Edited (with Introduction) by Dr. Don Rose
Other articles have discussed the benefits of a Mediterranean diet for those with a specific variant of arthritis (rheumatoid arthritis (RA), a painful disease of the joints). The article below discusses the most common form of the disease, osteoarthritis (OA) -- which, like RA, afflicts many seniors. The article also lists some supplements that may, in some cases, be helpful in preventing or mitigating OA, and provides suggestions for beneficial lifestyle changes. --D.R.
Osteoarthritis (OA), also known as degenerative arthritis or degenerative joint disease -- and sometimes referred to as "arthrosis" or "osteoarthrosis" or even "wear and tear” -- is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints. As the bone surfaces become less protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax.
OA is the most common form of arthritis. The word is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although many sufferers have little or no inflammation. OA affects nearly 21 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the population will have radiographic evidence of OA by age 65, although only 60% of those will be symptomatic (Green 2001).
There is no cure for OA, as it is impossible for the cartilage to grow back. However, if OA is caused by cartilage damage -- for example, as a result of an injury -- Autologous Chondrocyte Implantation may be a possible treatment.
Signs and symptoms
The main symptom of OA is chronic pain, causing loss of mobility and often stiffness. "Pain" is generally described as a sharp ache, or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called "crepitus") when the affected joint is moved or touched, and patients may experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Humid weather increases the pain in many patients.
OA commonly affects the hands, feet, spine, and the large weight-bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff and painful, and usually feel worse the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.
In smaller joints, such as at the fingers, hard bony enlargements may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen.
OA often affects multiple members of the same family, suggesting that there is hereditary susceptibility to this condition. A number of studies have shown that there is a greater prevalence of the disease between siblings and especially monozygotic twins, indicating a hereditary basis. Up to 60% of OA cases are thought to result from genetic factors. Researchers are also investigating the possibility of allergies, infections, or fungi as a cause.
OA may be divided into two types:
This type of OA is caused by aging. As a person ages, the water content of the cartilage decreases, and the protein composition in it degenerates, thus degenerating the cartilage through repetitive use or misuse. Inflammation can also occur, and stimulate new bone outgrowths, called "spurs" (osteophyte), to form around the joints. Sufferers find their every movement so painful and debilitating that it can also affect them emotionally and psychologically.
This type of OA is caused by other conditions or diseases, such as:
- Congenital disorders. For example:
--Congenital hip luxation.
--Abnormally-formed joints (e.g. hip dysplasia). People with such joints are more vulnerable to OA, as added stress is specifically placed on the joints whenever they move.
- Cracking joints. Some say evidence is weak that this has a connection to OA.
- Inflammatory diseases and all chronic forms of arthritis (e.g. gout and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.
- Injury to joints, as a result of an accident.
- Hormonal disorders.
- Ligamentous deterioration or instability.
- Obesity. Obesity puts added weight on the joints, especially the knees.
- Osteopetrosis (High bone density).
- Sports injuries, from exercise, athletic activity or work. For example, certain sports, such as weightlifting, running, or even football, put undue pressure on the knee joints. Injuries resulting in broken ligaments can lead to instability of the joint, and over time, wear of the cartilage and eventually osteoarthritis.
- Surgery to the joint structures.
Diagnosis is normally done through x-rays. This is possible because loss of cartilage, subchondral ("below cartilage") sclerosis, subchondral cysts, the narrowing of the joint space between adjacent bones, and bone spur formation (osteophytes) show up clearly in x-rays. Plain films, however, often do not correlate with the findings of a physical examination in the early stages of the disease.
With or without other techniques -- such as MRI (magnetic resonance imaging), arthrocentesis and arthroscopy -- a careful study of the duration, location, and character of the joint symptoms, and the appearance of the joints themselves, will help the doctor to determine whether his patient suffers from OA.
OA and Supplements
Supplements which may be useful for treating OA include:
--Antioxidants, including Vitamins C and E in both foods and supplements, provide pain relief from OA. (McAlindon TE, et al, 1996).
