Category Archives: osteoarthritis

Optimising supplements for managing joint pain and inflammation

Osteoarthritis is the most common cause of musculo-skeletal disability in the elderly and, within the secondary care system, its management is primarily focused on palliative relief using pharmaceutical drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. As with many pharmaceutical drugs, there are potential side effects, with treatment regimens also failing to address the progressive and complex nature of the condition.

The potential role of pharmaconutrients
Not surprisingly, given the safety profile of the majority of nutritional interventions, practitioners are continually striving to identify disease-modifying pharmaconutrients that are capable of both improving symptoms and preventing, slowing, or even reversing the degenerative process. Clinically, osteoarthritis is characterised by joint pain, crepitus (grating or cracking sounds on movement), stiffness after immobility and general limited movement. Identifying nutrients that can aid and support these symptoms are crucial to providing both relief from pain and treating the condition itself [1, 2].

Fatty acids as immunomodulators
Marine omega-3 fatty acids such as eicosapentaenoic acid (EPA) and the omega-6 fatty acid gamma-linolenic acid (GLA) exhibit anti-inflammatory effects through the production of eicosanoids – substances with both anti-inflammatory and immunoregulatory properties. As such, both are well documented as useful natural agents to help treat inflammatory diseases, alone and in combination.

Gamma-linolenic acid
GLA is found in certain plant-seed oils, including evening primrose seed oil, and is metabolised to dihomo-gamma-linolenic acid (DGLA) the direct precursor to anti-inflammatory and immunoregulatory products. Supplemental GLA has been shown to suppress acute and chronic inflammation in several conditions, including arthritis [3].

Omegaflex Duo
Omegaflex Duo is one supplement that combines glucosamine, calcium and EPA which is beneficial for bone health.

Eicosapentaenoic acid
The specific ratio of the principal omega-3 and omega-6 fatty acids AA (arachidonic acid) and EPA provides valuable information on the measure of the body’s eicosanoid balance and the AA:EPA ratio provides a direct indication of the inflammatory state of the body. Developing an anti-inflammatory treatment regime means preventing or reducing the accumulation of AA from the diet. By reducing AA through EPA supplementation, we reduce the substrate for the formation of inflammatory eicosanoids and increase the production of anti-inflammatory eicosanoids directly from EPA. Interestingly, whilst the benefits of EPA as a potent anti-inflammatory and immune-regulating fatty acid are well established, [4] these benefits are significantly superior for osteoarthritis sufferers when combined with glucosamine [5].

Glucosamine
As well as pain and joint degeneration, osteoarthritis also involves progressive loss of cartilage. Glucosamine is an amino monosaccharide believed to stimulate production of compounds called glycosaminoglycans and proteoglycans, the ‘building blocks’ of cartilage. Whilst glucosamine is important as a structural component, it is also known to exert specific pharmacologic effects by decreasing the production of inflammatory products. Glucosamine does this by regulating their production at the genetic level, by switching off genes that are directly involved in their production, thereby interfering with the inflammatory signalling cascade. When administered exogenously, it is used for the treatment of osteoarthritis as a prescription drug or a dietary supplement [6].

Calcium
The synovial fluid within joints contains calcium, as does the cartilage lining the joints. When that calcium crystallises, the resulting tiny shards wear away the joint surface and spur the release of enzymes that further break down cartilage. Not surprisingly, it is sometimes thought that because osteoarthritis is aggravated by calcium deposition in joints, osteoarthritis patients should avoid taking calcium. Formation of calcium crystals can, however, result in calcium deficiency and, whilst calcium serves to maintain healthy bones and teeth, it is also essential for the normal functioning of muscles, blood vessels and nerves. If proper management of calcium is not carried out, this could be harmful for osteoarthritis patients, who may be at a higher risk of also developing osteoporosis, especially if they are long-term users of NSAIDs [7].

