Osteoarthritis is a common disease that develops when linings of joints fail to maintain normal structure, leading to pain and decreased mobility. It is associated with aging and injury (it used to be called "wear-and-tear" arthritis), and can occur secondary to many other conditions. However, in most cases its true cause remains unknown.

Solanine is a substance found in nightshade plants, including tomatoes, white potatoes, all peppers (except black pepper), and eggplant. In theory, if not destroyed in the intestine, solanine could be toxic. A horticulturist, Dr. Norman Childers, hypothesized that some people with osteoarthritis may not be able to destroy solanine in the gut, leading to solanine absorption resulting in osteoarthritis. Eliminating solanine from the diet has been reported to bring relief to some arthritis sufferers in preliminary research.^{2 3} An uncontrolled survey of people avoiding nightshade plants revealed that 28% claimed to have a "marked positive response" and another 44% a "positive response." Researchers have never put this diet to a strict clinical test; however, the treatment continues to be used by some doctors in people who have osteoarthritis. As with the Warmbrand diet, proponents claim exclusion of solanine requires up to six months before potential effects can be seen. Totally eliminating tomatoes and peppers requires complex dietary changes for most people. In addition, even proponents of the diet acknowledge that many arthritis sufferers are not helped by using this approach. Therefore, long-term trial avoidance of solanine-containing foods may only be appropriate for people with severe cases of osteoarthritis who have not responded to other natural treatments.

Most of the studies linking allergies to joint disease have focused on rheumatoid arthritis, although mention of what was called rheumatism (some of which may have been osteoarthritis) in older reports suggests a possible link between food reactions and exacerbations of osteoarthritis symptoms.⁴ If other therapies are unsuccessful in relieving symptoms, people with osteoarthritis might choose to discuss food allergy identification and elimination with a physician.

Nutritional supplements that may be helpful: Glucosamine sulfate (GS), a nutrient derived from sea shells, contains a building block needed for the repair of joint cartilage. GS has significantly reduced symptoms of osteoarthritis in uncontrolled,^{6 7} and single-blind trials.^{8 9} Many double-blind studies have also reported efficacy.^{10 11 12 13 14} All published clinical investigations on the effects of GS in people with osteoarthritis report statistically significant improvement. Most research trials use 500 mg GS taken three times per day. Benefits from GS generally become evident after three to eight weeks of treatment. Continued supplementation is needed in order to maintain benefits.

Several criticisms of GS research have been raised, including criticisms about the methods used in certain research trials or the small number of subjects in each study.^{15 16} Regardless of the number of subjects in individual trials, the research has shown—in many controlled and several double-blind scientific studies—that GS has a statistically significant effect on reducing symptoms of osteoarthritis.

Chondroitin sulfate (CS) is a major component of the lining of joints. In structure, CS is related to several molecules of GS attached to each other. Levels of chondroitin sulfate have been reported to be reduced in joint cartilage affected by osteoarthritis. Possibly as a result, CS may help restore joint function in people with osteoarthritis.¹⁷ On the basis of preliminary evidence, researchers had believed that CS did not absorb in humans.¹⁸ As a result, double-blind CS research showing reduced symptoms in people with osteoarthritis was done mostly by injection.^{19 20} It now appears, however, that a significant amount of CS is absorbable in humans,²¹ though dissolving CS in water leads to better absorption than swallowing whole pills.²²

The importance of absorbability issues has recently been overridden by strong clinical evidence supporting the use of orally administered CS. With consistency, many double-blind trials have all shown that CS reduces pain, increases joint mobility, and/or shows objective evidence (including X-ray changes) of healing within joints of people with osteoarthritis.^{23 24 25 26 27 28 29 30 31 32} Most studies have used 400 mg of CS taken two to three times per day. One study found that taking the full daily amount (1,200 mg) at one time was as effective as taking 400 mg three times per day.³³ Reduction in symptoms typically occurs within several months.

Due to the similarity in structure, some doctors have questioned whether people with osteoarthritis need to take both glucosamine sulfate (GS) and chondroitin sulfate (CS). To date, no studies have compared GS versus CS versus the combination of both. The popular idea that GS is clinically "preferred" over CS, or that CS is "not necessary,"³⁴ has not been examined (let alone supported) by appropriate comparative research. An opposite theory, also popular, posits that GS and CS in combination have stronger effects than either supplement alone.³⁵ This idea is based only on anecdotes and hypotheses.

