Osteoarthritis, the most common chronic arthritis, accounts for half of all cases. Inflammation may occur, but OA is generally considered a non-inflammatory type of arthritis – referred to as degenerative joint disease or “wear-and-tear arthritis”.
Osteoarthritis (OA) is most prevalent in the aged and is probably related to the normal aging process (although it is seen occasionally in younger people and some forms have a genetic basis).
The usual symptoms are deep aching pains localized to the joint(s) involved, stiffness after rest, joint swelling and tenderness, a grating sound when the joint is moved, and in later stages bone deformities. The pain is usually present with movement of the joint and relieved by rest. The pain arises in the joint capsule, ligaments, tendons, muscles and bone surrounding the damaged cartilage.
As the disease progresses, the exposed bone tissue thickens and forms bony spurs that enlarge the bone ends. The spurs encroach on the joint space and may restrict joint movement. Patients complain of stiffness on arising that lessens with activity. The affected joints may make a crunching noise as they move. This sound, called crepitus, results as the roughened articular surfaces rub together. The joints most often affected are those of the fingers, the base of the thumb, the big toe, the cervical and lumbar spine, and large weight-bearing joints of the lower limbs (knees and hips).
Current theory holds that normal joint use prompts the release of enzymes that break down cartilage. In healthy individuals, this damaged cartilage is replaced. In people with OA, more is destroyed than replaced. Although its specific cause is unknown, OA may reflect the cumulative effects of years of compression and abrasion acting at joint surfaces (accompanied by excessive amounts of the cartilage-destroying enzymes) which ultimately cause the once smooth articular cartilages to soften, roughen, fray, and erode – resulting in friction. The tendons, ligaments, and muscles holding the joint together become weaker, and the joint itself becomes painful and stiff. There is usually some pain, but little or no swelling.
Biochemically the disease can be initiated by excessive pressure being applied to the joint i.e. in sport or manual work. Inflammation of the cartilage may also be associated with infection, toxic irritation, or by poor nutritional status of bones and surrounding structures. Epidemiologists have also identified hereditary factors which predispose people to osteoarthritis. Other contributing factors include poor diet, obesity, diabetes, a sedentary lifestyle, hypertension, bowel toxicity, hyperuricaemia, hypothyroidism and other endocrine disorders, hyper-insulinaemia, and high estrogen levels. Allergies and chemical sensitivities may also predispose or aggravate osteoarthritis.
The primary chemical change observed is the loss of proteoglycans (a protein sugar or mucopolysaccharide) from the hyaluronic backbone, and is initiated by activation of degenerative enzymes associated with inflammation. These proteoglycans are responsible for cartilage resilience or bounce and their loss from the cartilage results in a stiffer material that is more easily damaged by “wear and tear”. Proteoglycans account for 75-80% of normal cartilage, in osteoarthritis proteoglycans are reduced to 35-40%. The increased turnover and eventual loss of proteoglycans from osteoarthritic tissue is a consequence of an increase in chondrocyte metabolism.
At the same time there is some kind of matrix destabilization possibly the result of collagen fibers breaking. Collagen fibers provide the high tensile strength of cartilage. The physical properties are not unlike a mattress which can be compressed but not pulled apart sideways. The collagen/proteoglycan matrix provides the structural framework of the tissue and also forms a fluid compartment for the transport of nutrients, waste products, chemical messengers and hormones, to and from chondrocytes. Whether the breaking of the collagen fibers is a consequence of increased proteoglycan degradation is still not clear.
The degenerative enzymes can be modulated by Bromelain, Quercetin, Rutin, and EFA’s. Zinc, Manganese, Magnesium, Calcium, Vitamin D, C, B6, E, Glucosamine, and DLPA are all useful to help with inflammation. This combination of nutrients increases protein, proteoglycan and amino acid synthesis, facilitates repair of ligament and connective tissue, improves and restores bone growth and muscle action, increases blood vessel integrity and supports immune system function.
