MSM and arthritis

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.

Click here: Second Opinion Arthritis Treatment Kit

From Arthritis Today and the Arthritis Foundation

When James Coburn won an Oscar for Best Supporting Actor a few years ago, he gave credit to the supplement MSM for helping him overcome the crippling effects of rheumatoid arthritis pain.

MSM, he said, made it possible for him to work. Since that time MSM has been hawked by a number of different companies as the “cure” for arthritis.

Dr. Stanly Jacobs, the developer of MSM disagrees. “I don’t know of a single disease that MSM cures. We are not curing arthritis - I want that understood,” said Dr. Jacob in an interview with Arthritis Today. He says MSM’s major benefit for those with OA and RA is pain relief: It hasn’t been shown to repair or preserve cartilage or to modify or stop progression or joint destruction caused by inflammatory types of arthritis, and its effects last only as long as the supplement is taken.

MSM is a naturally-occurring sulfur compound. MSM supplements are made from DMSO (dimethyl sulfoxide.) Medical-grade DMSO is safe, and is widely used in medical processes. DMSO is the chemical used to protect human tissue (such as bone marrow, stem cells and embryos) when frozen for storage. It’s also an FDA-approved prescription drug (called Rimso) given by catheter for interstitial cystitis, a painful bladder condition.

MSM is a sulfur compound plentiful in fresh fruits and vegetables, milk, fish and grains, but quickly destroyed when foods are processed. Sulfur is provided by MSM.

MSM can be used daily as a supplemental form of dietary sulfur or whenever a need for higher levels of organic sulfur exists. The organic sulfur compound known as MSM (methylsulfonylmethane) is contained in minute amounts in the blood as well as most foods. Some experts believe that, like other sulfur compounds, it's a necessary building block for proteins, especially those found in the hair, muscles, and connective tissue of the joints and skin.

MSM has been publicized as an effective remedy for back pain, arthritis and a host of other disorders. Evidence for its healing potential, however, is anecdotal because few rigorously controlled scientific studies have yet been done concerning MSM use in humans.

Some rheumatologists remain suspicious of MSM because of its relationship to DMSO - a substance that has stirred controversy since the 1960s. An evaluation of DMSO may help to understand MSM better.

DMSO is both a prescription drug and an industrial solvent. It’s formed as a byproduct of wood pulp processing; its use is determined by the quality: Industrial-grade DMSO is found in paint thinners and antifreeze, and medical-grade DMSO is found in many medical laboratories. Its industrial usefulness comes from its remarkable solvent qualities, and much of its medical value from its ability to transport other substances through cell membranes. It is also reported to have anti-inflammatory and antioxidant properties.

Dr. Jacob says thousands of scientific papers have been published about DMSO’s chemistry. Some have shown DMSO can relieve muscle and joint pain; reduce inflammation; soften collagen to relieve scleroderma symptoms; help heal skin ulcers caused by diabetes and scleroderma; and relieve blood vessel constrictions common to Raynaud’s phenomenon. Other research has suggested it may help prevent brain damage after stroke or head injuries. And it appears to have few side effects, even at very high dosages.

DMSO is approved for use in many other countries for arthritis and related conditions.

In the early 1960s, Dr. Jacob headed the organ transplant program at Oregon Health Sciences University (OHSU) and was looking for a substance to preserve organs being stored for transplant when he stumbled across DMSO. Further research uncovered DMSO’s medical uses, and it was soon being hailed as a wonder drug.

But in the mid-’60s, DMSO fell out of favor with the FDA during its testing phase when an animal study, using high doses, showed changes in the lens of the eye. (There have, however, been no reports of problems with eyes of participants in human studies.)

DMSO’s ability as a solvent to transport molecules across cell membranes was also a potential problem. It meant that when used topically DMSO could carry anything - including toxins - straight through the skin and directly into the body.

DMSO also has a harmless but unpleasant side effect: Taken internally or even used externally, it causes a bad taste in the mouth and makes those who use it smell like garlic.

And so medical-grade DMSO faded from the consumer marketplace. Its reputation was further sullied as reports of bad reactions from arthritis patients who had used industrial-grade products purchased at roadside stands came to light.

Nonetheless, DMSO was approved in 1978 as the prescription drug Rimso for interstitial cystitis. Because medical-grade DMSO is an approved prescription drug (although only for one use), it can’t legally be sold over the counter or as a dietary supplement. Therefore, most of the DMSO people have been using has been the same quality used in industrial solvents - unfit for human use - and doctors have been rightly suspicious of these products.

Meanwhile, as Dr. Jacob and other researchers at OHSU continued to study DMSO, they found that 15 percent of DMSO was broken down into another sulfur compound in the human body. The compound, which they called MSM, had many of the helpful qualities of DMSO, with some distinct advantages: It lacked the distinctive oyster-garlic smell; it didn’t have the questionable history of DMSO; and it could be sold directly to consumers as a dietary supplement.

But it also lacked research: Unlike DMSO, which has many published studies and evidence of safety, there was little scientific evidence for or against MSM. Animal studies found MSM eased RA-like symptoms in mice, and it prolonged life for mice with a condition similar to lupus nephritis.

But even today, there are no scientifically accepted human studies, and what works in animals doesn’t always work in humans. Dr. Jacob and others have conducted human studies that they say show MSM relieves the pain of OA and other conditions. However, these studies are not published in peer-reviewed medical journals, and there is a potential conflict of interest: Dr. Jacob also serves as medical director for a company that produces and sells MSM.

