Easing the Ache of Arthritis

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), arthritis may be caused by inflammation of the tissue lining the joints. “The medical community has not definitively linked arthritis to any particular gene or nutritional deficiency, and the exact cause, to this day, is very debatable,” said Justin Marsh, director of marketing and CEO, Arthur Andrew Medical. “The disease encompasses a variety of conditions that may trigger an immune response and, in turn, inflame the joints.”

Some signs of inflammation include redness, heat, pain and swelling. Joints, the places where two bones meet, can become severely damaged by unrestrained inflammation over time. Arthritis commonly occurs in the hands, knees and shoulders. There are several types of arthritis, although the two most common ones are osteoarthritis and rheumatoid arthritis.

Osteoarthritis usually comes with age and most often affects the fingers, knees and hips. “Osteoarthritis, commonly known as ‘wear and tear arthritis,’ typically develops by over-use of the cartilage and, therefore, usually occurs with increasing age,” explained Frank Schonlau, director of scientific communication, Horphag. He added women are more commonly affected than men. Risk factors for osteoarthritis include obesity, as it increases the workload of articular cartilage, and hereditary factors that may render the cartilage less resistant to mechanical stress. Osteoarthritis can follow an injury to a joint in cases such as car accidents or sports. Years after the joint has apparently healed, the person may develop arthritis.

According to NIAMS, rheumatoid arthritis occurs when “the body’s own defense system doesn’t work properly: it affects joints and bones (often of the hands and feet), and may also affect internal organs and systems.”

Because arthritis is such a common ailment, there are a number of over-the-counter (OTC) and prescription drugs on the market. However, for those who are leery of taking such medications, there are many topical and internal natural products that can provide relief and support joint health.

Strong Framework

Calcium and vitamin D have shown to be effective in boosting and maintaining bone health, which goes hand in hand with healthy joints. “Calcium and vitamin D are definitely important factors in joint health, because bones provide the structural framework for the joint,” explained Micah Osborne, president, Membrel LLC. “When this structure begins to break down, you lose the normal spacing between two bones, thus increasing the frictional forces and pressure put on the supporting cartilage and ligaments. As the bone continues to deteriorate, osteophytes form, which can cause soft tissue irritation, inflammation and further cartilage injury.” One popular method for obtaining these important minerals is from eggshells, such as Membrell’s BoneHealth ESC (eggshell calcium) which delivers not only calcium and vitamin D, but magnesium as well.

In an 18-month study, researchers found a daily calcium supplement (555 mg/d) boosted bone mineral content (BMC) in teenage girls with low habitual calcium intake (n=96).¹ Compared with the control group, the supplemented group showed significantly greater gains in BMC over the intervention.

Magnesium deficiency has been shown to be a key factor in bone loss.² One study from the University of Tennessee concluded greater magnesium intake was significantly related to higher BMD.³ In the trial, 2,038 older, white men and women aged 70 to 79 had their dietary intake of magnesium assessed using a semi-quantitative food frequency questionnaire, and supplement data was collected based on a medication inventory. Researchers found magnesium intake was positively associated with BMD.

Have a Fatty (Acid)

There is an overwhelming amount of evidence that healthy fats can help reduce arthritis-related inflammation. A recent study from the Vascular and Inflammatory Diseases Research Unit, Ninewells Hospital, Dundee, Scotland, tested the effectiveness of cod liver oil (containing omega-3 essential fatty acids) as a non-steroidal anti-inflammatory drug-sparing agent (NSAID).⁴ Ninety-seven patients with rheumatoid arthritis were randomized to take either 10 g/d of cod liver oil containing 2.² g of omega-3 essential fatty acids (EFAs) or air-filled identical placebo capsules. At study’s end, 39 percent of the cod-liver patients (n=49), but only 10 percent (n=48) of the placebo were able to reduce their daily NSAID requirement by more than 30 percent. This study suggests cod liver oil supplements containing omega-3 fatty acids can be used as NSAID-sparing agents in rheumatoid arthritis patients.

