Msm and arthritis pain

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 dietary supplement methylsulfonylmethane (MSM) has been demonstarted to improve pain and function in patients with knee osteoarthritis (OA) and should be considered for short-term pain relief.

While the use of this supplement remained controversial for many years, it achieved notoriety when the actor, James Coburn, who had suffered with rheumatoid arthritis for many years, touted its benefits.

Linda Kim and colleagues reported a randomized, placebo-controlled trial of MSM at the American Association Naturopathic Physicians (AANP) 20th annual meeting (Kim L, Axelrod L, Howard P, et al. Efficacy of methylsulfonylmethane (MSM) in knee osteoarthritis pain: a pilot clinical trial. American Association of Naturopathic Physicians 20th annual meeting; August 24-27, 2005; Phoenix, AZ.)

"If standard anti-inflammatory drugs are contraindicated, a patient might give MSM a try. This provides only symptomatic relief, but MSM was associated with no problems or adverse effects in our study.

The study, which was presented at the AANP meeting by coauthor Dr Leslie Axelrod , randomized 50 patients to 12 weeks of MSM (n=25) or placebo (n=25). Eligible patients had documented knee OA (Kellgren-Lawrence grade 2 or 3) and significant pain (at least 40 mm on a 0-100 mm visual analog scale [VAS]). Other types of arthritis or chronic pain were excluded.

Patients had a washout of seven days for NSAIDs or other OA

treatments and then were randomized to 3 g bid of MSM (OptiMSM, Cardinal Nutrition) or to an identical-appearing placebo capsule. MSM patients took 1 g bid for the first two days, then increased to 3 g bid by the end of the first week of treatment.

The primary study end points were the WOMAC Index, the patient and physician global assessments of overall arthritis disease status and response to therapy, and laboratory measures including serum homocysteine, C-reactive protein, erythrocyte sedimentation rate, urine malondialdehyde (MDA), complete blood count/chemistry panel, fasting lipids, urinalysis, and stool occult blood test, all measured at baseline and again at 12 weeks.

Axelrod reported data for 21 MSM patients and 19 placebo patients who completed the trial. At week 12, WOMAC pain scores dropped by 14.6 mm in MSM patients vs 7.3 mm with placebo (12% difference, p=0.041). Function scores improved by 15.7 mm in MSM patients vs 8.8 mm in placebo patients (13.7% difference, p=0.045).

Homocysteine at 12 weeks decreased from 8.0 to 7.2 µmol/L in the MSM group (p=0.004 vs placebo). Urine MDA, a measure of lipid peroxidation, decreased from 16.7 to 14.3 µmol/L with MSM treatment (p=0.010).

"This pilot study showed that MSM 3 g bid for 12 weeks improved pain and physical function in patients with knee OA pain without major adverse events," the researchers concluded.

Similar benefits have been reported earlier by Usha and Naidu, who concluded in a study of 118 patients that MSM significantly decreased pain in knee OA and that combined MSM/glucosamine was even more effective (Usha PR, Naidu MUR. Randomized, double-blind, parallel, placebo-controlled study of oral glucosamine, methylsulfonylmethane and their combination in osteoarthritis. Clin Drug Invest 2004; 24:353-363. )

All of the marketed and tested MSM products are industrially produced by processing of dimethyl sulfoxide (DMSO), of which MSM is a metabolite. The resulting MSM retains many DMSO therapeutic effects but without DMSO's tendency to make those who use it smell like garlic.

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