Osteoarthritis (OA)

two women holding hands

General arthritis is an illness that can cause pain, inflammation and swelling of the joints wherever two or more bones meet. Osteoarthritis (OA) is the most common form of arthritis that impairs joint mobility, decreases range of motion and interferes with quality of life for millions of Americans. OA affects millions of people, some studies stating that 80 percent of Americans over the age of 50 are afflicted and it affects twice as many men as women. OA is a degenerative disease of the joints with single or multiple joint on set. It is characterized by changes in articular cartilage and by reactive formation at the joint edges and can lead to deformation. Osteoarthritis is not a true arthritis, but rather a complex disease of cartilage breakdown. Cartilage damage is caused by age, overweight and obesity, trauma, over-exercise, and general wear and tear. The most common joints affected are the hip, knees, spine, and hands, although other joints may be involved. 

There are several old and new theories regarding the pathogenesis of OA. The first is an obvious deterioration of articular cartilage. The second is caused by toxic blood. There is a definite buildup over time of acidity at the joints. Acid at the joints always induces inflammation. This most likely is due to the fact that over 80 percent of Americans have a high-acid diet. There are remarkable improvements when sufferers adopt a more ‘alkaline’ diet.  While there is a heredity (genetics) aspect to this condition, there is a growing body of evidence demonstrating the role of systemic factors such as growth factors; hormonal influences, microcirculation problems, nutrient deficiency, bone density, and muscle weakness. The newest theories regarding the development of OA involve the role of estrogen receptors in decreasing Interleukin-1b induced nitric acid protein expression and the possibility that it is a vascular disease of subchondral bone.

Clearly, there are a myriad of prescription and over-the-counter drugs in addition to botanicals and nutraceutical analgesic products to choose from.  There is a need for safe and effective treatments, not only for pain relief but for long-term management if the course of this degenerative disease will be more successfully treated in the future.

GOALS AND THERAPIES

Those with osteoarthritis should attempt to slow the development of this progressive disease, prevent deformities, lessen pain, reduce inflammation, eliminate risk and aggravating factors, with an overall goal of improving the quality of life. People with OA need both rest and exercise. It is important to get 8 or more hours of sleep each night, but too much rest can lead to joints becoming stiff. Exercise, when done correctly, helps people with osteoarthritis in many ways. It helps to maintain a healthy weight and decrease the stress on the joints. Exercise can also help improve mood and sleep quality. Stretching will increase flexibility. Low-impact aerobic exercise (for example, walking, bicycle riding, yoga, swimming, and Pilates will improve strength. See a doctor or qualified physical therapist for exercise advice.

Both hot and cold therapy can reduce the pain and inflammation of arthritis. Heat increases blood flow and flexibility to the area and is the cornerstone of treatment. You can apply a moist heating pad, a Thermophore, warm towels, a heat massage or a hot bath. Cold numbs the nerves around the joints and may decrease pain and swelling especially in an acute inflammatory situation. You can apply ice wrapped in a towel, soak in cold water, or use topical liniments. Apply cold for 20 minutes to reduce acute inflammation, but then add heat to get more blood flow into the area.

DIET

There is a definite connection between food and pain. The most important aspects of following a dietary approach to relieving the pain of arthritis involve balancing the acid/alkaline content of foods. Secondly, would be identifying Food Allergies. The most common food allergens are dairy products, wheat gluten, corn, eggs and nuts. In his best-selling book, Foods That Fight Pain, noted physician Dr. Neal Barnard lists several foods that induce inflammation and add to the pain process. He emphasizes that, regardless of nutritional value, the following foods tend to increase pain because they cause inflammation: cow’s milk, refined sugar, white flour and processed wheat, corn, red meats, canned foods, alcohol, starchy foods, spices, animal fat, coffee, food additives, eggs and the ‘nightshade’ vegetables (potatoes, tomatoes, bell peppers, eggplant and tobacco.) Minimizing these food choices may lead to a lower pain simply due to lower inflammation in the body. 

blueberries, blackberries and raspberries

On the other hand, foods beneficial to those with arthritis are rich in flavonoids and include blueberries, blackberries and other colorful fruits. Sulfur-containing foods such as garlic, onions, and cabbage are anti-inflammatory in nature. Those with arthritis should eat more raw and whole foods that are natural and easily digestible, maintain a low-sodium diet, and eliminate foods that excrete calcium (soft drinks, alcohol and protein-rich meats.) This dietary approach also works for patients who have rheumatoid arthritis.