S-adenosyl methionine (SAMe) possesses anti-inflammatory, pain-relieving, and tissue-healing properties that may help protect the health of joints,^{36 37} though the primary way in which SAMe reduces osteoarthritis symptoms remains unclear. A very large, though uncontrolled, trial of over 20,000 patients with osteoarthritis demonstrated "very good" or "good" clinical effect of SAMe in 71% of cases. Another 21% rated their improvement as "moderate," while only 9% rated the effect as "poor." The participants in this trial took 1,200 mg per day for one week, then 800 mg per day for one week, then 400 mg per day thereafter.³⁸ Double-blind reports studying effects in people with osteoarthritis have consistently shown that SAMe increases the formation of healthy tissue³⁹ and reduces pain, stiffness, and swelling better than placebo and equal to drugs such as ibuprofen and naproxen.^{40 41 42 43 44 45 46 47} These studies all used 1,200 mg of SAMe per day.

However, lower amounts of oral SAMe have also produced reductions in the severity of osteoarthritis symptoms in preliminary clinical studies. A two-year uncontrolled trial showed significant improvement of symptoms after two weeks at 600 mg SAMe daily, followed by 400 mg daily thereafter.⁴⁸ This amount was also used in a double-blind trial, but patients first received five days of intravenous SAMe.⁴⁹ A review of the clinical studies on SAMe concluded that its efficacy against osteoarthritis was similar to that of conventional drugs, but its tolerability was higher.⁵⁰

Years ago, researchers reported that supplemental niacinamide increased joint mobility, improved muscle strength, and decreased fatigue in people with osteoarthritis.^{51 52 53} These preliminary trials were followed by a more recent double-blind study confirming reduction in symptoms within 12 weeks.⁵⁴ Although amounts used have varied from study to study, many doctors recommend 250 mg of niacinamide four or more times per day (with higher amounts reserved for people with more advanced arthritis). The mechanism by which niacinamide reduces symptoms remains unknown.

People who have osteoarthritis and eat high levels of antioxidants from food have been reported to exhibit a much slower rate of joint deterioration, particularly in the knees, compared with people eating foods containing lower levels of antioxidants.⁵⁵ Of the individual antioxidants, only vitamin E has been studied in controlled trials. Vitamin E has reduced symptoms of osteoarthritis in both single-⁵⁶ and double-blind research.^{57 58} In these trials, 400–600 IU of vitamin E per day has been used. Results have been reported to occur within several weeks.

Boron affects calcium metabolism, and a link between boron deficiency and arthritis has been suggested.⁵⁹ Although boron levels in bones associated with osteoarthritis joints have been reported to be lower than boron in other bones, several other minerals also are deficient in the osteoarthritis bones.⁶⁰ An isolated double-blind study reported that 6 mg of boron per day, taken for two months, relieved symptoms of osteoarthritis in five of ten people compared with improvement in only one of the ten people assigned to placebo.⁶¹

New Zealand green-lipped mussel (Perna canaliculus) has been studied in people with osteoarthritis. In a recent uncontrolled trial, a lipid extract (210 mg per day) or a freeze-dried powder (1,150 mg per day) of green-lipped mussel were equally effective for 70% of the participants after three months; improvements included less joint tenderness, morning stiffness, and better overall function.⁶⁵ However, members of the Australian Rheumatism Association have reported side effects such as stomach upset, gout, and skin rashes occurring in people taking certain New Zealand green-lipped mussel extracts. There has also been one case of hepatitis reported in association with the use of a New Zealand green-lipped mussel extract.⁶⁶

D-phenylalanine, a synthetic variation of the amino acid L-phenylalanine, has reduced chronic pain due to osteoarthritis in an uncontrolled study.⁶⁷ In that report, 250 mg was given three to four times per day, with pain relief beginning in four to five weeks. Others have confirmed the effect of D-phenylalanine in pain control in preliminary human research.⁶⁸ D-phenylalanine inhibits the enzyme that breaks down some of the body’s natural pain killers, substances called enkephalins. By inhibiting this enzyme, enkephalins might be better able to decrease pain levels. Phenylalanine should be taken between meals, because protein found in food can compete for uptake of phenylalanine into the brain, potentially reducing its effect.⁶⁹ D-phenylalanine is available in combination with L-phenylalanine in products labeled D,L-phenylalanine or DLPA.

