osteoarthritis

Osteoarthritis: causes, drivers and interventions for protection

Osteoarthritis is a condition characterised by the World Health Organisation as the deterioration of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement. The degeneration and loss of cartilage can subsequently lead to alterations of the subchondral (underneath cartilage) bone. It is a reasonably common condition, 80% of adults over 50 will demonstrate some evidence of OA, which many people associated with wear and tear, as it is correlated with advancing age and excess pressure on joints.

However, it is slightly misleading to consider it a condition of wear and tear as this would suggest that the less you use your joints the less likely you are to develop osteoarthritis, this is not the case as sedentary lifestyle is a risk factor for the development of the condition. This blog will highlight the cause and drivers of osteoarthritis with interventions for protection against and support for those with this debilitating condition.1

Skip to Key Takeaways

Osteoarthritis is divided into two categories: primary and secondary.

Primary – is the form more associated with wear and tear and aging, this degeneration process tends to occur at the age of 50-60, with no predisposing abnormalities. These changes are due to cumulative effects of decades of use leading to stress on the collagen matrix of cartilage. This damage causes the release of enzymes which destroy collagen components. On top of that, as we age our ability to synthesise and restore normal collagen structure decreases.1

Secondary – as the name suggests means that OA occurs in association with a predisposing factor that has caused degenerative changes. These include.

  • Congenital abnormalities, such as hypermobility and abnormal joint structure
  • Trauma (Joint injury but also includes obesity and surgeries)
  • Crystal deposition (e.g., uric acid in gout)
  • Prescence of abnormal cartilage (genetic)
  • Inflammation (especially previous inflammatory disease such as rheumatoid arthritis)

Interventions to Support Osteoarthritis:

Repair of collagen matrix and regeneration of connective tissue cells

Cartilage is made up of specialised cells known as chondrocytes, these produce an extracellular matrix made up of collagen, proteoglycans, and elastin. This matrix acts as shock absorber in the joint, to take strain off the end of the bone and help prevent wear and tear on the cartilage itself. Therefore, supporting this matrix and regenerating chondrocytes is essential for supporting joint health.

Collagen – Collagen type II is a major component of the extracellular matrix of hyaline cartilage and its synthesis and catabolism is regulated by chondrocytes (cells found in cartilage connective tissue).2

Collagen type II fibres: the main structural component of cartilage, providing structure, firmness, and resistance to compression – account for 60% of cartilage. Studies have demonstrated that the supplementation of specific collagen peptides in young adults with functional knee problems led to a statistically significant improvement of activity-related joint pain. For more information on collagen, its different forms and functions within the joint see our blog.

Vitamin C– vitamin C is essential to produce collagen, it is a cofactor in the binding, cross-linking, and folding of collagen to provide its unique structure. Several in vitro studies have shown that vitamin C has an anabolic effect on cartilage. A threefold reduction in the risk of OA progression was found in the middle and highest tertials of vitamin C intake. Additionally, there is evidence that vitamin C is useful for pain relief particularly of the musculoskeletal system, and vitamin C deficiency is associated with higher incidence of pain. Accumulating evidence indicates that vitamin C can exhibit analgesic properties in some clinical conditions, thus potentially mitigating suffering and improving patient quality of life.3

Glycosaminoglycans (GAGs): mainly consist of two building blocks – aggrecan (a large proteoglycan containing chondroitin sulphate) and hyaluronic acid, both essential components for maintaining a cushioned and lubricated joint environment, allowing for easy joint movement – this accounts for approximately 40% of the cartilage.

Hyaluronic Acid – is another GAG in joints which provide a structural framework and allows cartilage to hold water. By the age of 70, hyaluronic acid contents has dropped by 80% leading to loss of connective tissue integrity, there by affecting joint health.

