Natural Treatments for Osteoarthritis
By Marcus Laux ND.
Osteoarthritis is the most prevalent form of arthritis in the U.S., according to the Arthritis Foundation. One-third of all American adults have X-ray evidence of osteoarthritis of the hand, foot, knee, or hip. Osteoarthritis is responsible for more than 7 million physician visits per year and is second only to cardiovascular disease as the cause of chronic disability in adults. As Baby Boomers age, the number of people suffering from osteoarthritis is expected to rapidly increase in the next 10 years.2 While osteoarthritis research has led to the development of promising new prescription and over-the-counter medications aimed at reducing pain, none has created the excitement of glucosamine sulfate, which actually addresses the underlying joint destruction.5
What Is Osteoarthritis?
Osteoarthritis is a complex, metabolic disorder of the cartilage and bones of certain joints.1,4 However, to fully understand how osteoarthritis develops, we need to understand how joints work.
A joint is formed when two or more bones are brought together and held in place by muscles and tendons. Some joints have very little range of movement, such as the joints of the ribs, while others have much more range of movement. Hips, knees, elbows, wrists, and thumbs are termed synovial joints, and have the greatest range of movement and mobility of human joints. To allow such mobility, synovial joints have a unique structure.11
The bones that form synovial joints are covered with cartilage. Tough fibrous tissue encloses the area between the bone ends and is called the joint capsule. The joint cavity within the capsule is lined with an inner membrane, called the synovial membrane. The membrane secretes synovial fluid, a thick, slippery fluid that fills the small space around and between the two bones. This fluid contains many substances that lubricate the joint and ease movement.4,11
The cartilage of synovial joints serves two very important functions. First, it provides a remarkably smooth weight-bearing surface; synovial joints move easily. Secondly, synovial cartilage serves as a shock absorber, providing a soft, flexible foundation. Healthy cartilage absorbs the force of the energy, transmits the load to the bone, and distributes the mechanical stress created by joint movement.4,11
Synovial joints function under almost continual mechanical stress. A joint's ability to withstand or resist this stress is a reflection of its health. When the mechanical stress is too great or the joint's ability to resist this stress is compromised, physical changes occur in the cartilage covering the bones.4,11
Cartilage is a tough, elastic tissue, comprised mostly of water, collagen, and complex proteins called proteoglycans.12 In osteoarthritis, the cartilage starts to weaken, becomes frayed, and eventually breaks down. This exposes the bones of the joint, which then rub together. A gritty feeling and grinding sound may occur when an osteoarthritic joint is bent and flexed. As osteoarthritis progresses, bits of bone and cartilage often break off and float inside the joint space. The bones may enlarge, causing the joint to lose its normal shape. Tiny bone spurs may grow on the joints' sides and edges. These physical changes in the diseased joint are responsible for progressive damage and continual pain.4,13
People with osteoarthritis most frequently describe their pain as deep and aching. The pain not only is felt in the affected joint but may also be present in the surrounding and supporting muscles.3 Joint inflammation also may occur, increasing the already considerable discomfort.1,4 Joint stiffness is another unfortunate component of osteoarthritis. Exercising the joint most often results in increased pain; however, stiffness tends to follow periods of inactivity.4 Humid weather often makes all osteoarthritis symptoms worse.3 As the disease progresses, the pain may occur even when the joint is at rest, creating sleepless nights and miserable days.3,4
Osteoarthritis' exact cause remains unknown. Researchers know aging doesn't appear to cause osteoarthritis. Cartilage in people with the disease show many destructive changes not seen in older persons without the disease.1,4,13 However, certain conditions do seem to trigger osteoarthritis or make it worse.