Several studies have suggested that individuals with osteoarthritis may benefit from supplementation with bovine cartilage. In one uncontrolled trial, use of injected and topical bovine cartilage led to relief of symptoms in most people studied.⁷⁰ A ten-year European study confirmed improvement with long-term use of bovine cartilage.⁷¹ Optimal intake of bovine cartilage remains unknown.

The use of DMSO for therapeutic applications is controversial, but some research shows that DMSO applied directly to the skin has anti-inflammatory properties and alleviates pain, including pain associated with osteoarthritis.^{72 73} DMSO appears to reduce pain by inhibiting the transmission of pain messages by nerves⁷⁴ rather than through a process of healing damaged joints. DMSO comes in different strengths and different degrees of purity. In addition, certain precautions must be taken when applying DMSO. For those reasons, DMSO should be used only with the supervision of a doctor.

Cetyl myristoleate (CMO) has been proposed to act as a joint "lubricant" and anti-inflammatory agent. In a double-blind study, 106 individuals with various types of arthritis that had failed to respond to non-steroidal anti-inflammatory drugs received CMO (540 mg per day orally for 30 days), while 226 other people received a placebo.⁷⁵ These individuals also applied CMO or placebo topically, according to their perceived need. Some 63.5% of those receiving CMO improved, compared with only 14.5% of those receiving the placebo (a statistically significant difference).

Herbs that may be helpful: Boswellia has unique anti-inflammatory action, much like the conventional non-steroidal anti-inflammatory drugs (NSAIDs) used by many for inflammatory conditions.⁷⁶ Clinical studies in humans are lacking, so use of this herb for people with osteoarthritis is theoretical. Unlike NSAIDs, however, long-term use of boswellia does not lead to irritation or ulceration of the stomach.

The silicon content of horsetail is believed to exert a connective tissue strengthening and anti-arthritic action in traditional medicine. Research has yet to investigate the effects of horsetail extracts in people with osteoarthritis.

White willow has anti-inflammatory and pain-relieving effects. Although the analgesic actions of willow are typically slow-acting, they tend to last longer than aspirin. One double-blind study found that a product featuring white willow (with black cohosh, guaiac (Guaiacum officinale), sarsaparilla, and aspen bark) effectively reduced osteoarthritis pain compared to placebo.⁷⁷ White willow products providing approximately 100 mg salicin per day are generally recommended.

Capsaicin, the "burning" substance in cayenne creams, has been used topically to relieve pain from osteoarthritis. The benefit from cayenne creams, generally containing 0.025–0.075% of the active ingredient capsaicin, has been confirmed in double-blind research.⁷⁸

According to arthritis research, saponins found in the herb yucca appear to block the release of toxins from the intestines that inhibit normal formation of cartilage. A double-blind but preliminary study suggested yucca might reduce symptoms of osteoarthritis.⁷⁹ Only limited evidence currently supports the use of yucca for people with osteoarthritis.

Cat’s claw has been used traditionally for osteoarthritis, though there is no scientific support for this practice.

Information about the effects of a particular supplement or herb on a particular condition has been qualified in terms of the methodology or source of supporting data (for example: clinical, double blind, meta-analysis, or traditional use). For the convenience of the reader, the information in the table listing the supplements for particular conditions is also categorized. The criteria for the categorizations are: "Primary" indicates there are reliable and relatively consistent scientific data showing a health benefit. "Secondary" indicates there are conflicting, insufficient, or only preliminary studies suggesting a health benefit or that the health benefit is minimal. "Other" indicates that an herb is primarily supported by traditional use or that the herb or supplement has little scientific support and/or minimal proven health benefit.

1. Warmbrand M. How Thousands of My Arthritis Patients Regained Their Health. New York: Arco Publishing, 1974.

2. Childers NF. A relationship of arthritis to the solanaceae (nightshades). J Internat Acad Pre Med 1982;Nov:31–7.

3. Childers NF, Margoles MS. An apparent relation of nightshades (Solanaceae) to arthritis. J Neurol Orthop Med Surg 1993;14:227–31.

4. Taylor MR. Food allergy as an etiological factor in arthropathies: a survey. J Internat Acad Prev Med 1983;8:28–38 [review].

5. Altman RD, Lozada CJ. Practice guidelines in the management of osteoarthritis. Osteoarthritis Cartilage 1998;6(Suppl A):22–4 [review].

6. Tapadinhas MJ, Rivera IC, Bignamini AA. Oral glucosamine sulphate in the management of arthrosis: report on a multi-centre open investigation in Portugal. Pharmtherapeutica 1982;3:157–68.