WHAT ARE COX-2 INHIBITORS?

COX-2 is a chemical enzyme that is usually minimally present in the body. When activated, COX-2 regulates prostaglandin production within inflammatory cells. Efforts have been made in the treatment of osteoarthritis to block prostaglandin production since prostaglandins are hormone-like compounds that cause inflammation and produce pain. While aspirin and NSAIDs are effective anti-inflammatory analgesic agents, they are also responsible for both COX-2 and COX-1 inhibition. This is problematic because COX-1 inhibition “turns off” some important functions such as the repair and maintenance of stomach lining resulting in GI upset and ulceration. The approved COX-2 inhibitors drugs such as ibuprofen, naproxen, Aleve and Celecoxib (Celebrex) have increased risk of serious side effects. The drugs for OA have a higher risk of gastric problems and cardiovascular events such as heart attack, stroke especially when used over long periods of time  

The most commonly recommended natural COX-2 inhibitors include: Curcumin, Ginger, Boswellia, Feverfew, Devil’s claw, Bromelain and White willow bark.    

SUPPLEMENTAL PROTOCOL

  1. GLUCOSAMINE SULFATE and CHONDROITIN SULFATE
    Glucosamine sulfate (GS) is a component of connective tissue and cartilage in the body and is involved in the formation of tendons, bones, and ligaments. Studies find that GS reduces both symptoms and joint-space narrowing in patients with osteoarthritis or degenerative joint disease of the hips, spine, neck, knees, lower or middle back, and fingers. Glucosamine is a natural constituent of cartilage and is derived primarily from shrimp shells, although the shells of crab and other crustaceans are sometimes used. It contains a building block needed for cartilage repair and regeneration, and can be effectively used for “wear and tear” of articular cartilage. Chondroitin sulfate is another component of the lining of joints, and reduced levels have been reported in cartilage affected by osteoarthritis. This supplement can decrease inflammatory symptoms, lesson pain, and reduce the need for over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and Celebrex. The combination works better than either separately. Glucosamine sulfate is 90-95% absorbed from the gut and seems to be better absorbed than the HCL form. It may take 4-8 weeks to notice positive effects. Dosage: Glucosamine 500-1,500 mg daily. Chondroitin 250-750 mg daily.
  2. OMEGA 3, 6 FATTY ACIDS
    Omega 3 and 6 fatty acids are found in Flaxseed, Fish oil, Evening primrose oil and Borage oil.  These fatty acids not only show effective anti-inflammatory action they can reduce pain by acting as a lubricant for the joints. Keep in mind that glucosamine is not an anti-inflammatory, so combining GS with omega fatty acids is the best 1-2 punch for relieving OA pain: 2-4 grams per day.  Prefer to take a combination of Omega 3.6.9 essential fats.
  3. COX-2 INHIBITING HERBS
    These herbs have a long history of use in treating inflammatory conditions such as osteoarthritis, rheumatoid arthritis, and painful sports injuries. Research has confirmed their ability to alleviate pain and swelling and reduce muscular discomfort. Standardized extracts of these herbs will yield the highest therapeutic potential. Boswellia is free of side effects. It is responsible for the reduction of joint swelling, increased mobility, and improved relief of morning stiffness. Curcumin appears to block inflammatory pathways associated with OA and also has antioxidant effects.  Curcumin supplementation coupled with acupuncture was even more effective. Ginger suppresses prostaglandin synthesis Cox-1 and Cox-2, and with its safety record it offers a healthy therapeutic choice over the drugs. Dosage: As directed on label or see a qualified practitioner.
  4. VITAMIN C with BIOFLAVONOIDS, VITAMIN E and EXTRA ANTIOXIDANTS
    Antioxidants are critical for osteoarthritis patients. Research has found that a high intake of antioxidant vitamins can reduce levels of free radicals that destroy body tissues and create conditions where arthritis is likely to occur. Vitamin C is needed for the formation of collagen and may reduce the risk of cartilage loss. Bioflavonoids (especially Quercetin) enhance the absorption of vitamin C. When taken together bioflavonoids and vitamin C strengthen joints and promote cartilage repair. Vitamin C also works with Vitamin E to protect joint tissue from the degradation that often occurs in arthritic conditions. It has anti-inflammatory activity and is an effective free-radical scavenger. The alpha-tocopherol form of Vitamin E is the only significant lipid-soluble antioxidant present in plasma and red blood cells. Dosage:  Vitamin C 1,000-10,000 mg daily. The ester form of Vitamin C with additional Bioflavonoids is preferable. Vitamin E 400-1,000 IU daily.
