Treating Osteoarthritis With SAM-e

The science behind the benefit of this dietary supplement is still inconclusive

SAM-e for Osteoarthritis
Getty Images Credit: Jose Luis Pelaez Inc

Osteoarthritis (OA) is a common, disabling disease of the joints, that causes symptoms of pain, stiffness, and swelling, particularly in the knee, hip, spine, and hand joints.

The manner in which OA develops is actually quite complex but ultimately involves the destruction of the tissue that protects bones from rubbing together (this tissue is called the articular cartilage). This destruction of tissue triggers bone growth, which unfortunately creates bone spurs and misshapen joints, further impairing the function of the joint.

Due to the symptoms, especially pain, inflicted by osteoarthritis, people with OA naturally seek out therapies that can alleviate their pain. Dietary supplements have become increasingly popular, especially for those who cannot take traditional OA-easing medications like nonsteroidal anti-inflammatories  (NSAIDs).

One dietary supplement that some people use to treat their OA is called SAM-e (S-adenosylmethionine). 

Understanding SAM-e

You may be surprised to learn that SAM-e is actually found naturally in human cells. It's made from an amino acid called methionine and plays a role in regulating certain biochemical processes in cells like maintaining cell membranes, removing toxic substances from the body, and producing mood-enhancing chemicals. 

Interestingly, SAM-e was initially studied for its role in depression. In the depression studies, some of the participants with OA noted joint symptom improvement after taking SAM-e.

This launched a closer look into SAM-e's role as a pain reliever for those with osteoarthritis. 

Unfortunately, the results of studies on SAM-e have not provided robust evidence of its effectiveness. In fact, studies have shown that compared to placebo, SAM-e is about the same in easing symptoms of OA-related pain and physical function.

When compared with NSAIDs, studies show that those who took SAM-e had similar pain relief and improvement in joint function, although side effects were less in the SAM-e group. 

Lastly, in an older, small study comparing 1200mg per day of SAM-E with 200mg per day of Celebrex for 16 weeks (for knee osteoarthritis), Celebrex showed significantly more pain reduction than SAM-e in the first month. However, there was no significant difference between SAM-e and Celebrex by the second month.

Researchers from this study concluded SAM-e was slower to act, but over time was as effective as Celebrex for the management of knee osteoarthritis. 

Potential Adverse Effects of SAM-e

Like most medications or supplements, SAM-e can lead to some adverse symptoms, although these are uncommon, and usually seen at high doses. These adverse effects may include:

  • Nausea
  • Flatulence
  • Diarrhea
  • Vomiting
  • Headache

In addition, SAM-e may interact with certain dietary supplements or medications, like antidepressants, L-tryptophan, or St. John's Wort. This is why it's so important to tell your doctor all of the medications you are taking, including any over-the-counter medications.

Experts also recommend avoiding SAM-e if you have bipolar disorder or Parkinson's disease.

Also, the safety of SAM-e has not been evaluated in pregnancy or breastfeeding, so should be avoided. Lastly, there is concern that taking SAM-e may trigger a serious lung infection (called Pneumocystis pneumonia or PCP) in people who have a weakened immune system, like in people with HIV.

A Word From Verywell

If you have osteoarthritis, it's important to discuss a treatment plan with your doctor. For right now, it's unlikely that SAM-e will be part of that plan based on the inconclusive and limited evidence to back up its benefit. Hopefully, over time, larger, randomized studies will be performed to better determine the role of SAM-e in OA treatment.

Even so, do not get discouraged, as there are a number of therapies that can help ease your OA pain and improve your joint function such as weight loss (if you are overweight or obese), exercise, and physical therapy.

Medication is then reserved for acute symptoms, as they do not change the course of the disease. Common medications used to treat OA include:

Sources:

De Silva V et al. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Rheumatology (Oxford). 2011 May;50(5):911-20.

McAlindon TE et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014 Mar;22(3):363-88.

National Center for Complementary and Integrative Health. (2017). S-Adenosyl-L-Methionine (SAMe): In Depth.

Rutjes AWS, Nüesch E, Reichenbach S, Jüni P. S-Adenosylmethionine for osteoarthritis of the knee or hip. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007321.

SAM-e. (n.d.). Arthritis Foundation.

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