January 13, 1998   Personal Health:
The Arthritis Is at Bay, Thank You By JANE A. BRODY
The two questions I was asked most often in 1997 were "Is that dietary supplement still helping your arthritic
knees?" and "Are there results yet from the studies being done on this side of the Atlantic?"
 Fourteen months ago, following my arthritic spaniel's dramatic improvement upon taking a supplement containing  two  substances that play a role in the formation of cartilage, glucosamine and chondroitin sulfate, I decided to try the stuff  myself. Two months later, ignoring bemused queries like "Are you barking yet?" I reported about a 30 percent   improvement -- not an absence of pain and stiffness, but less of them and little or no swelling after activities like tennis   and ice skating that gave my knees a workout.
 Now a year later my dog and I are still taking the supplement, though at lower daily doses. My dog, who will be 13 in   June, is free of pain and stiffness. He walks two hours a day, goes up and down stairs easily and regularly climbs a  mountain road with me.
 I continue to play singles tennis two to four times a week and skate four or five times a week, and I have added a daily  three-and-a-half-mile brisk walk to my activities.
 Despite recent X-rays showing advanced arthritis in one knee and moderately advanced arthritis in the other, my knees  do not swell anymore and are no longer stiff after prolonged sitting. I do not have pain-free knees, but I no longer have  disabling discomfort, a chronic limp or difficulty going down stairs, and I have greatly reduced my use of ibuprofen, which while relieving pain and swelling may contribute to joint deterioration.
Anecdotes Abound
My dog and I are not alone. My mailbox has been stuffed with testimonials from others who have ventured into this  form of alternative medicine to cope with their arthritis. One elderly Brooklyn man said that after three years of  crippling pain, he has thrown away his cane and now walks a mile a day. An Arizona woman in her 70's who could  hardly walk now walks a mile and a half every morning with her once equally crippled 13-year-old dog. A 67-year-old  man in North Carolina reports that after being sidelined by arthritis, he has resumed square dancing.
An orthopedic surgeon in Rochester, N.Y., told of one patient who canceled knee replacement surgery after improving  on the supplements.
And the Arizona doctor who last January turned glucosamine and chondroitin into a national craze, Dr. Jason
Theodosakis, author with Brenda Adderly and Barry Fox of "The Arthritis Cure" (St. Martin's Press, $22.95 hardcover  and $6.50 paperback), said he was among thousands of patients helped by one or both substances, neither of which is  covered by medical insurance because they are sold as dietary supplements, not drugs.
In a follow-up work, "Maximizing the Arthritis Cure" to be published next week by St. Martin's Press ($22.95), Dr.
Theodosakis includes  additional testimonials, among them ones from a 70-year-old man who said he was able to dance for the first time in  10 years and a priest who was no longer stiff getting off his knees in church.
No dietary supplement alone can be expected to cure osteoarthritis, the wear-and-tear degeneration of the cartilage
 that cushions the ends of bones in each body joint. Dr. Theodosakis devotes the bulk of his new book to exercises that  foster aerobic conditioning, muscular strength and flexibility and a diet that counters overweight. I can testify to the  value of both. My knees hurt when I carry just 10 extra pounds in my arms for any distance. If those pounds were on  my frame, they would be carried by my knees as well.
Furthermore, not everyone improves on the supplements. If cartilage has completely worn away, it cannot be rebuilt.
On average, about half those who try the supplements report reduced pain and stiffness.
What Studies Show
But anecdotes do not establish facts. Well-designed studies are needed to prove, or disprove, the value of a remedy.
Patients must be randomly assigned to take either the substance in question or a look-alike inactive or comparison
remedy, and neither patients nor evaluating physicians can know who is on what until the study is completed. And,  while positive results from good studies continue to be published in Europe, there are still no published results of such  studies in people on this side of the Atlantic. Two unpublished American studies, good but less than perfect, have been  completed using the combination treatment and a third more exacting study, in Canada, is nearly finished. It enlisted 100 patients in a 16-week trial of glucosamine alone.
The Canadian physician, Dr. Joseph B. Houpt, a rheumatologist at the University of Toronto, maintains that there is
little point in testing the combination regimen before defining the benefits of the individual components. Other
researchers, pointing to extensive studies in Europe of glucosamine alone and a few studies of chondroitin, believe the combination is synergistic, that is, the two together produce greater benefits than would be expected simply from  adding together their individual effects.
Dr. Houpt also explained that "these are difficult studies to do." Each patient must be thoroughly evaluated to
document the extent of arthritic changes within the joints, pain, stiffness, swelling and functional disabilities like
trouble climbing up and down stairs, walking or getting up after prolonged sitting.
Dr. Amal K. Das Jr., an orthopedic surgeon in Hendersonville, N.C., has completed a study of nearly 100 patients
treated for six months with both glucosamine and chondroitin sulfate. He said, "We found the combination of 1,500  milligrams glucosamine and 1,200 milligrams of chondroitin daily to be effective for treating the pain of mild to  moderate arthritis confirmed by X-ray." Patients were evaluated using numerous measures of pain, including their  discomfort when walking and climbing stairs. Dr. Das said, as have others, that the supplements had caused no adverse  reactions.
Another study, of 34 Navy Seals and divers by Dr. Alan Philippi and Dr. Christopher Leffler at the Portsmouth Naval  Medical Center in Virginia, is said by other researchers to have found significant relief of knee pain but no
improvement in function after eight weeks on the supplements.
Several new university-based studies of arthritic horses and dogs as well as basic laboratory studies continue to point  to functional benefits and healthy changes in joint cartilage associated with the supplements. For example, Dr. Louis  Lippiello, a biochemist at Medical Professional Associates of Arizona, found in cell cultures and in dogs that each  substance independently increased synthesis of cartilage components and that the two together did even better. 
                     Copyright 1998 The New York Times Company