Some families seem to have a lot of osteoarthritis, pointing to a genetic factor. This is most commonly seen in people who have osteoarthritis of the hands.4 Repeated trauma can contribute to osteoarthritis, too. Athletes, extremely active people, and individuals who have physically demanding jobs often develop the disease. Persons who have certain bone disorders are more prone to osteoarthritis due to the continuous, uneven stress in their hips and knees.4,13
Obesity also is a risk factor for the disease. In overweight women, osteoarthritis of the knee is fairly common.13 Excess pounds also may have a direct metabolic effect on cartilage beyond the effects of increased joint stress 14,15 Obese people also often have more dense bones. Research has shown dense bones may provide less shock-absorbing function than thinner bones, allowing more direct trauma to the cartilage.16
While there is currently no sure way to prevent osteoarthritis or slow its progression, some lifestyle changes may reduce or delay symptoms. The Arthritis Foundation states that maintaining a healthy weight, losing weight if needed, and regular exercise are effective osteoarthritis prevention measures.1
Optimal calcium intake in younger years is vital to ensure a healthy aging skeletal system.17-19 Vitamins A, C, D, and E have been studied for their role in osteoarthritis prevention. These vitamins also have shown benefit in individuals who have osteoarthritis.20-22
The goal of treatment is to reduce or relieve pain, maintain or improve movement, and minimize any potential permanent disability.4 Typically, non steroidal anti-inflammatory druGlucosamine Sulfate or NSAIDs (pronounced n-sayds) such as aspirin and ibuprofen are used for pain and inflammation relief. These medications are effective in treating only the pain of osteoarthritis.3
These medications have many side effects, some of which are serious. NSAID induced gastrointestinal complications cause more than 100,000 hospitalizations and nearly 16,500 deaths annually in the U.S.23 Aspirin can cause an extremely annoying and continual ringing in the ears. NSAIDs frequently cause damage to the stomach lining, which can produce uncomfortable heartburn and abdominal pain. Continued NSAID use may lead to the development of stomach ulcers. NSAID related ulcers can perforate the stomach lining and cause life-threatening bleeding.3 Most NSAIDs also interfere with blood clotting and may cause kidney damage. When older persons take NSAIDs, dizziness, drowsiness, memory loss, and decreased attention span may occur.3
Acetaminophen (Tylenol® and similar medications) is similar to aspirin and other NSAIDs in its pain-relief abilities. However, acetaminophen doesn't reduce inflammation. 24 And while acetaminophen doesn't have the same side effects of aspirin and other NSAIDs, if large doses are taken, liver damage can occur.23
Newer medications called COX-2 inhibitors provide both pain relief and reduce inflammation without the many side effects of acetaminophen, aspirin, and other NSAIDs.25,26 More recent research has indicated that, in certain situations, COX-2 inhibitors also can cause stomach lining damage and bleeding.27,28 While aspirin, NSAIDs, and COX-2 inhibitors may reduce osteoarthritis pain, they do nothing to stop or slow down cartilage deterioration. In other words, these medications have no effect on the disease itself.24
That is why many believe glucosamine sulfate and chondroitin sulfate are preferable to pain relievers and anti inflammatory medications in osteoarthritis treatment: they actually improve synovial joint health.12 And they do this without potentially life-threatening side effects.
Glucosamine Sulfate and Chondroitin Sulfate
Glucosamine Sulfate improves the health of joints affected by osteoarthritis. This supplement is so effective that even physicians who mostly rely on conventional medications routinely recommend it to their patients with osteoarthritis. In fact, Glucosamine Sulfate is so good at treating osteoarthritis, many physicians use it for their own osteoarthritic joints.29
There is even more good news. When glucosamine sulfate is combined with low molecular weight Chondroitin Sulfate, even greater benefits can be achieved. Glucosamine Sulfate and Chondroitin Sulfate are naturally occurring compounds found in human joints.6,7 The right Glucosamine Sulfate/Chondroitin Sulfate combination actually reverses damage in joints affected by osteoarthritis, in turn significantly reducing pain and stiffness.8-10
Glucosamine occurs naturally in the body and is found in synovial fluid. Glucosamine is a basic building block for proteoglycan, one of the important compounds of synovial cartilage.5,30,31 It also is required for the formation of lubricants and protective agents for the joints.30
In Europe, Glucosamine Sulfate and Chondroitin Sulfate have been used to treat osteoarthritis for more than 10 years. While persons with arthritis felt much better when they took Glucosamine Sulfate and Chondroitin Sulfate, no one really knew how these compounds worked. When European and American researchers first started to study glucosamine, they discovered Glucosamine Sulfate can reduce synovial joint inflammation. This explains why people felt better after taking it.
Additional study of Glucosamine Sulfate and Chondroitin Sulfate
As the scientific study of Glucosamine Sulfate progressed, researchers determined it can stimulate the growth of cartilage cells,32 inhibit proteoglycan breakdown, and rebuild cartilage damaged from osteoarthritis. 5,30,31 In other words, Glucosamine Sulfate does not simply make persons with osteoarthritis feel better; Glucosamine Sulfate actually makes persons with osteoarthritis get better.
Glucosamine Sulfate is the form of glucosamine used in research. It's the sulfate salt of glucosamine and breaks down into glucosamine and sulfate ions in the body.32 The sulfate part of Glucosamine Sulfate plays an important role in proteoglycan synthesis.30
Chondroitin Sulfate also provides cartilage strength and resilience.9 Chondroitin Sulfate is an important component of the cartilage proteoglycan of synovial joints. Because Chondroitin Sulfate helps the production of proteoglycans, researchers believe Chondroitin Sulfate works in a similar nature to Glucosamine Sulfate.9,10
Glucosamine Sulfate and Chondroitin Sulfate, Benefits in Taking Them Together?