7. Giordano N, Nardi P, Senesi M, et al. The efficacy and safety of glucosamine sulfate in the treatment of gonarthritis. Clin Ter 1996;147:99–105.

8. D’Ambrosio E, Casa B, Bompani G, et al. Glucosamine sulphate: a controlled clinical investigation in arthrosis. Pharmatherapeutica 1981;2(8):504­8.

9. Crolle G, DiEste E. Glucosamine sulfate for the management of arthrosis. Curr Ther Res 1980;7:104–9.

10. Qiu GX, Gao SN, Giacovelli G, et al. Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis. Arzneimforsch Drug Res 1998;48:469–74.

11. Reichelt A, Förster KK, Fischer M, et al. Efficacy and safety of intramuscular glucosamine sulfate in osteoarthritis of the knee. Arzneimforsch Drug Res 1994;44:75–80.

12. Drovanti A, Bignamini AA, Rovati AL. Therapeutic activity of oral glucosamine sulfate in osteoarthritis: a placebo­controlled double­blind investigation. Clin Ther 1980;3(4):260–72.

13. Vaz AL. Double-blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulphate in the management of osteoarthritis of the knee in out­patients. Curr Med Res Opin 1982;8(3):145–9.

14. Pujalte JM, Llavore EP, Ylescupidez FR. Double-blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthrosis. Curr Med Res Opin 1980;7(2):110–4.

15. da Camara CC, Dowless GV. Glucosamine sulfate for osteoarthritis. Ann Pharmacother 1998;32:580–7.

16. Barclay TS, Tsourounis C, McCarthy GM. Glucosamine. Ann Pharmacother 1998;32(5):574–9.

17. Kerzberg EM, Roldan EJA, Castelli G, Huberman ED. Combination of glycosaminoglycans and acetylsalicylic acid in knee osteoarthritis. Scand J Rheum 1987;16:377.

18. Baici A, Hörler D, Moser B, et al. Analysis of glycosaminoglycans in human serum after oral administration of chondroitin sulfate. Rheumatol Int 1992;12:81–8.

19. Kerzberg EM, Roldán EJA, Castelli G, Huberman ED. Combination of glycosaminoglycans and acetylsalicylic acid in knee osteoarthrosis. Scand J Pheumatol 1987;16:377–80.

20. Rovetta G. Galactosaminoglycuronoglycan sulfate (Matrix) in therapy of tibiofibular osteoarhtirits of the knee. Drugs Exptl Clin Res 1991;17:53–7.

21. Conte A, Volpi N, Palmieri L, et al. Biochemical and pharmacokinetic aspects of oral treatment with chondroitin sulfate. Arzneim-Forsch 1995;45:918–25.

22. Ronca F, Palmieri L, Panicucci P, Ronca G. Anti-inflammatory active of chondroitin sulfate. Osteoarthritis Cartilage 1998;6(Suppl A):14–21.

23. Uebelhart D, Thonar EJ-M, Delmas PD, et al. Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study. Osteoarthritis Cartilage 1998;6(Suppl A):39–46.

24. Verbruggen G, Goemaere S, Veys EM. Chondroitin sulfate: S/DMOAD (structure/disease modifying anti-osteoarthritis drug) in the treatment of finger joint OA. Osteoarthritis Cartilage 1998;6(Suppl A):37–8.

25. Bucsi L, Poór G. Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of knee osteoarthritis. Osteoarthritis Cartilage 1998;6(Suppl A):31–6.

26. Bourgeois P, Chales G, Dehais J, et al. Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3X400 mg/day vs placebo. Osteoarthritis Cartilage 1998;6(Suppl A):25–30.

27. Pipitone V, Ambanelli U, Cervini C, et al. A multicenter, triple-blind study to evaluate galactosaminoglucuronoglycan sulfate versus placebo in patients with femorotibial gonarthritis. Curr Ther Res 1992;52:608–38.

28. Bazières B, Loyau G, Menkès CJ, et al. Le chondroïtine sulfate dans le traitement de la gonarthrose et de la coxarthrose. Rev Rhum Mal Ostéoartic 1992;59:466–72.

29. Conrozier T, Vignon E. Die Wirkung von Chondroitinsulfat bei der Behandlung der Hüft Gelenksarthrose. Eine Doppelblindstudie gegen Placebo. Litera Rheumatologica 1992;14:69–75.

