Commonly Dietary Supplements for Joint Pain or Arthritis

As I have previously noted, I will now be writing my blog posts at a new location--Supplement Updates.  I thought that I would provide a stand alone recap of many of the commonly used dietary supplements for joint pain or arthritis as basically a final post for this blog site.

Bromelain for knee osteoarthritis?

Bromelain is an ingredient common in many dietary supplements which are marketed for promoting joint health. Does it actually work?

"BACKGROUND: Osteoarthritis (OA) of the knee is the most prevalent joint disorder. Previous studies suggest that bromelain, a pineapple extract, may be a safer alternative/adjunctive treatment for knee OA than current conventional treatment."

"DISCUSSION: This study suggests that bromelain is not efficacious as an adjunctive treatment of moderate to severe OA, but its limitations support the need for a follow-up study."

Brien S, Lewith G, Walker AF, Middleton R, Prescott P, Bundy R. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM. 2006 Dec;99(12):841-50.

Whether or not weather affects your arthritis pain?

Whether or not weather affects your arthritis pain?

Does weather really affect the severity of your joint pain? Though, I've often wondered this myself, intuitively I've often felt quite sure that there is a relationship between weather conditions and my own joint pain. In fact, most people with arthritis assert with conviction that weather conditions do influence the severity of their pain (Laborde et al, 1986).

Despite our strongly held convictions with respect to the question as to whether or not weather impacts the severity of joint pain, I recently read a clinical trial which tested this hypothesis. In a recent article published in the American Journal of Medicine (McAlindon et al, 2007), they studied 200 geographically isolated individuals with osteoarthritis of the knee. Not surprisingly, their study results confirmed that both cold weather as well as increases in atmospheric pressure are both associated with an increase in joint pain severity.In addition to these recent findings, they also offered some plausible explanations of why cold weather as well as increases in barometric pressure have an impact on arthritis pain severity.

They hypothesized that cold temperatures, for example, could have a direct effect on the viscosity of synovial fluid or indirect effects on inflammatory mediators. Basically, this means that cold temperatures could increase the viscosity or thickness of your joint fluid in much the same way that cold temperatures would affect the oil that you use to lubricate your car's engine. In terms of how barometric pressure affects your arthritis pain, they had some ideas in this regard as well. They cited cadaver studies which show that the intraarticular pressure (pressure inside of your joint) is actually much lower than atmospheric pressure.

Consequently, increases in barometric pressure may actually affect your joint biomechanics. Now that we've established the association between cold weather, increases in barometric pressure, and joint pain, where does that leave us? If you are one of the millions of Canadians or Americans who suffer from Arthritis, now that winter is upon us, there are two simple options for minimizing the impact of weather on your arthritis pain. The simplest solution, particularly if you live in very cold weather climate, is to minimize your exposure to the outdoors--as much as possible. At the very least, be cognizant of how your exposure to the cold affects your joint pain. Secondly, if possible, it gives you one more excuse to take a warm vacation during the winter months.

Please visit: http://www.arthroleve.com/ regularly to find out information on our upcoming special offers.

McAlindon T, Formica M, Schmid CH, Fletcher J. Changes in barometric pressure and ambient temperature influence osteoarthritis pain. Am J Med. 2007 May;120(5):429-34.Laborde JM,

Dando WA, Powers MJ. Influence of weather on osteoarthritis. Soc Sci Med. 1986; 23(6):549-554.

Cell-based cartilage repair: illusion or solution for osteoarthritis.

One treatment option for osteoarthritis which is not widely used yet, but may offer hope for people who suffer from osteoarthritis in the near future, is cell-based cartilage repair. I will keep my blog readers up to date on recent developments in stem-cell therapies for osteoarthritis.


Reference:

Richter W. Cell-based cartilage repair: illusion or solution for osteoarthritis. Curr Opin Rheumatol. 2007 Sep;19(5):451-6.

Osteoarthritis: a comorbid marker for longer life?

Interestingly, a recent study compared the mortality rate of different chronic conditions in patients with or without osteoarthritis. In the various disease groups, lower mortality rates were observed in the patients who additionally had osteoarthritis. Further research is required to confirm and better understand this association.

"Diseases are often described and studied as if they occur in isolation of other disease states, yet many individuals have multiple chronic conditions" (Lee et al, 2007).

"In summary, osteoarthritis was remarkably consistent in its association with a 20% to 35% reduction in 5-year mortality rates in U.S. veterans when present with different combinations of chronic conditions, whereas COPD unsurprisingly increased the risk of mortality. Given that positive spillover effects of osteoarthritis on mortality have not been previously reported in the literature, further research is warranted to confirm or refute these findings and to examine possible reasons for the observed results, such as NSAID use conferring a survival benefit or a healthy lifestyle/health worker effect" (Lee et al, 2007).