Dr. Jacob contends MSM does not need research because the DMSO studies can be applied to this breakdown product. He also says MSM is safe, citing animal toxicology studies from manufacturers.

So far, MSM shows most promise as a pain reliever. MSM appears to act by inhibiting pain impulses that travel along nerve fibers, acting as an analgesic. This property, along with the compound's potential anti-inflammatory actions, are often cited in explaining its use for combating the symptoms of arthritis, fibromyalgia, carpal tunnel syndrome and allergies.

In addition, MSM may reduce muscle spasms, increase blood flow and possibly contribute to the maintenance and repair of cartilage. Studies in rats indicate that MSM may help to delay the growth of certain types of cancerous tumors.

Those who use MSM supplements contend that it not only helps treat osteoarthritis--the degenerative form of arthritis that wears down cartilage over time--but rheumatoid arthritis, lupus and other autoimmune-related conditions as well.

Numerous studies have shown that sulfur levels in arthritic joints are lower than in healthy joints. MSM may help by delivering needed sulfur to the afflicted areas. Once in the joints, exactly how MSM works remains unclear: It may exert an anti-inflammatory, analgesic effect similar to that of aspirin.

It may also help to maintain or repair cartilage, the gel-like substance that cushions joints and that is a key ingredient of connective tissue. In a preliminary, double-blind study of 16 patients with degenerative arthritis, the pateints who took 2,250 mg of MSM daily for six weeks reported an 82% reduction in pain on average. Only two of those takng the placebo reported decreased pain--about 20%.

Taken in conjunction with supplements such as SAMe and glucosamine sulfate, MSM may be useful for treating chronic back pain resulting from muscle strain, ligament sprain, or the early degenerative changes that can affect joints and discs in the back. Advanced disc disease does not appear to respond to MSM treatment, however.

MSM comes as:

• powder
• lotion
• liquid
• gel
• cream
• capsule

Dosage Information

• Arthritis: Take 500 mg two or three times a day. Using MSM cream or gel in addition to the supplement may provide extra benefit. Rub the cream on the painful area four or five times a day for best results.
• Back pain: Take 500 mg three times a day. Using MSM cream or gel in addition to the supplement may provide extra benefit. Rub the cream on the painful area four or five times a day for best results.

Guidelines for Use

• Take MSM with or directly after meals to lessen the possibility of gastrointestinal upset.
• If you find that MSM increases your energy level, avoid taking it too close to bedtime.
• For most ailments, allow at least a month to see results.

General Interaction

• If you are on a blood thinner (anticoagulant), such as aspirin or warfarin (Coumadin), consult with your doctor before taking MSM. It can occasionally have a blood-thinning effect.

Possible Side Effects:

• Because no rigorously controlled studies of MSM usage of any length have been done in humans, long-term effects are not presently known.
• Some people develop minor gastrointestinal discomfort, such as cramping and increased stool frequency with MSM use.
• In rare cases, a skin rash may appear. Stop using MSM if this or any other allergic reaction occurs.

Some rheumatologists are cautiously recommending MSM. Kenneth Neiman, MD, a rheumatologist and internal medicine specialist in Tarzana, Calif., recommends MSM for OA and for pain, but not as a substitute for prescription arthritis drugs. “My patients with aggressive RA need aggressive treatment with proven disease-modifying drugs,” he says. “I use MSM in conjunction with those drugs.”

Some physicians are concerned that MSM may interfere with other drugs and cause complications. Ronenn Roubenoff, MD, a rheumatologist and nutritional expert at Tufts University/ New England Medical School, says, “Sulfur compounds, like those in MSM, are very active in the body and can have powerful effects,” he says. “We really don’t know what the effects will be over time,” he says in an interview with Arthritis Today.

“MSM is worth clinical trials,” says Dr. Roubenoff. “We need to keep an open mind, and not just reject things out of hand. But we also shouldn’t give up the scientific method just because there is a lot of hype about a product. It needs to be tested.”

Bottom line: MSM may be safe, but there is no convincing scientific evidence it helps arthritis. And DMSO may help with a number of arthritis-related conditions, but it is not safe for consumers to use products available on the open market.

DMSO and MSM are both taken several ways: orally; applied externally as lotions or gels; given intravenously and injected.

• If you decide to experiment with these substances, be sure to tell your doctor and ask your doctor to monitor you for any adverse effects with regular blood, kidney and liver function tests.
• Don’t stop taking disease-modifying medication if you have RA or another autoimmune disease.
• Consult your doctor if you are taking heparin or other blood-thinners, including herbs and aspirin, because both substances may have some blood thinning effects.
• Buy MSM only from an established company that you can be sure will stand by its products - and be wary of companies making “miracle” and other hyped claims.
• Start with a low dosage of 500 milligrams (mg) or less twice a day and gradually increase the amount until you notice some effect. Most sources suggest 1,000 mg (1 gram) twice a day. MSM is most often taken in capsules or dissolved in a liquid.
• Be patient. But if you don’t see any difference after two months, you may never - and it may not be worth continuing to expose yourself to unknown risks.
• Tell your doctor if you get diarrhea, stomach upsets or mild cramps; these side effects are common, especially at higher doses. Lowering the dose may stop these symptoms.

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