Osteoarthritis is the most common cause of disability in the United States. Also known as degenerative joint disease, osteoarthritis affects nearly 27 million Americans, according to Arthritis Foundation estimates.

This painful condition develops when cartilage tissue in the joints breaks down. The Arthritis Foundation reports that the exact cause of osteoarthritis is not yet known; however, certain risk factors make it more likely: being overweight, suffering a joint injury, repeatedly overusing a certain joint, lacking physical activity, and aging. Over time, some people experience extreme inflammation and permanent damage to the joint—sometimes even requiring joint replacement.

In addition to encouraging exercise and weight loss, the primary way conventional doctors treat osteoarthritis is through pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), these drugs do not alleviate the underlying cause of osteoarthritis; however, they do help ease pain and inflammation. NIAMS also reports there are side effects associated with these drugs, especially if they are used on a long-term basis.

The high price of pain relief

NSAIDs, such as Advil and Aleve, and COX-2 inhibitors like Vioxx and Celebrex block the activity of enzymes that cause pain and inflammation. They also impede the production of prostaglandins (hormone-like substances), which promote inflammation.

But because these enzymes and prostaglandins are important for other functions in the body, including blood flow and digestion, if you block their activity, health problems can occur. Not only has NSAID use been shown to cause life-threatening ulcers, but the drugs are also associated with diarrhea, dizziness, headaches, heartburn, ringing in the ears, nausea and many other side effects. Surprisingly, research shows that long-term use of NSAIDs also damages joint cartilage, making osteoarthritis much worse over time.

NIAMS warns that NSAIDs should not be taken with many other drugs, so it’s important to talk to your doctor before taking NSAIDs on a regular basis. In addition, NIAMS recommends that people over age 65 and those with a history of ulcers or gastrointestinal bleeding use NSAIDs with caution.

The introduction of COX-2 inhibitors was meant to reduce the ulcers and digestive issues associated with NSAID use. But according to the U.S. Food and Drug Administration, the side effects of COX-2 inhibitors are even more dangerous, including a risk of heart attacks. As a result of these side effects, Vioxx was taken off the market in 2004. It was later reintroduced with a black box warning required by the FDA. Celebrex has the same risks.

Fortunately, many natural alternatives to COX-2 inhibitors and NSAIDs can alleviate pain while working on the underlying cause of osteoarthritis. Some natural substances have been studied for decades and are proven to promote joint health. While many of these substances don’t provide immediate relief, they have been scientifically proven to protect and repair joint tissue.

Old favorites

Glucosamine sulfate, a natural substance found in healthy joint cartilage, has been the subject of hundreds of studies. Most show that it treats the root cause of osteoarthritis by helping the body manufacture and rebuild joint cartilage. Based on the published research, the dosage is 1,500 mg daily.

Glucosamine sulfate is often combined with chondroitin sulfate, a natural compound typically derived from purified shark or beef cartilage or bovine trachea. Chondroitin is a larger molecule than glucosamine, so it may not be as readily absorbed. A study released in the February 2009 issue of Arthritis & Rheumatism found that a highly purified (at least 95 percent) form of chondroitin sulfate prevented joint degradation in individuals with knee osteoarthritis. The study participants took 800 mg of the purified chondroitin for two years.

According to the Natural Standard Research Collaboration, “The consensus of expert and industry opinions supports the use of chondroitin and its common partner agent, glucosamine, for improving symptoms and stopping (or possibly reversing) the degenerative process of osteoarthritis.”

Methylsulfonylmethane (MSM) is a key source of sulfur in the body, and numerous studies have demonstrated that sulfur is important for joint function. In 2008, researchers at the University of California, San Diego confirmed that MSM relieves inflammation and protects joint cartilage. Their research was published in the FASEB Journal. Dosage is 1,200 mg daily.

Keep in mind that all three of these substances take several weeks or even months to work. People needing quicker pain relief should try a highly concentrated form of curcumin, the active substance in turmeric. A study presented at the September 2011 Osteoarthritis Research Symposium International demonstrated that a combination of curcumin (BCM-95) and the herb boswellia was more effective than Celebrex at eliminating pain.

New and effective

The newest natural ingredient for the treatment of osteoarthritis is avocado/soybean unsaponifiables (ASU) made from phytosterols in avocado and soybean oils. Phytosterols are cholesterol-like compounds found in plants.

Several double-blind, clinical studies have demonstrated that ASU is effective in reducing pain and inflammation associated with osteoarthritis. A 2001 study showed that patients with knee osteoarthritis were able to significantly reduce their intake of NSAIDs while taking ASU. A 2008 meta-analysis published in Osteoarthritis Cartilage confirmed these results. Dosage for ASU is 300 mg daily.

“NSAIDs can be dangerous,” says Jacob Teitelbaum, MD, author of Pain Free 1-2-3 (McGraw-Hill, 2006). “Fortunately, there are natural anti-inflammatory compounds that deliver the same analgesic benefits without the deadly side effects.”