Glucosamine – composed of a glucose and an amine molecule it has been shown to stimulate the production of glycosaminoglycans (GAGs), which give the shock absorbing capabilities of cartilage. It also promotes the incorporation of sulphur into cartilage. Studies show that the ability to manufacture glucosamine declines with age, therefore cartilage loses its shock-absorbing and gel-like functions, affecting the health of the joint and contributing to the progression of OA. Studies have shown reduced pain and improved quality of life in patients with OA.4

MSM – contains high levels of sulphur which are important for maintaining normal connective tissue. MSM has also been demonstrated to have anti-inflammatory activities, chemoprotective properties, prostacyclin (PGI2) synthesis inhibition, anti-atherosclerotic action, salutary effect on eicosanoid metabolism, and free radical scavenging activity. In a pilot study MSM (3 g twice a day) improved symptoms of pain and physical function during the short intervention without major adverse events.5

Bridge the nutrition gap

Other nutrients including vitamins A, D and E, B6, zinc, copper and boron are all essential for collagen production. A deficiency in any one of these nutrients will contribute to accelerated joint degeneration. Therefore, it is recommended to use a multi vitamin and mineral to ensure optimal intake of all nutrients.1

Reduce inflammation

Inflammation plays a major role in osteoarthritis by contributing to both joint pain and degradation of the joint, therefore interventions to reduce inflammation are essential for supporting wellbeing of OA patients.

Boswellia – is an Ayruvedic herb with anti-inflammatory properties. These anti-inflammatory effects have been investigated for their benefits in osteoarthritis (OA), and it appears that oral Boswellia supplements can suppress pain and immobility associated with OA quite significantly with the effects taking as little as a week to occur. (Examine.com). as well as reducing inflammation it is thought that Boswellia’s mechanism of action on joints also includes the prevention of GAG degradation and improved blood supply to joint tissues.1

Proteolytic enzymes – taken away from food, to simply prevent the breakdown of dietary protein, has been shown to reduce inflammatory markers including IL-6 and CRP5. Studies performed with bromelain (a proteolytic enzyme from pineapple) demonstrated as reduction in pain, swelling and joint stiffness in OA patients.

Celadrin – Celadrin® is a patented combination of fatty acids which beneficially enhance the integrity of cell membranes in the body thus, subduing the inflammatory process and reducing pain. Hence Celadrin® is considered an aid to joint mobility and flexibility. It has high affinity for small joints, such as fingers. It is a combination of plant based fatty acids including cetyl myristoleate, cetyl palmiotoleate, cethy laureate, cetyl palmitate and cetyl oleate. Evidence shows that these fatty acids stabilise and enhance the integrity of cell membrane and therefore halts the production of inflamamtory compounds. It has also been shown to reduce the production of inflammatory markers including IL-6. It has been shown to improve knee range of motion, flexion and overall joint function in OA patients compared with placebo.1 Celadrin can be used orally and/or topically.

Other interventions to reduce inflammation include:

  • Reducing foods high in omega 6 – e.g., farmed meats, dairy products and vegetable oils (such as sunflower and corn oils). These are high in the omega 6 fat Arachidonic acid or Linoleic Acid (precursor to arachidonic acid). Arachidonic acid can be converted to the pro-inflammatory prostaglandin PGE
  • Increasing sources of omega 3 from e.g., oily fish and flax, chia seeds and/or a supplement containing EPA. EPA is found in oily fish or can be supplemented; alpha linolenic acid is found in flax and chia seeds and dark leafy green vegetables and can be converted to EPA by the body. EPA is converted into anti-inflammatory prostaglandins.
  • The ratio of omega 6 to 3 is very important, most people are consuming too high a level of omega 6 to 3 and therefore are often producing excess amounts of pro-inflammatory prostaglandins.
  • Curcumin – found in turmeric, has been shown to inhibit Cox-2 enzymes which produce inflammatory prostaglandins.
  • Obtaining good levels of vegetables (6-8 per day) including dark leafy greens high in anti-inflammatory phytonutrients and antioxidants.
  • Vitamin E has been shown to supress inflammatory markers (IL-6, TNFα and NO) and down regulate the transcription factor NF-kB. Sources of Vitamin E are avocados, almonds, green vegetables, and olives.