  5. VITAMIN D3 along with CALCIUM CITRATE and MAGNESIUM
    Vitamin D3 deficiency is associated with greater progression of osteoarthritis in the knee joint. In addition to its effects on calcium metabolism, vitamin D plays a role in the normal turnover of articular cartilage. Calcium and magnesium are essential for bone and cartilage growth. Dosage: Vitamin D 400-800 IU daily; Calcium citrate 1,000-1,500 mg daily; Magnesium 400-600 mg daily.
  6. HYALURONIC ACID
    Hyaluronic acid is a naturally occurring polymer found in connective tissue in the human body whose function is to cushion and lubricate. Supplemental Hyaluronic acid is derived from rooster comb and provides support for a healthy and youthful appearance by hydrating and soothing the skin. It also supports joint function and comfort by promoting healthy synovial fluid composition and joint lubrication. Dosage: 140-420 mg daily.
  7. PYCNOGENOL or GRAPE SEED EXTRACT
    Pycnogenol and grape seed extract are proanthocyanidins that functions as natural anti-inflammatory agents but also improve joint flexibility, especially of the knees. Pycnogenol contains polyphenols, catechins and procyanidins that help to repair connective tissue by reducing the prostaglandins that cause inflammation, and inhibit histamine release responsible for tissue damage. They also help to decrease the need for NSAID or analgesic use. Dosage: 50 mg 2-3 times daily.
  8. MSM (METHYLSULFONYLMETHANE)
    MSM has become increasingly popular in recent years. Its sulfur content is thought to help explain its ability to aid in arthritis therapy. Sulfur is needed to form connective tissue and normalize the immune system. MSM has been the object of several studies that have confirmed its ability to improve joint integrity and alleviate suffering from strains, sprains, and other athletic injuries. Typically, the benefits of MSM become evident in about 2-21 days. MSM may be more beneficial when used in combination with COX-2 inhibiting herb and Vitamin C. Dosage: 1,000-2,250 mg a day
  9. GREEN MUSSEL LIPID EXTRACT
    The extract comes from the ocean green mussels along the coastal waters of New Zealand. The extract is an omega-3 oil that is used for severe and/or resistant cases of inflammation.  When used properly, this supplement offers effective relief to patients with no side effects. Dosage: Loading dose of 2 capsules twice daily for 3-6 weeks, then one capsule twice a day maintenance. Brand name is Lyprinol.
  10. NIACINAMIDE and N-ACETYLCYSTEINE
    Although the mechanism is not understood, Niacinamide delays the onset of osteoarthritis and progressively improves its control rather than merely relieving symptoms. Although they do not act merely as anti-inflammatory or analgesic agents, Niacinamide and n-acetylcysteine work together to interrupt the damaging cascade of cellular events associated with arthritis that directly and negatively impact joint tissue. Through their combined action they help preserve the integrity and function of joint tissue, including cartilage and synovial fluid. Niacinamide is preferred over niacin and is less hepatotoxic. Niacin is also used successfully in treating rheumatoid arthritis.  Dosage: As directed by a qualified practitioner.
  11. MULTIVITAMIN/MINERAL FORMULA
    Taking a therapeutic multivitamin/mineral formula is essential for repairing cartilage and tissues.  Antioxidants are critical for arthritis for several reasons.  Sufferers appear to have low plasma levels of many antioxidants (vitamins C and alpha-tocopherol), which makes supplementation important to tackle free radical problems. Low zinc and copper levels have been found in patients with OA.  Dosage: As directed on label.
  12. ASTAXANTHIN
    A compound recognized to alleviate inflammation in a number of test cases.  When taken at therapeutic doses for 8 weeks, astaxanthin may work as well as drugs such as Celebrex.  It appears to have better efficacy for pain and inflammation when mixed with Krill oil and has a very low side effect profile and no contraindications. Dosage: See package for suggested dosage.
  13. SHEA NUT EXTRACT
    A newer product marketed as Flex-Now is a shea nut extract that is derived from Traditional African Medicine. The shea nut yields a 70 percent triterpene extract and appears to be most effective for relief of knee arthritis.  Dosage: 1 tablet 3 times daily for at least 2-3 months.
  14. ARNICA (ARNICA MONTANA) and other TOPICAL TREATMENTS