An acid environment around the joint will also activate these enzymes and thus precipitate the loss of proteoglycan. Chondrocytes are cells within the joint that produce these proteoglycans. Stimulation of these cells by particular nutrients can forestall some of the degenerative changes associated with arthritis. Thus, improving the chondrocytes healing potential is essential in the treatment of osteoarthritis. Bone cells, the osteocytes and osteoblasts, become metabolically very active in osteoarthritis and bone remodeling is evident.
According to allopathy – the course of osteoarthritis is usually slow and irreversible and is thought to be medically untreatable as it was a result of “wear and tear”. In most cases, you will be offered symptom control with a mild pain reliever like aspirin, along with moderate activity to keep the joints mobile. Osteoarthritis is rarely crippling, but it can be, particularly when the hip or knee joint are involved. Each year, thousands of people around the world die from the adverse effects of both the anti-inflammatory medications and steroids. To add insult to injury, some research suggests that there is mounting evidence that non-steroidal anti-inflammatory drugs actually cause certain features of osteoarthritis to progress faster – by inhibiting the synthesis of proteoglycans and thus damaging cartilage. Interestingly, Folic acid 6-6.4 mg and Vitamin B12 200ug reduces the need for NSAID’s with improvements in hand grip and reduced tenderness in joints.
Osteoarthritis is now understood to be a disease due to the disordered synthesis of proteoglycan and collagen. Both biosynthetic pathways can be regulated by nutritional means, and manipulation with nutritive substances has been shown to have significantly beneficial results in regulating cartilage metabolism and the progression of the disease is slowed or reversed.
A new magnetic therapy is reported to provide significant relief to about 70% of the patients treated. The magnetic fields are assumed to stimulate the growth and repair of articular cartilage and to reverse the effects of OA. Another technique under investigation involves injecting hyaluronic acid into the affected joint cavities. Hyaluronic acid is a natural sulphated polysaccharide that lubricates and cushions the joint. Its viscoelastic nature (kind of like Silly Putty) enables it to bounce back to its original shape after being compressed. Hence, it protects the joint surfaces from further erosion and relieves discomfort.
Obesity increases the risk of developing osteoarthritis by putting undue stress on the joints – knees and hips, for example, will not cause as much discomfort when they have less weight to carry. Some form of gentle exercise, such as swimming, cycling or walking, together with a sensible diet that promotes fat loss, whilst preserving precious lean muscle, will therefore help to prevent osteoarthritis, or minimize symptoms if you already have the condition.
Furthermore, regular exercise can play a vital role in the prevention and treatment of all forms of arthritis. Exercise is essential for reducing pain and retarding joint deterioration and helps to prevent stiffness. But you also need to respect your body’s limitations in order for exercise to be beneficial. Exercise helps to keep joints healthy by encouraging the flow of synovial fluid into and out of the cartilage, and strengthens the supporting, protecting structures (muscles, tendons, ligaments) and increases the range of motion, shock absorption, and flexibility of joints. Exercise is important in both the prevention and treatment of arthritis because unused joints tend to stiffen. Proper instruction is essential, since great harm can be done with what could be a normally easygoing activity. Swimming, water exercise, yoga and tai chi have been found to be slow and careful enough to loosen joints without causing additional discomfort.
An extract from New Zealand’s green-lipped mussel has been found to contain a glycoprotein which may help treat arthritis. The presence of this compound is thought to indirectly prevent the inflammation which occurs when the body’s immune system starts attacking healthy tissue. The glycoprotein achieves this by blocking certain actions of neutrophils, the white blood cells which alert the immune system.
Regenerating the joint cartilage is the first priority in the treatment of osteoarthritis. Liquid bovine tracheal cartilage may be used as it is an anti-inflammatory and aids connective tissue repair. For joint repair to take place the following nutrients are needed for the support of collagen, cartilage and bone: Glucosamine sulphate; Vitamin D; Calcium ascorbate; Manganese chloride; Magnesium hydroxide; MSM; and Zinc gluconate tri-hydrate. These nutrients help reduce inflammation and therefore joint pain, whilst also enhancing the growth and repair of bones. Also retards cartilage erosion and repairs damaged cartilage.
