By Karin Granstrom Jordan, M.D.
Osteoarthritis & Rheumatoid Arthritis
There are many studies confirming the excellent effect and safety of glucosamine sulfate. In one well designed study of 178 patients suffering from osteoarthritis of the knee (Qiu GX et al., 1998), one group was treated for 4 weeks with glucosamine sulfate 1500 mg daily and the other group with ibuprofen at 1200 mg per day. Glucosamine relieved the symptoms as effectively as ibuprofen, and was significantly better tolerated than ibuprofen. The safety and tolerability of glucosamine can easily be explained by the fact that it is a physiological substance normally used by the body.
As with most natural remedies the therapeutic effect of glucosamine does not come immediately, and usually takes some weeks to appear (1-8 weeks). Once achieved, it tends to persist for a notable time even after discontinuation of the treatment.
- A one-year long, double blind clinical study including 42 patients with osteoarthritis showed that chondroitin sulfate was well tolerated and significantly reduced pain and increased joint mobility. The patients were given 800 mg chondroitin sulphate per day or placebo (Uebelhart D et al., 1998).
- In another double-blind study 119 patients with finger-joint osteoarthritis were followed for 3 years. The chondroitin dosage was 400 mg three times daily. X-rays of the finger joints were carried out at the start and at yearly intervals. The number of patients that developed progression of the disease was significantly less in the group treated with chondroitin sulfate (Verbruggen G et al., 1998).
- The improvement in walking time was studied in 80 patients with osteoarthritis in the knee. In this double-blind study the treatment period was 6 months and the chondroitin sulfate dosage 400 mg twice daily. The minimum time to perform a 20 meter walk showed a constant reduction of time only in the chondroitin group. Lower consumption of pain-killing drugs and excellent tolerability was also observed (Bucsi et al., 1998).
Glucosamine alone or in combination with chondroitin sulfate is more and more becoming recognized as the treatment of choice for osteoarthritis even in the United States. Its ability to actually repair and improve joint function in addition to providing pain relief gives it a significant advantage compared to conventional treatment.
While aspirin/salicin has been shown to have a lowering effect on some of the pro-inflammatory factors, it can also increase ukotriene LTB4, which is a major inflammation promoting mediator. An interesting study (Engstrom K et al., 1997) compared the effect on pro-inflammatory substances of aspirin alone with a combination of low-dose aspirin and fish oil. The results showed that the combination of fish oil and low-dose aspirin has significantly more favorable effects on the pattern of pro-and anti-inflammatory factors than the aspirin alone. LTB4 increased 19% when aspirin was taken by itself, but decreased 69% after intake of aspirin and fish oil together.
Omega-3-oils, such as fish oil (EPA and DHA) and flax seed oil, have the ability to suppress the production of inflammatory mediators and thereby influence the course of chronic inflammatory diseases such as RA. (Kremer JM et al. 1985 and 1992).
A new enteric-coated fish-oil preparation was used in a one-year, double blind study of 78 patients with inflammatory bowel disease. The absorption rate and tolerability was high with this preparation, and after one year 59% of the fish-oil group remained in remission compared to 36% in the placebo group, indicating a significant anti-inflammatory effect (Belluzzi A et al., 1996)
In recent studies, dietary omega-3 oils have shown a suppressive effect on the production of the cytokines IL-1b and TNF-a, which stimulate the production of collagenase and pro-inflammatory prostaglandins (PGE2) (James MJ et al., 1997; Caugey GE et al., 1996). When fish oil supplementation was given to rheumatoid arthritis patients, arachidonic acid levels were reduced by 33% compared to presupplement values (Sperling RI et al., 1987), suggesting that increase of dietary omega-3 oils can be complementary in treating rheumatoid arthritis.
A large number of publications from around the world have confirmed the usefulness of dietary supplementation with omega-3 oils in relieving tender joints and morning stiffness in patients with RA, in some cases eliminating the need for NSAID medication (Kremer JM et al., 1995). Skoldstam et al. (1992) and Lau et al. (1993) found that patients consuming fish oil were able to significantly reduce their NSAID dose compared with a control group.
Of 12 published double blind and placebo-controlled studies with a duration of 12-52 weeks, decreased joint tenderness was the most common favorable outcome reported. Fish oil supplementation significantly decreased the use of NSAIDs in the three studies in which NSAIDs were used. Unlike NSAID use, fish oil consumption is not associated with gastrointestinal toxicity. The results of the studies suggest that the effective dose of fish oil is approximately 3-6 grams per day. Higher dosages did not give better results. There are indications that the combination of EPA and DHA, as it is found in fish oil, has a synergistic effect (Robinson DR et al., 1989).
A study by James MJ et al. (1997) emphasizes the potential for increased efficacy of anti-inflammatory drugs, when using omega-3 oils in the diet. It was observed that diets rich in omega-3 oils and low in omega-6 fats had a drug sparing effect with decreased side effects. Drug toxicity is estimated to contribute 60% of the total cost of treating RA patients in the United States (Prashker MJ et al., 1995). Use of omega3-oils in the diet would appear to offer a simple, safe and inexpensive way to reduce toxicity and side effects from RA medications.
We know, however, that oxidative stress or free radical damage is a factor of importance in the development of osteoarthritis, just as it is a major cause of most chronic degenerative diseases as well as aging. There is also strong evidence that oxidative damage occurs in RA patients. Increased oxidation of lipids (peroxidation) as well as depletion of ascorbate in serum and synovial fluid has been observed. High doses of vitamin E, which is a powerful antioxidant, are reported to diminish pain. Most importantly, tumor necrosis factor alpha (TNF-a), which plays a key role in RA, is well-known to cause oxidative stress.
In order to counteract free radical damage, antioxidants are needed. A diet rich in vegetables and fruits is likely to add important antioxidants to the body. This may not always be enough, however. Vitamin C and vitamin E supplements have been studied and found to be important in the treatment of osteoarthritis. Deficient vitamin C intake, which is common with elderly people, impairs the synthesis of collagen, the main protein of cartilage (Bates CJ, 1977). Studies on vitamin E have shown its ability to stimulate the production of cartilage components, such as glycosaminoglycans, as well as to inhibit the breakdown of cartilage.
Healthy food and a minimum of toxins may be more important for our health than we want to believe. The body strives to heal itself, whether it is a cut finger, a cold or a damaged or inflamed joint. It makes sense to find ways to support the body with natural substances that the body can use in the healing process.
Recent research has provided us with new insights into the mechanisms of arthritis, and left us with a scientific understanding of how natural remedies work in harmony with the body rather than against it.