 

Written by Dr Nina Bailey

References
1. Lopez HL: Nutritional interventions to prevent and treat osteoarthritis. Part I: focus on fatty acids and macronutrients. PM & R : the journal of injury, function, and rehabilitation 2012, 4:S145-154.
2. Lopez HL: Nutritional interventions to prevent and treat osteoarthritis. Part II: focus on micronutrients and supportive nutraceuticals. PM & R : the journal of injury, function, and rehabilitation 2012, 4:S155-168.
3. Dawczynski C, Hackermeier U, Viehweger M, Stange R, Springer M, Jahreis G: Incorporation of n-3 PUFA and gamma-linolenic acid in blood lipids and red blood cell lipids together with their influence on disease activity in patients with chronic inflammatory arthritis–a randomized controlled human intervention trial. Lipids in health and disease 2011, 10:130.
4. Calder PC: Omega-3 polyunsaturated fatty acids and inflammatory processes: Nutrition or pharmacology? British journal of clinical pharmacology 2012.
5. Gruenwald J, Petzold E, Busch R, Petzold HP, Graubaum HJ: Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis. Advances in therapy 2009, 26:858-871.
6. Rovati LC, Girolami F, Persiani S: Crystalline glucosamine sulfate in the management of knee osteoarthritis: efficacy, safety, and pharmacokinetic properties. Therapeutic advances in musculoskeletal disease 2012, 4:167-180.
7. Vestergaard P, Rejnmark L, Mosekilde L: Fracture risk associated with use of nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, and acetaminophen and the effects of rheumatoid arthritis and osteoarthritis. Calcified tissue international 2006, 79:84-94.

 

Share

Fish and fish oils may be important for bone health

The long chain omega 3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found in oily fish such as salmon, mackerel, trout and sardines, play an important role in optimal health.  As previously mentioned in my blog posts they are important for our hearts, brain, eyes and may protect against various conditions.  There is also some evidence to suggest that these fatty acids are important for bone health and perhaps prevent against osteoporosis and osteoarthritis.

Pharma Nord Bio Fish Oil
A new study has found that fish consumption may protect against bone loss.

A new study published in the American Journal of Clinical Nutrition (1) has found that fish consumption may protect against bone loss.  The study aimed to look at the association between dietary intake of fatty acids and fish and bone mineral density in older adults (average age of 75 years).  The study tracked changes in bone mineral density over a four year period.

The results of the study showed that high intakes of fish, 3 or more servings of fish a week, were associated with maintenance (ie no changes) in bone mineral density in men and women.  The study was only an association study so it does not prove that eating fish can prevent bone loss in old age however, previous studies  have also found that eating a diet rich in fish or having good intakes of the fish oils EPA and DHA, may contribute to a reduced risk of osteoporosis.  It is thought that the fish oils may be working to protect bone through their anti-inflammatory actions.  Inflammation in the body is known to be involved in the process of bone loss.

More evidence and further research is needed before firm conclusions can be drawn, however, oily fish has been shown in numerous studies to benefit health so including at least 2 servings a week in the diet is a good idea.   For individuals who don’t regularly eat fish a fish oil supplement rich in DHA and EPA may be worth considering but it is always best to check with a medical doctor prior to starting any new supplement regimen.

A healthy diet is important for strong, healthy bones.  Calcium, vitamin D are well known to be important for healthy bones but there are many other nutrients that are involved in bone strength such as magnesium, zinc, copper, potassium, silicon, manganese, vitamin K, vitamin C, vitamin B and phytonutrients – biochemical plant compounds found in fruits and vegetables.  A varied, healthy diet, especially on rich in fruits and vegetables and unprocessed unrefined pulses, beans, nuts/seeds and wholegrains, will provide a huge array of nutrients that may positively impact bone health.  Please read my other posts relating to bone health for more information on how good nutrition may be helpful to keep bones strong.

(1)  Emily K Farina EK et al.  2011.  Protective effects of fish intake and interactive effects of long-chain polyunsaturated fatty acid intakes on hip bone mineral density in older adults: the Framingham Osteoporosis Study.  Am J Clin Nutr.  93:1142-1151.

Written by Ani Richardson

Share

Garlic may protect against hip osteoarthritis

Garlic livens up any meal and I am sure many Christmas dinners will include this vegetable.  I wrote before about garlic being used for lowering blood pressure and now a new study (1) suggests that women who consume a diet rich in allium vegetables such as garlic, onions and leeks, have lower levels of hip osteoarthritis.  The research took place in the UK at King’s College London and the University of East Anglia

Osteoarthritis is the most common form of arthritis in adults, affecting around 8 million people in the UK, and women are more likely to develop it than men. It causes pain and disability by affecting the hip, knees and spine in the middle-aged and elderly population. Currently there is no effective treatment other than pain relief and, ultimately, joint replacement (2).  For more info on osteoarthritis please visit Arthritis Care, a UK based charity for those suffering with the condition.