Achievement of normal body weight

It is very important to consider body weight in OA patients as obesity is a driver of trauma to joints, placing excess stress and therefore accelerating degeneration of cartilage. This blog will not discuss weight loos in full details, but it is important to consider blood sugar regulation but limiting refined carbohydrates and including lean protein, healthy fat in fibre in meals to improve insulin sensitivity, which can aid maintenance of normal weight.  See our blog for more information with regards to weight loss strategies.

Non-Nutritional Interventions

Exercise 

Lack of exercise decreases the hydration of joint cartilage and decreases muscle strength placing further strain on joints. Pain for OA reduced movement and exercise is reduced, this inactivity can lead to weight gain, exacerbating the vicious cycle. Additionally, strengthening muscles around the joint is important for joint stability and reducing excess stress that may be placed on joints. Exercises which strengthen muscles around the joint but are not significantly weight bearing are recommended such as swimming and isometrics.

Running has for a long time been associated with deterioration of the knee joint leading to osteoarthritis, however now there is conflicting evidence and there is potential that emerging evidence suggests that running has a positive effect on joint health.8

Backward walking

One form of exercise which has gained much attention is backward walking – Backward walking (BW) is a counter sequential exercise and is a common method of rehabilitation training and disease-assisted treatment. Studies have shown that BW has a helpful effect on improving lower limb proprioception, gait synergy and improving limb balance. Many studies have concluded that BW can improve the symptoms of patients with knee osteoarthritis (KOA) and can be used for rehabilitation and adjunctive treatment of KOA, however the paper also states more evidence is needed.9 

One thing is certain, is that keeping active whilst ensuring that joints are used optimally, without abnormal structural issues is essential for maintaining the health of the joint and protecting against and improving symptoms of OA.

Topical Analgesics 

Topical applications can be very useful for relieving and pain/or localised inflammation. Topical products with most evidence for OA relief include capsaicin and as well as topical forms of Celadrin®, see above.

Manual therapies

Other therapies which have been shown to help support pian, motion and recovery in OA patients and could be considered as an adjunct to nutrition and exercise include1

  • Acupuncture
  • Magnetic therapiesRelaxation Techniques

Protocol for acute OA

  • Anti-inflammatory diet (as above)
  • CytoProtect Joints 2 capsules per day
  • MSM 1 per day
  • Glucosamine Hydrochloride 3 per day
  • Celadrin 2 per day
  • Multi vitamin and mineral, CoQ10 Multi
  • Gentle muscle building exercise
  • Therapies discussed above as preferred

Protocol for long-term joint maintenance

  • Anti-inflammatory diet (as above)
  • Multi vitamin and mineral, CoQ10 Multi
  • CytoProtect Joints 2 capsules per day
  • Celadrin 2 per day
  • 2 x Organic vitamin C
  • Gentle muscle building exercise
  • Therapies discussed above as preferred

Glossary

  • Chondrocytes – Cartilage-forming cells. chromosome. Pairs of structures within cells made of DNA. confluent monolayer. An unbroken layer of cells, one cell thick.
  • Cartilage – a firm, elastic, flexible type of connective tissue of a translucent whitish or yellowish colour; gristle.
  • Collagen – A natural protein that forms connective tissue and provides strength, resilience, and support to the skin, ligaments, tendons, bones, and other parts of the body.
  • Proteoglycans – composed of multiple glycosaminoglycans attached to a core protein. These core proteins are sometimes attached to a hyaluronic acid molecule.
  • Isometrics – a system of physical exercises in which muscles are caused to act against each other or against a fixed object.

Key Takeaways

  • Osteoarthritis is caused by a degeneration of cartilage in joints leading to pain and reduces functionality.
  • Risk factors for osteoarthritis include age, injury/trauma, obesity, abnormal joint structure, genetic abnormalities to cartilage and age.
  • Interventions for osteoarthritis include supporting collagen production, reducing inflammation, normalising body weight, and strengthening surrounding muscles to stabilise joint.
  • Cartilage production can be supported with Type 2 collagen hyaluronic acid, glucosamine, vitamin C and ensuring there are optimum levels of all nutrients including vitamin A, D, E, B6, zinc and copper.
  • Exercise is essential for preventing cartilage degradation and providing muscle strength. Although excess weight bearing exercise should be done with caution and not when there are joint injuries or abnormalities. Swimming, cycling and backwards walking have shown to be effective for OA patients.
  • Other therapies such as magnetic therapy, acupuncture and relaxation techniques have also been shown to be helpful for OA patients.