Reference:

Lee TA, Pickard AS, Bartle B, Weiss KB. Osteoarthritis: a comorbid marker for longer life? Ann Epidemiol. 2007 May;17(5):380-4.

Results of a study just published links diet with osteoarthritis risk

Monounsaturated Fatty Acids (MUFA):

A study just recently published in the medical journal, Osteoarthritis Cartilage, found a link between higher intakes of monounsaturated fatty acids and bone marrow lesions. Bone marrow lesions are important in the pathogenesis of osteoarthritis (Wang et al, 2007).

What does this mean?

When I was in medical school, one type of diet gaining popularity was the Mediterranean diet (Spain, Italy, and Greece). This particular diet was of interested as people in this region were noted to have lower levels of cholesterol and a lower incidence of cardiovascular disease. People in this region consume reasonably large quantities of Olive Oil, which has a high MUFA content. Not surprisingly, there is a high content of MUFAs in this Mediterranean diet.

1. A diet high in MUFA (versus a high-carbohydrate diet) improves glycemic control in individuals with adult onset diabetes (NIDDM) who maintain body weight.
2. Individuals with elevated triglycerides or insulin levels also may benefit from a high-MUFA diet.
3. Additionally, there is epidemiological evidence that dietary MUFAs have a beneficial effect on the risk of coronary heart disease.

However, despite the numerous potential benefits of MUFAs, there is some preliminary evidence that they may have adverse effect on your joint health. However, the risk of MUFAs on bone marrow lesions is not firmly established and further studies are required.
If your health concerns include type II diabetes, coronary heart disease, or high cholesterol, you may want to discuss the Mediterranean Diet with your physician, dietitian, etc.

Wang Y, Wluka AE, Hodge AM, English DR, Giles GG, O'sullivan R, Cicuttini FM. Effect of fatty acids on bone marrow lesions and knee cartilage in healthy, middle-aged subjects without clinical knee osteoarthritis. Osteoarthritis Cartilage. 2007 Oct 13;

Risedronate for treating osteoarthritis

Risedronate for treating osteoarthritis?


Risedronate is a bisphosphonate type drug which is approved by the FDA for prevention and treatment of osteoporosis. It has been recently evaluated for the treatment of osteoarthritis.
In animal models, some studies have shown that it has decreased pain and slowed the progression of arthritis. However, results in human trials have been less promising. Perhaps further research in this area is required.

"Although risedronate (compared with placebo) did not improve signs or symptoms of OA, nor did it alter progression of OA, a reduction in the level of a marker of cartilage degradation was observed. A sustained clinically relevant improvement in signs and symptoms was observed in all treatment and placebo groups" (Bingham et al, 2006).

Bingham CO 3rd, Buckland-Wright JC, Garnero P, Cohen SB, Dougados M, Adami S, Clauw DJ, Spector TD, Pelletier JP, Raynauld JP, Strand V, Simon LS, Meyer JM, Cline GA, Beary JF. Risedronate decreases biochemical markers of cartilage degradation but does not decrease symptoms or slow radiographic progression in patients with medial compartment osteoarthritis of the knee: results of the two-year multinational knee osteoarthritis structural arthritis study. Arthritis Rheum. 2006 Nov;54(11):3494-507.

Role of raloxifene as a potent inhibitor of experimental postmenopausal polyarthritis and osteoporosis.

"In postmenopausal rheumatoid arthritis (RA), both estrogen deficiency and the inflammatory disease contribute to the development of generalized osteoporosis. Hormone replacement therapy (HRT) with estradiol preserves bone mineral density (BMD) and ameliorates arthritis, but long-term therapy is no longer an option due to significant side effects. We therefore used a mouse model of human RA to test the hypothesis that a selective estrogen receptor modulator (SERM), the raloxifene analog LY117018, could be beneficial in the treatment of both arthritis and osteoporosis" (Joschems et al, 2007).

"CONCLUSION: In a well-established model of postmenopausal RA, the raloxifene analog LY117018 potently inhibits the progression of arthritis and the associated development of osteoporosis, both in a prophylactic and in a therapeutic regimen. Since long-term HRT has been associated with significant side effects, raloxifene may be a useful adjuvant treatment for postmenopausal RA" (Joschems et al, 2007).


Jochems C, Islander U, Kallkopf A, Lagerquist M, Ohlsson C, Carlsten H.Role of raloxifene as a potent inhibitor of experimental postmenopausal polyarthritis and osteoporosis. Arthritis Rheum. 2007 Sep 28;56(10):3261-3270.

