(Research article)
Osteoarthritis treatments
Conventional medicine does not yet have a proven
treatment to stop or slow the progression of osteoarthritis.
The nutritional supplements, glucosamine and chondroitin
sulfate, have emerged as a treatment alternative for
some patients suffering from osteoarthritis pain.
Perhaps the most important aspect of glucosamine and chondroitin sulfate
supplements is that they are thought to help slow or prevent the degeneration
of joint cartilage, the underlying cause of osteoarthritis pain. Glucosamine
and chondroitin sulfate dietary supplements may also help alleviate existing
joint pain. Presently, it is thought that unlike many medications available
to treat arthritis pain and inflammation, glucosamine and chondroitin
sulfate supplements have very few side effects.
However, glucosamine and chondroitin sulfate nutritional supplements
do not offer the desired pain relief for all osteoarthritis patients.
At the time of this article, the benefits and risks of taking glucosamine
and chondroitin sulfate have not been definitively proven, and long term
studies are needed to better understand their effects.
Osteoarthritis – a degenerative joint condition
Osteoarthritis occurs when the cartilage on the ends of the joints wears down
and the exposed bones rub together. This degenerative process causes excess
friction in the joints, which leads to loss of motion, stiffness and joint
pain. Osteoarthritis is more common among middle-aged and older individuals.
Symptoms can range from mild to very severe pain in the back, neck, hands,
hips, knees and/or feet. When degenerative osteoarthritis occurs in the back,
it is usually referred to as facet joint osteoarthritis (because it
affects the facet joints in the spine). When occurring in the neck, it is
usually called cervical osteoarthritis.
Glucosamine and chondroitin sulfate dietary supplements
Glucosamine and chondroitin sulfate are naturally found in connective tissues
in the human body, such as those covering the ends of bones in the joints.
Glucosamine is extracted from animal tissues such as crab, lobster or shrimp
shells, while chondroitin sulfate is found in animal cartilage such as tracheas
or shark cartilage (1). They are commonly taken as dietary supplements (also
known as nutritional supplements).
Glucosamine and chondroitin sulfate are believed to impact the cartilage
degeneration process of osteoarthritis in the following ways:
-
Glucosamine sulfate is thought to help with
cartilage formation and repair (1). Some laboratory
tests show that glucosamine sulfate may help protect
joint cartilage by limiting breakdown and helping
to build up levels of cartilage (2). Glucosamine
hydrochloride, another form of glucosamine, is considered
to be equally effective as the sulfate form. It is
absorbed more easily by the body and can be taken
in lower dosages with the same effectiveness as glucosamine
sulfate.
-
Chondroitin sulfate is part of a protein
molecule that helps give cartilage its elastic
properties and is thought to have an anti-inflammatory
effect, which can help to reduce the painful swelling
in the joints that occurs when the exposed bones
in the joint rub together (3). In addition, chondroitin
sulfate may also help slow the breakdown of cartilage
and help restore cartilage growth to better cushion
the joints (2).
Combining nutritional supplements with other treatments
Glucosamine and chondroitin sulfate may not provide sufficient pain relief
for all osteoarthritis patients. Many patients find it is best to use glucosamine
and chondroitin sulfate nutritional supplements in conjunction with other
conservative treatments (under the guidance of their treating physician),
such as:
-
Pain medication that has anti-inflammatory
properties, such as ibuprofen, COX-2 inhibitors,
naproxen and other non-steroidal anti-inflammatory
drugs (NSAIDs). Acetaminophen may also be helpful
for relief of joint pain associated with osteoarthritis.
Taking glucosamine and chondroitin sulfate nutritional
supplements may reduce some patients’ need
for anti-inflammatory or pain medications, while
others may continue to take other medications for
pain relief. However, patients taking daily aspirin
therapy should avoid taking chondroitin sulfate
supplements, as it may contribute to bleeding.
-
Gentle stretching exercises can help maintain
flexibility and range of motion as well as reduce
stiffness in the muscles and joints. Engaging in
gentle physical activity may also help maintain
overall back health even after a flare-up of osteoarthritis
pain is relieved.
-
Water therapy (specific exercises performed
in a pool) can help patients with severe osteoarthritis
pain. Pool therapy allows the joints to be unweighted
by the water, which may be less painful than other
types of exercise. Another gentle form of exercise
is using an elliptical machine or a stationary
exercise bike, which provide forms of aerobic
exercise that are low-impact on the joints.
-
Traction for cervical osteoarthritis and/or
manual manipulations (e.g. chiropractic or
osteopathic) can help to control the chronic
pain and other symptoms of osteoarthritis, as
well as provide relief from severe episodes of
pain. Patients considering traction should always
work with a physician to ensure correct and safe
use of the traction devices, as improper application
of traction can be detrimental.
Additional non-medical approaches (e.g. acupuncture, yoga or Tai Chi,
instrument assisted soft tissue techniques such as Active Release Technique
(ART), Graston Technique (GT), muscle energy techniques, proprioceptive
neuromuscular rehabilitation (PNF), Nimmo method, massage and others)
may also be effective for some patients. Sometimes rest or weight loss
may be recommended for certain patients in order to reduce stress on
the joints. Some patients may also require a short period of rest and
medication to reduce joint inflammation before they begin to exercise.
The proper course of treatment will differ for each patient and should
be supervised by a health professional.
Surgery for osteoarthritis
In rare cases, spine fusion surgery may be required to treat severe osteoarthritis
pain. However, fusion surgery is generally not optimal, because osteoarthritis
usually affects multiple vertebral levels, and multilevel fusions are generally
not advisable.
References:
-
Arthritis Foundation. “Alternative therapies:
glucosamine and chondroitin sulfate.” 2004. http://www.arthritis.org/conditions/alttherapies/Glucosamine.asp#Whatare.
-
Deal, C.L.: “Neutraceuticals as Therapeutic
Agents in Osteoarthritis.” Rheumatic Disease
Clinics of North America. 1999: 379-395.
-
National
Institutes of Health. National Center for Complimentary
and Alternative Medicine. “Questions
and Answers: NIH Glucosamine/Chondroitin Arthritis
Intervention Trial (GAIT).” 2004. http://nccam.nih.gov/news/19972000/121100/qa.htm.
|
|
