Theodosakis, author of The Arthritis Cure, says new studies indicate that acetaminophen may not be an effective pain reliever for arthritis, and he notes the American College of Rheumatology will change its recommendation in its next set of guidelines.

"Shortly after [the college's] guidelines were issued, the first double-blinded studies with Tylenol came out, and one of the studies showed it was no better than placebo. The other study showed that anti-inflammatories are clearly better at relieving pain," he says.

Dietary Supplements for Arthritis

Dietary supplements such as glucosamine and chondroitin are not technically drugs, but many substances you ingest can affect the body like medicine. Glucosamine and chondroitin are substances found naturally in the body, and may be involved the in the making or the repair of cartilage.

Pros:

• The supplements are inexpensive and available without a doctor's prescription.
• Studies have shown that glucosamine and chondroitin may relieve arthritis pain as well as NSAIDs.
• Studies also show they may help prevent cartilage damage in people with osteoarthritis.

Cons:

• Dietary supplements haven't been studied under rigorous standards, as drugs have, so long-term safety and effectiveness is not known.
• They are not regulated by the FDA, so supplements may not contain the amounts promised on the label or may be substandard in other ways.
• Doctors may not recommend them because they are dietary supplements.
• Chondroitin acts like a blood thinner, and may cause bleeding in people who also take prescription blood thinners or NSAIDs for pain relief.

Theodosakis, who serves on the oversight committee of the National Institutes of Health study on glucosamine and chondroitin, recommends these supplements. Over the past several years, extensive research has supported their use, he says.

People with diabetes should check their blood sugar levels more often when taking glucosamine, because it's a sugar. Those with shellfish allergies should ask their doctor about taking glucosamine, because it is derived from shellfish.

Published October 2004.

SOURCES: Terence Starz, MD, clinical professor of medicine, division of rheumatology, University of Pittsburgh School of Medicine; chief of rheumatology, University of Pittsburgh Medical Center. Jason Theodosakis, MD, assistant clinical professor, University of Arizona College of Medicine. Sudhir Diwan, MD, director, division of pain medicine, Weill Cornell Medical Center; and assistant professor of anesthesiology, Weill Medical College of Cornell University. WebMD Medical Reference, "Anti-Inflammatory Painkiller Drugs and Arthritis." Fox Chase Cancer Center, news release, Oct. 4, 2004. Medscape.com Medical News, March 18, 2003, "NSAIDs May Reduce Lung Cancer Risk." Alimentary Pharmacology & Therapeutics, May 2004. The Merck Manual of Diagnosis and Therapy. Arthritis Foundation web site. WebMD Medical News: "Aspirin Lowers Pancreatic Cancer Risk." WebMD Medical News: "Painkillers Help Prevent Breast Cancer." WebMD Medical News: "Vioxx Unsafe: So What About Similar Drugs?" American Family Physician, June 15, 2003. Pfizer, Inc. news releases, Oct. 15 and Oct. 18, 2004. Arthritis & Rheumatism, Sept. 2000, Feb. 2002. Annals of the Rheumatic Diseases, Aug. 2004. FDA news release, Sept. 30, 2004. BMJ, June 2002. Time, Oct. 18, 2004.

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