A similar study found fish oil rich in n-3 polyunsaturated fatty acids—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), specifically—could reduce inflammation and inflammation-induced bone loss in chronic inflammatory diseases like rheumatoid arthritis, periodontitis and osteoporosis.⁵

The fruit from the silver vine plant (Actinidia polygama; AP) has long been used as a folk medicine in Korea for the treatment of pain, rheumatoid arthritis and inflammation. A study from Kyung Hee University, Korea, looked at the anti-inflammatory effects of ALA, using acetic acid or carrageenan-induced inflammation models, were investigated in mice or rats, respectively.⁶ Results suggested that the anti-inflammatory activity of ALA might be due to the suppression of the enzymes responsible for the prostanoid biosynthesis involved in inflammation. Further evidence that fatty acids are beneficial for inflammation can be seen in a meta-analysis from York University, Toronto, Ontario.⁷ Researchers examined 17 randomized, controlled trials assessing the pain relieving effects of omega-3 polyunsaturated fatty acids (PUFAs) in patients with rheumatoid arthritis or joint pain secondary to inflammatory bowel disease (IBD) and dysmenorrhea. Supplementation with omega-3 PUFAs reduced patient-reported joint pain intensity, minutes of morning stiffness, number of painful and/or tender joints, and NSAID consumption.

One popular topical remedy is the use of cetylated fatty acids (CFAs) as Celadrin, from Proprietary Nutritionals. In 2004, a study from Hesslink Ventures of San Diego, Calif., was conducted to determine the benefit of CFAs on knee range of motion and function in patients with osteoarthritis.⁸ Sixty-four patients with chronic knee osteoarthritis were evaluated at baseline and at 30 and 68 days after consuming either placebo or Celadrin (n=33). After 68 days, patients treated with Celadrin exhibited improved knee range of motion and overall function, compared to placebo. A similar study was conducted at the University of California in Oakland.⁹ Forty patients with knee pain received either Celadrin topical cream or a placebo. All of the patients who used Celadrin showed significant improvement in knee range-of-motion, ability to ascend/descend stairs, ability to rise from sitting, walk and sit down, and unilateral balance.

A Spoonful of Amino Sugars and Glycosaminoglycans

Natural eggshell membrane is useful in joint supplements, as it contains naturally occurring glycosaminoglycans (GAGs)—chondroitin and hyaluronic acid (HA)—as well as collagen and other proteins.

Schonlau noted, “A long tradition for rebuilding cartilage lost by biomechanical overuse are the amino sugars, such as glucosamine and chondroitin, which are believed to represent nutritional building blocks for cartilage renewal. While the evidence from clinical trials isn’t entirely consistent, these dietary building blocks are safe and not harmful, and thus are widely used for improving joint function.”

In a review on dietary supplements and their effectiveness in osteoarthritis from Creighton University, Omaha, Neb., it was suggested that glucosamine sulfate can improve symptoms of pain related to osteoarthritis, as well as slow disease progression in patients with knee osteoarthritis.¹⁰ Chondroitin sulfate also appears to reduce osteoarthritis symptoms and is often combined with glucosamine; however, according to the study, there is no reliable evidence that the combination is more effective than either agent alone. One study from Hospital del Mar, Spain, found chondroitin sulfate interferes with the progression of structural changes in joint tissues and can be used in the management of patients with osteoarthritis.¹¹ Another study, conducted at University of Calgary, Alberta, examined the effects of chondroitin sulfate (CS) alone and CS plus glucosamine sulfate (GS) in a dietary bar formulation on inflammatory parameters of adjuvant-induced arthritis and on the synthesis of interleukin-1beta (IL-1beta) and matrix metalloprotease-9 (MMP-9).¹² Following 25 days pretreatment with dietary bars containing either CS alone, CS plus GS, or neither CS nor GS, rats were either sham injected or injected with Freund’s complete adjuvant into the tail vein. Rats were fed the respective bars for another 17 days after inoculation. Researchers found treatment with CS plus GS, but not CS alone, significantly reduced clinical scores, incidences of disease, joint temperatures, and joint and serum IL-1beta levels. Treatment with CS alone and CS plus GS inhibited the production of edema and prevented raised levels of joint MMP-9 associated with arthritis. Similarly, CS alone and CS plus GS treatment also prevented the development of cartilage damage associated with arthritis.

A recent study from Erasmus Medical Center, Rotterdam, Netherlands, questioned the effective-ness of glucosamine sulfate as a symptom and disease modifier for osteoarthritis.¹³ A total of 222 patients with hip osteoarthritis took 1,500 mg/d of oral glucosamine sulfate or placebo once daily for two years. Researchers found that glucosamine sulfate was no better than placebo in reducing symptoms and progression of hip osteoarthritis.

“While research has shown that glucosamine is beneficial in reducing pain, some people are unable to take glucosamine orally due to stomach irritability,” said Lynn Schrum, president, Better Living Distributors. “The Better Living Pain Relief Patch™ is a natural patch with glucosamine, chondroitin, cetyl myristoleate, willow bark extract and meadowsweet, which provides time-released consistency, so there is no need to take multiple oral doses throughout the day, eliminating possible stomach irritability.”

