Position statements

Arthritis and Exercise: The Essentials

Put simply, exercise is good for arthritis.

The strength of the evidence varies across different studies but there is no debate that people with arthritis can experience improvements in their condition and overall wellbeing by participating in regular, appropriate exercise.

Yet significant confusion about the benefit and safety of exercise for people with arthritis still exists within the community, reflected in the large number of exercise-related calls to our national Arthritis Infoline. People with arthritis frequently report fear of making symptoms worse and a lack of knowledge about what to do and how to get started, ultimately resulting in sub-optimal physical activity levels. Australian GPs have also told us, via our Voice of GP survey¹, that they lack confidence in prescribing the most appropriate exercise for their patients with arthritis. Recognising this uncertainty, Arthritis Australia has worked with a group of experts to bring together this guide for consumers, health professionals and fitness & exercise providers.

Its purpose is to provide clear, evidence-based recommendations about the role of exercise in the prevention of arthritis and ongoing management of individuals with the condition.  These recommendations will drive the development of criteria that can be used to evaluate whether current and proposed community exercise programs are suitable for people with arthritis.

We hope that by pulling together this information we can offer a significant opportunity for the fitness industry to link with health sector professionals such as GPs, physiotherapists, and exercise physiologists. For these allied health professionals, we believe that creating and strengthening referral pathways into suitable evidence-based exercise programs will greatly assist the overall objective of preventing and managing arthritis and improving the quality of life for people living with the condition.

The position statement is endorsed by:

• Australian Rheumatology Association
• Australian Physiotherapy Association
• Exercise and Sports Science Association
• Fitness Australia

Australian Rheumatology Association and Arthritis Australia Statement  regarding the use of glucosamine for the treatment of Osteoarthritis 

Recent media reports have raised concern over the use of glucosamine in the treatment of osteoarthritis.  These reports appear to be based on two unrelated recent events:

1. A change in recommendation by the American College of Rheumatology (ACR) [1]

In October 2019 the ACR updated their guidelines for the management of osteoarthritis from a longstanding conditional recommendation against the use of glucosamine for osteoarthritis (on the basis that it probably does not help), to a strong recommendation against the use of glucosamine for osteoarthritis (on the basis that it convincingly does not help).  They did not cite new safety concerns.

2. A recent paper highlighting the known risks associated with glucosamine, particularly in people with shellfish allergy [2]

This paper reviewed 366 glucosamine related adverse drug reactions reported to the Therapeutic Goods Administration between 2000-2011, including 43 classified as severe, possibly related to the known risks of glucosamine in those with shellfish allergy.  This highlights a valid concern but the number of adverse events needs to be considered in the context of the many hundreds of thousands of people who took glucosamine during that period. This suggests that severe adverse reactions are very uncommon.

Many other osteoarthritis treatment guidelines make conditional recommendations against the use of glucosamine on the basis that it probably does not help, including The Royal Australian College of General Practitioners guideline for the management knee and hip OA [3].

Arthritis Australia and Australian Rheumatology Association comment:

This information highlights growing evidence that glucosamine does not help people with osteoarthritis and is a reminder that people with shellfish allergy should not take glucosamine (which is commonly derived from shellfish).  It does not identify any new safety concerns and should not cause undue alarm in people already taking glucosamine.

Comment from The Royal Australian College of General Practitioners (RACGP):

Dr Harry Nespolon, President of the RACGP stated “The RACGP does not recommend the use of glucosamine as a way of preventing osteoarthritis. If you have concerns about using glucosamine or treatment for osteoarthritis I recommend you have a chat with your local GP about the options available to you.”

References:

[1] https://www.rheumatology.org/Portals/0/Files/Osteoarthritis-Guideline-Early-View-2019.pdf

[2] https://www.ncbi.nlm.nih.gov/pubmed/31597786

[3] https://rheumatology.org.au/gps/clinical-guidelines.asp

Media Contacts:

Australian Rheumatology Association – T:  02 9252 2356  E:  [email protected]

Arthritis Australia – T:  02 9518 4441  E:  [email protected]

The Royal Australian College of General Practitioners – T: 03 8699 0939 | E: [email protected]

Download: Statement regarding glucosamine for the treatment of osteoarthritis

Key messages 

• Stem cell therapies offer great promise as a potential treatment strategy for a range of conditions, including osteoarthritis.
• However, research is still in its early stages and so far there is not enough high quality evidence to know whether these therapies are safe and effective for osteoarthritis.
• Clinically unproven stem cell therapies may pose serious risks to your health. These risks include infection, ectopic tissue formation (growth of body tissues in the wrong place) and allergies.
• Some clinics in Australia and overseas are marketing unproven stem cell therapies for osteoarthritis directly to consumers. Changes will soon be introduced to improve regulatory oversight of these therapies and to prohibit advertising of unproven stem cell therapies directly to consumers in Australia.[i]
• Ongoing, high-quality research through properly regulated clinical trials is required to determine what role, if any, stem cell therapies may play in the treatment of osteoarthritis.

Background

Osteoarthritis is a leading cause of pain and disability in the Australian population. It affects two million people and costs the health system at least $2 billion a year. With an ageing and increasingly obese population, the prevalence of osteoarthritis is expected to increase to 5.5 million people by 2030.

Currently, there are no disease-modifying therapies with a credible evidence base for osteoarthritis. Hence there is a pressing need for quality research into potential new treatments for the condition.

Autologous stem cell therapies offer promise as a potential treatment for osteoarthritis. These therapies for osteoarthritis usually involve the collection of a patient’s own fat cells which are then purified, stimulated and re-injected into an osteoarthritic joint.

However, at present there is not enough evidence to support the use of these stem cell therapies for osteoarthritis. Current research is still in its early stages and understanding of how effective and safe these therapies are is limited. Further research, through properly conducted randomised controlled clinical trials, is essential to determine the therapeutic role of stem cell treatments for osteoarthritis.

Some clinics in Australia are marketing these unproven autologous fat-derived stem cell therapies for osteoarthritis directly to consumers, despite the lack of sufficient evidence of benefit and safety. These treatments are often provided at substantial financial costs to consumers, including treatment and follow-up costs, as well as the potential cost of emergency medical care in the event of medical complications.

The Therapeutic Goods Administration, which is responsible for regulating therapeutic goods in Australia, will soon be introducing changes to increase regulatory oversight of stem cell therapies and prohibit advertising of unproven stem cell therapies directly to consumers.ⁱ  Arthritis Australia strongly supports these changes.

More information

Australian Rheumatology Association Position Statement on Stem Cell Therapies

Therapeutic Goods Administration. Consumer guide to stem cell treatments and regulation.

Stem Cells Australia

International Society for Stem Cell Research

[i] https://www.tga.gov.au/media-release/regulation-autologous-cell-and-tissue-products

Download:  Arthritis Australia stem cell position statement