Glucosamine is an amino sugar, a major building block of proteoglycans, and is needed to make the glycosaminoglycans (GAGs), proteins that bind water in the cartilage matrix. Besides providing raw material for the synthesis of proteoglycans and GAGs, glucosamine’s mere presence acts as a stimulant to the cells that produce these products, the chondrocytes. In fact, glucosamine has been found to be the key factor in determining how many proteoglycans are produced by the chondrocytes. If there is a lot of glucosamine present, then a lot of proteoglycans will be produced, and a lot of water will be held in its proper place. But if only a little glucosamine is available, fewer proteoglycans will be made, and less of the precious water will be attracted to the area. It appears that altered glucosamine metabolism is part of the background of arthritis. Glucosamine has also been shown to spur chondrocytes to produce more collagen and proteoglycans, and it also normalizes cartilage metabolism, which helps to keep cartilage from breaking down.
Extensive research has been conducted including double-blind studies – conclusions being drawn that glucosamine actually rebuilds the damaged cartilage. It has been proven to be a safe and effective treatment for osteoarthritis. By helping the body to repair damage to eroded cartilage, it helps quell pain and relieve swelling and tenderness, with minimal or no side effects. According to recent biochemical and pharmacological findings, the administration of glucosamine (1500mg) tends to normalize cartilage metabolism, so as to inhibit the degradation and stimulate the synthesis of proteoglycans and, finally, to restore, at least partially, articular function.
Where glucosamine helps to form the proteoglycans that sit within the spaces in the cartilage “netting”, chondroitin sulphates act like “liquid magnets”, attracting fluid into the proteoglycans – the fluid acts as a spongy shock absorber and sweeps nutrients into the cartilage (Articular cartilage has no blood supply, so all of its nourishment and lubrication comes from the liquid that ebbs and flows as pressure to the joint is applied and released. Without this fluid, cartilage would become malnourished, drier, thinner and more fragile). Besides drawing in precious fluid, chondroitin protects existing cartilage from premature degradation and stimulates the synthesis of new cartilage.
An excerpt from “The Arthritis Cure”, by Dr Jason Theodosakis: “To put it briefly, in order to qualify as a truly chondro-protective agent, a compound must be able to
1. Enhance cartilage cell macromolecule synthesis (glycosaminoglycans, proteoglycans, collagens, proteins, RNA, and DNA)
2. Enhance the synthesis of hyaluron (the substance that gives the joint fluid its thick viscosity, providing lubrication between the synovial membrane and cartilage).
3. Inhibit the enzymes that degrade the cartilage cell macromolecules.
4. Mobilise thrombi, fibrin, lipids, cholesterol deposits in synovial spaces, and blood vessels in surrounding joints.
5. Reduce joint pain.
6. Reduce synovitis.
Clinical studies have shown that glucosamine can accomplish objectives 1,2,5, and 6, while chondroitin handles numbers 1,3,4,5, and 6. Their overlapping abilities explain why the glucosamine and chondroitin is such a powerful one-two punch against osteoarthritis.”
Strengthening subchondral bone is also very important. Nutrient support for repairing subchondral bone tissue includes therapeutic levels of Microcrystalline hydroxyapatite and Calcium citrate (the most absorbable forms of Calcium) combined with balanced amounts of Magnesium diglycinate, Zinc diglycinate, Manganese diglycinate and other synergistic minerals. Ipriflavone is also valuable. It a form of isoflavonoid that has the ability to activate osteoblasts (bone building cells) and inhibit bone resorption, resulting in enhanced bone formation and increased bone density.
There are many ways to reduce inflammation. Turmeric, Indian Olibanum, and Ginger are a powerful combination of anti-inflammatory herbs, all with potent regulating activity on inflammatory eicosanoids. Turmeric also has a strong antioxidant action to reduce inflammatory triggers. One of the best formula for pain.
A broad spectrum antioxidant would provide the ascorbic acid necessary for collagen synthesis, which is in turn vital to joint repair. There is some evidence to show that antioxidants – Vitamin A, C, and E, plus Selenium – may have beneficial effects on arthritis. High potency marine lipids, Omega 3 essential fatty acids, have been demonstrated to exert anti-inflammatory effects in cases of osteoarthritis.
