A 62-year-old woman comes to the office due to moderate osteoarthritis of the knees. At her last appointment 3 months ago, recommendations for weight management and exercise were made. Since then, the patient has exercised only twice and has made no dietary changes. She reports continued stiffness and pain in her knees and has decided to start a glucosamine supplement as recommended to her by a friend. The patient asks which brand of supplement to buy. Which of the following is the most appropriate statement?

Question

A 62-year-old woman comes to the office due to moderate osteoarthritis of the knees.  At her last appointment 3 months ago, recommendations for weight management and exercise were made.  Since then, the patient has exercised only twice and has made no dietary changes.  She reports continued stiffness and pain in her knees and has decided to start a glucosamine supplement as recommended to her by a friend.  The patient asks which brand of supplement to buy.  Which of the following is the most appropriate statement?

Quizplus · Accepted Answer

This patient with knee osteoarthritis is nonadherent with standard first-line recommendations and continues to have symptoms. She is now considering a complementary and alternative medicine supplement and is asking for specific recommendations for which formulation to buy. Some studies with glucosamine have shown a small benefit in reducing the pain of knee osteoarthritis (Choice C). However, research has been hampered by poor manufacturing standards (eg, quantity and purity of ingredients) within the herbal supplement industry. For the benefit of a patient who is pursuing complementary and alternative medicine products, the physician should consult with or direct the patient to reliable, independent third parties (eg, US Pharmacopeia) that have evaluated the products in question for purity and proper manufacturing practices; however, these agencies typically do not review safety or effectiveness. If no independent review is available, the patient should be so informed. (Choices A and D) These responses redirect the patient to standard osteoarthritis recommendations. However, the patient has already rejected standard management, and this may be seen as dismissive and insulting. (Choice B) Not all supplement brands maintain equal manufacturing standards. Although the US FDA has only limited regulatory authority for nutritional supplements, independent evaluations from other sources are often available and frequently helpful. Educational objective: The US FDA has only limited regulatory authority regarding complementary and alternative medicine supplements, which often have poor manufacturing standards. Third-party review organizations (eg, US Pharmacopeia) may have independent information for some products and can be used to guide patient choice. References: Dietary supplements quality analysis tools from the United States Pharmacopeia. (http://www.ncbi.nlm.nih.gov/pubmed/26857794)

A 62-Year-Old Woman Comes to the Office Due to Moderate