Research has discovered Glucosamine Sulfate and Chondroitin Sulfate act synergistically (work well together) in improving joint health. Several studies have investigated this action 32-37 and it's recommended that Glucosamine Sulfate and Chondroitin Sulfate be taken together. However, low molecular weight chondroitin sulfate (Chondroitin Sulfate) is the preferred Chondroitin Sulfate form, and the form that has shown the most promise in studies.
Importance of Low Molecular Weight Chondroitin Sulfate
When Chondroitin Sulfate was first studied, it was given to six healthy volunteers, six patients with rheumatoid arthritis, and six patients with osteoarthritis. Researchers then measured the levels of Chondroitin Sulfate in all study subjects. They found no evidence of Chondroitin Sulfate in any of the subjects.38 This single study led many physicians and scientists to believe Chondroitin Sulfate can't be absorbed, and was not an effective natural treatment.
However, several other studies in healthy volunteers have reported Chondroitin Sulfate can be absorbed.39-43 The distinct difference for these find in Glucosamine Sulfate is thought to be associated with the types of Chondroitin Sulfate used in the studies. Some forms are much more absorbable than others. This was demonstrated in a recent study using Chondroitin Sulfate with lower molecular weight. A higher absorption is observed for low-molecular weight Chondroitin Sulfate.43
This means Chondroitin Sulfate products with a low molecular weight may be better absorbed, allowing the Chondroitin Sulfate to get into the bloodstream and the synovial fluid of joints where it's needed.
Several vitamins, minerals, enzymes, and natural supplements have benefits for individuals with osteoarthritis. Proteolytic enzymes effectively offer relief of the pain, stiffness, and swelling of osteoarthritis.
Folic acid and vitamin B12 can reduce the number of tender joints and increase joint mobility.43 Vitamins C, D, and E not only may prevent osteoarthritis, but inhibit the disease's progression.22,44 Niacinamide improves joint function, range of motion, and muscle strength.45 Clinical studies using the herb Boswellia serrata have yielded good results in osteoarthritis.46
Application of ointments on osteoarthritic joints may be helpful in reducing pain and stiffness. Menthol-based preparations can provide soothing relief to painful joints. Capsaicin ointments and gel made from cayenne pepper also are very beneficial. When applied to the skin, capsaicin first stimulates, then blocks, nerve fibers that transmit pain messages. Capsaicin depletes nerve fibers of a neurotransmitter called substance P. This neurotransmitter transmits pain messages and activates inflammation in osteoarthritis. Capsaicin ointment is very effective in relieving osteoarthritis pain in many individuals.47,48
Is there anything else I can do for joint pain and stiffness?
When osteoarthritis occurs in the hands, use of a paraffin dip can be very comforting.1 A licensed health care practitioner can provide information about how to safely use paraffin dips at home.
Exercise is an excellent way to keep joints mobile, decrease pain, and increase body strength, too. Water aerobi-Chondroitin Sulfate also can reduce the pressure and stress on joints.49,50
The Arthritis Foundation strongly suggests making movement an integral part of your life. When you're in less pain and have more energy, more range-of motion, and a better outlook on life, you'll reduce stress and be a much healthier person despite your osteoarthritis.
One important last thought
When we don't feel well, we sometimes have a tendency to self-diagnose. If you haven't been evaluated by a licensed health care practitioner for your joint pain and stiffness, you need to do so. These symptoms may be caused by other illnesses and may require much different treatment. Only a licensed health care practitioner can provide a certain diagnosis of osteoarthritis.
Osteoarthritis may be a part of life for many of us as we age; however, constant pain and stiffness need not be. Glucosamine Sulfate combined with absorbable Chondroitin Sulfate can actually improve damage in joints affected by osteoarthritis and significantly reduce pain and stiffness. And it can be an empowering way to improve your health.
1. Arthritis Foundation. Osteoarthritis. Available at: www.arthritis.org/answers/diseasecenter/oa.html Accessed June 26, 2001.
2. Buckwalter JA, Stanish WD, Rosier RN, et al. The increasing need for nonoperative treatment of patients with osteoarthritis. Clinical Orthop. 2001;345:36-45.
3. McCaffery M, Pasero C. Pain characteristiChondroitin Sulfate: osteoarthritis. In: Pain: Clinical Manual. 2nd ed. St. Louis, Mo: Mosby, 1999: 523-524.
