Arthritis Osteo

 

Osteoarthritis Introduction

Osteoarthritis (OA) is also known as degenerative joint disease, osteoarthrosis, and hypertrophic osteoarthritis. Osteoarthritis affects both the cartilage and bony surface of joints. The most common joints affected are:

  • The vertebral
  • Knee
  • Hip
  • Metatarsals (feet bones)
  • and Metacarpals (hand bones)

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Osteoarthritis causes an alteration in the consistency of the cartilage, causing it to become less spongy and hard. This cause wears on the bony surface, which then becomes hypertrophic (increases growth). This overgrowth of bone results in osteophytes, or bone spurs which impinge on the surrounding soft tissues. Overtime the joint becomes stiff, does not absorb shock, and the space in between the joint narrows. In healthy joints, this space is occupied by synovial fluid. This viscid lubricating fluid acts like the oil in the hinge which reduces friction. In Osteoarthritis the synovial fluid is altered and amounts are decreased, resulting in more damage to the hard surfaces in the joint.[1]

Osteoarthritis is considered a disease of aging. It is primarily a “wear and tear” disease from a lifetime of use, and in many cases, overuse. There are no predispositions to the development of Osteoarthritis. There are, however, many preventative measures that can prolong its onset. There is a subset of Osteoarthritis, due to secondary causes such as genetic abnormalities, trauma, and inflammatory diseases (gout, rheumatoid arthritis). Individuals with these conditions will be predisposed to developing the disease earlier than the “wear and tear” group.[2]

Osteoarthritis affects both men and women. Onset is usually earlier in men than women. It is found in all races, even in animals. It is the most common disorder of joints. Incidence of Osteoarthritis begins in the 20’s and 30’s and by the age of 40 almost every person shows some signs of the disease in one joint. By the seventh or eight decade Osteoarthritis is extremely common.[3]

Osteoarthritis Symptoms

The onset of osteoarthritis is usually gradual, with the first symptom being pain in the joint. Patients may complain of stiffness in the morning and following periods of rest. The stiffness is usually made worse from exercise. Later in the course of Osteoarthritis radiating pain may be a complaint as osteophytes press on nerves exiting the spinal column. Tenderness may become worse, crepitus (crackling) of the joints will become apparent, and the individual may become slightly immobilized.[4]

Clinical signs of Osteoarthritis include enlargement of the metacarpal joints in the hand (Heberden’s nodes and Bouchard’s nodes), swelling around the joint capsule, and decreased range of motion.[5]

Osteoarthritis Statistics

  • Osteoarthritis is the leading cause of disability for individuals over 75 years of age.
  • Approximately 43 million Americans suffer from Osteoarthritis. That is just under 20% of the population or 1 in 6 people. This number is expected to increase to 60 million by the year 2020.
  • 80% of people over the age of 50 have osteoarthritis.
  • 35% of the cases of Osteoarthritis involve the knee(s).[6]

Osteoarthritis Treatment

Conventional Osteoarthritis Treatment is primarily focused on rehabilitation. Drugs make up only 15% of the regimen, and are reserved, solely for the symptomatic relief of this degenerative condition. Non-steroidal anti-inflammatory (NSAID) medications such as aspirin, Advil, and Aleve are used to reduce pain and inflammation. These over-the-counter medicines are not recommended for long term, due to their adverse side effects. Acetaminophen (Tylenol) can also be used in place of NSAIDs to relieve pain, as it exhibits far fewer and less severe side effects. Muscle relaxants may also be used to provide relief when muscle strains develop due to Osteoarthritis. Corticosteroid therapy is not recommended as a treatment.[7]

Supplements helpful for Osteoarthritis

Alternative treatment is focused on providing the correct nutrients for the tissue. The therapeutic goal is to enhance the repair of collagen and surrounding tissues, while decreasing inflammation and limiting further damage.

