr. Lutz Heide of the University of Tubingen and his colleagues followed 127 adults with osteoarthritis of the hip or knee. The patients were divided into three "arms." Over six weeks, one group took two doses of willow bark extract every day, while another took two daily doses of the anti-inflammatory drug diclofenac, and a third took placebo pills. In addition, the researchers followed 26 RA patients who were randomly assigned to take either willow bark extract or placebo pills for six weeks. By the end of the study, pain scores on a standard measure had fallen among osteoarthritis patients who were on willow bark extract, but only to a degree similar to that seen in the placebo group.

Vioxx, the popular drug for osteoarthritis pain by Merck, has been pulled off the market as of October 2004 due to concerns about heart problems and strokes.

Older people with osteoarthritis are more likely to hang on to good physical function if they exercise on a regular basis. In a two-year study of more than 5,700 older adults with osteoarthritis, researchers at Northwestern University in Chicago found that men and women who were consistently active were less likely to develop physical limitations that interfered with their day-to-day lives.

Glucosamine and MSM work better together for arthritis
A new study, which was published in Clinical Drug Investigations, made big news in July 2004. The study found  that the combination of glucosamine and methylsulfonylmethane -- better known as MSM -- is more effective against osteoarthritis than either nutrient alone. Although the individual nutrients did improve pain and swelling in patients' affected joints, the combined therapy was more effective than MSM or glucosamine alone in reducing these symptoms and improving the function of joints. In a clinical trial conducted at at the Institute of Medical Sciences in Hyderabad, India, 118 patients with mild to moderate osteoarthritis were treated three times daily with either 500 milligrams of glucosamine, 500 milligrams of MSM, a combination of both, or an inactive placebo. After 12 weeks of treatment, the average pain score had fallen from 1.74 to 0.65 in the glucosamine-only group. In MSM-only participants, it fell from 1.53 to 0.74. However, in the combination group, it fell from 1.7 to 0.36. The researchers also found that the combination treatment had a faster effect on pain and inflammation compared to glucosamine alone. All of the treatments were well tolerated. "It can be concluded," the researchers say, "that the combination of MSM with glucosamine provides better and more rapid improvement in patients with osteoarthritis." SOURCE: Clinical Drug Investigations, June 2004.

An increase in blood pressure may be more likely when the painkiller Vioxx rather than other similar drugs are used to treat arthritis.

Just because aspirin, ibuprofen and similar pain relief medications can be purchased at a local supermarket or gas station without a prescription does not mean people should not take basic precautions when using them, according to the National Consumers League and the US Food and Drug Administration. The two groups joined together to launch on Thursday their "Take With Care" campaign to educate consumers about the safe use of nonprescription pain relievers. "Although these medicines are safe when taken as directed, many consumers don't realize the potency of OTC pain relievers," Peter J. Pitts, associate commissioner of the Food and Drug Administration said during the campaign launch. Some of the potentially serious side effects associated with the misuse of over-the-counter pain relievers include an increased risk of liver problems and kidney damage.

High levels of fat and (n-6) fatty acids in cancellous bone in osteoarthritis.
Plumb MS, Aspden RM. Lipids Health Dis. 2004 Jun 18;3(1):12.
Background: Osteoarthritis is strongly linked with obesity and patients with osteoporosis (OP) have a low body mass index. Anecdotal evidence, clinical and laboratory, suggests that Osteoarthritis bone contains more fat. However, conversion of osteoblasts to adipocytes is reported in OP and this would suggest that the more porous OP cancellous bone would have a high fat content. Objectives: To test the hypothesis that Osteoarthritis bone contains more fat than OP bone. Methods: Cores of cancellous bone were obtained from femoral heads of patients undergoing surgery for either Osteoarthritis or OP. Lipids were extracted using chloroform-methanol, weighed and expressed as a fraction of core mass and volume. A fatty acid analysis was performed using gas chromatography. Results: Osteoarthritis bone contained twice as much fat per unit volume of tissue as OP. Levels of n-6 fatty acids were elevated in Osteoarthritis, especially arachidonic acid (C20:4 n-6) which was almost double that found in OP. Conclusions: These data support the hypothesis that lipids may play a significant role in the pathogenesis of Osteoarthritis and may provide part of the key to understanding why Osteoarthritis and OP lie at opposite ends of the spectrum of bone masses.

