Arthritis claims that deserve a straight answer

What to skip at the supplement shelf

Glucosamine and chondroitin haven't shown a clear, useful change for most people. If you try either one, decide what result would make the cost worthwhile.

Vitamin D matters when a test shows you're low. Taking more hasn't been shown to ease knee arthritis by itself.

Turmeric may give some people modest short-term relief, but products aren't all the same. Have a doctor or pharmacist check medicine conflicts before you spend money on it.

What to believe about scans and worn joints

A scan can show wear without explaining all your soreness. Some joints look rough on a report and still work fairly well.

The reverse happens too. You can hurt even when the scan doesn't look alarming.

Don't let one phrase on a report decide everything. Your motion, strength, sleep, old injuries, and daily work also matter.

What to ask before paying for a procedure

PRP means platelet-rich plasma. A provider draws your blood, concentrates one part, and places that part in the sore joint.

Some smaller studies found less soreness, but one large study found no clear gain in knee soreness or cartilage. No study has shown that PRP puts lost cartilage back.

Ask what improvement to watch for and when it might start. Get the full cost and ask what comes next if nothing changes.

Good advice admits the limits. QC Kinetix can discuss regenerative care without surgery, including PRP that clinic staff prepare by concentrating part of your blood.

Sources

1. A BMJ network meta-analysis of 10 large trials in 3,803 patients found that compared with placebo the difference in pain intensity on a 10 cm visual analogue scale was -0.4 cm for glucosamine, -0.3 cm for chondroitin and -0.5 cm for the combination - none crossing the pre-specified minimal clinically important difference of -0.9 cm. Industry-independent trials showed smaller effects than commercially funded ones (P=0.02 for interaction).

   Wandel S, et al. — Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis.. BMJ, 2010. DOI: 10.1136/bmj.c4675.

2. In a 70-participant randomized double-blind placebo-controlled trial, Curcuma longa extract improved VAS knee pain versus placebo by -9.1 mm (95% CI -17.8 to -0.4, P=0.039) and WOMAC pain by -47.2 mm, but did NOT change effusion-synovitis volume on MRI or cartilage composition. The authors flag modest sample size and 12-week duration as limitations.

   Wang Z, et al. — Effectiveness of Curcuma longa Extract for the Treatment of Symptoms and Effusion-Synovitis of Knee Osteoarthritis : A Randomized Trial.. Ann Intern Med, 2020. DOI: 10.7326/M20-0990.

3. A two-year randomized placebo-controlled trial in 146 participants with symptomatic knee OA raised serum 25-hydroxyvitamin D by a mean 16.1 ng/mL with cholecalciferol 2000 IU/day, testing whether vitamin D supplementation reduces symptom and structural progression of knee osteoarthritis.

   McAlindon T, et al. — Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial.. JAMA, 2013. DOI: 10.1001/jama.2012.164487.

4. The RESTORE randomized clinical trial (n=288) compared three weekly intra-articular injections of leukocyte-poor PRP with saline placebo in symptomatic mild-to-moderate medial knee OA. At 12 months the mean change in knee pain was -2.1 versus -1.8 points (difference -0.4, 95% CI -0.9 to 0.2, P=.17) and the mean change in medial tibial cartilage volume was -1.4% versus -1.2% (P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

5. In the Framingham Osteoarthritis Study, 710 people over 50 with NO radiographic evidence of knee osteoarthritis underwent knee MRI: 89% had 'any abnormality'. Osteophytes appeared in 74%, cartilage damage in 69% and bone marrow lesions in 52%. Prevalence of at least one abnormality was 90-97% in painful knees and 86-88% in painLESS knees.

   Guermazi A, et al. — Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study).. BMJ, 2012. DOI: 10.1136/bmj.e5339.

6. A prospective cross-sectional study contacted 273 of 317 US direct-to-consumer stem-cell centres posing as a 57-year-old man with knee osteoarthritis. The mean advertised price of a unilateral same-day stem-cell knee injection was $5,156 (SD $2,446; 95% CI $4,550-5,762, n=65), and the mean claimed clinical efficacy was 82% (SD 9.6%, n=36) - a figure the authors describe as a gap between the published literature and marketing claims.

   Piuzzi NS, et al. — The Stem-Cell Market for the Treatment of Knee Osteoarthritis: A Patient Perspective.. J Knee Surg, 2018. DOI: 10.1055/s-0037-1604443.

7. FDA states verbatim that stem cell products, stromal vascular fraction (adipose-derived), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products have NOT been approved 'for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.