Meat has a form of fat that encourages inflammatory agents in the body. Fats can regulate eicosanoids, which control inflammation, pain, and other symptoms of arthritis. Reducing the omega 6 oils seems to help. Canola is the best fat to use, since it contains a balance of both omegas, although beware that most canola oil on the market now is genetically modified. Olive oil is also acceptable. Flax oil contains almost twice as much omega 3 fatty acids as does fish oil, and combinations are encouraged.
All tea, coffee, alcohol, and processed foods need to be eliminated. Reduce consumption of highly refined foods, saturated fats, sugar and salt. Increase consumption of whole grain cereals, hard nuts, and apple pectin. These foods are rich in silicon which have been found to be important in bone homeostasis. A healthy diet with fresh fruit and vegetables boosts the immune system and provides the sufferer with extra energy to fight the disease. Use Garlic (inhibits free radical formation) and Kelp (rich source of minerals) in cooking. A free form amino acid complex should be part of the program to help repair tissue. Some form of fiber, such as oat bran or rice bran, should be eaten daily, and the diet should be low in saturated fats. Foods that should be consumed include eggs; onions; garlic or asparagus whose sulfur content helps to remove metals; the amino acid histidine, which is also good for removing metals; green leafy vegetables, which are needed for Vitamin K; fresh vegetables; non-acidic fresh fruits; whole grains; oatmeal; brown rice; and fish.
A good multivitamin is essential to protect from free radical damage and to repair illness and cartilage. The free radical scavenger Super Oxide Dismutase (SOD) is useful both orally and in injection form for the relief of the stiffness, pain, and swollen joints in arthritis. SOD is a member of a group of enzymes found mainly in the fluids inside the cells – it protects against damage by free radicals. DMSO (dimethyl sulphoxide) is another free radical scavenger that relieves the stiffness and pain. Its effects are enhanced when taken with other vitamins and minerals such as A, B complex, C, E, Zinc, and Selenium. 50 % of patients given 600 IU of Vitamin E for a period of 10 days reported an analgesic effect. This effect my be due to may be due to Vitamin E’s role in prolonging the life of fibroblasts, and to stabilizing lysosomal membranes, thus inhibiting the release of inflammatory mediators. Vitamin E’s role as an antioxidant is also likely to play a significant role. DMSO has also been used topically to treat arthritis. Vitamin E is also good and helps to mobilize the joints. Calcium and Magnesium chelate are essential to prevent bone loss (Magnesium is also required to form the synovial fluid which surrounds the joints), and Silica is needed for Calcium absorption and the connective tissue.
Vitamin B3 increases the circulation to deep tissues by dilating small arteries, and may promote synovial regeneration thus contributing to the reversal of cartilage erosion and synovitis. Niacinamide alone or in conjunction with other water soluble vitamins can improve joint mobility and function. Severely damaged or ankylosed joints do not respond. Vitamin C plus Bioflavonoids is for structural integrity of capillaries and collagen formation, also is a powerful free radical destroyer. Germanium is a powerful antioxidant that also relieves pain. Bromelain, from pineapple, reduces inflammation and aids digestion. DLPA is good for relieving chronic pain. Osteoarthritis may be helped by lipotropes or SAM-e (important in lipid metabolism), which is active in cell membrane fluidity (it is thought that a fatty acid imbalance of the omega 3’s and 6’s may cause arthritis and other degenerative diseases).
A deficiency of Vitamin B5 results in pathological changes to the joint which closely resemble the changes of osteoarthritis, including the claudication of cartilage, and the formation of osteophytes. Supplementation of Vitamin B5, results in benefits in 7-14 days and cessation of the treatment results in a relapse of symptoms. The mechanism of action of B5 in osteoarthritis may relate to its requirement for the N-acetylation of glucosamine (which requires acetyl CoA) and thus for the synthesis of proteoglycans. Royal Bee Jelly, rich in pantothenic acid, is reportedly helpful.
Vitamin C and D reduce the risk of cartilage loss and disease progression. Deficiency of Vitamin C may be associated with defects in collagen proline hydroxylation, possibly creating repair problems in connective tissue. Thus, Vitamin C may be useful in regenerating cartilage in addition to neutralizing some of the hormones and enzymes associated with inflammation that cause leakage and damage.
