It’s well-known that obesity can cause or exacerbate osteoarthritis (OA) through excessive mechanical loading. But another mechanism through which obesity can affect joint health is via inflammation and we now know that our gut microbes play a crucial role.
Recent research by Schott et al. has looked into the link between obesity, gut microbes and OA. They found a difference between the types of gut bacteria in obese mice compared to lean mice. The obese mice had more pro-inflammatory and fewer anti-inflammatory species than lean mice. The imbalance led to accelerated knee OA due to systemic inflammation and macrophage migration to the synovium. Interestingly, they found that oligofructose, a non-digestible prebiotic fibre, can help restore a normal lean gut microbiota in obese mice. The restoration of lean gut microbes was “associated with reduced inflammation in the colon, circulation and knee and protection from OA”.
Obviously one could wonder whether these findings apply to humans. About a year ago Dai et al. published the results of long-term studies on around 6000 people. Their findings consistently showed that higher total fibre intake was related to a lower risk of getting symptoms of knee OA!
A group of researchers from McGill University looked at the effects of yoga on people with arthritis. Their findings were published in The Journal of Rheumatology. 75 sedentary adults with either rheumatoid arthritis or knee osteoarthritis and with a mean age of 52 years were randomly assigned to a yoga group or a waiting list. The yoga group took part in two 60 min classes and one home practice each week for 8 weeks duration. Yoga poses were modified to suit individual requirements.
Significant improvements were noted in physical, pain, general health, vitality, and mental health scales with most benefits still evident 9 months later. The researchers conclude that this new evidence suggests yoga may help sedentary individuals with arthritis safely increase physical activity, and improve physical and psychological health.
Most of us have us have used paracetamol at some point in our lives, whether to bring down a fever, for a headache, joint pain or some other painful condition. In fact, if we have a look in our medicine cabinets we’ll probably find a box…or two! Machado et al. from George Institute for Global Health at the University of Sydney recently reviewed the scientific literature with the aim of investigating the efficacy and safety of paracetamol (acetaminophen) in the management of spinal pain and osteoarthritis of the hip or knee. They included 13 randomised controlled trials in their review and the results were published in the BMJ.
They found that for low back pain, paracetamol was ineffective at reducing pain or disability and at improving quality of life. It’s important to point out that by “ineffective”, they mean that paracetamol did not provide more benefit than a placebo. For hip and knee osteoarthritis they found that there was a significant, although not clinically important, effect on pain and disability in the short term. Adverse events were not more likely with paracetamol than placebo but patients taking paracetamol are 4 times more likely to have abnormal results on liver function tests.
Although the clinical importance of the last finding is uncertain, paracetamol has been linked to increasing incidence of mortality, increased risk of cardiovascular, gastrointestinal and renal disease. This study has prompted the BMJ to release an editorial discussing the use of paracetamol for back pain and osteoarthritis. One of the problems for GPs is that the National Institute for Clinical Excellence (NICE) recommends paracetamol as the first port of call for low back pain and arthritis. Taking this option away leaves NSAIDS and opioids which both present even more health risks… Non-pharmalogical options should be pursued and developed i.e. physical activity and exercise, weight loss, nutritional supplements and physiotherapy of course!
It’s well known that increasing the time spent doing moderate intensity physical activities has wide ranging benefits on health. Guidelines recommend 150 minutes a week of moderate to vigorous physical activity. What about those unable to engage in moderate or vigorous physical activities due to health issues? Could light physical activity work too?
A study by professor Dunlop et al. looked at the effects of physical activity in people with knee osteoarthritis or risk factors for knee osteoarthritis. As well as finding benefits to moderate activity, they found that spending more time doing light intensity physical activities reduced the risk of onset and progression of disability due to osteoarthritis. They concluded that “an increase in daily physical activity time may reduce the risk of disability, even if the intensity of that additional activity is not increased.”
In a recent study published in Annals of the Rheumatic Diseases and reported in Medical News Today, Sara Kelly and colleagues from the Arthritis Research UK Pain Centre at The University of Nottingham have discovered a new way to possibly decrease the chronic pain affecting people with osteoarthritis. They studied a protein receptor called TRPV1 which is present in the synovial membranes of joints. These receptors are responsive to pain. Injecting TRPV1 agonists directly into the joint produced pain relieving effects.
