Glucosamine, Chondroitin and MSM as alternative therapies for scleroderma
Much is known, and is being discovered, about the pathological mechanisms that occur in scleroderma, but approved treatments are scarce; and there is considerable disagreement about the effectiveness of even the approved therapies. This has led patients with scleroderma to explore complementary and alternative approaches, nutritional materials, and "foods", natural and "organic" substances which are unapproved. These materials are generally less expensive than the products of the pharmaceutical industry, which makes them attractive to the patient. Alternative therapies are widely advertised. Testimonials to their effectiveness tend to be numerous and very convincing. Thus, these products are used by many patients with various forms of rheumatic diseases and with scleroderma. Glucosamine is available without prescription in pharmacies, grocery stores, nutritional supplement outlets and on the web. An immense literature has accumulated supporting the effectiveness of glucosamine for almost any illness, especially inflammatory diseases, including scleroderma. Glucosamine can be used alone or in combination with other agents, such as chondroitin sulfate. One brand of glucosamine, with several different names, depending on the country in which it is found, is known as DONA, a Rotta Pharmaceuticals product from Italy. It is now available in over sixty countries, including the United States and Canada. In some European countries a prescription is required. Patients with inflammatory and rheumatic conditions of all kinds try these products even though first recommended for osteoarthritis; they are viewed as being building blocks for the joint cartilage, which is lost in the process of this disease. Nevertheless glucosamine has become a panacea, a "cure-all", a remedy for all ills; the word derived from the Greek panakeia , meaning "all-healing" . In much of the rest of the world glucosamine is taken alone, without the many additives so common on the US market, including chondroitin sulfate. MSM (methylsulfonylmethane) is sometimes added. The literature that we read tells us that these combinations may be superior to the single product glucosamine alone.
Initially it was argued that all of the articles supporting the effectiveness of these agents, alone, and in combination, were financed by industry, meaning that the company that made the agent paid for the study. Of course this would suggest that only favorable comments and literature would be published. Increasingly, in the case of glucosamine, we are seeing reports not financed by the companies that produce and market the products, most of which support its effectiveness. As I write this I am reading an article on the effectiveness of glucosamine and MSM for osteoarthritis by authors from India, who claim no support from industry. Either agent, glucosamine or MSM alone worked, but the combination worked best. The article was published in 2004. Glucosamine is derived from the shells of sea crustaceans, is inexpensive and easily purified. Chondroitin sulfate, generally derived from cow cartilage, is more expensive to obtain and to purify.
Very little is known about many aspects of glucosamine sulfate use. It is not known how well an oral preparation is absorbed. One study presented at the October, 2004 annual Rheumatology meeting said that it was well absorbed, while another presentation said that it was so poorly absorbed that it could not be effective. Further, the mechanism of action is not clear. It has been described as a building block for cartilage. Many scientists think that it blocks important inflammatory mediators and thus is anti-inflammatory in all tissues. Side effects and drug interactions are unknown. Still, many thousands of people use it alone or combined with other additives. No known problems have arisen. Many other studies are needed.
MSM is said to be a nutrient that is effective in relieving muscle and joint pain in scleroderma, interstitial cystitis, and many other rheumatic diseases; even allergies are said to be helped by this agent alone, as well as in combination with glucosamine and chondroitin. MSM is important because it provides dietary sulfur. MSM is 34% sulfur by weight, and is found in all plants, soils, fruits, meats and vegetables. This naturally occurring sulfur is not similar to inorganic sulfides, sulfites, sulfates and sulphonamides, to which many people are allergic.
Dr. Stanley W. Jacob from the Oregon Health and Science University in Portland, Oregon, has written extensively about its effectiveness as an anti-inflammatory and as an aid in building disulfide bonds which are necessary in the structure of joint components. These components are made in part from glucosamine and collagen, which are sulfur dependent. MSM is a derivative of DMSO (dimethyl sulfoxide), which is believed to be anti-inflammatory and analgesic, but causes an unpleasant taste and odor. Roughly 15% of DMSO is converted in the body to dimethyl sulfone, another name for MSM. The difference is the inclusion of a single additional oxygen atom. MSM does not have a disagreeable taste or odor. DMSO is approved by the Food and Drug Administration (FDA) for treatment of interstitial cystitis; but neither DMSO nor MSM are FDA approved for any other indication. All agents discussed so far are protected by the Dietary Supplement Health and Education Act (DSHEA) of 1994, which prevents FDA oversight of "foods" and complementary and alternative medicines (CAMs). DMSO is used to protect human tissue such as bone marrow, stem cells and embryos when frozen for storage. The DMSO which is used for interstitial cystitis is called "Rimso". Rimso-50 solution, available at some pharmacies, is a medical rather than industrial grade of DMSO. It can be used for "off-label" medical conditions such as scleroderma.
As you might know, Dr Jacob's books "The Miracle of MSM" and "MSM: The Definitive Guide" advise using the agent for the treatment of scleroderma, administered orally, intravenously for severe cases, and also by topical application to soften the skin. Although MSM does not cure scleroderma, according to the doctor, 70% of patients experience some degree of improvement. Dr. Jacob claims to have treated hundreds of patients with scleroderma. He began in the 1960's by using DMSO and had excellent results, but patients would not continue because of the unpleasant taste and odor. With MSM the results were even better. Although the books and other publications by Dr. Jacob and associates discuss the successes of treatment for scleroderma, a careful search for controlled trials published in scientific medical journals produced no articles on MSM or DMSO for scleroderma. One of the authors discusses the lack of controlled clinical trials. See the review by Jeremy Appleton, co-author of "MSM, The Definitive Guide: The Nutritional Breakthrough for Arthritis, Allergies and More", at www.amazon.com. He says "This is the best book on the topic"; he argues that the evidence is not "flimsy". Dr. Jacob's experience treating 18,000 patients with the agent cannot be dismissed lightly. These patients, of course, had a variety of problems, not just scleroderma.
In conclusion, I have discussed three alternative medicines for treating the pain and the other features of scleroderma. None of these are proven to be effective, and side effects could occur. There are many other alternative approaches that could be described.
—Robert B. Buckingham, M.D.