Sam was 38 years old when his knees began to ache. Even getting up from a chair was uncomfortable and he found himself waking in the wee hours to take pain meds and to rub them just for a little relief. He was almost 40 and, after all, it was bound to start sometime….
Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis. If you don’t have symptoms yet, you likely will, and you definitely already know someone who does.
The two major risk factors for osteoarthritis are aging and obesity. The Center for Disease Control estimates that 33.6% of those 65 and older have osteoarthritis. And as we gain more
weight, we increase our chances of developing it.
Osteoarthritis (OA) is the insidious and progressive destruction of a synovial joint complex. Characteristic changes to the joint can start as early as age 25, usually after an injury. OA can affect your hands, wrists, knees, hips and spine.
Treatment costs amount to billions every year for pain management and (eventually)
joint replacement. 2 In recent years there have been promising results combining a procedure which creates small fractures on the cartilage surface with stem cell injections that may decrease the need for replacement but, that’s to be covered in another article.
In 2011 a group of clinical researchers at Stanford discovered that the inflammation associated with OA is quite complex.
Other researchers have identified signaling proteins, called cytokines, which activate specific enzymes in the joint tissue that begin to break down cartilage proteins. We do not yet understand why this happens, but, whatever the underlying cause, all of the tissues of the joint are affected, the cartilage, bone, ligaments, menisci and the synovial tissue.
The Center for Disease Control estimates that 33.6% of those 65 and older have osteoarthritis.
There are multiple genetic components and environmental factors which are still being elucidated. One of the environmental factors is early nutrition. Anthropologists have detected an association between a lack of nutrients and osteoarthritis. The incidence of OA
appears to have increased in Native Americans after they changed from hunter gathers to farmers. The primary crop was corn, and though they filled their bellies, they gave up the diversity of nutrients that they once consumed.
An extensive literature review did not yield much in the way of how to prevent the destruction of joints that occurs with osteoarthritis, but there are some non prescription approaches to the pain and inflammation that delay the time in which one needs to take stronger prescription medications or undergo expensive procedures.
Prescription options for treatment of pain are non-steroidal anti-inflammatory drugs (NSAIDs) (i.e., Celebrex and Voltaren) and steroids. All can have serious side effects and, as with all medications, should be used with caution.
Non-prescription or “natural” treatment options include chondroitin sulfate, Boswellia serrata, turmeric, glucosamine, MSM, eggshell membrane, and the combination product bromelain, trypsin, and rutin.
Chondroitin is a building block of cartilage. It is a component of a class of proteins called proteoglycans that combine to create cartilage.
The Agency for Healthcare Research and Quality reported in a 2006 comparative update that “…There were no clear differences between glucosamine or chondroitin and oral NSAIDs for pain or function, though evidence from a systematic review of higher-quality trials
suggests that glucosamine had some very small benefits over placebo for pain. Head-to-head trials showed no difference between topical and oral NSAIDs for efficacy in patients with localized osteoarthritis. …”
More interestingly, in June 2010 Hochberg published an analysis of randomized clinical trials that confirmed that chondroitin slowed the progression of OA.
Of special note, rheumatologists and orthopedic surgeons disagree on the findings in the literature, with the various groups citing studies that prove treatment options that support their respective practices.
Bottom line: Chondroitin sulfate improves symptoms and slows the progression of OA.
Boswellia serrata is a tree resin that has been used for centuries for its anti-inflammatory properties. A Cochrane review in 2001 showed mixed results, however, the authors reported that there were two well-designed studies that indicated that Boswellia serrata extract
improved pain, but did not improve function significantly.
Bottom line: Studies look promising, but more research is needed.
Turmeric has had a lot of press lately. The curcumins in this aromatic spice have a direct effect on a number of inflammatory chemicals. Curcumin has been used successfully to modify a number of human diseases form cholecystitis to cancer.
The challenge has been absorption. When taken alone there is little to no increase in blood levels. When taken with piperine (from black pepper), levels are significantly increased. Other formulations are available. One of note is Meriva ® , which demonstrated significant improvements in pain and walking distance as well as a decrease of inflammatory molecules.
Eggshell membrane contains the building blocks of joints and connective tissues. Small studies have evaluated eggshell membrane for pain, stiffness and function. Overall, after two months there were significant improvements in pain and stiffness but not function.
Bottom Line: Treatment with eggshell membrane likely has benefit, but more studies are needed to consider this a mainstream treatment.
A number of people take glucosamine supplements, but the data to support glucosamine efficacy is sadly lacking. In 2013 Wu and colleagues did an analysis demonstrating no significant effect of glucosamine on symptoms of osteoarthritis.
MSM is frequently used in combination with chondroitin and glucosamine. The
data for its use are limited. In a small well designed trial in which the participants
took MSM three times a day there was a statistically significant difference in physical function but no difference in pain scores.
Bottom Line: The studies are not conclusive that there is no benefit. It would be interesting to see studies that include X-rays or MRI reports.
Wobenzyme PS (also known as Phlogenzym) is a combination of the bromelain, trypsin and rutin that was developed in Germany. This combination was compared with the prescription
medication Voltaren. The study was 6 weeks long. Both groups had similar improvements in all parameters studied.
Bottom Line: Wobenzyme® PS is effective for treatment of OA of the knee for 6 weeks. Longer studies which include imaging are needed.