Study Shows Effectiveness of Short and Long Term Use of Topical Cream for Osteoarthritis ProHealth.com March 24, 2003 Results of a clinical study published in the March 2003 Journal of Rheumatology show long term benefits of topical application of a preparation containing camphor, glucosamine and chondroitin sulfate. The research shows continuous reduction of pain resulting from osteoarthritis of the knee, with clinically significant results within four weeks. According to the study’s principal investigator, the information also suggests that topical application of these agents is an effective route of administration. Under the auspices of the Department of Complementary Medicine, RMIT University, and the Centre for Complementary Medicine, Monash University, both in Melbourne, Australia, a single centered, randomized, double-blind, placebo-controlled trial was performed with 63 subjects chosen from the community after assessment for eligibility. Key to the assessment criteria was a diagnosis of osteoarthritis of the knee based on the American College of Rheumatology definition, which includes knee pain most days during the prior month, as well as morning stiffness of the knee for 30 minutes or less. Patients were randomly assigned to use a topical preparation containing camphor, glucosamine, and chondroitin sulfate, or a placebo, for eight weeks. The two treatment groups were similar with respect to demographic composition and illness history. The active preparation was a water-soluble cream containing glucosamine sulfate, chondroitin sulfate and shark cartilage of which 10 to 30 percent is chondroitin sulfate, camphor (3.1%) and scented with peppermint oil. This exact preparation is formulated using a proprietary technique – FUSOME – aimed at maximizing skin penetration of the beneficial ingredients. This unique system consists of high efficiency emulsifiers and skin emollients and micro-encapsulation of the beneficial ingredients. The placebo preparation was a simple cosmetic cream that used conventional skin emollients, petrolatum and mineral oil, and conventional emulsifiers; stearic acid and glycerol stearate, rather than the proprietary technology. The primary outcome measure was an assessment of subjective pain using a Visual Analogue Scale (VAS). Secondary outcome measures included measures of pain, stiffness and physical function using the Western Ontario and the McMaster Universities Osteoarthritis Index (WOMAC) and quality of life using the SF-36 questionnaire. The study showed a significant difference between the two groups existed after the first day of use of creams. Nearly all of the patients using the cream obtained immediate pain relief. Additionally, the results showed there was a greater mean sustained reduction in pain at both four weeks and eight weeks for the experiment group compared to the placebo group. A majority of the cream users experienced gradually and continually improving pain relief over the eight weeks. A surprising result was that with continued use, one-third of the experiment group had their chronic osteoarthritis pain completely or nearly completely eliminated within eight weeks or less. According to Marc Cohen, MD, PhD, Department of Complementary Medicine, Faculty of Life Sciences, RMIT University, and principal investigator of this study, "The observed gradual and continual improvement in pain scores is likely to be due to the glucosamine and chondroitin content and this is consistent with previous studies." Oral administration of glucosamine and chondroitin sulfate have been consistently shown in previous studies to relieve the pain and joint stiffness associated with osteoarthritis and long-term consumption of glucosamine may reduce the radiographic progression of osteoarthritis of the knee. Glucosamine, although it is rapidly absorbed from the gastrointestinal tract when taken orally, is subject to uptake and degradation by the liver and uptake into non-joint tissues. Therefore, when administered orally (typically 1500 mg of glucosamine and 1200 mg of chondroitin sulfate daily), only a small percentage is available to the joint. Says Dr. Cohen, "Our results clearly show that the proprietary system in this product effectively targets osteoarthritic knee pain and provides immediate pain relief along with long term improvement of pain with continued use." Dr. Cohen adds, "The study shows promise, regardless of mode of action, for those osteoarthritis patients who have not had success with oral glucosamine/chondroitin, or, who prefer to apply a topical preparation over taking numerous pills several times a day." (J Rheumatol 2003;30:523-8)

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