Osteoarthritis

Osteoarthritis – Symptoms, Causes & Treatment

Osteoarthritis is a degenerative joint disease characterised by degradation of both the cartilage and the sub-chondral bone in the joint.  In is a chronic disease that affects many individuals in Perth and Australia wide.

The smooth cartilage surface becomes pitted and irregular, and the joint becomes painful and stiff. The tendons, muscles and ligaments holding the joint become weaker, and eventually the joint may become deformed.

Commonly affected joints include the distal interphalangeal joints of the hands, the first carpometacarpal joint, the hips, the knees, the first metatarsophalangeal joint and the cervical and lumbar spine.

Osteoarthritis is the most common joint disorder and is caused by ageing, poor diet and lifestyle choices, environmental impacts and wear and tear on the joint. Symptoms rarely develop before the age of 40 but affect nearly everyone over the age of 70. As many as 90% of individuals over the age of 40 show degenerative changes radiographically, although not all of these individuals have symptoms.

Causes of Osteoarthritis

• Primary: a normal result of ageing caused by wear and tear on the joint
• Secondary: due to trauma, mechanical problems, septic arthritis, poor detoxification, long term bowel dysbiosis, previous inflammatory disorders, hemophilia, congenital bone and joint disorders etc.

Risk factors

• Increasing age
• Environmental impacts
• Obesity
• Excessive or repetitive high-impact exercise or sport
• Jobs that involve kneeling, squatting for more than an hour a day
• Sedentary lifestyle
• Acidic diet
• Bowel toxicity
• Previous trauma to joint
• History of inflammatory joint disease

Signs and symptoms of Osteoarthritis

• Stiffness: early morning, after activity and after rest; often the first symptom
• Localised pain in joint < initial movement, by end of the day, after use, cold and damp, > rest, warmth
• Decreased range of motion
• Weakness in the joint
• Crepitus
• Local tenderness and swelling
• Bony overgrowth (osteophytes)
• Bone deformity (Bouchard‘s or Heberden‘s nodes)

Differential diagnosis

• Rheumatoid arthritis
• Gout
• Polymyalgia rheumatica
• SLE (Lupus)
• Viral polyarthritis
• Ankylosing spondylitis
• Psoriatic arthritis
• Fibromyalgia
• Reiter‘s syndrome (autoimmune condition triggered by infection)

TREATMENT STRATEGY

• Relieve pain and inflammation
• Reduce oxidative damage
• Support joint integrity and repair
• Improve joint mobility and strength
• Remove any obstacles to joint health
  • Excess weight
  • Sedentary lifestyle
  • Nutritional Deficiency
  • Pro-inflammatory diet
  • Poor posture
  • High impact exercise

Diet plan guidelines for Osteoarthritis

• Minimise pro-inflammatory, acid-forming foods: sugar, refined carbohydrates, trans fats, excessive commercially produced red meat, omega-6 fatty acids, caffeine and alcohol
• Emphasise anti-inflammatory foods: in cold-water oily fish, berries, nuts and seeds, turmeric, ginger, green tea, olive oil
• Emphasise antioxidant-rich foods to promote tissue repair: berries, green tea, turmeric, fruits and vegetables
• Balance fatty acid intake: increased consumption of omega-3 fatty acids and decreased consumption of omega-6 fatty acids can improve symptoms and reduce NSAID use
• Extra-virgin olive oil: shown to be anti-inflammatory in arthritis due to the constituent oleocanthal, which possesses similar properties to ibuprofen
• Reduce red meat and soft drink intake: contain phosphorus which pulls calcium from bones which can be deposited around joints. Vegetarian diet has much better P:Ca ratio and has been shown to have much lower incidence of OA
• Green juices and smoothies to increase alkalinity of tissues
• Reduce nightshade vegetables: alkaloids in nightshades may inhibit collagen repair or promote inflammatory degeneration in sensitive individuals
• Weight loss diet: essential in overweight or obese clients. Excess weight places an increased burden on weight-bearing joints and increased adipose tissue is associated with increased circulating inflammatory mediators.