If you have questions regarding the topics that have been raised, or any other health matters, please do contact me (Helen) by phone or email at any time.

helen@cytoplan.co.uk
01684 310099

Amanda Williams and the Cytoplan Editorial Team


References 

  1. Pizzorno JE, Murray MT. Textbook of Natural Medicine 4th Ed. 2013. Elsevier
  2. Zdzieblik D, Oesser S, Gollhofer A, König D. Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides. Appl Physiol Nutr Metab. 2017;42(6):588-595. doi:10.1139/apnm-2016-0390
  3. Carr AC, McCall C. The role of vitamin C in the treatment of pain: new insights. J Transl Med. 2017;15(1):77. Published 2017 Apr 14. doi:10.1186/s12967-017-1179-7
  4. Ogata T, Ideno Y, Akai M, et al. Effects of glucosamine in patients with osteoarthritis of the knee: a systematic review and meta-analysis. Clin Rheumatol. 2018;37(9):2479-2487. doi:10.1007/s10067-018-4106-2
  5. Kim LS, Axelrod LJ, Howard P, Buratovich N, Waters RF. Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. Osteoarthritis Cartilage. 2006 Mar;14(3):286-94. doi: 10.1016/j.joca.2005.10.003. Epub 2005 Nov 23. PMID: 16309928.
  6. Marie-Eve Paradis, Patrick Couture, Iris Gigleux, Johanne Marin, Marie-Claude Vohl, Benoît Lamarche. (2015) ‘Impact of systemic enzyme supplementation on low-grade inflammation in humans’, PharmaNutrition. Volume 3, Issue 3. Pages 83-88
  7. Brien S, Lewith G, Walker A, Hicks SM, Middleton D. Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evid Based Complement Alternat Med. 2004;1(3):251-257. doi:10.1093/ecam/neh035
  8. Timmins KA, Leech RD, Batt ME, Edwards KL. Running and Knee Osteoarthritis: A Systematic Review and Meta-analysis. Am J Sports Med. 2017 May;45(6):1447-1457. doi: 10.1177/0363546516657531. Epub 2016 Aug 20. PMID: 27519678.
  9. Wu Y, Lei C, Huangfu Z, Sunzi K, Yang C. Effect of backward walking training on knee osteoarthritis: protocol of a systematic review and meta-analysis. BMJ Open. 2020;10(10):e040726. Published 2020 Oct 31. doi:10.1136/bmjopen-2020-040726

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17 thoughts on “Osteoarthritis: causes, drivers and interventions for protection

  1. Please would you send on your price list and catalogue.
    Thank you – (by post if possible to new address).

  2. My husband – healthy 83 year old- had just told me he’d slept badly because of ongoing shoulder and knee joint pain, and there was your article in my inbox! Wonderful synchronicity! I struggle to get him to take tablets but give him magnesium, 50+, Glutathione, Vit C and D plus a healthy organic diet with olive oil and coconut oil . He suffers with severe constipation so I give him dandelion root tincture and hawthorn and ashawagandha for his heart( high BP). He’s reasonably active but could do more – we walk in the hills here in N Wales several times a week , weather permitting. Of the supplement you mention, which would be the most effective and could I replace any or the ones I give him? He doesn’t take any pharmaceutical drugs, accept the occasional paracetamol , because of unpleasant and dangerous side effects ( like rubber knees causing him to fall over – from Blood pressure tablets etc!) many thanks. A very comprehensive and well researched , and clearly explained article. Thank you .