This study reports (1,2) to be the first of its kind to delve deeper into the dietary patterns and influences that could impact on development and prevention of osteoarthritis.  The study was a cross-sectional study conducted in a large population-based volunteer cohort (group) of twins. Food intake was evaluated using a specialist Food Frequency Questionnaire and osteoarthritis was assessed via x-ray images.  The study looked at over 1,000 healthy female twins, many of whom had no symptoms of arthritis at the start of the research.

Analysis of the results found that a dietary pattern of intake that was high in fruit and vegetables was inversely associated to hip osteoarthritis – this means that the more fruit and vegetables eaten the lower the risk of hip osteoarthritis.  Further analysis of results revealed that consumption of ‘non-citrus fruit’ and ‘alliums’ had the strongest protective effect against osteoarthritis (1).

Garlic and allium vegetables contain a compound known as diallyl disulphide.  It might be this compound which is protective against hip osteoarthritis.  The authors of this study investigated this compound further and found that diallyl disulphide limits the amount of cartilage-damaging enzymes when introduced to a human cartilage cell-line in the laboratory (1).

The findings of this study not only highlight the possible effects of diet in protecting against osteoarthritis, but also show thefuture potential for using compounds found in garlic to develop treatments for the condition (1,2).  In a press release (2) Dr Frances Williams, lead author from the Department of Twin Research at King’s College London, says: “While we don’t yet know if eating garlic will lead to high levels of this component in the joint, these findings may point the way towards future treatments and prevention of hip osteoarthritis.  It has been known for a long time that there is a link between body weight and osteoarthritis. Many researchers have tried to find dietary components influencing the condition, but this is the first large scale study of diet in twins. If our results are confirmed by follow-up studies, this will point the way towards dietary intervention or targeted drug therapy for people with osteoarthritis.”

Another scientist, Professor Ian Clark of the University of East Anglia said (2): “Osteoarthritis is a major health issue and this exciting study shows the potential for diet to influence the course of the disease. With further work to confirm and extend these early findings, this may open up the possibility of using diet or dietary supplements in the future treatment osteoarthritis.”

In their conclusion the authors of this study write (1)The investigation of diet in OA [osteoarthritis] is an area fraught with methodological issues and there are few largescale studies in the literature. This study is among the first and is unique in its use of dietary patterns and population-based twins to overcome some of the major technical difficulties of diet epidemiology in complex traits. The chief finding is that a ‘healthy diet’ containing high intake of fruit and vegetables (and alliums in particular – the onion genus including garlic, onions, shallots, chives and leeks) are protective for hip OA”.

Diet and nutrition can make an impact on all areas of the body.  Vegetables and fruits are full of vitamins, minerals and flavonoids (bioactive plant nutrients) and it is important to eat a variety of these foods daily (a minimum of 5 portions).  For more diet related ideas to protect against osteoarthritis please read my previous posts here 

Garlic supplements are available to buy but as yet it is not known if these would provide benefit for the protection against osteoarthritis, further evidence would be needed to look into the potential benefits such supplements.

(1)Williams FMK et al.  2010.  Dietary garlic and hip osteoarthritis: evidence of a protective effect and putative mechanism of action.  BMC Musculoskeletal Disorders.  11:280  doi:10.1186/1471-2474-11-280

(2)King’s College London (2010, December 16). Garlic could protect against hip osteoarthritis. ScienceDaily. Retrieved December 20, 2010, from http://www.sciencedaily.com­ /releases/2010/12/101216101833.htm

 

 

Written by Ani Kowal

Share

Can rosehip be useful for sufferers of osteoarthritis and rheumatoid arthritis?


Rheumatoid arthritis is an autoimmune disease; a disease when, for unknown reasons, the body starts to attack itself.  In Rheumatoid arthritis the attack occurs on the membranes (synovial membranes) of a joint which becomes chronically inflamed – this can cause pain, swelling, morning stiffness, muscle wasting and osteoporosis.  Eventually bone and cartilage is damaged.  Rheumatoid arthritis can affect several joints and commonly occurs in people aged between 30 and 50.  The condition is three times more common in women than men and seems to run in families. Conventional treatment centres around pain relief and reduction of inflammation, most commonly with drugs called NSAIDs, Non steroidal anti-inflammatory drugs.