Recent study exposes longitudinal risk factors for femoral cartilage loss

 The risk factors for femoral cartilage loss in knee osteoarthritis have been described in the results of a recent study.  These include:

• female gender
• smoking (cigarettes)
• age
• severity of lower limb muscle weakness

From the study authors:

"This study provides evidence confirming that significant risk factors are associated with femoral cartilage loss and these include gender (female), age, smoking, and severity of lower limb muscle weakness. It also supports the hypothesis that femoral cartilage swelling reflected by an increased baseline cartilage volume could be a predictor of disease progression. Our findings also provide interesting clues to implement preventive measures that can possibly prevent or reduce knee cartilage loss" (Ding et al, 2007).

Reference:
Ding C, Martel-Pelletier J, Pelletier JP, Abram F, Raynauld JP, Cicuttini F, Jones G. Two-year prospective longitudinal study exploring the factors associated with change in femoral cartilage volume in a cohort largely without knee radiographic osteoarthritis. Osteoarthritis Cartilage. 2007 Sep 22

Does oral calcictonin have a role in treating knee osteoarthritis?

Calcitonin is a hormone produced by the thyroid gland which is taken by some patients to treat osteoporosis. New research suggests that calcitonin may have a condroprotective effect (Chondrocytes are cells found in cartilage) in addition to the well-established effect on bone resorption (Karsdal et al, 2006).

"By improving functional disability and by reducing levels of biomarkers that are thought to be predictive of joint space narrowing (and thus cartilage loss), oral sCT at a dose of 1 mg might be a useful pharmacologic agent in human knee OA" Manicourt et al, 2006).


*Please refer to the disclaimer text.
Karsdal MA, Tanko LB, Riis BJ, Sondergard BC, Henriksen K, Altman RD, Qvist P, Christiansen C. Calcitonin is involved in cartilage homeostasis: is calcitonin a treatment for OA? Osteoarthritis Cartilage. 2006 Jul;14(7):617-24. Epub 2006 May 12.

Manicourt DH, Azria M, Mindeholm L, Thonar EJ, Devogelaer JP. Oral salmon calcitonin reduces Lequesne's algofunctional index scores and decreases urinary and serum levels of biomarkers of joint metabolism in knee osteoarthritis. 1: Arthritis Rheum. 2006 Oct;54(10):3205-11.

Could my back or neck problem be related to OA?

Yes, it could. Vertebrae are bones, and areas between them are joints protected by cartilage disks. In addition to the problems resulting from disk erosion, osteophytes can also grow around the vertebrae in the neck or back. These can put pressure on the nerve root or other surrounding tissues (impingement on the spinal foramina), creating symptoms such as

· pain that radiates down the leg or arms (radicular pain)
· muscle spasms
· muscle atrophy
· neurological deficits

What does the doctor see on an X-ray to diagnose OA?

In a joint affected by osteoarthritis, the space where the two bones meet is abnormally narrow. This condition, known as joint space narrowing, results from the cartilage breakdown that occurs with OA. The radiologist will also look for bony outgrowths at the edges of joints (osteophytes), another characteristic of OA.

Tai chi for osteoarthritis: a systematic review.

One treatment option for osteoarthritis (OA) that many people would never even think to consider is Tai Chi. Tai Chi is an ancient Chinese martial arts form of meditation with a constant flow of energy and movement. A recent meta-analysis compared the results of various randomized controlled trials on Tai Chi for OA. Over all, some of the studies have found positive results on pain reduction and physical function. There also have been some conflicting results on its efficacy for oa. However, since Tai Chi may have many other potential benfits and poses no serious risk, it may be an option for people with OA to consider. It's estimated that over 200 million people practice Tai Chi everyday. *Please refer to disclaimer text.

"Two RCTs suggested significant pain reduction on visual analog scale or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) compared to routine treatment and an attention control program in knee OA." (Lee et al, 2007)

"In conclusion, there is some encouraging evidence suggesting that tai chi may be effective for pain control in patients with knee OA. However, the evidence is not convincing for pain reduction or improvement of physical function. Future RCTs should assess larger patient samples for longer treatment periods and use appropriate controls" (Lee et al, 2007).



Lee MS, Pittler MH, Ernst E. Tai chi for osteoarthritis: a systematic review.Clin Rheumatol. 2007 Sep 14;

Intraarticular corticosteroid for treatment of osteoarthritis of thhttp://draft.blogger.com/post-edit.g?blogID=7454461409489585192&postID=5109947534333920108e knee.

Many people who suffer from osteoarthritis of the knee consider various treatment options including intra-artcicular injections of corticosteroids or injections of corticosteroids into their knee joints. Cortiocosteroids are drugs which are used to suppress inflammation.