    Arnica can be used effectively as a topical gel to relieve osteoarthritis. In recent studies arnica gel was as effective as ibuprofen gel in osteoarthritis of the hands. Arnica is also available in a sublingual tablet that can be dissolved under the tongue to relieve pain and reduce inflammation.  Sublingual tablets are frequently prescribed after surgery to relieve pain and promote healing. Dosage: Apply gel or cream 2-3 times a day. Dissolve 2 or 3 tablets under tongue 2-3 times a day for 2 weeks. Other potential OA and pain-relieving remedies available include: Capsacian, MSM cream, EMU oil and Glucosamine cream.
  15. SAMe
    An amino acid that occurs in all living cells, SAMe is a critical component of healthy joints and tissues. It helps our bodies make and regulate hormones and contributes to the building blocks of cartilage and cell membranes. SAMe is required to manufacture all sulfur-containing compounds in the body, including glutathione. One problem is its cost: $2-$7 a day. Approved for treatment in Germany, 80 percent of those who use it feel better with no side effects. Dosage: 200-1,200 mg/day.
  16. SILICA
    Silicon is a mineral that supplies silica which is important for the formation of apatite crystal, the primary constituent of bone. The branded mineral complex SierraSil has been shown to provide fast and effective relief of OA of the knee along with improving joint motility. Dosage: See package label.
  17. DLPA (DL-PHENYLALANINE)
    Phenylalanine is an essential amino acid required for normal growth, development and maintenance of soft tissue. Since it is not made in the body it must be obtaining from food. DLPA is not an analgesic by itself, but may act to extend the pain-killing ability of naturally produced substances. Therefore, pain relief produced by the use of DLPA is more natural than brought about by the use of drugs. Dosage: 1,000-3,000 mg daily.
  18. COLLAGEN HYDROLYSATE
    Collagen is the most abundant protein found in the body and the most important functional component of intracellular connective tissue.  It is a ubiquitous tissue found in bone, teeth, and muscle. Because it has an amino acid pattern identical to collagen, the material known as collagen hydrolysate may influence the synthesis of type II collagen, thus benefiting cartilage production.  Dosage: As directed on package.
  19. SOY PROTEIN
    Soy protein supplementation may help reduce pain and inflammation associated with osteoarthritis. Soy protein seemed to work better in men than in woman. In men, significant reduction in pain and medication use, as well as improved daily functions were reported by a group taking soy milk, but not in a group drinking cow’s milk. Dosage: 50-100 mg of soy isoflavones daily.
  20. ALOE VERA
    This miracle herb works at the cellular level. Aloe can systematically reduce pain, swelling, and inflammation in the involved joints and bones associated with arthritis. Dosage: 2-4 ounces daily.
  21. FOLIC ACID and VITAMIN B12
    Patients taking vitamin B12 found a rise in serum osteocalcin, a protein dependent on vitamin K. Some researchers suggest that bone metabolism is affected by vitamin B12 deficiency.  Folic acid levels, usually found to be low in the elderly, may also add to depleted bone metabolism. Dosage: Folic acid 1-3 grams daily; Vitamin B12 1,000-5.000 mcg daily.
  22. ACUPUNCTURE
    New research published in the Annals of Internal Medicine shows acupuncture can dramatically decrease pain among patients suffering from osteoarthritis. Unlike rheumatoid arthritis, which can affect people of any age and is thought to be an autoimmune disease, osteoarthritis is primarily a degenerative disease suffered by older individuals.
  23. SELENIUM
    Selenium is a component of glutathione, which protects the body from oxidative stress.  Some studies suggest that selenium take for a period of months, helps decrease the pain and inflammation associated with joint problems.  Dosage: 200-400 mcg daily.
  24. MANGANESE and BORON
    Manganese is a trace mineral that plays a role in the synthesis of chondroitin sulfate, an important component of articular cartilage. It is better when combined with Vitamin C. Manganese is recognized as being deficient in Western societies. Boron has long been reported as an essential element in plants, but only recently was considered essential in humans. Boron appears to play a role in the synthesis of steroid hormones and vitamin D. Dosage: Manganese 2-4 mg daily; Boron 6-9 mg a day.
  25. COLOSTRUM
    Colostrum may be beneficial in the repair of damage from the overuse of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Dosage: As directed.