Osteoarthritis is the most common type of arthritis.  The disease occurs due to the gradual degeneration of the cartilage which lines the joints.  This causes pain, swelling and restricted movement.  The condition most commonly affects weight bearing joints such as the hips and knees but may also attack the joints in the hands and feet.  Women are twice as likely as men to be affected and the most common form of treatment are NSAIDs, non-steroidal anti-inflammatory drugs, to relieve pain and reduce swelling/inflammation.



Arthritis Care is an organisation there to help people with all forms of arthritis – please visit their website for further information.



Recently I was made aware that rose hip could be beneficial to individuals suffering with arthritis.  Rosehips are a particularly rich source of vitamin C and antioxidant flavonoids (plant chemicals).  Research seems to suggest that standardised rose-hip powder made from the seeds and husks of fruit from a wild variety of English rose-hip, called Rosa canina, may be helpful in reducing inflammation and hence be useful in rheumatoid- and also osteo- arthritis.



Laboratory cell studies (1,2,3,4) first indicated that rosehip may have anti-inflammatory properties and more recently studies using rosehip as a dietary supplement have found that it may be useful for those suffering from rheumatoid (5,6) and osteoarthritis (7,8,9,10)



A recently published study (5) was carried out to investigate if a rose-hip (Rosa canina) supplement could reduce symptoms in patients with rheumatoid arthritis.   The study was well designed and patients received treatment with 5g capsulated rose-hip powder 5g daily or matching placebo for 6 months.  After 6 months those receiving the rosehip had an improved score according to a recognised Health Assessment Questionnaire whereas the placebo group actually had a worsened score after 6 months.  There was also indication that physical scores were improved with rosehip supplementation. The authors of the study conclude that their results indicate that patients with rheumatoid arthritis may benefit from additional treatment with rose hip powder.  An earlier study (6) found that 5g of rosehip daily seemed to reduce joint tenderness and increase quality of life in patients with rheumatoid arthritis.  Both of these studies are preliminary and further research trials would be necessary before a firm conclusion can be drawn, but the evidence adds to previous research indicating that antioxidants and flavonoids are useful in rheumatoid arthritis 



An analysis(8) of different studies looking at the potential use of rosehip for the treatment of osteoarthritis found that supplementation with rosehip may be useful in pain reduction when compared to placebo.  The results indicated that rosehip may be more effective than paracetamol in reducing pain in osteoarthritis sufferers.  The authors of the study call for larger, long-term clinical trials.



The amount of rosehip used in studies has been around 5g daily.  Supplements made from powdered rosehip are easy to find.  More evidence is needed before firm recommendations for the use of rosehip in arthritis can be made however, you may wish to discuss the use of such a supplement with your health professional.  Please read the posts linked at the start of this piece for more interesting information on nutrients that may be useful in the treatment of osteoarthritis and rheumatoid arthritis.


 


(1)Larsen E.  Et al.  2003.  An antiinflammatory galactolipid from rose hip (Rosa canina) that inhibits chemotaxis of human peripheral blood neutrophils in vitro. J Nat Prod.  66: 994–995.
(2)Winther K. Et al.  1999.  The anti-inflammatory properties of rose-hip. Inflammopharmacology.7: 63–68.
(3)Kharazmi A & Winther K.  1999.  Rose hip inhibits chemotaxis and chemiluminescence of human peripheral blood neutrophils in vitro and reduces certain inflammatory parameters in vivo. Inflammopharmacology. 7: 377–386.
(4)Schwager J et al.  2008.  Anti-inflammatory and chondro-protective effects of rose hip powder and its constituent galactolipids GOPO. Poster presentation at the World Congress of Osteoarthritis (OARSI), Rome, 18–21 September 2008.
(5) Willich SN et al.  2010.  Rose hip herbal remedy in patients with rheumatoid arthritis – a randomised controlled trial. Phytomedicine. 17(2):87-93.
(6) Rossnagel K et al.  2007.  Can patients with rheumatoid arthritis benefit from the herbal remedy rose-hip? : a randomised, double-blind, placebo-controlled clinical trial January-June 2007. Rheum Dis.  66 (Suppl II): 603.
(7) Chrubasik C et al.  2008.  A one-year survey on the use of a powder from Rosa canina lito in acute exacerbations of chronic pain. Phytother Res. 22(9):1141-8.
(8) Christensen R et al.  2008.  Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients?–a meta-analysis of randomized controlled trials.  Osteoarthritis Cartilage.  16(9):965-72
(9) Chrubasik C et al.  2008.  A systematic review on the Rosa canina effect and efficacy profiles. Phytother Res. 22(6):725-33.
(10) Winther K et al.  2005.  A powder made from seeds and shells of a rose-hip subspecies (Rosa canina) reduces symptoms of knee and hip osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial. Scand J Rheumatol. 34(4):302-8.