Patients have a choice between intra-articular injections of corticosteroids and intra-articular injections of Hyaluronic acid (HA). Note, that oral Hyaluronic acid is not comparable to intra-articular HA, much in the same way that oral corticosteroids are not used for osteoarthritis, while intra-articular injections are used instead.

"AUTHORS' CONCLUSIONS: The short-term benefit of IA corticosteroids in treatment of knee OA is well established, and few side effects have been reported. Longer term benefits have not been confirmed based on the RevMan analysis. The response to HA products appears more durable" (Bellamy et al, 2006).

"There seem to be beneficial effects on pain and patient global assessment, but little or no effect (versus placebo) on function"(Bellamy et al, 2006).


This article also suggested that while intra-articular injections of corticosteroids may have a faster onset of action, when compared to intra-articular injections of HA, however, HA injections appear to have a more durable or long-lasting response.

*Please consult your consult your physician to discuss your condition and treatment options.
Also, please refer to the disclaimer text.

Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005328.

What are some of the treatment options for osteoarthritis (OA)?

A multifaceted approach is best for maximum control over osteoarthritis. Every patient is unique and should—in conjunction with a physician—use whatever combination of treatments works best:

· patient education about OA
· exercise
· weight control
· physiotherapy
· anti-inflammatory drugs
· non-narcotic analgesics such as acetaminophen
· alternative medicines and natural remedies
· acupuncture
· local injections of glucorticoids
· surgery to relieve chronic pain in damaged joints

*Please refer to disclaimer text

Acupuncture for osteoarthritis of the knee.

Conclusions of a recent meta-analysis (Manheimer et al, 2007), "Sham-controlled trials show clinically irrelevant short-term benefits of acupuncture for treating knee osteoarthritis. Waiting list-controlled trials suggest clinically relevant benefits, some of which may be due to placebo or expectation effects."

• No serious adverse events were reported from acupuncture in this meta-analysis which invovled more than 9 individual Randomized Controlled Trials.
• The Study concluded that"current evidence from several large-scale, high-quality
  RCTs suggests that acupuncture may be an effective treatment for older patients with osteoarthritis of the knee."
• However, they also noted that it was difficult to tell how much of the benefit patients recieved from acupuncture could be attributed to the placebo effect.
• In evaluating the randomized controlled trials which they pooled in this meta-analysis, they found that one study problem was that many patients who were not randomized to receive acupuncture, actually dropped out of the studies.
• This suggests that patients who in rolled in these studies had a likely preference for recieving acupuncture treatement and would simply drop out if they were randomized to a control group.
• Either way, given the favorable safety profile of acupuncture, it may be worth considering for patienst who suffer from osteoarthritis of the knee.

*Please refer to the disclaimer text.

Manheimer E, Linde K, Lao L, Bouter LM, Berman BM. Meta-analysis: acupuncture for osteoarthritis of the knee. Ann Intern Med. 2007 Jun 19;146(12):868-77

What are the symptoms of OA?

Pain is the most frequent symptom of OA. Other common symptoms are morning stiffness in the joint, limited range of movement, and crepitus (a crackling sound or feeling) when the joint is moved.

The pain of osteoarthritis is described as a sharp ache or burning sensation that worsens with use. Pain increases as cartilage erodes and bone surfaces lose their protection. The chronic pain and stiffness leads to decreased movement, which in turn allows the muscles to atrophy and ligaments to become lax.

What is primary osteoarthritis (OA)?

Osteoarthritis is classified as primary (idiopathic) when the exact cause is unknown, and secondary if it is associated with a specific disease or condition such as diabetes. Most primary OA is related to aging. Approximately 80-90 percent of men and women have evidence of OA by the time they reach age 65.

In the vast majority of cases, OA develops silently before causing noticeable pain and stiffness. Affected individuals often do not have any symptoms until after age 50.

What causes osteoarthritis?

In OA, biochemical and metabolic changes in the body result in the breakdown of joint cartilage. Over time, the joint cartilage wears away and bony growths (osteophytes) may form at the edges of joints. The cartilage loses its ability to effectively cushion the area between the two bones, and osteophytes may press on surrounding tissue. This results in pain that may range from mild to disabling.

How do joint injuries result in OA?

Chondrocytes are cells in the joint that produce cartilage. They normally die off (apoptosis) at a rate of less than 1 percent. But within 48 hours of trauma to a joint, the cell death rate shoots up dramatically—sometimes as high as 37 percent. The dying cells stimulate the release of enzymes that destroy cartilage, which in turn can lead to arthritis.