This preliminary study was designed to investigate the potential of a marine derived multi-mineral supplement (Aquamin) to allow for reduced NSAID usage over three months in subjects with moderate to severe OA of the knee. Early in the trial, six subjects discontinued participation because subjects described increased knee pain and did not wish to continue in the trial. These subjects were treated on average until day 45 +/- 16 days (mean +/- SD) (range 28 to 65 days) and the timing of their withdrawal coincided with the time they were stopping their NSAID use (i.e. after four weeks or 28 days on study treatment). Of interest, five of the six subjects who withdrew due to increased knee pain were on placebo and only one was receiving Aquamin. The five subjects on placebo withdrew at the following days of treatment: 28, 32, 39, 41, and 64 days and the one subject on Aquamin had the longest time on treatment (65 days) before discontinuation. This suggests that none of the subjects dropped out of the trial when they were at 50% of their NSAID dose; however, 27% (6/22) withdrew due to increasing pain after stopping their NSAID use entirely. Although not statistically significant, 36% (5/14) of subjects withdrew from the placebo group while only 13% (1/8) withdrew from the Aquamin group due to increasing pain after stopping their NSAID use. Although more research is needed, these data suggest that Aquamin treatment compared to placebo may have been helpful to keep people in the trial (with less pain in the affected knee) while they reduced their NSAID use by 50–100%.
Of interest, placebo and Aquamin treatments were significantly different in the change from V2 (baseline) to V4 (one month on treatment and after two weeks with NSAID dose at 50%) with higher adjusted mean values for ROM for passive and active extension (173° vs. 168°; p = 0.028) as well as a greater six-minute walking distance (1408 ft vs. 1295 ft; p = 0.03) for subjects on Aquamin compared to placebo. This was an improvement of 8.7% over the distance walked at baseline. Although, these distances appear to be small, our subjects with severe OA indicated the ability to walk even a little bit further was important to them. It is interesting to underline that these significant results at V4 compared to V2 were recorded not only following Aquamin treatment but also while NSAID dosage was reduced by 50%. These results suggest that Aquamin may provide some improved function in the setting of a 50% reduced but not eliminated NSAID dose.
It should be noted that the positive results did not continue once NSAID use was abolished completely. Thus, Aquamin cannot entirely replace NSAIDs as a treatment for OA. However, Aquamin may allow for a reduced need for NSAIDs which may have substantial health benefits including a reduction in many of the adverse and well documented side effects of NSAIDS. Further study is needed to verify this information and to explore the ability of Aquamin to improve walking distance and range of motion for subjects with osteoarthritis of the knee.
The limitations to this study include the short duration of treatment (12 weeks) and limited sample size; however, the extent of the daily pain endured by sufferers of OA is highlighted by the fear and reluctance of these subjects to completely eliminate NSAID usage for eight consecutive weeks. Although the differences reported are small, to the subjects with moderate to severe OA, the ability to walk and move more freely is of enormous importance. Additional studies of longer treatments in a greater number of subjects are necessary to fully explore the treatment effect of Aquamin in OA.
Aquamin is composed of multiple minerals and the 'active ingredient' for the complex is difficult to determine. A number of minerals in Aquamin may have anti-inflammatory and anti-oxidant properties which may directly and/or indirectly influence the efficacy of this unique complex. While the prominent mineral present in Aquamin is calcium (dosage = 80% calcium RDA) its role in joint health remains unclear and warrants further study. Magnesium, was given at the daily dosage providing 14% (male) to 18% (female) US RDA. This may have influenced OA symptoms by affecting the utilization of calcium or by potentially reducing the inflammation around the affected joint. Both manganese and selenium were given at the daily dosage providing up to 16% and 4% of their RDA respectively. Both of these trace minerals have been reported to reduce the appearance of osteoarthritic lesions and reduce the severity of symptoms in OA.