Ask the Doctors December 2003 Issue

Ask Dr. Marks: 12/03

Since I am unable to swallow pills, I wonder about the effectiveness I can expect from chondroitin sulfate if I open a capsule and take the contents with food?

The effectiveness of chondroitin sulfate will not be altered by opening capsules and taking the substance with food. The real question is, “Is chondroitin sulfate effective?”

There are many studies, dating back to 1980, that report that there is some effectiveness with chondroitin sulfate. On the whole, these studies were conducted on a small patient population and were not rigorously controlled.

Currently, there is a well-controlled multicenter, five-year study underway on chondroitin sulfate, funded by the U.S. government. The results will not be available for at least a few years. Until then, the only conclusion we can draw on chondroitin sulfate is that it probably does not do any harm but its usefulness in osteoarthritis is yet to be proven.

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I’ve heard a lot about the “microfracture” technique for the repair of damaged knee cartilage—specifically, that it is very effective and lasts a long time. Can you explain the procedure and what its advantages are over conventional methods of knee repair?

The microfracture technique of cartilage repair has been performed in North America for more than a decade. It is an arthroscopic technique in which the damaged cartilage is first removed down to the underlying bone. A sharp, pointed surgical awl is then used to perforate the bone in several places. This causes bleeding from the microfractures and allows access to stem cells and various healing factors.

During the first few months following surgery, fibrocartilage grows into the defect. Fibrocartilage is different than articular cartilage and lacks many of the wear characteristics of a normal joint. It does, however, provide pain relief for the medium term but will usually wear out over the long term, causing osteoarthritis.

It is important to remember that the microfracture technique is not for generalized osteoarthritis. It is used only for relatively small defects in the articular cartilage, usually caused by trauma due to injury. Its advantage over other techniques of articular cartilage repair is that it can be performed as an outpatient procedure. It is not designed for patients who suffer from extensive osteoarthritis.

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Will moving to a warmer climate help my arthritis?

Most arthritis sufferers report that they feel better in a warm climate. Researchers have found that warm climates may modestly help the symptoms of arthritis. What is more important, however, is that the climate be consistent. There should be no large and frequent changes in the climate. It is believed that wide swings in barometric pressure aggravate the symptoms of arthritis.

When choosing a location, you should look for other reasons for moving rather than just the climate. If you have family or friends in the area, this is a more compelling reason for a move than merely climate.