Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 28;13(23):7240.
doi: 10.3390/jcm13237240.

Endocrinologic Abnormalities Observed Among Total Joint Arthroplasty Patients Using "Artri King" and Related Over-the-Counter Supplements: A Cautionary Tale from a Safety Net Hospital

McKenzie Culler  1 , Cory K Mayfield  1 , Arjun Aron  1 , Laura Del Val  2 , Donald Longjohn  1   2 , Nathanael D Heckmann  1   3
Affiliations

Endocrinologic Abnormalities Observed Among Total Joint Arthroplasty Patients Using "Artri King" and Related Over-the-Counter Supplements: A Cautionary Tale from a Safety Net Hospital

McKenzie Culler et al. J Clin Med. .

Abstract

Background/Objectives: Artri King is an over-the-counter supplement previously marketed to treat joint pain and arthritis. In 2022, the Food and Drug Administration (FDA) issued a product warning after it discovered Artri King contained hidden ingredients including dexamethasone, diclofenac, and methocarbamol. Given the risk of adrenal insufficiency in the context of long-term dexamethasone use, we sought to report on adverse endocrinologic outcomes observed among patients endorsing the use of these supplements who presented to an orthopedic surgery clinic at a county safety net hospital. Methods: Preoperative patients presenting from November 2023 to June 2024 were screened for supplement use. Data were collected including patient demographics and comorbidities. Serum cortisol, adrenocorticotropic hormone (ACTH), and C-reactive protein (CRP) were obtained to assess adrenal function. Recommendations from Endocrinology regarding perioperative stress dose corticosteroids were also recorded. Standard descriptive statistics were employed to report our results. Results: In total, 13 patients (6 female and 7 male) were identified with a mean age of 62.8 years (range of 47-79 years) and an average BMI of 32.03 kg/m2 (range of 22.93-45.81 kg/m2). The average duration of use was 10.2 months (range of 1-36 months). One patient developed new-onset diabetes mellitus while taking supplements. Nine patients had low cortisol levels (<6.7 mcg/dL), necessitating referral to Endocrinology, and two were found to have concomitantly low ACTH levels (<5 pg/mL). Endocrinology recommended perioperative stress dose corticosteroids for all nine patients with low cortisol. Conclusions: Artri King and similar supplements may lead to severe endocrinological consequences. We recommend routine screening and continued management of patients who endorse supplement use.

Keywords: Artri King; adrenal insufficiency; osteoarthritis; supplement.

PubMed Disclaimer

Conflict of interest statement

Nathanael D. Heckmann reports a relationship with Corin U.S.A. that includes consulting or advisory and equity or stocks. Nathanael D. Heckmann reports a relationship with Intellijoint Surgical Inc. that includes consulting or advisory and equity or stocks. Nathanael D. Heckmann reports a relationship with MicroPort Orthopedics Inc. that includes consulting or advisory. Nathanael D. Heckmann reports a relationship with Zimmer Inc. that includes consulting or advisory. Nathanael D. Heckmann reports a relationship with the American Academy of Orthopaedic Surgeons that includes board membership. Nathanael D. Heckmann reports a relationship with AAOS American Joint Replacement Registry that includes board membership. Nathanael D. Heckmann reports a relationship with the American Association of Hip and Knee Surgeons that includes board membership. Donald Longjohn reports a relationship with 3M that includes financial or material support from a company or supplier. McKenzie Culler, Cory K. Mayfield, Arjun Aron, and Laura Del Val declare no conflicts of interest.

References

    1. Steinmetz J.D., Culbreth G.T., Haile L.M., Rafferty Q., Lo J., Fukutaki K.G., Cruz J.A., Smith A.E., Vollset S.E., Brooks P.M., et al. Global, Regional, and National Burden of Osteoarthritis, 1990–2020 and Projections to 2050: A Systematic Analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5:e508–e522. doi: 10.1016/S2665-9913(23)00163-7. - DOI - PMC - PubMed
    1. McDonough C.M., Jette A.M. The Contribution of Osteoarthritis to Functional Limitations and Disability. Clin. Geriatr. Med. 2010;26:387–399. doi: 10.1016/j.cger.2010.04.001. - DOI - PMC - PubMed
    1. Alkan B.M., Fidan F., Tosun A., Ardıçoğlu O. Quality of Life and Self-Reported Disability in Patients with Knee Osteoarthritis. Mod. Rheumatol. 2014;24:166–171. doi: 10.3109/14397595.2013.854046. - DOI - PubMed
    1. Basedow M., Runciman W.B., March L., Esterman A. Australians with Osteoarthritis; the Use of and Beliefs about Complementary and Alternative Medicines. Complement. Ther. Clin. Pract. 2014;20:237–242. doi: 10.1016/j.ctcp.2014.08.002. - DOI - PubMed
    1. Kennedy J., Wang C.-C., Wu C.-H. Patient Disclosure about Herb and Supplement Use among Adults in the US. Evid. Based. Complement. Alternat. Med. 2008;5:451–456. doi: 10.1093/ecam/nem045. - DOI - PMC - PubMed

LinkOut - more resources