The study was performed on rats so before being used on humans the results will need to be replicated in clinical trials and monitored for potential side effects.
Until then the best self-help advice for those with osteoarthritis is weight loss (if it affects joints in the lower limbs), stretching & strengthening exercises and maintaining moderate levels of activity. Nutritional supplements can also help (see related articles here).
Osteoarthritis (OA) is a common source of joint pain, stiffness and swelling. It’s a leading cause of chronic disability and affects about 8 million people in the UK and 27 million in the US. OA leads to the gradual degeneration or wear and tear of joint surfaces and is often the cause of knee and hip replacements. Can nutritional supplements prevent or slow down the process? In my opinion, supplements can be separated into 2 groups: those that decrease inflammation and those that promote the regeneration of joint surfaces. I’d like to focus on the latter.
For quite a while, glucosamine, chondroitin and methylsufonylmethane (MSM) have been used to treat osteoarthritis.
Glucosamine contains glycosaminoglycans which are a major component of joint cartilage. The glucosamine that is available commercially is derived from the exoskeleton of shellfish. Although inconsistent results have been reported, in 2009, a team at the University of Aberdeen led by C Black reviewed the literature on the clinical effectiveness of glucosamine in slowing or arresting the progression of OA of the knee. Only trials that met stringent criteria were used. They found that there were ‘statistically significant improvements in joint space loss, pain and function for glucosamine sulphate and in 2 studies the need for knee arthroplasty (replacement) was reduced from 14.5% to 6.3% at 8 years follow-up’ . Another study found ‘a 50 % reduction in the incidence of osteoarthritis-related surgery of the lower limbs during a 5-year period’. In 2007 a the WHO Collaborating Center for Public Health Aspect of Osteoarticular Disorders at the University of Liege conducted a review of published studies that concluded that ‘glucosamine sulphate (but not glucosamine hydrochloride) and chondroitin sulphate have small-to-moderate symptomatic efficacy in OA, although this is still debated. With respect to the structure-modifying effect, there is compelling evidence that glucosamine sulphate and chondroitin sulphate may interfere with progression of OA’ . In other words, there is compelling evidence that glucosamine sulphate and chondroitin sulphate prevent joint space narrowing by promoting the regeneration of articular cartilage. Almost all trials have found the safety of glucosamine sulphate and chondroitin sulphate to be equal to placebo.
Chondroitin is also a glycosaminoglycan and a component of joint cartilage. Commercial chondroitin is derived from the cartilage of cows, pigs, shark, fish or birds. See above for results of research.
MSM occurs naturally in many primitive plants and in many foods and beverages. The mechanism of its action is uncertain but sulphur is thought to play a part. A literature review of MSM in the treatment of OA by a team at the University of Southampton showed that there was ‘positive but not definitive evidence that MSM is superior to placebo in the treatment of mild to moderate OA of the knee’. Last year an Israeli team led by EM Debbi published a study showing that, after taking MSM for 12 weeks, there was a small improvement in pain and physical function in patients with radiographic confirmed knee OA.
Recently ESM Technologies has funded research on the benefits of eggshell membranes. The eggshell membrane is just underneath the shell and surrounds the egg white. It’s interesting to note that in general, commercially funded trials show larger effects than industry independent trials.
Eggshell membrane or Natural Eggshell Membrane (NEM) as it is also known contains glucosamine, chondroitin and hyaluronic acid (also a glycosaminoglycan found in joints). In 2009, two papers were published (Journal of Clinical Interventions in Aging and Clinical Rheumatology) on the use of eggshell membrane to treat joint and connective tissue disorders. Both studies were led by Kevin Ruff and sponsored by ESM Technologies. The results were extremely encouraging and showed statistically significant improvements in pain, stiffness and flexibility. The positive results may be due to better bioavailability of joint sustaining compounds from eggshell membranes or possibly to researcher bias due to vested interests. This year, a study by the same author looked into the safety of NEM and concluded that it was safe for human consumption. Hopefully this will lead to independent research to look at the efficacy of NEM supplementation for joint disorders.
As we can see, there are several nutritional supplements that can aid the regeneration of joints. Here are the recommended daily dosages:
- Glucosamine Sulphate 1500 mg/day
- Chondroitin Sulphate 1200 mg/day
- NEM 500 mg/day