Ask the Doctors May 2005 Issue

Ask Dr. Marks: 05/05

I have been taking glucosamine and chondroitin for some time. Now the company that makes the combination has added hyaluronic acid to the supplement. What can you tell me about hyaluronic acid — its pros and its cons?

Hyaluronic acid is found in normal joint fluid and acts as a lubricant. It is also found in articular cartilage. Injectable hyaluronic acid is used in the treatment of mild to moderate osteoarthritis of the knee. It is injected directly into the knee in a series of three or four injections one week apart. Not everyone on this therapy obtains relief, but those who do usually experience pain relief for up to six months. Hyaluronic acid has also been added to oral combination supplements, but to date there is no evidence that it improves the effectiveness of glucosamine or chondroitin. Oral hyaluronic acid is digested in the gastrointestinal tract and poses no known risks to the patient. Although glucosamine and chondroitin act as mild anti-inflammatories, they do not promote the regeneration of articular cartilage.


Is there any evidence of a relationship between arthritis and the consumption of alcohol?

Similar to other medical conditions, there are risk factors that increase an individual’s chance of developing osteoarthritis. Included among the risk factors for osteoarthritis are joint injuries due to sports or work-related activities, obesity, and genetic predisposition.  The consumption of alcohol is not generally considered a risk factor for osteoarthritis.  Alcohol consumption does play a role in other conditions similar to arthritis, such as osteonecrosis, a disease that leads to bone breakdown. It may also play a role in the triggering of certain types of gout attacks. Moderate use of alcohol, however, does not play a part in the development of osteoarthritis.


I don’t sleep well because of fibromyalgia, which causes muscle pain in my hip, neck, and spine. What suggestions can you offer?

Sleep deprivation and muscle pain are only a few of the symptoms of fibromyalgia.  Fatigue, morning stiffness, and headaches are other symptoms of this complex disease. Although the causes of fibromyalgia are unknown, sleep disturbance may play an important role. Stress, depression, and anxiety can prevent a person from getting the proper sleep needed for normal brain function. It is believed that fibromyalgia patients may have problems with how their brain and spinal cord process pain. The brain may have low levels of chemicals such as serotonin and norepinephrine, which can lead to depression, fatigue, and pain. One of the more successful ways to treat fibromyalgia  is with tricyclic antidepressants (Elavil, Sinequan) that induce sleep and relieve depression and anxiety. These medications are taken at bedtime and in lower doses than those used to treat depression.