Pining for Pine

Pycnogenol, an antioxidant found in French maritime pine bark extract, is thought to have a positive effect on reducing inflammation. “Pycnogenol inhibits the pro-inflammatory master switch (NF-kappaB), which orchestrates the whole inflammatory machinery,” said Schonlau. A double blind, placebo-controlled study evaluated the efficacy of 100 mg/d of Pycnogenol in a three-month study in osteoarthritis patients.¹⁴ Osteoarthritis symptoms were evaluated by Western Ontario and McMaster Universities (WOMAC) scores, mobility by recording walking performance (treadmill). Treatment (n=77) and placebo groups (n=79) were comparable for age, sex distribution, WOMAC and osteoarthritis index scores, walking distances and use of NSAIDs. The global WOMAC score decreased by 56 percent in the treatment group; walking distance in the treadmill test was prolonged from 68 minutes at the start to 198 minutes after three months treatment. The use of drugs decreased by 58 percent in the treatment group; gastrointestinal complications decreased by 63 percent in the treatment group; and treatment costs were reduced significantly compared with placebo. Researchers concluded, “Pycnogenol offers an option for reduction of treatment costs and side effects by sparing anti-inflammatory drugs.”

A similar study, conducted by Horphag, involved 37 patients with osteoarthritis who received either a placebo or Pycnogenol (50 mg, tid) for three months.¹⁵ There was a significant improvement in total WOMAC score and WOMAC subscale score of pain and physical function at 60 and 90 days of treatment. There was significant reduction in pain, stiffness, physical function and decreased usage of NSAIDs in the Pycnogenol supplement group. An additional study aimed to determine whether oral intake of Pycnogenol contains sufficient concentrations of active principles to inhibit key mediators of inflammation.¹⁶ Blood samples from seven healthy volunteers were obtained before and after five days administration of 200 mg/d Pycnogenol. It was found that Pycnogenol effectively prevented inflammation disorders in patients by moderation the immune system response.

Break Down, Shake Down

Arthur Andrew Medical has focused its attempts on pinpointing digestive abnormalities as the most common cause of arthritis. “A normal digestive tract is permeable enough to allow nutrients to pass into the bloodstream. For patients who have Leaky Gut Syndrome (LGS) or an abnormally high percentage of permeability undigested food, particles such as fats, proteins, starches, bacteria and even yeast can enter the bloodstream,” Marsh said. As the particulates ferment, they can cause the immune system to respond with inflammation, the body’s way of trying to heal itself. “Unfortunately joint material is dense and tends to resist expansion. When these areas become inflamed, they can be extremely tender,” he added.

In order to combat this inflammation, Arthur Andrew Medical has been studying the efficacy of using enzymes. “A digestive enzyme can help to completely assimilate food into usable nutrients. ... The next step is to repair the small intestine by using strong doses of probiotics and select enzymes, such as chitin, protease and cellulose to eliminate yeast. Once the yeast is eliminated, the probiotics can repair the micro-tears in the gut. ... Systemic enzymes can digest undigested food particles in the blood before they can trigger an autoimmune response,” he continued. Systemic enzymes help quickly eliminate inflammation and modulate the immune system.

One study evaluated the effects of intra-articular injection of carboxymethylated chitosan (produced by deacetylation of chitin) and tissue inhibitor of metalloproteinase-1 (TIMP-1) on osteoarthritis.¹⁷ White rabbits (n=32) underwent unilateral anterior cruciate ligament transection (ACLT) and were randomly divided into groups, recieveing either injections of CMCTS of varying levels or a placebo. According to the study, CMCTS may have a protective effect on articular cartilage of osteoarthritis.

A similar study with different enzymes assessed the efficacy of poly(lactide-co-glycolide) (PLGA), poly(L-lactic acid) (PLA) and poly(caprolactone) (PCL) on inflammation.¹⁸ Results showed injection of 20 percent paclitaxel-loaded PLA microspheres significantly reduced all measures of inflammation in the antigen arthritis rabbit model.

Neprinol®, an enzyme supplement from TMN Health, is purported to be an anti-inflammatory. Its main ingredient, serrapeptase (Serratio peptidase), is a proteolytic enzyme. In a study from researchers at the University of Naples, Italy, the efficacy and tolerability of Serratio peptidase were evaluated in a multicentre, double blind, placebo-controlled study of 193 subjects suffering from acute or chronic ear, nose or throat disorders.¹⁹ It was concluded that Serratio peptidase, among other things, has anti-inflammatory activity and acts rapidly on localized inflammation.