Glucosamine sulfate Glucosamine is responsible for the gel like nature of the cartilage. It stimulates the production of cellular components that allow the cartilage to hold more water. By yielding a greater water capacity, the cartilage maintains its healthy texture. This healthy, gel like texture allows the cartilage to absorb shock from the everyday physical activities that is the cause of osteoarthritis. The levels of glucosamine synthesized by the body begin to decline with age, which may point to the cause of Osteoarthritis being a disease of aging. Some 90-98% of ingested glucosamine is thought to be absorbed.[8]

In one study supplementation with glucosamine sulfate retarded the progression of knee osteoarthritis in participants. Participants did not see any radiological evidence of joint space narrowing after taking the supplement.[9] In another study, participants taking glucosamine had improvement of pain and stiffness symptoms. There was also no decrease in joint space after taking the supplement. The study concluded that glucosamine was an effective long-term treatment for Osteoarthritis.[10]

Chondroitin sulfate Chondroitin sulfate is similar to glucosamine, except its molecules are much larger than glucosamine. This size difference is particularly relevant in the absorption of chondroitin sulfate-0-13%. Glucosamine is a precursor to chondroitin in the body. Studies have shown that supplementation with chondroitin sulfate reduces pain and improves joint function in patients with Osteoarthritis.[11] Because chondroitin sulfate absorption is only about 8-13%, glucosamine is the preferred choice for the dietary supplementation routines of persons suffering from this condition.[12]

Niacinamide (Vitamin B3) Niacinamide is an effective treatment for osteoarthritis. It can improve joint function, range of motion, and muscle strength. Clinical study has shown that its supplementation resulted in a 29% increase in the Global arthritis impact scale, compared to a 10% worsening with placebo. Although iIt did not improve pain, it did allow for a reduction in the dosage of NSAIDs.[13] It is important to note that elevated doses of niacinamide can be toxic to the liver and may cause adverse side effects. Vitamin B3 therapy should be done under the supervision of a physician.

SAM-e (S-adenosylmethionine) SAM-e is formed from the amino acid methionine and ATP (energy). This nutrient is necessary for the proper formation of various cartilage components. SAM-e may also possess protective properties for cartilage-containing compounds. SAM-e is often deficient in patients with Osteoarthritis.

SAM-e also has mild analgesic and anti-inflammatory properties that make it a great treatment for Osteoarthritis. In a study that compared SAM-e to Celebrex, a popularly prescribed NSAID, supplementation resulted in both decreased pain and improvement of overall symptoms. Alhough its onset of action was slower, SAM-et was also found to be as effective as Celebrex. [14] Other studies have discovered that supplementation of SAM-e was often paralleled to a reduction in pain. It was also credited with creating a marked improvement in joint function and a decrease in joint limitation. SAM-e has not been proven to have any side effects.[15]

Vitamin E Vitamin E is a potent anti-oxidant and effective anti-inflammatory. It is an vital component in the integrity of cellular membranes. Study has shown Vitamin E to improve symptoms in Osteoarthritis sufferers. This fat-soluble vitamin stimulates healthy cartilage production.[16] In one particular study, supplementation with Vitamin E resulted in a 52% reduction in pain. This was compared to only a 10% reduction with patients receiving placebo.[17] Another study found Vitamin E actually increased joint mobility, reduced swelling around the joint, and increased the walking time of participants.[18]

Vitamin C Vitamin C supports connective tissue metabolism. It is important in the protection of bodily cartilage and aids its repair. Vitamin C also helps to incorporate the many cellular components that help cartilage hold water. Vitamin C is considered a potent anti-oxidant.[19] It has also been shown to reduce risk of cartilage loss and disease progression in individuals with Osteoarthritis of the knee.[20]

Boron Boron is considered an essential nutrient for healthy cartilage. It is required for the synthesis of collagen, and for maintenance of the cartilage structure as a whole. Some individuals may be deficient in boron due to specific environmental factors, such as low levels in the soil. In study, the supplementation with boron showed a 50% improvement in symptoms for individuals with Osteoarthritis, compared to only a 10% improvement in those receiving placebo.[21] It is especially helpful for those osteoarthritis sufferers whose diets are low in boron.

Harpagophytum procumbens (Devil’s Claw) Devil's Claw has anti-inflammatory and analgesic effects. The most potent preparation of Devil’s claw is often in an extract form. Its supplementation was found to be as effective as refecoxib, a prescription NSAID. It was also useful for treatment of Osteoarthritis of the hip, knee, and spine.[22] Other studies have found it to decrease pain, crepitus, and stiffness of Osteoarthritis in the knee and hip. Devil’s Claw may also increase mobility in specific joint cavaties.[23]

Boswellia serrata Boswellia is anti-inflammatory, analgesic, and anti-arthritic agent. It is very useful for treatment of osteoarthritis. Not only does boswellia improve the blood supply to joints, it has also been shown to prevent the age related decline in cartilage production. An extract standardized to boswellic acid is most efficacious. Various studies have shown that supplementation of boswellia serrata decreased pain, increased flexion, and improved one’s walking ability. It also decreased swelling around the affected joint.[24]

References

[1] Beers M and Berkow R. The Merck Manual; 17th Ed. 1999. Osteoarthritis: 449-451.

