Arthritis is one of the cornerstones of the market for complementary medicines. The British public spends hundreds of millions of pounds a year on a burgeoning range of supplements that claim to ease aches and pains. But do they work?

This is a question the Arthritis Research Campaign (ARC) hopes to answer with the first comprehensive, evidence-based report on the use of complementary medicines in patients with arthritis. The full, 80-page report can be downloaded free of charge from www.arc.org.uk, but below are some of the findings that caught my eye.

Before we get into which remedies work best, I have focused on self-help measures for people with the “wear and tear” type osteoarthritis (OA) that typically affects the hands, knees, hips and spine, as opposed to the less common but often more severe inflammatory form of rheumatoid arthritis (RA).

It is thought that there are at least six million people in the UK with painful OA in one or both knees. At least two million people show signs of arthritic change in their hips, and close to ten million have OA of the spine. And many more will have minor changes in small joints of the hand, particularly the thumb.

Conventional treatment centres on the use of non-steroidal, anti-inflammatory drugs such as ibuprofen and diclofenac to control symptoms until such time as joint replacement may become necessary. But lots of patients also turn to complementary approaches.

A fifth of the products reviewed by ARC's expert panel were shown to have little or no benefit based on available evidence, and many of the others were marginal. I don't think any of my patients are taking the two products - the herbal mixture Phytodolor and the nutritional supplement S-adenosylmethionine (SAMe) - that came out best.

Phytodolor contains extracts of aspen, common ash bark and golden rob herb, which have been shown to have both anti-inflammatory and painkilling action. Most of the trials used a dose of 30-40 drops of the mixture, three times a day. There were no serious side-effects, although there were reports of stomach upset and some skin allergies. Phytodolor is available in some pharmacies.

SAMe occurs naturally in the body and laboratory tests suggest that it can stimulate the manufacture of collagen and proteoglycans, the two major constituents of the cartilage that lines joints, and that it also has mild painkilling properties. It may increase the risk of bleeding if taken with blood-thinning medicines such as aspirin, heparin and warfarin. The dose used in the studies was 400-1,600mg daily and it is available as a capsule from some pharmacies.

Two more familiar names - fish oils and glucosamine - didn't fare so well. While fish oils demonstrated a useful anti-inflammatory effect in patients with RA (a full five stars for effectiveness), studies suggest they don't offer much to people with the much more common OA (just one star).

The results for glucosamine were more encouraging but, at a mediocre three stars, the benefits don't appear to live up to the hype. But if you take a closer look at the studies some interesting themes emerge. Not all glucosamine supplements are equal. If you take the right type (glucosamine sulphate) at the right dose (1,500mg a day) then you are much more likely to get benefit (three stars). As a rough rule of thumb, it can provide similar pain relief as paracetamol, but won't do much to help your stiffness.

Of course, supplements aren't the only self-help approach. Lots of people swear by various dietary manipulations - avoiding tomatoes seems popular among my patients - but there is no good evidence that what you eat has any impact on the state of your joints. A healthy diet may help to keep your joints in optimum health but, according to the ARC's medical director, Professor Alan Silman, cutting out one or more food groups will not slow the progression of the disease, or significantly reduce day-to-day symptoms.

Mechanical pressures on the joint have attracted much more interest in recent years. A better understanding of the loads on the joint has led to the evolution of new approaches to OA, particularly of the knee. These include losing weight, wearing orthotic shoe insoles to keep joints properly aligned, and exercises aimed at strengthening the muscle groups around the damaged joint to keep it well supported.

But perhaps the simplest technique for arthritic knees is patellar taping. Using tape to alter the position of the kneecap reduces the strains on the knee and can provide almost immediate relief in some patients. It is easy to manage yourself, but you will need to be assessed by a physiotherapist who can show you how to do it. Ask for a referral from your GP or go privately for £30-£40 a consultation.

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