4. Bancroft DA, Pigg JS. Osteoarthritis syndromes. In: Porth CM. Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998: 1133-1138.
5. Gaby AR. Natural treatments for osteoarthritis. Alternative Medicine Review. 1999;4:330-441.
6. Uebelhart D, Thonar EJ, Zhang J, Williams JM. Protective effect of exogenous chondrotin 4,6-sulfate in the acute degradation of articular cartilage in the rabbit. Osteoarthritis Cartilage. 1998;6:6-13.
7. Leeb BF, Schweitzer H, Montag K, Smolen JS. A meta-analysis of chondroitin sulfate in the treatment of osteoarthritis. Journal of Rheumatology. 2000;27:205-211.
8. Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clinical North Am. 1999 May;25(2):379-95.
9. McAlindon TE, LaVallery MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: A systematic quality assessment and meta-analysis. JAMA. 2000;283:1469-1475.
10. Kelly Glucosamine Sulfate. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint. Alternative Medicine Review. 1998;3:27-39.
11. Siedel HM, Ball JW, Dains JE, Benedict GW. Classification of joints. In: Mosby's Guide to Physical Examination. 4th ed. St. Louis, Mo: Mosby, 1999: 695.
12. McCarty MF. Enhanced synovial production of hyaluronic acid may explain rapid clinical response to high-dose glucosamine in osteoarthritis. Medical Hypotheses 1998;50,507-510.
13. National Institutes of Health. Osteoarthritis. Available at: www.nih.gov/niams/healthinfo/osteoarthritis/osteohandout_breaks.html. Accessed July 3, 2001.
14. Millward-Sadler SJ, Wright MO, Lee H, Caldwell H, Nuki G, Salter DM. Altered electrophysiological responses to mechanical stimulation and abnormal signaling through alpha5beta1 integrin in chondrocytes from osteoarthritic cartilage. Osteoarthritis Cartilage. 2000;8:272-278.
15. Martin JA, Scherb MB, Lembke LA, Buckwalter JA. Damage control mechanisms in articular cartilage: the role of the insulin-like growth factor I axis. Iowa Orthop J. 2000;20:1-210.
16. Antoniades L, MacGregor AJ, Matson M, Spector TD. A cotwin control study of the relationship between hip osteoarthritis and bone mineral density. Arthritis Rheum. 2000;43:1450-1455.
17. Heaney RP, Gallagher JC, Johnston CC, Neer R, Parfitt AM, Whedon GD. Calcium nutrition and bone health in the elderly. American Journal of Clinical Nutrition. 1982;36:986-1013.
18. Optimal calcium intake. NIH Concerns Statement. 1994;12:1-31.
19. Tranquilli AL, Lucino E, Garzetti GG, Romanini C. Calcium, phosphorus and magnesium intakes correlate with bone mineral content in postmenopausal women. Gynecology Endocrinol. 1994;8:55-58.
20. Tiku ML, Shah R, Allison GT. Evidence linking chondrocyte lipid peroxidation to cartilage matrix protein degradation. Possible role in cartilage aging and the pathogenesis of osteoarthritis. Journal of Biological Chemistry. 2000;275:20069-20076.
21. Sowers M, Lachance L. Vitamins and arthritis. The roles of vitamins A, C, D, and E. Rheum Dis Clinical North Am. 1999;25:315-332.
22. McAlindon TE, Jacques P, Zhang Y, et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996;39:648-656.
23. Graumlich JF. Preventing gastrointestinal complications of NSAIDs. Risk factors, recent advances, and latest strategies. Postgrad Medicine 2001 May;109(5):117-20, 123-8. Complete article available online at: www.postgradmed.com/issues /2001/05_01/graumlich.htm.
24. Lehne RA. Acetaminophen. In: Pharmacology for Nursing Care. 3rd ed. Philadelphia, Pa: W.B. Saunders; 1998: 705-706.
25. Ballinger A, Smith G. COX-2 inhibitors vs. NSAIDs in gastrointestinal damage and prevention. Expert Opin Pharmacother. 2001;2:31-40.
26. Goldstein JL, Correa P, Zhao WW, et al. Reduced incidence of gastroduodenal ulcers with celecoxib, a novel cyclooxygenase-2 inhibitor, compared to naproxen in patients with arthritis. American Journal of Gastroenterology. 2001;96:1019-1027.
27. Colville-Nash PR, Gilroy DW. Potential adverse effects of cyclooxygenase-2 inhibition: evidence from animal models of inflammation. BioDruGlucosamine Sulfate. 2001;15:1-9.