 

Almada, A. Natural Cox-2 Inhibitors: The Future of Pain Relief. Nutritional Science News. Aug. 5(8): 338-342.

Alt Med News. Pycnogenol Functions as an Anti-inflammatory Agent. Natural Pharmacy. March 5(3): 5

Barnard, N. Foods That Fight Pain, Harmony Books, Crown Publishing Company, New York, NY. 1998.

Burke, ER. No More Aching Joints. Natural Choices, Vol 3. 2002. Distributed by Enzymatic Therapies, USA.

Blumenthal, M. (review). Devil’s Claw Shown Effective for Osteoarthritis in Clinical Study. Herbclip, Jan. 6, 2001.

Boron-Monograph. Alternative Medicine Review, December 2004. 9(4): 434-436.

CLA Could Block Cox-2 _Expression. Vitamin Retailer, December, 2005. 12(12); 48.

Clark, K. Collagen Hydrolysate in Joint Health. Natural Pharmacy, Dec. 2005. 9(6): 1, 14-15.

DeKorte, C. What You Should Know About Arthritis, Pharmacy Times, July 2003, 69(7); insert.

Dorley, J. Inflammation Management, Inflammation Management Newsletter, On-line newsletter. 2/7/2003.

Gaby, AR, Natural Treatments for Osteoarthritis. Alternative Medicine Review, October, 4(5): 330-347.

Harte, E. Arthritis. Integrative Medicine, Feb/March 2003. 2(1): 38-40.

Holt, S. Natural Agents for Joint Pain and Mobility. Natural Pharmacy. Sept 2000. 4(8):12-14.

Hudson, T. Women’s Health Update. Townsend Letter, Feb/March 2009. 307(8): 151-154.

Hudson, T. Osteoarthritis: Selected Research, New Ideas, Promising Approaches. Townsend Letter, Feb-March 2010. 308(8): 87-91.

Hyaluronic Acid. Information sheet, Pure Encapsulation Research. www.Purecaps.com

Knowlton, L. Investigating SAMe. Geriatric Times. Sept/Oct 2001, 2(5): 23-24.

Krieger, E. Gaining on Joint Pain. Alternative Medicine, Oct 2002. #52. Pp34-39.

Mercola, J. How to Beat Arthritis Naturally with Acupuncture, Turmeric. www.mercola.com

Mishra, LC, Singh, B, Dagenais, S. Scientific Basis for Therapeutic Use of Ashwagandha. Alternative Medicine Review, Aug 2000, 5(4): 334-345.

Oliff, HS. Special Arnica Gel as Effective as Ibuprofen Gel in Osteoarthritis of the Hands. Herbalgram #76. November 2007. P. 28.

Ottarino, SG. Medical Herbal Therapy. Nocolin Fields Pub. Plymouth, NH. 1999.

Prentice, LF, Wang, Y. The Effects of Nutritional Supplements on Osteoarthritis. Alternative Medicine Review, September 2004. 9(3): 275-294.

SierraSil manufactured by Serra Mountain Minerals, based in Vancouver, BC.

Soy Protein Relives Arthritis Symptoms in Men. NNFA Today, June 2005, 19(6): 5.

Srejic, E. Bare Bones of Arthritis. HSR Health Supplement Retailer, June 2006. 12(6): 14,19.

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