Osteoarthritis treatment, supplements herbs vitamins pills, diet and food - Natural and alternative therapy and remedy by Ray Sahelian, M.D.
November 14 2014

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 occur earlier in women, the prevalence among men and women is equal. The diagnosis is largely clinical because X-ray findings do not always correlate with symptoms.
Common risk factors for osteoarthritis and causes
Age older than 50.
Obesity (pressure on weight-bearing joints) is a common cause.
History of immobilization.
Injury to the joint.
Joint hypermobility or instability.
Prolonged occupational or sports stress. For adults trying to protect their knee health, it may be best to avoid extreme ends of the exercise spectrum, such as too much high-impact exercise or too little physical activity. While playing tennis and excessive running can speed up the deterioration of knee cartilage, so can just sitting on the sofa or a chair in the front of the computer.
   Regular, mild to moderated distance running doesn't seem to increase your chances of developing knee osteoarthritis, and it may even help reduce the risk. American College of Rheumatology, news release, Nov. 15, 2014.
Diet that has a lot of sugar and junk foods and lacks adequate fresh fruits, vegetables, and omega-3 fatty acids. A healthy diet throughout life that includes lots of antioxidant rich fruits and vegetables reduces the risk for joint aches.
Smokers with arthritis have quicker joint deterioration than non-smokers.
Athletes, especially those who started as children or adolescents, are more likely to develop osteoarthritis than more sedentary individuals. Femur deformities cause their thighbone to have abnormal contact with their hip socket.

Natural osteoarthritis treatment
The most commonly used alternative or complementary nutrients for osteoarthritis are glucosamine and chondroitin. Several other nutrients and herbs may potentially help reduce symptoms. Devil's claw, cat's claw, ginger, nettle, pine bark extract, rosehip, turmeric, willow bark, Indian frankincense and vegetable extracts of avocado or soybean oils are all among the herbal medicines traditionally used to treat osteoarthritis and additional research is required to determine their overall effectiveness.

Joint Power Rx - A formula with powerful herbs and nutrients

Osteoarthritis is debilitating, glucosamine and chondroitin alone are often not enough. The ingredients:

Glucosamine sulfate (from shellfish) is helpful in osteoarthritis particularly if combined with other nutrients.
Chondroitin sulfate is a major constituent of cartilage providing structure, holding water and nutrients, and allowing other molecules to move through cartilage.
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 is also known as cetyl myristoleate. Many formulas over the counter promoted for joint health include CMO.
Boswellia serrata extract has been found helpful in knee osteoarthritis.
Curcumin extract from the turmeric root.
Cat's claw extract
herb from South America.
Devil's claw extract
herb from South America.
Grape seed extract supplement
Sea cucumber extract

There are a number of nutritional supplements that should be considered, either alone or together. These include the basic vitamins such as vitamins C and D, along with important omega-3 anti-inflammatory fatty acids such as those found in fish oils, EPA and DHA. SAM-e, a nutrient often used as a natural antidepressant, may offer some benefits but I suggest you keep the dosage low to avoid insomnia. Pomegranate, ginger and curcumin (the active extract from turmeric, found in curry spice) are foods and spices to consider adding to one's diet on a regular basis. Additional beneficial nutrients and herbs are found in Joint Power Rx, a formula that has many of the ingredients important to maintain joint health. These nutrients can be helpful in dogs and other animals with degenerative joint problems. Treatment and prevention of a degenerative joint condition is different than that of rheumatoid arthritis. Osteoarthritis is the common form of arthritis associated with aging, while rheumatoid arthritis is an autoimmune disorder in which the immune system mistakenly attacks the lining of the joints, leading to inflammation, pain and stiffness.

Chondroitin sulfate or sulphate
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 sulfate, 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. 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. Glucosamine supplements are known to enhance joint health in those with arthritis, and it seems reasonable to take both supplements. The most common dose of glucosamine is 1500 mg a day while that of chondroitin is 500 to 1000 mg per day.

Effects of an Oral Administration of Glucosamine Chondroitin Quercetin Glucoside on the Synovial Fluid Properties in Patients with Osteoarthritis and Rheumatoid Arthritis.
Biosci Biotechnol Biochem. 2009.
The effects of an orally administered combination of a glucosamine chondroitin quercetin glucoside supplement on the synovial fluid properties of patients with osteoarthritis and rheumatoid arthritis were investigated. Forty-six osteoarthritis and twenty-two rheumatoid arthritis patients were administered with the glucosamine chondroitin quercetin supplement orally for 3 months. The osteoarthritis patients showed a significant improvement in pain symptoms, daily activities (walking and climbing up and down stairs), and changes in the synovial fluid properties with respect to the protein concentration, molecular size of hyaluronic acid, and chondroitin 6-sulphate concentration. However, no such effects were observed in the rheumatoid arthritis patients. These results suggest that the glucosamine chondroitin quercetin supplement exerted a special effect on improving the synovial fluid properties in osteoarthritis patients. The dosage was 1200 mg glucosamine hydrochloride, 300 mg shark cartilage (consisting of about 100 mg of chondroitin), and 45 mg of quercetin.

Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo.
Osteoarthritis Cartilage. 2004.
A total of 120 patients with symptomatic knee osteoarthritis were randomized into two groups receiving either 800mg chondroitin sulfate or placebo per day for two periods of 3 months during 1 year. Primary efficacy outcome was Lequesne's algo-functional index (AFI); secondary outcome parameters included VAS, walking time, global judgment, and paracetamol consumption. AFI decreased significantly by 36% in the chondroitin sulfate group after 1 year as compared to 23% in the placebo group. Radiological progression at month 12 showed significantly decreased joint space width in the placebo group with no change in the chondroitin sulfate group. Tolerability was good with only minor adverse events identically observed in both groups. This study provides evidences that oral chondroitin sulfate decreased pain and improved knee function. The 3-month intermittent administration of 800mg/day of oral chondroitin sulfate twice a year does support the prolonged effect known with symptom-modifying agents for osteoarthritis.

Fish oils, omega-3 fatty acids
A multicenter study of the effect of dietary supplementation with fish oil omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis.
J Am Vet Med Assoc. 2010. Pet Nutrition Center, Hill's Pet Nutrition Inc, Topeka, KS, USA.
To determine the effects of feeding a diet supplemented with fish oil omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis. Results suggest that in dogs with chronic osteoarthritis receiving carprofen because of signs of pain, feeding a diet supplemented with fish oil omega-3 fatty acids may allow for a reduction in carprofen dosage.

Glucosamine and MSM work better together
The combination of glucosamine and methylsulfonylmethane -- better known as MSM -- appears to be 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 1.7 to 0.6 in the glucosamine-only group. In MSM-only participants, it fell from 1.5 to 0.7. However, in the combination group, it fell from 1.7 to 0.3. 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. Clinical Drug Investigations, June 2004.

Does glucosamine by itself help osteoarthritis ?
   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.

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

Pomegranate benefit
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.

Vitamin C
I am a 65 year old male bothered by osteoarthritis symptoms. I have taken Vitamin C in the 1-2 gram range for many years. I have been researching osteoarthritis diets and remedies online and discovered new sites that say research on guinea pigs show high doses of vitamin C worsen osteoarthritis. Do you have any advice on this?
   I have not seen such studies in humans. Most people can take 100 to 1000 mg of vitamin C daily without major side effects. In fact, one study shows some benefit.

The effects of vitamin C supplementation on incident and progressive knee osteoarthritis: a longitudinal study.
Public Health Nutr. 2010. Department of Epidemiology, College of Public Health, University of South Florida, Clearwater, FL, USA.
To evaluate the association between vitamin C supplementation and the incidence and progression of radiographic knee osteoarthritis (OA). Prospective cohort study. Male and female participants aged 40 years and above. Individuals without baseline knee OA who self-reported vitamin C supplement usage were 11 % less likely to develop knee OA than were those individuals who self-reported no vitamin C supplement usage.

Vitamin D may be of benefit
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.

Exercise and osteoarthritis symptoms
Moderate exercise can help older adults with osteoarthritis ease their pain and fatigue. Strength training, for instance weight training, can help ease pain and improve physical functioning in people with osteoarthritis of the knee.
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.

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Metabolic causes of osteoarthritis
The exact physiological causes of osteoarthritis are not fully understood. Multiple factors (e.g., heredity, trauma, and obesity) interact to cause this disorder. Any event that changes the environment of the chondrocyte has the potential to cause it. Although usually occurring as a primary disorder, osteoarthritis can occur secondary to other processes. The pathophysiology 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:
   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.

Osteoarthritis pain usually worsens when the temperature drops or when the barometric pressure increases. Some 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 joint pain. Cold temperatures may, for instance, affect joint range of motion, or the flow of the synovial fluid that lubricates the joints.