Written by Ani Kowal

Share

A weighty issue for osteoarthritis

In my last post I wrote about certain how nutritional supplements may aid pain reduction and other measures of osteoarthritis severity.  Eating a healthy diet is important in helping to reduce the symptoms of osteoarthritis for other reasons too – a balanced, healthy diet throughout life is crucially important in order to maintain a steady, healthy weight and prevent long-term overweight and obesity.



Being overweight is a risk factor for the development of osteoarthritis and will also worsen the condition over time.  The extra weight places stress on the cartilage and joints. When osteoarthritis is severe total joint replacement is sometimes necessary.  Being overweight is the primary risk factor for joint replacement in osteoarthritis sufferers.



A recently published study (1) assessed over 30,000 healthy volunteers in Melbourne, Australia.  Their body mass index (BMI), waist-to-hip-ratio (a measure of abdominal obesity), fat mass and percentage body fat were recorded.  The relationship between different measures of overweight and risk of subsequent primary knee and hip joint replacement was measured. 



The results showed that those with a higher body weight, BMI, fat mass and percentage fat had a significantly increased risk of joint replacement.  Waist circumference and waist-to-hip ratio were also associated with an increased risk i.e. the more weight carried around the waist/stomach correlated to the risk of joint replacement.  This is important to note since weight/fat round the middle/stomach area is linked to metabolic issues and is also a risk factor for other problems such as heart disease and diabetes. 



The study therefore indicates that extra weight, and where the weight is carried, are important factors to consider in osteoporosis.  Fat mass and percentage fat were also associated with an increased risk of primary knee and hip joint replacement even 10 – 15 years after their original measurement.



According to the study authors extra weight and fat mass in the body contribute to increased stress on the joints which could increase the risk of osteoarthritis progression and subsequent joint replacement surgery in sever osteoarthritis suffers.  It is also likely that metabolic factors are involved in the progression of osteoarthritis since fat around the waist/middle, known as central adiposity, is known to contribute to a condition known as metabolic syndrome.  This condition is associated with type two diabetes and is a risk factor for heart disease.  Fat (adipose) tissue can be involved in the production and release of hormones and other chemicals known as cytokines which are linked to cartilage destruction and inflammation in the body.



The authors conclude, “The obesity epidemic occurring in developed countries is likely to have a significant impact on the future demands for knee and hip replacements for osteoarthritis and understanding the mechanism of action will be important in effective prevention of osteoarthritis“.


Trying to achieve (and stick to) a balanced, healthy, daily diet is important for the maintenance of a healthy lifetime weight and prevention against overweight and obesity, as well as a whole array of other conditions. 


 


(1)Wang Y, Simpson JA, Wluka AE, Teichtahl AJ, English DR, Giles GG, Graves S, Cicuttini FM.  2009.  Relationship between body adiposity measures and risk of primary knee and hip replacement for osteoarthritis: a prospective cohort study. Arthritis Res Ther.  11(2):R31. [Epub ahead of print]


Written by Ani Kowal

Share

Seaweed supplement may help with osteoarthritis

In October last year I discussed osteoarthritis.  A recent study(1) has found that a supplement derived from seaweed seems to be helpful in reducing the need for painkillers in some individuals that suffer from this debilitating condition.



Osteoarthritis is a degenerative joint disease.  The exact cause is unknown but the slow destructive process usually begins when the stress placed on the joint surfaces is unusually high.  This kind of stress can cause changes in the cartilage and bone surfaces.  There are also some links to nutritional problems.  In the western world excess weight, especially in later life, and sedentary lifestyles add to the pressure and stress on joints.  For more introductory information on the condition you may find it helpful to read my last post on osteoarthritis.



Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used by osteoarthritis sufferers to relieve symptoms and pain.  However, many individuals prefer not to take these agents which have been linked to a variety of side effects such as gastrointestinal problems, stomach and digestive ulcers and cardiovascular (heart) problems.  As explored previously the nutritional supplements glucosamine and chondroitin may be helpful to some individuals with osteoarthritis and omega 3 fatty acids could be useful in the reduction and prevention of over-inflammation.  Minerals such as calcium, magnesium, copper, manganese, selenium and zinc may also have a positive effect.