For some people who develop arthritis, an allergy or intolerance to particular foods may be a contributing factor. An elimination diet is one of the best ways to identify problem foods, but pinpointing the culprit foods can be difficult and it is best to consult your qualified Health care Practitioner. Red meat, sugar products, citrus fruits, green peppers, eggplant, tomatoes, potatoes, paprika, cayenne pepper, tobacco and salt may all be problems. The nightshade family contain a toxic alkaloid called solanine that some people, particularly those suffering from arthritis, are highly sensitive to. Solanine interferes with enzymes in the muscles, and may cause pain and discomfort. Another group of foods known as salicylates also have been shown to increase inflammation in arthritics. Wheat and milk may also be culprits. Many arthritics seem to improve if digestion is augmented. This can be done by either taking digestive enzymes or apple cider vinegar with meals. Improving digestion and the acidity of the stomach ensures complete breakdown of any antigenic food protein that may exacerbate the condition.
Eating Nettles or drinking Nettle tea (3 cups a day) is an old remedy for arthritis – anti-inflammatory. Herbs that help to ease arthritis include Feverfew (good for pain and soreness), Meadowsweet, Celery seed, and White Willow. Dandelion root and Horsetail tea is recommended for degenerative arthritis. For inflamed hand joints, take a decoction or tincture of Devil’s claw. Ginger, Coriander, Cinnamon and Aloe Vera can be used to treat arthritis. Angelica is a good tonic and is warming. Barberry taken as a tea or applied as a compress can be used. Basil can provide relief from the pain of arthritis. Other herbs such as Comfrey, Burdock, Black Cohosh, Valerian root, Chaparral leaves, Gotu kola, Chickweed, Dong Quai, and, Bog bean may help. Alfalfa leaves, Brigham tea, Parsley tea, and Yucca extract (used successfully at the Desert Arthritis Clinic) are also good choices.
For aching joints try a liniment made with Comfrey tincture and a few drops of Black Pepper essential oil. A bath of Arnica tincture, Rosemary, Basil and Lavender to promote relaxation and relieve pain. Slippery elm and Cayenne applied to affected joints as a poultice may provide relief. Rub Calamus oil into the affected joints to improve circulation and drainage. Camphor oil is indicated for the treatment of arthritis also.
Aromatherapy oils can provide soothing aromatic relief. Juniper essential oil in a bath or in a massage blend may be useful – it is stimulating and anti-rheumatic. Petitgrain massaged into the limbs may also be useful for osteoarthritis. Lemon and Cypress essential oils are detoxifying, and can be used in the bath or in a massage to help the body eliminate toxins. Chamomile, Lavender, and Rosemary are anti-inflammatory and pain-relieving; use in local massage or in a compress. Black Pepper, Eucalyptus, Marjoram and Benzoin will improve the circulation in the area. Coriander, Clary sage, Eucalyptus, Ginger, Marjoram, Vetiver, and Cedarwood may also provide relief. Skin brushing may help by stimulating the lymphatic system.
Tissue salts may be useful in conjunction with nutritional and herbal support. Ferr phos may be used in acute attacks with fever, inflammation of the joint which is swollen and red. Painful joints aggravated by motion may also benefit from this remedy. Nat phos when there are acid conditions. May be used alternatively with Nat sulph. Nat mur is if there is creaking of the joints. Mag phos may be of value, alternating with Calc phos, for the relief of pain in osteoarthritis.
Apis is for hot, stinging pain. Arnica may be useful for sprained joints that improve during movement, but worsen after prolonged movement or rest. It also helps with long term joint and muscle complaints such as osteoarthritis. Bryonia may be useful for joint inflammation such as osteoarthritis. It is indicated when stitching pains occur in swollen pale or red joints. Colchicum, when it is worse in warm weather, with inflamed joints, irritability, and sensitivity to touch. Pulsatilla is for when pain moves from one joint to another. Ruta grav is for the treatment of deep aching pain especially in the bones. Rhododendron is for when arthritis is worse in stormy weather. Rhus tox may be used for muscle and joint pain i.e. osteoarthritis, restless legs, stiffness in the lower back, and strains. Symptoms are made worse by cold and damp, and after rest – improving with movement.
