DEAR DR. ROACH: Please tell me about the supplement SAMe. I am a woman, 58, who suffers from osteoarthritis from my exercise routine, which is three days of heavy lifting with free weights and 15 miles of jogging each week. I love the workouts but not the pain it causes in my hands, knees and lower back.
I get relief from ibuprofen and the like, but these can cause problems with long-term use. I have checked with several doctors and pharmacists concerning this supplement, but they know nothing about it. Doctors in Europe have been prescribing it since the 1970s. Can you give me your opinion of this supplement? -- K.Z.
ANSWER: S-adenosyl methionine, usually referred to as SAMe, is a naturally occurring substance found in the body, and it has been used as a supplement in people with depression and those with osteoarthritis. It appears to have effectiveness in both cases. Regular readers of this column know that I seldom recommend supplements, but SAMe is one of the few that has good data backing it up. In a meta-analysis of 11 trials, SAMe was found to be about as effective at improving function and pain as ibuprofen-like drugs but with fewer adverse effects.
It may take two full months to reach peak effectiveness, based on a 2004 study.
As always, I have to warn that supplements are not FDA-regulated. SAMe is also relatively expensive (about $40 for 60 tablets at a U.S. warehouse store). Very inexpensive products are a warning that the product may not be of high quality or even contain what it is supposed to. This supplement is generally considered safe, but it is always best to speak with your doctor before taking any supplement.
DEAR DR. ROACH: I was admitted to the hospital for aseptic meningitis. I am being treated with Arimidex for a history of ovarian cancer. Could this medication be affecting my immune system? -- S.R.
ANSWER: Meningitis is an inflammation of the lining of the brain. There are several different kinds, although we usually think of bacterial meningitis, one of the most serious and immediately life-threatening infectious emergencies there is.
“Aseptic” in this context means nonbacterial, and viral infection is the most common cause. Many viruses can cause meningitis, but we especially look for the herpes family of viruses, partially because there is a specific treatment, but also because it can be complicated by encephalitis, which is inflammation of the brain itself. Like all meningitis, the primary means of diagnosis is a lumbar puncture, also called a spinal tap. The exact results help guide the clinician to the correct diagnosis. Most cases of viral meningitis go away by themselves.
Arimidex (anastrazole) is an aromatase inhibitor, which prevents the body from making estrogens. I could not find any reports of this medicine causing aseptic meningitis, and it does not adversely affect the immune system. There are medicines that can cause aseptic meningitis, the most common of which are ibuprofen and sulfa antibiotics.
In anyone with a history of cancer, I worry about cancer cells getting into the spinal fluid, a condition called carcinomatous meningitis. Breast and lung cancer are notorious original sources for these cells, as are melanoma and GI cancers. This would be rare for ovarian cancers, but if your doctor is concerned, he or she will send the spinal fluid for cytological evaluation.