The researchers of this current study(1) tested a calcium and magnesium-rich seaweed-derived multi-mineral supplement for the management of knee osteoporosis.  Previously this seaweed supplement was used in a small pilot study(2) and it proved useful in improving the walking distances in osteoarthritis sufferers, it also seemed to reduce the pain and stiffness of osteoarthritis of the knee over 12 weeks of treatment.  The supplement used was derived from a red algae (Lithothamnion corallioides) which is rich in calcium and magnesium and a variety of other trace minerals including manganese, selenium, zinc, boron, copper and potassium.  The latest trial(1) was small but well designed and also lasted 12 weeks. 



The study included 22 older adults with knee osteoarthritis.  The participants were randomly assigned to take either the seaweed supplement or an inactive ‘placebo’ capsules for 12 weeks.  After the first two weeks of treatment, all of the patients were asked to cut their NSAID use in half for the next two weeks, then stop using the medication completely for the rest of the study. In general, it was found that patients taking the seaweed supplement performed better on tests of walking distance and knee joint range of motion after one month of treatment, despite their NSAID use being halved.  The supplement was not effective in entirely replacing NSAID treatment.  Five patients in the placebo group dropped out of the research study due to worsening of pain, compared to only one patient taking the seaweed supplement.


 


In conclusion, the mineral seaweed supplement was found to be potentially helpful to people suffering with knee arthritis, the supplement allowed sufferers to reduce their use of NSAIDs by 50% or more and still show improvements in walking ability and range of motion in the knee joint.  The supplement also seemed helpful in reducing the pain associated with the condition.



It’s not fully clear why the seaweed supplement might aid arthritis symptoms. It contains a mix of trace minerals (as well as many other nutrients), with the main ingredients being calcium and magnesium.  Additional, larger, studies of longer treatments are necessary in order to fully explore the treatment effect of a seaweed derived multi-mineral supplement.  The supplement may have been having an effect via a variety of complex mechanisms in the body such as anti-inflammatory and/or anti-oxidant mechanisms.


 


Many alage, spirullina, chlorella and plankton supplements available to buy on the internet and in health food stores.  These food-supplements are made from natural seaweed sources and contain a broad range of trace minerals and other nutrients such as vitamins, amino acids, essential fatty acids and flavonoids (bioactive plant nutrients).  It is thought that these sorts of food-supplements are highly absorbable by the body and may provide more benefit than chemically manufactured supplements.



(1)Frestedt JL, Kuskowski MA, Zenk JL.  2009.  A natural seaweed derived mineral supplement (Aquamin F) for knee osteoarthritis: a randomised, placebo controlled pilot study. Nutr J. 8:7
(2) Frestedt JL et al.  2008.  A natural mineral supplement provides relief from knee osteoarthritis symptoms: a randomized controlled pilot trial. Nutr J.  7:9.


Written by Ani Kowal

Share

Dietary and nutritional help for osteoarthritis sufferers

As I mentioned on Monday, the 12th October marks World Arthritis Day 2008.  Today I am going to cover osteoarthritis which is the most common type of arthritis.  The disease occurs due to the gradual degeneration of the cartilage which lines the joints.  This causes pain, swelling and restricted movement.  The condition most commonly affects weight bearing joints such as the hips and knees but may also attack the joints in the hands and feet.  Women are twice as likely as men to be affected and the most common form of treatment are NSAIDs, non-steroidal anti-inflammatory drugs, to relieve pain and reduce swelling/inflammation. 


For more info on osteoarthritis please visit Arthritis Care, a UK based charity for those suffering with the condition.



My intention had been to start off by reviewing some of the evidence surrounding glucosamine sulphate and chondroitin sulphate in relieving symptoms of osteoarthritis.  However the press pounced on a story earlier this week and you may have read headlines saying that dietary supplements of glucosamine and/or chondroitin fare no better than placebo in slowing the progression of knee osteoarthritis. (Oh the media do love a negative story!).  The study(1) being referred to did indeed find that neither glucosamine sulphate nor chondroitin sulphate worked to slow the loss of knee cartilage in osteoarthritis.  However, the researchers have said that some of their findings were confusing and that more study was needed before any definite conclusions could be drawn.  In addition to this it was quite a small study which can affect the statistical analysis of results, and a small sub-set group of patients (with grade 2 osteoarthritis) did appear to show a trend toward benefit from the supplements (but the benefit was not statistically/mathmatically significant) compared to placebo.  The study did not measure the effects of supplementation on pain levels, or other symptoms, in the osteoarthritis sufferers.