--Chondroitin sulphate improves symptoms of OA, and delays its progression (Poolsup N et al, 2005).
--Collagen hydrolysate (a gelatin product) may also prove beneficial in the relief of OA symptoms, as substantiated in a German study by Beuker F. et. al. and Seeligmuller et. al. In their 6-month placebo-controlled study of 100 elderly patients, the verum group showed significant improvement in joint mobility.
--Ginger (rhizome) extract - has improved knee symptoms moderately (Altman RD, 1991).
--Glucosamine: A molecule derived from glucosamine is used by the body to make some of the components of cartilage and synovial fluid. Supplemental glucosamine may improve symptoms of OA and delay its progression (Poolsup N et al, 2005). However, a recent large study suggests that glucosamine is not effective in treating OA of the knee (McAlindon et al 2004).
--Methylsulfonylmethane (MSM): A small study by Kim et al. suggested that MSM significantly reduced pain and improved physical functioning in OA patients without major adverse events (Kim et al). The authors cautioned that although this short pilot study did not address the long-term safety and usefulness of MSM, they suggest that physicians should consider its use for certain osteoarthritis patients.
--S-adenosyl methionine: small scale studies have shown it to be as effective as NSAIDs in reducing pain, although it takes about four weeks for the effect to take place.
--Selenium deficiency has been correlated with a higher risk and severity of OA, therefore selenium supplementation may reduce this risk.
--Vitamins B9 (folate) and B12 (cobalamin) taken in large doses significantly reduced OA hand pain, presumably by reducing systemic inflammation (Flynn MA 1994).
--Vitamin D deficiency has been reported in patients with OA; supplementation with Vitamin D3 is recommended for pain relief (Arabelovic, 2005).
Other nutritional changes shown to aid in the treatment of OA include elevated saturated fat intake (Wilhelmi G, 1993) and elevated body fat (Christensen R, 2005). Reducing sugar, processed foods, and fatty foods (despite the apparent contradiction) have helped many. According to Dr. John McDoughall, a low-fat vegetarian diet can reduce arthritis symptoms. A macrobiotic diet has been known to reduce symptoms as well.
Lifestyle change may be needed for effective symptomatic relief, especially for knee OA (De Filippis L, 2004). No matter what the severity, or where the OA lies, conservative measures such as weight control, appropriate rest and exercise, and the use of mechanical support devices are usually beneficial to sufferers. In the case of OA of the knees, knee braces, a cane, or a walker can be a helpful aid for walking and support. Regular exercise, if possible, in the form of walking or swimming, is encouraged.
Applying local heat before exercise, and cold packs after, can help relieve pain and inflammation, as do relaxation techniques.
Altman RD, Marcussen KC. Arthritis Rheum. 2001 Nov; 44(11):2531-8.
Arabelovic S, McAlindon TE. Curr Rheumatol Rep. 2005 Mar; 7(1):29-35.
Christensen R. Osteoarthritis Cartilage. 2005 Jan; 13(1):20-7.
Curtis CL et al. Proc Nutr Soc. 2002 Aug; 61(3):381-9.
De Filippis L et al. Reumatismo. 2004 Jul-Sep; 56(3):169-84.
Flynn MA, Irvin W, Krause G. J Am Coll Nutr. 1994 Aug; 13(4):351-6.
Green GA. Understanding NSAIDS: from aspirin to COX-2. Clin Cornerstone 2001; 3:50-59. PMID 11464731.
McAlindon T, Formica M, LaValley M, Lehmer M, Kabbara K. Effectiveness of glucosamine for symptoms of knee osteoarthritis: Results from an internet-based randomized double-blind controlled trial. Am J Med 2004; 117:643-9. PMID 15501201.
McAlindon TE, Jacques P, Zhang Y, et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum 1996; 39:648-656.
Mooney V. Spinal arthritis complete treatment guide. Spine-health.com, May 25, 2005.
Wilhemi G. Z Rheumatol. 1993 May-Jun; 52(3):174-9.
Dr. Don Rose writes books, papers and articles on computers, the Internet, AI, science and technology, and issues related to seniors.