First Do No Harm…

One of the most difficult elements of being a physician is caring for someone in pain while having nothing to offer.  We are compelled at least to attempt to provide something palliative, when there is no cure.  But, we must all recognize our goals, and as with any intervention, heed the risks.  We all welcomed Vioxx when it hit the market as the next and best pain reliever.  And for those suffering with the daily draining discomfort and disability of osteoarthritis, Vioxx seemed to be a godsend.  Well, now we know different.  Here it seems the unfortunate risks outweigh the benefits.  Vioxx is clearly out, but where does that leave us?

If you are one of the many who suffer from osteoarthritis this question is surely on your mind.  Osteoarthritis is the most common type of the many forms of arthritis, affecting millions of Americans.  It represents a complex response of our joint tissues to aging and environmental and genetic factors.  It used to be that doctors and patients accepted stiff, painful joints as an inevitable consequence of aging.  And, because osteoarthritis was considered unavoidable, medical intervention focused primarily on relieving pain with nonsteroidal anti-inflammatory medications and steroid injections. That thinking has changed.  It is now understood that the risk and burden of osteoarthritis can be reduced by dietary and other lifestyle changes including all those good things that seem to be generally enhancing for one’s health: exercise, weight control, mind-body techniques that reduce mental and muscular tension, and even a few dietary and nutritional supplements.

Obesity, recently elevated to a major risk factor for coronary heart disease, also causes osteoarthritis.  In fact, though it may appear obvious that weight bearing joints would be damaged by the burden of excess pounds, remarkably not just these joints are more prone to developing arthritis in overweight people.  All joints are affected, implying a systemic effect of obesity as well.  Fortunately this effect is reversible.  And better yet even small amounts of weight loss convey large benefits.  In the Framingham Knee Osteoarthritis Cohort Study, people who lost just 10 pounds or more over ten years cut their risk of osteoarthritis of the knee in half.

Regular exercise, a great weight loss tool, also independently helps stop development or progression of osteoarthritis.  This occurs as a consequence of various physiological changes that follow exercising any joint:  joint fluid production is increased, joint strength is enhanced, pain is lessened and overall joint function has even been shown to be maximized.  Though you might intuitively believe that exercising an already arthritic joint would be bad, the opposite is true.  Exercise improves the damaged joint by stabilizing and strengthening it.  So, if you have not yet been exercising regularly, don’t be intimidated. Just start with whatever you can do easily. Get help if you need it. Just do it!

When it comes to symptom relief there is more good news.  Unbeknownst to many, there is and has been for some time, an alternative to those nonsteroidal anti-inflammatory drugs (NSAIDs).  NSAIDs which can cause stomach pain, kidney damage, and paradoxically, may also inhibit cartilage repair and accelerate cartilage destruction, need not be the mainstay of your treatment. Studies dating back twenty years have been touting the benefits of glucosamine sulfate – a natural product found in the human body.  Glucosamine sulfate exists in the body to build and maintain cartilage, tendons, and other connective tissues while inhibiting the growth of cartilage-destroying enzymes.  Osteoarthritis is the result, in part, of a short supply of glucosamine in our joints, resulting in severe pain and swelling in the joints, and loss of flexibility in the limbs.  The best news is that the benefits of this natural remedy go well beyond symptom relief.  On January 21, 2001 MSNBC reported the conclusions of what the prestigious and quite conservative Lancet medical journal found with respect to use of glucosamine sulfate in treating osteoarthritis.  In no uncertain terms the Lancet article reported, “Previous studies had indicated glucosamine could dull the pain of arthritis, but experts say the latest study shows for the first time that it can improve structure in the joints.”  Studies have shown that oral supplements of glucosamine sulfate are readily absorbed and can lead to stimulation of healthy new cartilage and other protective molecules.  Studies have also shown that this benefit came without any toxicity, contraindications, or other harmful side effects.

Glucosamine should be taken every day.  It is a slow acting supplement that may take up to three months to show its full benefits. Dosage is 1,500 mg per day.  It is best taken with several other components that have been shown to be important in cartilage synthesis and repair.  Chondroitin sulfate also exists naturally in our cartilage and has a synergistic effect when used in combination with glucosamine to treat osteoarthritis and promote overall joint health and resilience.  Enteric coated chondroitin sulfate has been suggested to be most beneficial as it is better absorbed by our bodies.  Several essential vitamins and minerals are important for their role in synthesis and repair of cartilage: Vitamins E and C, Pantethine (Vit B5), Vitamin A and B6, Zinc, and Copper.  Omega-3 fatty acids from fish oils are yet another helpful component:  an excess consumption of omega-6 as compared to omega-3 fats predisposes to inflammation, while supplementing omega-3 fats has been shown to actually diminish inflammation.

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