In one multi-centre, double blind, placebo-controlled trial, the clinical efficacy of the anti-inflammatory enzyme serrapeptase was studied.²⁰ Out of 174 patients who underwent Caldwell-Luc antrotomy for chronic abscesses, 88 received 10 mg of serrapeptase three times on the day before the operation, once on the night of the operation and three times daily for five days after operation; the other 86 received placebo. The degree of swelling in the serrapeptase-treated patients. Maximal swelling throughout all the post-operative points of observation was also significantly smaller in size in the serrapeptase-treated group than in the placebo-treated group.

Herb is the Word

Popular in topical creams, herbs have been shown to provide temporary relief of joint pain. One popular topical pain reliever, Stopain® by DRJ Group Inc., contains peppermint oil and eucalyptus oil. “Peppermint and eucalyptus are popular in topical creams due to their analgesic properties,” explained Bob Miller, president and CEO, DRJ Group Inc. “In addition, Stopain’s extra-strength spray and roll-on formulas contain glucosamine and dimethylsulfone (MSM), essential nutrients that support joint health and mobility.” A study from Pharmaceutical Research, Utah, compared the efficacy of an herbal ointment to a placebo ointment in relieving the pain and stiffness of osteoarthritis.²¹ The herbal preparation contained substances believed by alternative practitioners to be helpful in treating osteoarthritis. Subjects were randomized to an active (n = 11) or a placebo (n = 8) group. Herbal ointment and control contained small amounts of capsaicin and menthol and were similar when applied. Significant differences between the active and placebo groups for pain (P < 0.05) and stiffness (P < 0.05) were found when the baseline phase was compared with the fourth week. An herbal ointment was shown to be effective in relieving the pain and stiffness of osteoarthritis without adverse effects. Another study added menthol to Celadrin and tested its effectiveness.²² Individuals diagnosed with knee osteoarthritis (n=10; age, 66.⁴ +/- 11.⁵ years) and severe pain of the elbow and wrist were tested for pain and functional performance before and after one week of treatment with a topical cream consisting of Celadrin and menthol applied twice per day. One week of treatment with a topical cream consisting of Celadrin and menthol was effective for reducing pain and improving functional performance in individuals with arthritis of the knee, elbow and wrist. However, the study states that further work is needed to determine the impact of menthol in such a cream.

Arnica (Arnica montana L), a flowering plant found predominantly in Europe, is popular due to its anti-inflammatory effect. “Arnica has been known for years for its healing abilities,” Eileen Sheets, managing director, Bioforce USA, said. “In order to really heal joints, you must get the inflammation down. Arnica rub can pave the way for better results with glucosamine and chondroitin,” she continued. According to a recent study, the sesquiterpene lactones (SL), secondary plant metabolites from the flowers of the arnica plant, exert anti-inflammatory effects mainly by preventing nuclear factor (NF)-kappaB activation because of alkylation of the p65 subunit.²³ Unfortunately, the same study also found arnica has been classified as a plant with strong potency to induce allergic contact dermatitis. However, another study supported the use of arnica as a homeopathic remedy as an anti-inflammatory.²⁴ The anti-inflammatory effect of Arnica montana 6cH was evaluated using acute and chronic inflammation models. In the acute model, carrageenin-induced rat paw edema, the group treated with Arnica montana 6cH showed 30 percent inhibition compared to control (P < 0.05). In the chronic model, Nystatin-induced oedema, the group treated three days previously with Arnica montana 6cH had reduced inflammation six hours after the inflammatory agent was applied.

There are numerous options for those suffering from arthritis. As a retailer, adequate education on each specific option is a must, as well as educating consumers. This will enable them to choose the most effective treatment for their pain.

References

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19. Mazzone A et al. "Evaluation of Serratia peptidase in acute or chronic inflammation of otorhinolaryngology pathology: a multicentre, double-blind, randomized trial versus placebo." J Int Med Res. 1990 Sep-Oct;18(5):379-88.

20. Tachibana M et al. "A multi-centre, double-blind study of serrapeptase versus placebo in post-antrotomy buccal swelling." Pharmatherapeutica. 1984;3(8):526-30.

21. McKay L et al. "Effect of a topical herbal cream on the pain and stiffness of osteoarthritis: a randomized double-blind, placebo-controlled clinical trial." J Clin Rheumatol. 2003 Jun;9(3):164-9.

22. Kraemer WJ. "A cetylated fatty acid topical cream with menthol reduces pain and improves functional performance in individuals with arthritis." J Strength Cond Res. 2005 May;19(2):475-80.

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