30. L’Hirondel JLL. Klinische Doppelblind-Studie mit oral verabreichtem Chondroitinsulfat gegen Placebo bei der tibiofermoralen Gonarthrose (125 Patienten). Litera Rheumatologica 1992;14:77–82.

31. Morreale P, Manopulo R, Galati M, et al. Comparison of the antiinflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol 1996;23:1385–91.

32. Leeb BF, Petera P, Neumann K. Results of a multicenter study of chondroitin sulfate (Condrosulf) use in arthroses of the finger, knee and hip joints. Wien Med Wochenschr 1996;146:609–14.

33. Bourgeois P, Chales G, Dehais J, et al. Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3X400 mg/day vs placebo. Osteoarthritis Cartilage 1998;6(Suppl A):25–30.

34. Murray MT. Which is better: Aged versus fresh garlic; glucosamine sulfate versus chondroitin sulfate. Am J Natural Med 1997;4:5–8.

35. Theodosakis J, Adderly B, Fox B. The Arthritis Cure. New York: St. Martin’s Press, 1997.

36. Schumacher HR. Osteoarthritis: The clinical picture, pathogenesis, and management with studies on a new therapeutic agent, S-adenosylmethionine. Am J Med 1987;83(suppl 5A):1–4 [review].

37. Harmand MF, Vilamitjana J, Maloche E, et al. Effects of S-adenosylmethionine on human articular chondrocyte differentiation: An in vitro study. Am J Med 1987;83(suppl 5A):48–54.

38. Berger R, Nowak H. A new medical approach to the treatment of osteoarthritis. Report of an open phase IV study with ademetionine (Gumbaral). Am J Med 1987;83:84–8.

39. Konig H, Stahl H, Sieper J, Wolf KJ. Magnetic resonance tomography of finger polyarthritis: Morphology and cartilage signals after ademetionine therapy. Aktuelle Radiol 1995;5:36–40.

40. Domljan Z, Vrhovac B, Durrigl T, Pucar I, et al. A double-blind trial of ademetionine vs naproxen in activated gonarthrosis. Int J Clin Pharmacol Ther Toxicol 1989;27:329–33.

41. Müller-Fassbender H. Double-blind clinical trial of S-adenosylmethionine in versus ibuprofen in the treatment of osteoarthritis. Am J Med 1987;83(suppl 5A):81–3.

42. Vetter G. Double-blind comparative clinical trial with S-adenosylmethionine and indomethacin in the treatment of osteoarthritis. Am J Med 1987;83(suppl 5A):78–80.

43. Maccagno A. Double-blind controlled clinical trial of oral S-adenosylmethionine versus piroxicam in knee osteoarthritis. Am J Med 1987;83(suppl 5A):72–7.

44. Caruso I, Pietrogrande V. Italian double-blind multicenter study comparing S-adenosylmethionine, naproxen, and placebo in the treatment of degenerative joint disease. Am J Med 1987;83(suppl 5A):66–71.

45. Marcolongo R, Giordano N, Colombo B, et al. Double-blind multicentre study of the activity of s-adenosyl-methionine in hip and knee osteoarthritis. Curr Ther Res 1985;37:82–94.

46. Glorioso S, Todesco S, Mazzi A, et al. Double-blind multicentre study of the activity of S-adenosylmethionine in hip and knee osteoarthritis. Int J Clin Pharmacol Res 1985;5:39–49.

47. Montrone F, Fumagalli M, Sarzi Puttini P, et al. Double-blind study of S-adenosyl-methionine versus placebo in hip and knee arthrosis. Clin Rheumatol 1985;4:484–5.

48. Konig B. A long-term (two years) clinical trial with S-adenosylmethionine for the treatment of osteoarthritis. Am J Med 1987;83:89–94.

49. Bradley JD, Flusser D, Katz BP, et al. A randomized, double blind, placebo controlled trial of intravenous loading with S-adenosylmethionine (SAM) followed by or SAM therapy in patients with knee osteoarthritis. J Rheumatol 1994;21:905–11.

50. di Padova C. S-adenosylmethionine in the treatment of osteoarthritis. Review of the clinical studies. Am J Med 1987;83:60–5 [review].

51. Kaufman W. The use of vitamin therapy for joint mobility. Therapeutic reversal of a common clinical manifestation of the ‘normal’ aging process. Conn State Med J 1953;17(7):584–9.

