There are two primary types of arthritis:
- Osteoarthritis is a degenerative joint disease in which the cartilage that covers the ends of bones in the joint deteriorates, causing pain and loss of movement as bone begins to rub against bone.
- Rheumatoid arthritis is an autoimmune disease in which the joint lining becomes inflamed as part of the body's immune system activity. Rheumatoid arthritis is one of the most serious and disabling types, affecting mostly women.
This is the most common form of arthritis and is associated with aging, obesity, and morbidity. The etiology of OA has not yet been fully elucidated, but as the result of a workshop held in 1995, some authorities on arthritis proposed the following consensus:
Osteoarthritic diseases are a result of both mechanical and biological events that destabilize the normal coupling of degradation and synthesis of articular cartilage chondrocytes and extracellular matrix, and subchondral bone...when clinically evident, osteoarthritis diseases are characterized by joint pain, tenderness, limitation of movement, crepitus, occasional effusion, and variable degrees of inflammation without systemic effects.
Currently, the most conventional medical treatment for symptomatic OA is nonsteroidal anti-inflammatory drugs (NSAID's) (e.g., ibuprofen and indomethacin) and acetaminophen. Although NSAID's may alleviate pain and reduce inflammation, the relief is only temporary and NSAID's have been associated with side effects, such as gastric irritation.
Furthermore, NSAID's may actually interfere with cartilage healing and thus facilitate the progression of OA. Acetaminophen has a better benefit-to-risk ratio than NSAID's, but it, too, treats only the symptoms without altering the disease process. It's is like putting a band aid on a wound; it doesn't help with healing process, just prevents further bleeding.
Some common prescription medications have also caused a stir in the news as of late. These too are classified as NSAID's and include Vioxx and Celebrex, among others. These are more technically known as cyclooxygenase-2 inhibitors (COX-2 inhibitors).
COX-2 inhibitors are a class of drugs which selectively inhibit COX-2, an enzyme involved in the inflammation pathway, while sparing COX-1, thereby reducing gastrointestinal toxicity. These are the newest classes of NSAID's, but have recently come under fire because of a recent study that will soon be published. Vioxx has been under scrutiny for possibly hiking the risk of heart problems.
This study is among the largest to date to analyze the safety profile of COX-2 inhibitors and will compare experimental Prexige, to two older NSAIDS. The study is expected by some to respond to the safety concerns. More information will surely be emerging over the next few months, but to me it is a no-brainer to be weary of these "safe" medications.
As of now, it appears that those at greatest risk for adverse cardiovascular reactions are those who are already predispositioned for such issues. Remember, though, many folks with OA fall into this category since, if you recall from above, overweight and obesity are linked with the onset of OA.
Given the shortcomings of the aforementioned pharmacologic interventions, alternative strategies to alleviate OA symptoms and slow progression are being explored. One such strategy is the use of the nutrition supplements glucosamine, which is a so called "chondroprotective agent" available without prescription. In addition, chondroitin and MSM are both popular alternatives for NSAID's and prescription medications.
Glucosamine is essential for the synthesis of all glycoproteins, including those in articular cartilage such as glycosaminoglycans (GAG's) and proteoglycans, which are responsible for shock absorption. Glucosamine is the rate-limiting substrate in the biosynthesis of GAG's and it plays an essential role in the synthesis of proteoglycans.
The glucosamine-dependent GAG and proteoglycan content in articular cartilage is gradually reduced in OA, hence the theoretical rationale for glucosamine supplementation. In addition to serving as a substrate for cartilage formation, some evidence suggests that glucosamine may activate chondrocytes to produce proteoglycans.
Glucosamine is available in a number of forms, such as free glucosamine, glucosamine hydrochloride (HCl), glucosamine sulfate and others. Glucosamine HCl and sulfate have both been reported to be absorbed about the same, but the majority of studies have used the sulfate form, which for me makes me feel more confident about using this form.
There are over a dozen supportive studies demonstrating that glucosamine is equal to or better than NSAID's. The results include decreased pain and improved function, which obviously would improve the quality of life.
The most common dose used in studies is 1500 mg on a daily basis. Some products recommend taking this in 3 divided doses of 500 mg each; however, recent research has demonstrated one 1500 mg dose is just as effective.
Chondroitin sulfate is known as an intact glycosaminoglycan, that's found in connective tissue. It is thought to stimulate cartilage biosynthesis and provide raw materials with no direct anti-inflammatory actions.
Like, glucosamine, there are over a dozen supportive studies with such positive results as decreased swelling and pain with movement and at rest, tenderness, and increased range of motion.
The effective dose of chondroitin is 1200 mg daily. Like glucosamine, it can be taken in divided doses throughout the day (400 mg, 3 times/day) or more conveniently in one dose, as there is supportive literature for both methods.
Last but not least, since three's a charm, MSM rounds out the list of "popular" and possibly effective joint health products. MSM is an organic form of sulfur shown to alleviate inflammation and resulting pain. Preliminary research suggests MSM might inhibit degenerative changes in arthritis.
The dosage typically recommended is 1-2g/day; however, there is much less research on MSM compared to the previous two ingredients. Research has shown, though, that MSM at least up to 2600 mg/day is safe for most adults.
There is currently a large, multicenter 5 year trial that's winding down as we speak (expected completion date in March 2005). This trial is comparing glucosamine only vs. glucosamine and chondroitin vs. chondroitin only vs. placebo vs. a prescription medication. This will be the first study to compare some of these ingredients against one another and to a prescription medication for OA and will tell us what are/is the most effective ingredients when trying to reduce the symptoms of OA.
Until then, however, it is safe to say that the three ingredients mentioned above make a sound "Joint Cocktail." Of course, always consult with your physician before taking this or any dietary supplements and never forget about the importance of weight loss, eating well and exercise for the ultimate in joint health and mobility.
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