I am going to continue along my planned lines of mentioning glucosamine and chondroitin sulphate supplementation for osteoarthritis as there are a number of studies that do indicate that these agents may well be beneficial to sufferers of the condition.



Glucosamine sulphate is an essential building block in the manufacture of cartilage and, taken as a supplement, may reduce the pain and inflammation associated with osteoarthritis.  Several studies exist which show glucosamine to be an effective treatment for osteoarthritis(2,3,4,5). Glucosamine sulphate has also been shown to control the symptoms of osteoarthritis as well as the NSAID ibuprofen (6,7). The normal recommended dose of glucosamine sulphate is 500 mg, three times daily. Once therapeutic benefit is achieved, it is usually possible to taper down to a once or twice a day dose.



Another agent which is often used in conjunction with glucosamine sulphate is chondroitin sulphate.  Chondroitin sulphate seems to work by attracting fluid into the joint cartilage tissue. This may improve the spongy, shock-absorbing qualities of the cartilage, and may also help bring essential nutrients to the area.  Many trials have shown that supplementation with chondroitin sulphate can reduce pain, increase joint mobility and/or cause healing within the joints of osteoarthritis sufferers (8,9,10,11). The normal recommended dose of chondroitin sulphate is 400 mg, three times a day.


 


Glucosamine and chondroitin are very often combined together in nutritional supplements designed to enhance joint health, although it is yet uncertain whether a combination works more effectively than either agent alone.  A review(12) published this year concluded that “although the evidence is not entirely consistent, most research suggests that glucosamine sulphate can improve symptoms of pain related to osteoarthritis, as well as slow disease progression in patients with osteoarthritis of the knee. Chondroitin sulphate also appears to reduce osteoarthritis symptoms and is often combined with glucosamine, but there is no reliable evidence that the combination is more effective than either agent alone”



The evidence for other supplements aiding osteoarthritis is not strong(13) and further trials are needed however, there is indication that antioxidant vitamins such as vitamin C, E and Beta carotene, vitamins D and various B vitamins as well as omega 3 fatty acids may be involved with reducing symptoms.  To me this highlights the importance of a healthy diet rich in a variety of fruits and vegetables, to provide the body with vitamins and minerals, together with regular inclusion of oily fish to provide omega 3 fatty acids (which can act as anti-inflammatory agents in the body).



1.Sawitzke AD et al.  2008.  The Effect of Glucosamine and/or Chondroitin Sulfate on the Progression of Knee Osteoarthritis: A Report from the Glucosamine/Chondroitin Arthritis Intervention Trial. Arthritis & Rheumatism.  58:3183-3191.
2.Reginster JY et al.  2001.  Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial.  Lancet.  357:251-256.
3.Noack W et al.  1994. Glucosamine sulphate in osteoarthritis of the knee. Osteo and Cart.  2:51-59
4.Pujalte JM et al.  1980.  Double blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthrosis. Curr Med Res Opin.  2:110-114
5.Dovanti A et al.  1980.  Therapeutic activity of oral glucosamine sulphate in osteoarthritis: a placebo-controlled double-blind investigation. Clinical Therapeutics.  3(4):266-272
6.Qiu GX et al.  1998.  Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis.  Arzneimittelforschung.  48:469-474
7.Muller-Fabbender H et al.  1994.  Glucosamine sulphate compared to ibuprofen in osteoarthritis of the knee.  Osteo and Cart.  2:61-69
8.Uebelhart D et al.  1998.  Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study.  Osteoarthritis Cartilage.  6(Suppl A):39-46
9.Verbruggen G et al.  1998.  Chondroitin sulfate: S/DMOAD (structure/disease modifying anti-osteoarthritis drug) in the treatment of finger joint OA.  Osteoarthritis Cartilage.  6(Supplement A):37-38
10.Bucsi L et al.  1998.  Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of knee osteoarthritis.  Osteoarthritis Cartilage.  May 6, (Supplement A):31-36.
11.Leeb BF et al.  2000.  A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis.  J Rheumatol.  27(1):205-11
12. Gregory PJ et al.  2008.   Dietary supplements for osteoarthritis. Am Fam Physician. 77(2):177-84.
13.  Wang Y et al.2004.  The effect of nutritional supplements on osteoarthritis.  Altern Med Rev. 9(3):275-96.


Written by Ani Kowal

Share