52. Kaufman W. The use of vitamin therapy to reverse certain concomitants of aging. J Am Geriatr Soc 1955;11:927.

53. Hoffer A. Treatment of arthritis by nicotinic acid and nicotinamide. Can Med Assoc J 1959;81:235–8.

54. Jonas WB, Rapoza CP, Blair WF. The effect of niacinamide on osteoarthritis: A pilot study. Inflamm Res 1996;45:330–4.

55. McAlindon TE, Jacques P, Azang Y. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthrit Rheum 1996;39:648–56.

56. Machtey I, Ouaknine L. Tocopherol in osteoarthritis: a controlled pilot study. J Am Geriatr Soc 1978;25(7):328–30.

57. Blankenhorn G. Klinische Wirtsamkeit von Spondyvit (vitamin E) bei aktiverten arthronsen. Z Orthop 1986;124:340–3.

58. Scherak O, Kolarz G, Schödl Ch, Blankenhorn G. Hochdosierte Vitamin -E-Therapie bei Patienten mit aktivierter Arthrose. Z Rheumatol 1990;49:369–73.

59. Newnham RE. The role of boron in human nutrition. J Applied Nutr 1994;46:81–5.

60. Helliwell TR, Kelly SA, Walsh HP, et al. Elemental analysis of femoral bone from patients with fractured neck of femur or osteoarthrosis. Bone 1996;18:151–7.

61. Travers RL, Rennie GC, Newnham RE. Boron and arthritis: the results of a double-blind pilot study. J Nutr Med 1990;1:127–32.

62. Altman R, Gray R. Inflammation in osteoarthritis. Clin Rheum Dis 1985;11:353.

64. Stammers T, Sibbald B, Freeling P. Efficacy of cod liver oil as an adjunct to non-steroidal anti-inflammatory drug treatment in the management of osteoarthritis in general practice. Ann Rheum Dis 1992;51:128–9.

65. Gibson SLM, Gibson RG. The treatment of arthritis with a lipid extract of Perna canaliculus: a randomized trial. Comp Ther Med 1998;6:122–6.

66. Brooks PM. Side effects from Seatone. Med J Aust 1980;2:158 [letter].

67. Balagot RC, Ehrenpreis S, Kubota K, Greenberg J. Analgesia in mice and humans by D-phenylalanine: Relation to inhibition of enkephalin degradation and enkephalin levels. In: Bonica JJ, Liebeskind JC, Albe-Fessard DG, eds., Advances in Pain Research and Therapy, Vol 5. New York: Raven Press, 1983, .289–93.

68. Budd K. Use of D-phenylalanine, an enkephalinase inhibitor, in the treatment of intractable pain. In: Bonica JJ, Liebeskind JC, Albe-Fessard DG, eds., Advances in Pain Research and Therapy, Vol 5. New York: Raven Press, 1983, 305–8.

69. Seltzer S, Marcus R, Stoch R. Perspectives in the control of chronic pain by nutritional manipulation. Pain 1981;11:141–8 [review].

70. Prudden JF, Balassa LL. The biological activity of bovine cartilage preparations. Semin Arthritis Rheum 1974;3:287–320.

71. Reijholec V. Long term studies of antiosteoarthritic drugs: an assessment. Semin Arthritis Rheum 1987;17(2 Suppl 1):35–53.

72. American Medical Association. Dimethyl sulfoxide. Controversy and Current Status—1981. JAMA 1982;248:1369–71.

73. Jimenez RAH, Willkens RF. Dimethyl sulfoxide: A perspective of its use in rheumatic diseases. J Lab Clin Med 1982;100:489–500.

74. Jacob SW, Wood DC. Dimethyl sulfoxide (DMSO). Toxicology, pharmacology, and clinical experience. Am J Surg 114:414–26.

75. Siemandi H. The effect of cis-9- cetyl myristoleate (CMO) and adjunctive therapy on arthritis and auto-immune disease: a randomized trial. Townsend Letter for Doctors and Patients, Aug/Sept, 1997, 58–63.

76. Safayhi H, Mack T, Saieraj J, et al. Boswellic acids: Novel, specific, nonredox inhibitors of 5-lipoxygenase. J Pharmacol Exp Ther 1992;261:1143–6.

77. Mills SY, Jacoby RK, Chacksfield M, Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: A double-blind study. Br J Rheum 1996;35:874–88.

78. McCarthy GM, McCarty DJ. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands J Rheumatol 1992;19:604–7.

79. Bingham R, Bellow BA, Bellow JG. Yucca plant saponin in the management of arthritis. J Appl Nutr 1975;27:45–51.