Chondroitin Useful in Osteoarthritis
Back in the mid 1990s the America public became aware of effective nutritional alternatives to standard medical drugs for the treatment of osteoarthritis. Glucosamine was the first nutrient that became popular. Since then, many other nutrients and herbs have been promoted, including chondroitin. Chondroitin sulfate is a major constituent of cartilage providing structure, holding water, and allowing other molecules to move through cartilage—an important property, as there is no blood supply to cartilage. In degenerative joint disease, such as osteoarthritis, there is a loss of chondroitin sulfate as the cartilage erodes. But, few studies have looked at the long-term benefit of oral chondroitin supplements. In a study performed at University of Genova Medical School, in Italy, 12 individuals with arthritis of the hands were treated with 800 mg/day of chondroitin sulfate plus naproxen, and compared to 12 others who were given naproxen only. Naproxen is an anti-inflammatory medicine similar to Motrin and sold over the counter as Aleve. X-rays of the hands were done at the start of the study and again after 24 months. In both groups, degeneration of joints showed a general tendency to increase over time, however, the damage was much lower in those treated with chondroitin sulfate plus naproxen than in patients taking naproxen alone.
     Dr. Sahelian says: Although chondroitin by itself did not stop the continuing damage to joints, it did slow the progression of the osteoarthritis. Glucsosamine supplements are known to enhance joint health in those with arthritis, and it seems reasonable to take both supplements for the treatment of osteoarthritis. The most common dose of glucosamine is 1500 mg a day while that of chondroitin is 500 to 1000 mg per day.

The effect of nutritional supplements on osteoarthritis.
Altern Med Rev. 2004 Sep;9(3):275-96.
Osteoarthritis is the most common form of joint disease and cause of musculoskeletal disability in the elderly. Conventional management of Osteoarthritis primarily focuses on the relief of symptoms, using agents such as analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). These drugs, however, are associated with significant side effects and fail to slow the progression of Osteoarthritis . Several nutritional supplements have been shown to be at least as effective as NSAIDs at relieving the symptoms of Osteoarthritis , and preliminary evidence suggests several of these supplements may have a role in influencing the course of Osteoarthritis . The purpose of this article is to review the available literature on the effectiveness and safety of nutritional supplements for the treatment of Osteoarthritis .

Osteoarthritis questions
Q. What's the difference between osteoarthritis and rheumatoid arthritis is simple terms?
     A. Osteoarthritis and rheumatoid arthritis are quite different. Osteoarthritis is the gradual deterioration of cartilage in joints due to wear and tear and aging while rheumatoid arthritis is an autoimmune disorder that can strike at any age.

Q. Is MSM a good natural osteoarthritis treatment?
     A. Anecdotal reports indicate that MSM may be helpful as a natural osteoarthritis treatment but I have not seen any human studies to confirm this treatment.

Q. Does Lyprinol work in osteoarthritis?
     A. It may, there is some research available at the Lyprinol web page.

Q. I've heard that hyaluronic acid supplement is a good alternative osteoarthritis treatment.
     A. I have not seen any studies with oral hyaluronic acid as an alternative osteoarthritis treatment. I have heard a few reports that hyaluronic acid taken orally can cause a rash.

Q. Does glucosamine by itself help osteoarthritis ?
     A. The studies have been mixed. Some have shown glucosamine by itself is a natural remedy for osteoarthritis while other studies have come to the conclusion that glucosamine by itself is not much help. I prefer using glucosamine along with chondroitin, msm, cmo, and other nutrients.

Q. A physician from Bulgaria recommends that I take Tribulus Terrestris to improve osteoarthritis in my hip. Would you recommend this herb for my condition?
   A. We can't make individual recommendations. We have not heard of tribulus terrestris being used for osteoarthritis.

Additional links
white willow bark