Physical therapies such as massage, physiotherapy, osteopathic treatment, and magnetic induction therapy are useful adjuncts in the treatment of osteoarthritis.
Nutritional and Herbal support for Osteoarthritis includes:
Glucosamine 1200 Complex – Glucosamine is a natural substance found largely in cartilage, ligaments and tendons. This product was formulated to give the body the building blocks it needs to help repair cartilage, ligament & tendon damage, while offering an anti inflammatory action.
Omega 3 EFA’s – High quality natural Fish Oil is an excellent source of Omega-3 acids, Vitamin A & D & the essential fatty acids EPA & DHA. Provides an anti inflammatory action in the body.
DLPA – Elevates the body’s own natural pain killing hormones (endorphins). 400 mg 3-4 x daily for relief of chronic pain 3 wks.
Vitamin C, Quercetin and Bromelain – Bioflavonoids inhibit inflammation thus assisting in relief of chronic pain 3-4 x daily 3 wks.
Tryptophan – Increases pain threshold, may aid sleeping.
Some interesting points on Osteoarthritis:
Hot tubs and baths provide relief. Raw lemon rubs and hot castor oil packs are also extremely beneficial.
Drink steam-distilled water only.
Good posture is also important to prevent stiffness and crippling. Poor posture can cause body weight to be distributed unevenly, placing more stress on certain joints, resulting in unnecessary pain for the arthritic person. Overweight and obesity also affect the weight-bearing joints, which become irritated and stressed by having to carry too much of a load.
Alfalfa, Parsley, Celery seed, Ginger 1-2 grams per day (discourages inflammation and pain), hot Peppers, and Garlic make useful additions to the diet.
The bacteria responsible for Chlamydia non-specific urethritis has been linked as a cause of one form of arthritis in young women. In nearly half of the women with unexplained arthritis who were tested, Chlamydia was found in the joints. Seventy-five percent had raised antibody levels in the blood.
Copper has an anti-inflammatory effect when applied topically and is therefore helpful for arthritis. Copper bracelets leach the copper into the system through perspiration, therefore adding to Copper levels in the blood. Copper chelate rub applied to the affected joint may reduce the inflammation around the joint. Many osteoarthritic patients are Copper deficient and this may have a role in the pathogenesis of the disease as copper is required for the formation of sulfur cross linking in collagen formation. Manganese may repair worn-out cartilage. Zinc, an anti-inflammatory, may relieve some symptoms of arthritis.
Vitamin C is necessary to prevent the capillary walls in the joints from breaking down and causing bleeding, swelling, and pain. Folic acid, Vitamin B12, and Iron may be helpful in treating the anemia that may accompany arthritis. The frequency of liver disorders in arthritic patients may deter the conversion of carotene into Vitamin A. Difficulty in assimilating carbohydrates suggests a Vitamin B deficiency.
Wear correct fitting jogging shoes or massage sandals. This allows for better cushioning of knee an hip joints. Orthotics may be useful to support or correct alignment of ankles and thus posture.
Eat cold water fish (cod, tuna, salmon, trout, mackerel, and sardines) at least 3 times per week. These fish are rich in certain polyunsaturated fats called omega 3 fatty acids. Scientific evidence has now emerged to show that fish oils can prove helpful to arthritis sufferers, and may reduce inflammation if taken regularly. Inflammation is the body’s natural reaction to arthritic diseases, causing pain, swelling, redness and heat. Fish oil may also be taken in capsule form. Signs of improvement are usually felt within 2-3 months. Vegetarians may choose Flaxseed oil (1-2 dessertspoons a day) to obtain their omega-3 fatty acids.
Coeliac disease results from a sensitivity to the protein gluten, contained in wheat, oats, barley and rye. Gastro-intestinal discomfort, wind and diarrhea are the usual manifestations although these symptoms need not be present and arthritis or eczema may manifest.