I have previously reviewed a number of common alternative therapies for arthritis. The evidence concerning veterinary use specifically is often limited, but for common therapies, like glucosamine and acupuncture, there is often extensive research data in humans. While extrapolation from one species to another should always be viewed with caution, if something is shown by extensive evidence to be useless in humans, this is reason to be skeptical about its value for our pets.
Harriet Hall, at Science-Based Medicine, has recently reported on an extensive evidence review of arthritis therapies published by the American Academy of Orthopedic Surgeons (AAOS). This review evaluates common therapies, both conventional and alternative, and reinforces the conclusions I have previously come to regarding several of these. In particular, the evidence is clear and strong against the value of both glucosamine and acupuncture. And lest advocates of these immediately assume these conclusions are simply evidence of bias in favor of surgery, since the review was conducted by an organization of surgeons, I will point out that the report is equally critical of conventional surgical treatments that clearly don’t work either. They even cast doubt on the most common pharmaceutical therapy used, simply following where the evidence leads.
While this review by itself is not, of course, the sole and final word on any subject, it is part of a consistent and continually growing body of evidence which shows that several commonly recommended arthritis therapies simply do not work. At some point, hope and the placebo effect will have to give way to reality and we will have to start redirecting our resources away from studying and using such worthless treatments and into more promising therapies.
- Exercise – strong evidence for effectiveness
- Weight loss – moderate evidence for
- Acupuncture – strong evidence against
- Physical agents (TENS, ultrasound, etc.) – inconclusive
- Manual therapy (chiropractic, massage) – inconclusive
- Valgus-directing force brace – inconclusive
- Lateral wedge insoles – moderate evidence against
- Glucosamine and chondroitin – strong evidence against
- NSAIDs – strong evidence for
- Acetaminophen, opioids, pain patches – inconclusive (this is particularly interesting since acetaminophen is the standard first-choice drug)
- Intraarticular corticosteroid injections – inconclusive
- Hyaluronic acid injections – strong evidence against (and if injections are ineffective, those oral diet supplements certainly don’t have a chance)
- Growth factor injections and/or platelet-rich plasma – inconclusive
- Needle lavage – moderate evidence against
- Arthroscopy with lavage and debridement – strong evidence against
- Partial meniscectomy in osteoarthritis patients with torn meniscus – inconclusive
- Valgus-producing proximal tibial osteotomy – limited evidence
- Free-floating interpositional device – no evidence; consensus against