Supplements that support Osteoarthritis

      Supplements that reduce pain and inflammation in Osteoarthritis

• High dose Omega-3 EFAs up to 5 day:
  • Equivalent to 9-14 standard 1000 mg fish oil capsules
  • Fish oil supplements need to be taken for at least 2-3 months before an effect will be noticed as it takes a period of time for inflammatory pathways to be modified.
• Curcumin daily between meals: must be in a bioavailable form – may be enhanced with piperine, or as a complex with phospholipids
  • Ginger
  • Bioflavonoids
  • Bromelain
  • MSM (organic sulphur compound)
  • SAMe
    • Shown to exhibit analgesic and anti-inflammatory properties in lab and animal studies; favourable results when used to ameliorate the symptoms of OA. May need up to a month of continual usage for benefits to show.  Also beneficial in supporting the methylation pathway and acts as a natural antidepressant.
  • Avocado-soybean unsaponifiables (ASU)
    • A natural vegetable extract made from 1/3 avocado oil and 2/3 soybean oil and studied extensively in Europe where it is routinely used to treat OA
    • Studies show that ASU inhibits production of inflammatory cytokines, inhibits the breakdown of cartilage, stimulates collagen synthesis, improves symptoms of OA and reduces or eliminates the use of NSAIDs
    • In a 3-month study of 260 people, aged 45 to 80 years, who had osteoarthritis of the knee, ASU was shown to yield significant improvements compared to placebo (Apelboom et al, 2001)
    • A meta-analysis of randomised controlled trials found that 300 mg ASU for at least 3 months was positively associated with improvement in symptoms compared to placebo (Christensen et al, 2007)
    • The French government has tracked the use of ASU for over 15 years with no adverse results and ASU is a suitable alternative than using NSAID’s.
  • Green tea extracts
    • Studies have shown that compounds found in green tea, including epigallocatechin gallate (EGCG), inhibit the expression of inflammatory cytokines in arthritic joints. Additional studies have found that EGCG from green tea inhibits both IL-1B and the inflammatory cytokines COX-2 and nitric oxide synthase-2 (Ahmed et al, 2002 & 2005)
    • Overall, laboratory studies have found that EGCG is non-toxic and that green tea consumption was effective at preventing osteoarthritis and may benefit patients by reducing inflammation and slowing the breakdown of cartilage.

Repair cartilage and connective tissue

• Glucosamine sulphate and chondroitin sulphate – natural component of proteoglycans, the building blocks of cartilage, and thought to increase their synthesis when taken orally. Glucosamine and chondroitin are more effective taken together for osteoarthritis than either substance taken alone.
  • Hyaluronic acid – found in synovial fluid and forms the backbone of proteoglycans
  • Vitamin C and bioflavonoids
  • Vitamin D3 – deficiency is linked to OA

Herbal considerations

• Anti-inflammatory/ anti-rheumatic –  devil‘s claw, boswellia, black cohosh, cat‘s claw, turmeric, nettle leaf, ginger, feverfew
• Analgesic – California poppy, Jamaica dogwood, willow bark, capsaicin (topical)
• Alkalising – celery seed, meadowsweet, dandelion leaf, alfalfa
• Detoxify – nettle leaf, burdock, yellow dock, celery seed, dandelion
• Circulatory stimulants – prickly ash, cayenne, ginkgo
• Topical applications – capsaicin cream, emu oil etc.

Lifestyle / Physical measures

• Low impact exercise (e.g. swimming, cycling, yoga, tai chi): to stretch and relax muscles surrounding osteoarthritic joints as well as strength training for the same muscle groups
• Avoidance of high-impact exercise and sport
• Bodywork: chiropractic, physiotherapy etc
• Acupuncture
• Avoidance of aspirin and NSAIDs: inhibit cartilage repair
• Weight reduction if necessary

Functional Medicine Treatment of Osteoarthritis

The above nutritional, supplemental, herbal and lifestyle interventions may assist in the support of osteoarthritis.  To gain a deeper level of healing and repair it is necessary to assess and correct any imbalances with the gut, methylation cycle and detoxification pathways. 

We have experience with osteoarthritis patients and often find that the majority have complications with digestion, gut dysbiosis and blocks in their methylation and folate pathways.    Addressing these underlying body systems is vital in the long term treatment and management of osteoarthritis. 

Much of the inflammation created in a patient with osteoarthritis can stem from the complications and imbalances within the gastrointestinal tract while detoxification pathways are often impaired where there are imbalances with the folate and methionine pathways in the body. 

Those with the MTHFR genetic polymorphism have a 30-50 % increase in having impaired pathways.  These variations in turn decrease and limit the patients detoxification processes contributing to osteoarthritis and other inflammatory conditions.

If you or a family member are suffering from Osteoarthritis we would love to hear from you.  What treatments have worked the best for the management of your symptoms?  Have you tested and addressed gut imbalances and significantly improved? 

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