Ask the Expert

This month’s selection:

I am interested in knowing more about SAMe for treating osteoarthritis. I have read about it on several websites, and it seems to be as effective as NSAIDs in controlling pain but with fewer side effects. Are there any data showing which brand is most effective? Are there any data supporting the contention that SAMe builds cartilage?  

Denise Walters, CRNP
Mandan, North Dakota

Response:

SAMe is a natural compound that exists in the human body, and it is a derivative of certain essential amino acids, such as methionine and adenosine triphosphate. Those marketing SAMe propose that additional supplementation is beneficial.

In using the supplement to treat patients with depression, it was observed that some patients with arthritis experienced decreased pain. Further study resulted in limited evidence of SAMe being effective for osteoarthritis.

Side effects of SAMe include nausea and vomiting. Potential drug interactions focus on possible serotonin syndrome, so concurrent use with selective serotonin reuptake inhibitors, tramadol, and dexamethorphan should be monitored closely.

Evaluation of the efficacy, safety, and manufacturing of natural or herbal remedies often is of lower quality than studies required for traditional pharmaceuticals. Two excellent resources to provide unbiased information about natural products with clinical claims include Cochrane Reviews (there is a review on SAMe for knee/hip osteoarthritis pain) and The Medical Letter.

SAMe butane disulfonate is the formulation with the highest bioavailability and longest shelf life. However, there are no data showing which brand is most effective.

Regarding the contention that SAMe builds cartilage, this is the proposed mechanism that has been shown in animal models.

Physicians treating patients with osteoarthritis should keep in mind the following considerations:

• Many patients are helped by nonpharmacologic strategies, including exercise, physical therapy, and heat therapy.

• Acetaminophen can help osteoarthritis pain (unless there is hepatic insufficiency or ethyl alcohol abuse) with a maximum dose of 4 g/day.

• NSAIDs may be necessary and can relieve the pain of osteoarthritis. Avoid use in patients with a history of cardiovascular disease or renal insufficiency, and/or gastrointestinal bleeding.

Preferred agents include celecoxib and ibuprofen. Avoid the use of indomethacin. Chronic use requires consideration of gastroprotection with either a proton pump inhibitor or misoprostol.

— Rosemary Laird, MD, MHSA, AGSF, is medical director of the Health First Aging Institute in Melbourne, Florida.