    1. Hi Charmain – the supplements your husband is taking are all good – if you want to drop off anything then glutathione does not need to be taken every day. I would recommend celadrin and glucosamine capsules for his joint pains and they will begin to work within a couple of weeks. I would go for 2 of each daily for two weeks and then reduce to 1 daily of each once the pain has reduced.

  3. Thank you, very informative, I can see I have been doing some things wrongly, however I can’t afford a lot of expensive supplements.

  4. Another excellent, informative and well researched article – thank you! Wish their was just one nutrient pill from those recommended!

  5. Is this OA: pain & stiffness above my patella on left side? It is worse in my left leg especially when both legs are stiff in the morning.
    I’m 76 & very active, biking, table tennis, sailing.
    Thanks
    Lynne
    lsjaboard@gmail.com

    1. Hi Lynne – It is almost impossible to be diagnostic in something like this without examination. It is possible it is arthritis, but unless this joint has had more wear and tear than our other joints, it would be unusual for it to occur only in one joint. It is great you are so active and that will help your joints stay mobile. But as we age the ability of the body to repair wear and tear begins to wane and this is when conditions like arthritis set in. Please can I advise you to go to your Dr who will be able to tell you if the problem you are experiencing is arthritis or if in fact it is something else. Once you know this please do come back and we can make recommendations as to supplements that can help with the problem.

    2. I would suggest from your symptoms it’s tight quads. If stretching the quads isn’t easing it then it may be the soft tissue of the lower leg has become stuck and is restricting the quad from free movement.

      You would be better to consult a professional bodyworker, physio etc for a proper examination of the exact cause(s) and suggested programme to free things up again.

  6. Interesting article, thanks for bringing all the constituent parts together in one place.
    I would add another contributor to the primary phase. We constantly work our muscles but rarely stretch them back out again to regain their normal/ natural length.
    People expect to stretch after anything that they perceive as exercise, but rarely recognise sitting at a desk 8 hours a day (and possibly an hour each morning and evening to get to that desk), plus another couple of hours sitting watching TV, reading, or using a laptop or tablet or phone, as exercise.

    Sustained poor posture – especially that we adopt to maintain these activities – probably cause as much trauma to muscles as accidents, injuries, operations and other causes together.

    These shortened muscles then pull the relevant joins into a closer contact than is natural, leaving insufficient space for synovial fluid etc to maintain a good lubricating presence.

    Combined with the poor hydration levels of the average person, this leads to a significant deterioration in joints generally, delivering us at the door of the cartilage breakdown phase.

    Having specialised in treating pain and mobility problems for some 14 years now, I truly believe that if we were taught correct hydration and stretching techniques from school age we would suffer very few of the effects we call ‘old age’.

    Throw in decent nutrition advice and we would be into our 50s and 60s before we had many problems (barring accident and natural illness of course).

    Thanks again for a thought-provoking article.

    1. Hi Natalia – I cannot tell which supplement you are referring to sorry. But broadly, the same protocol as helps with osteoarthritis will help with rheumatoid arthritis. The same inflammation and joint degradation are present. However because RA is an autoimmune condition it is usually helpful to also address diet and factors that help modulate overaction of the immune system. If you want individual help please complete a health questionnaire, available on our website under Nutrition Advice and we can help you directly.

  7. A really excellent article. But could you do one on Rheumatoid Arthritis please? Are the supplements the same or different?

  8. I was surprised not to see selenium (Se) mentioned in your article here. Se is required in proper amounts for cartilage homestasis and deficiency is long known to hinder the growth and development of cartilage as well as bone. Everybody rushes to prescribe chondrotin or glucosamine but given the known levels of Se in soils are generally depleting globally due to bad agricultural practices, shouldn’t we be considering Se as our chief go-to nutrient in cases of OA?

    1. Hi Maeve – Yes, we agree that it would be good to have discussed selenium in this article. We do use it within protocols for osteoarthritis and appreciate the depletion of selenium in soils. The main function is through redox homeostasis, which wasn’t discussed in this article therefore we will look at this for further articles, and always advise ensuring there are optimum levels of nutrients as a base. Thanks, Helen

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