28. Laudanno OM, Cesolari JA, Esnarriaga J, et al. Gastrointestinal damage induced by celcecoxib and rofecoxib in rats. Digestive Disease Science. 2001;46:779-784.
29. Frank E, Bendich A, Denniston M. Use of vitamin-mineral supplements by female physicians in the United States. American Journal of Clinical Nutrition. 2000;72:969-975.
30. Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clinical North Am. 1999 May;25(2): 379-95.
31. Glucosamine sulfate. Monograph. Alternative Medicine Review. 1999;4:193-195.
32. Bassleer C, Rovati L, Franchimont P. Stimulation of proteoglycan production by glucosamine sulfate in chondrocytes isolated from human osteoarthritic articular cartilage in vitro. Osteoarthritis Cartilage. 1998;6:427-434.
33. Setnikar I. Antireactive properties of chondroprotective druGlucosamine Sulfate. International Journal of Tiss Reac. 1992;14:253-261.
34. Lippiello L, Woodward J, Karpman R, Hammad TA. In vivo chondroprotection and metabolic synergy of glucosamine and chondroitin sulfate. Chinese Orthop. 2000;381:229-240. Abstract.
35. Canapp SO Jr, McLaighlin RM Jr, Hoskinson JJ et al. Scintigraphic evaluation of doGlucosamine Sulfate with acute synovitis after treatment with glucosamine hydrochloride and chondroitin sulfate. American Vet Research. 1999;60:1552-1557. Abstract.
36. Johnson KA, Hulse DA, Hart RC, et al. Effects of an orally administered mixture of chondroitin sulfate, glucosamine hydrochloride and manganese ascorbate on synovial fluid chondroitin sulfate 3B3 and 7D4 epitope in a canine cruciate ligament transection model of osteoarthritis. Osteoarthritis Cartilage. 2001;9:14-21. Abstract.
37. Shankland WE. The effects of glucosamine and chondroitin sulfate on osteoarthritis of TMJ: A preliminary report of 50 patients. Cranio. 1998;16:230-235.
38. Das A Jr, Hammad TA. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage. 2000;8:343-350.
39. Baici A, Horler D, Moser B, et al. Analysis of glycosaminoglycans in human serum after oral administration of chondroitin sulfate. Rheumatol Int. 1992;12:81-88.
40. Conte A, de Bernardi M, Palmieri L, et al. Metabolic fate of exogenous chondroitin sulfate in man. Arzneim Forsch. 1991;41:768-772.
41. Ronca G, Conte A. Metabolic fate of partially depolymerized shark chondroitin sulfate in man. International Journal of Clinical Pharmacological Research. 1993;13(suppl):27-34.
42. Ronca F, Palmieri L, Panicucci P, Ronca G. Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis Cartilage. 1998;6(suppl):14-21.
43. Adebowale AO, Cox DS, Liang Z, et al. Analysis of glucosamine and chondroitin sulfate content in marketed products and the Caco-2 permeability of chondroitin sulfate raw materials. JAMA. 2000;3:37-44.
44. Crolle G. D'Este E. Glucosamine sulphate for the management of arthrosis: a controlled clinical investigation. Curr Medical Research Opin. 1980;7:104-109.
45. Jonas WB, Rapoza CP, Blair WF. The effect of niacinamide on osteoarthritis: a pilot study. Inflamm Research. 1996;45:330-334.
46. Kulkarni RR, Patki PS, Jog VP, Gandage SG, Patwardhan B. Treatment of osteoarthritis with herbomineral formulation: a double-blind, placebo-controlled, cross-over study. Journal of Ethno-pharmacology. 1991;33:91-95.
47. McCarthy GM, McCarty DJ. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. Journal of Rheumatology. 1992;19:604-607.
48. McCleane G. The analgesic efficacy of topical capsaicin is enhanced by glyceryl trinitrate in painful osteoarthritis: a randomized, double blind, placebo controlled study. European Journal of Pain. 2000;4:355-360.
49. Felson DT, Lawrence RC, Hochberg MC. Osteoarthritis: new insights. Part 2: treatment approaches. Annual International Medicine. 2000; 7:726-37.
50. Halbert J, Crotty M, Weller D, Ahern M, Silagy C. Primary care-based physical activity programs: effectiveness in sedentary older patients with osteoarthritis symptoms. Arthritis Rheum. 2001;45:228-34.
Author Marcus Laux is a licensed naturopathic medical doctor.
Joint Pain Relief
Arthritis inflammation, joint pain relief treatments and exercises.