Numerous studies have been performed showing a favorable comparison between SAMe and placebo, naproxen, [Caruso 1987] ibuprofen, [Muller-Fassbinder 1987; Glorioso 1985] aspirin, and other treatment alternatives. Studies of SAMe in the treatment of osteoarthritis have also been notable for the number of patients treated and the length of treatment. Of particular interest is a noncontrolled, clinical, phase IV trial performed by Berger and Nowak [1987] and involving over 20,000 patients suffering from osteoarthritis of the hip, knee, spine, and finger. Patients were given oral SAMe 1200 mg/day in the first week, 800 mg/day in the second week, and 400 mg/day from the third week to the end of the study, at eight weeks. The trial was completed by 92.7% of the participants. Of these, 71% described the efficacy of treatment as "very good" or "good", 21% as "moderate", and only 9% as "poor". In addition, the vast majority assessed tolerance as good or very good rather than moderate or poor (87%, 8%, and 5%, respectively).

Also of note is a 2-year trial conducted by Benno König.[1987] This open, multicenter trial involved 108 patients with osteoarthritis of the hip, knee, and spine. These patients were given oral SAMe 600 mg/day for 2 weeks and then 400 mg/day until the end of treatment. Symptom severity was assessed before treatment, at weeks 1 and 2, and then monthly throughout the remainder of the treatment period. A total of 106 patients completed the first year of the trial, and 97 completed the full 2 years.

This study showed SAMe to be not only well tolerated, but highly effective. Benefits were seen within the first few weeks of treatment and continued to increase through month 12. Efficacy continued throughout the study. While 20 patients did report side effects, none were severe enough to cause discontinuation of treatment. It is also interesting to note that no adverse effects at all were reported by any participant during the last 6 months of the trial.

Other, more recent studies have explored different aspects of SAMe as a treatment for osteoarthritis, such as the effects of IV loading followed by oral treatment [Bradley 1994] and the effect of treatment on cartilage signal intensity in finger osteoarthritis [König 1995]. This latter study found a significant increase of signal intensity after treatment, which the researchers present as a sign of structural improvement.

Overall, researchers concluded that SAM-e is safe in the treatment of various forms of osteoarthritis, is well tolerated by a wide variety of patients, including the geriatric population and patients on concomitant medications. Patients taking SAM-e can benefit from its anti-inflammatory and analgesic properties without sustaining damage to gastrointestinal mucosa or other systemic damage.

References

Reviews
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Schumacher HR Jr. Osteoarthritis: the clinical picture, pathogenesis, and management with studies on a new therapeutic agent, S-adenosylmethionine. Am J Med. 1987;83(5A):1-4.

Trials Barcelo HA, Wiemeyer JC, Sagasta CL, Macias M, Barreira JC. Effect of S-adenosylmethionine on experimental osteoarthritis in rabbits. Am J Med. 1987;83(5A):55-59.

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(SA):84-88.

Bradley JD, Flusser D, Katz BP, et al. A randomized, double blind, placebo controlled trial of intravenous loading with S-adenosylmethionine (SAM) followed by oral SAM therapy in patients with knee osteoarthritis. J Rheumatol. 1994;21:905-911.

Brandt KD. Effects of nonsteroidal anti-inflammatory drugs on chondrocyte metabolism in vitro and in vivo. Am J Med. 1987;83(5A);29-34.

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(5A):66-71.

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.

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Konig H, Stahl H, Sieper J, Wolf KJ. Magnetic resonance tomography of finger polyarthritis: morphology and cartilage signals after ademetionine therapy. [Article in German] Aktuelle Radiol. 1995;5:36-40.

Laudanno OM. Cytoprotective effect of S-adenosylmethionine compared with that of misoprostol against ethanol-, aspirin-, and stress-induced gastric damage. Am J Med. 1987;83(5A):43-47.

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