[2] Pizzorno J, Murray M, Joiner-Bey H. The Clinicians Handbook of Natural Medicine. 2002; Churchill Livingstone New York. Osteoarthritis: 364-371.

[3] Beers M and Berkow R. The Merck Manual; 17th Ed. 1999. Osteoarthritis: 449-451.

[4] Beers M and Berkow R. The Merck Manual; 17th Ed. 1999. Osteoarthritis: 449-451.

[5] Beers M and Berkow R. The Merck Manual; 17th Ed. 1999. Osteoarthritis: 449-451.

[6] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml American Association of Family Practice. November 2004.

[7] Beers M and Berkow R. The Merck Manual; 17th Ed. 1999. Osteoarthritis: 449-451.

[8] Pizzorno J, Murray M, Joiner-Bey H. The Clinicians Handbook of Natural Medicine. 2002; Churchill Livingstone New York. Osteoarthritis: 364-371.

[9] Pavelka K et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3 year randomized placebo controlled double blind study. Arch Intern Med. 2002 Oct 14; 162(18): 2113-2123.

[10] Reginster JY et al. Long term effects of glucosamine sulfate on osteoarthritis progression: a randomized placebo controlled clinical trial. Lancet. 2001 Jan 27; 357(9252): 251-256.

[11] Uebelhart D et al. Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a 1-year randomized double blind multi-center study versus placebo. Osteoarthritis Cartilage. 2004 Apr; 12(4): 269-276.

[12] Pizzorno J, Murray M, Joiner-Bey H. The Clinicians Handbook of Natural Medicine. 2002; Churchill Livingstone New York. Osteoarthritis: 364-371.

[13] Jonas WB, Rapoza CP, Blair WF. The effect of niacinamide on osteoarthritis: a pilot study. Inflamm Res. 1996 Jul; 45(7): 330-334.

[14] Najm WI, Reinsch S, Hoehler F, Tobis JS, Harvey PW. S-adenosylmethionine versus celecoxib for the treatment of osteoarthritis symptoms: a double blind crossover trial. BMC Musculoskelet Disord. 2004 Feb 26; 5(1): 6.

[15] Soeken KL, Lee WL, Bausell RB, Agelli M, Berman BM. Safety and efficacy of s-adenosylmethionine for osteoarthritis. J Fam Pract. 2002 May; 51(5): 425-430.

[16] Pizzorno J, Murray M, Joiner-Bey H. The Clinicians Handbook of Natural Medicine. 2002; Churchill Livingstone New York. Osteoarthritis: 364-371.

[17] Machtey I, Ouknine L. Tocopherol in osteoarthritis: a controlled pilot study. J Am Geriatr Soc. 1978; 26: 328-330.

[18] Scherak O et al. High dose vitamin E therapy in patients with activated arthritis. Z Rheumatol. 1990; 49: 369-373.

[19] Sowers M, Lachance L. Vitamins and arthritis: The roles of Vitamins A, C, D and E. Rheum Dis Clin North Am. 1999 May; 25(2): 315-332.

[20] McAlindon TE et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996 Apr; 39(4): 648-656.

[21] Travers RL, Rennie GC, Newnham RE. Boron and arthritis: the results of a double blind pilot study. J Nutr Med. 1990; 1: 127-132.

[22] Gagnier JJ, Chrubasik S, Manheimer E. Harpagophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complement Altern Med. 2004 Sep 15; 4(1): 13.

[23] Wegener T, Lupke NP. Treatment of patients with arthrosis of the hip or knee with an aqueous extract of devil’s claw (Harpagophytum procumbens DC). Phytother Res. 2003 Dec; 17(10): 1165-1172.

[24] Kimmatkar N et al. Efficacy and tolerability of boswellia serrata extract in treatment of osteoarthritis of the knee: a randomized double blind placebo controlled trial. Phytomedicine 2003 Jan; 10(1): 3-7