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.
Long-term, habitual use of the painkiller acetaminophen -- known as paracetamol in many parts of the world -- may cause a decline in kidney function in some people, according to a study of middle-aged women. Overall, one in 10 of the 1,700 women studied over 11 years experienced a 30 percent decline in their kidney's filtration function. Acetaminophen, which is sold under the brand name Tylenol by a subsidiary of Johnson & Johnson and is also marketed generically, was alone among commonly used painkillers to show an association with kidney impairment.   
   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.
Based on data from previous studies, the use of externally applied NSAIDs -- a group of anti-inflammatory drugs that includes ibuprofen and ketoprofen -- don't help patients with osteoarthritis over the long term. After 2 weeks, these so-called topical NSAIDs are no better than inactive "placebo" lotions for the treatment of osteoarthritis.

Joint Cracking
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
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. 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.

Exercise and movement
People suffering from creaky knees may want to give Tai Chi a try. Researchers have found that practicing the Chinese mind-body exercise leads to improvements in pain, function and even mental health for people with osteoarthritis of the knee. Some of these benefits persisted for a full year after the study began -- months after people had stopped doing the exercises. Arthritis & Rheumatism, 2009.

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.

Osteoarthritis Research
PM R. 2012. Nutritional interventions to prevent and treat osteoarthritis. Part II: focus on micronutrients and supportive nutraceuticals. The goals of pharmaconutrition for metabolic optimization are to drive biochemical reactions in a desired direction and to meet health condition-specific metabolic demands. Applying advances in nutritional science to musculoskeletal medicine remains challenging, given the fluid and dynamic nature of the field, along with a rapidly developing regulatory climate over manufacturing and commerce requirements. The purpose of this article is to review the available literature on effectiveness and potential mechanism for OA of micronutrient vitamins; minerals; glycosaminoglycans; avocado-soybean unsaponifiable fractions; methylsulfonylmethane; s-adenosylmethionine; undenatured and hydrolyzed collagen preparations; phytoflavonoid compounds found in fruits, vegetables, spices, teas, and nuts; and other nutrients on the horizon.

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.

Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis.
N Engl J Med. 2006.
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 ] vs. moderate to severe). The primary outcome measure was a 20 percent decrease in knee pain from baseline to week 24. 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. Adverse events were mild, infrequent, and evenly distributed among the groups. 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.

Soy protein may alleviate osteoarthritis symptoms.
Phytomedicine. 2004.
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.

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.
Lipids Health Dis. 2004.
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. 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. These data support the hypothesis that lipids may play a significant role in the pathogenesis and may provide part of the key to understanding why osteoarthritis and OP lie at opposite ends of the spectrum of bone masses.

Osteoarthritis natural treatment with supplements herbs vitamins questions
What's the difference between osteoarthritis and rheumatoid arthritis is simple terms?
   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.

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

I've heard that hyaluronic acid supplement is a good alternative osteoarthritis treatment.
   As of 2012, I have not seen any long term human studies with oral hyaluronic acid as an alternative osteoarthritis treatment.

A physician from Bulgaria recommends that I take tribulus terrestris, one of the common sexual enhancers found in libido enhancing products, to improve osteoarthritis in my hip. Would you recommend this herb for my condition?
   I can't make individual recommendations. I have not heard of tribulus terrestris being used for osteoarthritis.

Is white willow bark helpful for joint pain?
   I have not studied this herb in enough detail yet.

I am a 69 year old female in excellent health. I take 5 mg of Ramipril daily for blood pressure that averages around 145/90. My normal pressure is 120/70 with the Ramipril. I had 4 months of chemo therapy in 2009 for stage 3 lymphoma, non- Hodgkins, and am now in complete remission. My blood pressure has increased over the past few years, perhaps because of the chemo, as nothing else has changed as far as cholesterol readings. I started taking Hydraplenish which contains chondrotin sulfate, glucosamine, hyaluronic acid and MSM. I initially had good results for my osteoarthritis and torn meniscus. I have now been taking Hydraplenish for 2 months, and I just returned from the ER because of heart palpitations that I believe were caused by the Hydraplenish. I checked out negative on all the tests, and I do have one friend who experienced heart palpitations after taking Hydraplenish for 6 days. Because of my initial great results with the Hydraplenish, I decided with my doctor to have Euflexxa injected into my knee. I experienced an immediate reaction while being injected: sweating, nausea, extreme diarrhea, and pain. I cancelled the next 2 injections. I might add that I react to many things, and I am careful about what I put into my body. for instance, I cannot tolerate Vitamin E in any form. My reaction to the Euflexxa was not normal, and I believe I am reacting to the hyaluronic acid, or possibly also the MSM. Prior to my visit to the ER this am, I had been experiencing major muscle cramping throughout my body for the past week. I have stopped taking the Hydraplenish, and I will let you know if any of these issues improves.