ASU and osteoarthritis



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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The term “ASU” could mean Arizona State University... but in this article it doesn't. It actually describes extracts that consist of one-third avocado oil and two-thirds soybean oil following hydrolysis.

A number of small experiments have shown this mixture to prevent damage to synovial cells (cells that line the joint capsule) by cytokines (proteins that cause inflammation). There is also some evidence that ASU stimulates collagen synthesis. This is important since collagen is a major building block of cartilage.

Four clinical trials have been published (1-4) regarding the relative effectiveness and safety of ASU. All four trials- a total of 751 patients -were randomized and double blind in design. They compared ASU (300 mg once a day) with placebo in people with osteoarthritis of the knee or hip. All of the trials used standard measures for osteoarthritis studies. And all patients randomized into the studies had osteoarthritis, pain of at least moderate severity, and were using NSAIDS (non-steroidal anti-inflammatory drugs) for pain control. A subset of patients had established pain of at least six months duration but were not on NSAID.

All four trials had similar outcomes as far as pain measurement, function, NSAID use, and patient global outcome. There were similarities in adverse events and withdrawals. One study had a primary outcome of x-ray joint space narrowing. The duration of study was three months in two, six to eight months in one, and 24 months in the fourth.

The design of the study was to add ASU on to NSAID therapy. The maximum effect of ASU supplementation was felt to occur at one to three months after initiation of the compound. All the trials allowed for adjustment of NSAID dose.

Three trials demonstrated better pain and functional ability with ASU plus NSAID compared with placebo plus NSAID over three to six months. In all three, better pain relief was achieved with a lower dose of NSAID. Both these effects took several months to develop.

A fourth trial showed no difference in pain, functional ability, or daily NSAID use over 24 months. This trial examined patients with osteoarthritis of the hip only, and the NSAID dose was relatively low. Also, joint space narrowing progressed from a starting mean of 1.9 mm to 1.7 mm over two years in both groups.

Three trials had similar levels of efficacy demonstrated.

In all four trials there was no difference in the number of patients reporting at least one adverse event. Adverse event withdrawals were low and similar in the three trials.

There is some evidence from the first three trials that ASU both reduces pain and reduces NSAID consumption. The one longer study of osteoarthritis in the hip showed no difference in any outcome.

All four trials used ASU from one source (Pharmascience, France). In the two trials evaluating both knee and hip osteoarthritis, similar benefit was found. The one looking at only knee osteoarthritis was positive, the one looking at only hip osteoarthritis was negative.

Given that NSAIDs are can cause kidney, cardiovascular, and gastrointestinal side-effects, reducing dosage may be a good thing.

People with osteoarthritis might want to consider the use of ASU over the short term.

There are potential problem: supply, availability of the medicine by prescription, and pharmaceutical consistency and quality.



References:

1. F Blotman et al. Efficacy and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip. Revue du Rheumatologie [English edition] 1997 64: 825-834.

2. E Maheu et al. Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip. Arthritis & Rheumatism 1998 41: 81-91.

3. T Appelboom et al. Symptoms modifying effect of avocado/soybean unsaponifiables (ASU) in knee osteoarthritis. Scandinavian Journal of Rheumatology 2001 30: 242-247.

4. M Lequesne et al. Structural effect of avocado/soybean unsaponifiables on joint space loss in osteoarthritis of the hip. Arthritis & Rheumatism 2002 47: 50-58.

5. YE Henrotin et al. Avocado/soybean unsaponifiables increase aggrecan synthesis and reduce catabolic and proinflammatory mediator production by human osteoarthritic chondrocytes. Journal of Rheumatology 2003 30: 1825-1834.



Comment in:



Clin Rheumatol. 2004 Jun;23(3):274.



Avocado-soybean unsaponifiables (ASU) for osteoarthritis - a systematic review.

Ernst E.

Peninsula Medical School, Universities of Exeter and Plymouth, Devon, Exeter, UK. Edzard.Ernst@pms.ac.uk

Patients suffering from osteoarthritis (OA) are often tempted to try 'alternative' treatment options. Avocado/soybean unsaponifiables (ASU) have shown some promise for OA. This systematic review is aimed at critically evaluating the data from rigorous clinical trials of ASU. Six databases were searched for randomised, placebo-controlled, double-blind trials of ASU. Four studies could be included. Key data were extracted according to predefined criteria and tabulated as well as discussed in narrative form. The methodological quality of the four studies was high. They included patients with OA of the knee and hip. The dose of ASU was 300 mg/day and one trial also included a group treated with 600 mg/day. Three of the four trials suggested efficacy of ASU for improving the symptoms of OA. The majority of rigorous trial data available to date suggest that ASU is effective for the symptomatic treatment of OA and more research seems warranted. However, the only real long-term trial yielded a largely negative result.



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