Nutrition and Joint Care
- Glucosamine and Chondroitin
Although the book title is a bit of a misnomer, The Arthritis Cure details the importance of glucosamine and chondroitin to the health of cartilage. Glucosamine can be purchased over-the-counter at health food stores, pharmacies, and discount stores as glucosamine sulfate or glucosamine HCl, often in combination with chondroitin sulfate. The labelling often recommends an initial dose of 1500 mg of glucosamine sulfate and 1200 mg of chondroitin sulfate for 60 days, then a maintenance dose of 500 mg of each daily following that.Some have argued that chondrotin is a very large molecule and may be difficult to be absorbed into the bloodstream. Because glocusamine is a sugar, some have suggested large doses may increase your risk of developing diabetes. Also, if your cartilage is severly damaged, added nutrients may be akin to throwing fertilizer on the sidewalk and expecting grass to grow.
- Glucosamine and Chondroitin
- Omega-3 Fatty Acids
These are natural inflammation fighters and can be obtained from fish, either through eating 2-5 fish meals per week or a teaspoon of fish oil per day. Fish oil is also widely available in an encapsulated form if you do not find the taste palatable.
- Vitamin C
Vitamin C is a well known anti-oxidant and aids in fighting inflammation. Note that if you are taking Vitamin C on a regular basis, the body can only use about 250 mg per day.
Calcium is a well known nutrient for bone growth and maintenance of bone density. Besides natural sources in dairy products, leafy green vegtables, and yogurt, calcium may be supplemented using calcium carbonate (as in Tums), or in calcium citrate in products such as Citracal. Studies have shown that calcium in calcium citrate is more easily absorbed, though that is a more expensive product.Recently some concern has been raised over the possibility of high lead levels in calcium carbonate supplements, so expect to see some labeling soon certifying certain brands as “lead free”.
is a new drug that is prescribed for osteoporosis patients. The product works by decreasing the activity of the cells that cause bone loss. There is some thought that the drug could also be helpful for those needed to fight osteoloysis after a total hip replacement.Another treatment for osteoporosis uses Miacalcin, a calcitonin-salmon nasal spray, combined with calcium supplements and adequate Vitamin D. Calcitonin is a hormone that inhibits bone resorption. Both are prescription medications, ask your doctor.
- General Tips
Arthritis Today article on exercise.
Orthopedic surgeon Dr. Robert Klapper and exercise rehabilitation trainer Lynda Huey describe their program to help strengthen your hip muscles without damaging the cartilage. If you need surgery their program can be used after surgery to regain function and strength.
More information on Heal Your Hips from Amazon.com
- Gait Analysis
Dr. Bob Arnot has has some suggestions for modifying your gait to reduce wear and tear on joints, particularly the knees. There is also advice on shoes and supplements.
More information on Wear and Tear from Amazon.com
- Diet and Exercise
A team of authors, including nutritionists, an arthritis researcher and exercise physiologist have collaborated on book with a program for decreasing pain and improving patient outlook using diet, suppliments and exercise. The book is entitled, “Strong Women and Men Beat Arthritis”.
More information on Strong Women and Men Beat Arthritis from Amazon.com
Inflammation and Pain Management
Non-steroidal Anti-Inflammatory Drugs are often prescribed for arthritis, the effectiveness of NSAIDs in relieving pain and reducing inflammation may vary from one patient to another depending on the brand and formulation. NSAIDs generally have a risk of ulceration and gastrointestinal bleeding. Most also have a thinning effect on the blood. Here are some commonly prescribed NSAIDs.
- Ibuprofen (Motrin)
- Indomethacin (Indocin)
- Naproxin Sodium (Aleve)
NSAIDs work by inhibiting the production of two enzymes, known as cox-I and cox-II. The cox-I enzyme is a “good” enzyme in that it is part of the mechanism for protecting the gastrointestinal system from attack by its own digestive processes. Cox-II is the enzyme that is associated with inflammation caused by the body’s immune response. The cox-II inhibitors target only the cox-II enzyme and, thus, have been shown to be less of a risk to the GI-system. At one time three Cox-II inhibitors had been approved for marketing in the United States. Recently, however, Vioxx and Bextra were pulled from the market as evidence showed that at high doses they increase the risk of heart failure. Celebrex remains on the market, but is under scrutiny as part of this group of medications.
Disease Modifying Drugs (DMARDs) for rheumatoid arthritis
If one suffers from osteoarthritis not induced by an immune response, joint pain may be effectively treated by pain relievers without incurring the added risks of NSAIDs. Some pain relievers may contain addictive substances.
- CT Scan
A contrast medium is injected into the joint and x-rays are taken, possibly from several angles of the afflicted joint. The contrast agent helps the radiologist see features such as cartilage and ligaments not normally visible with the standard x-ray.
- Bone Scan
In the bone scan, the patient is injected with a mildly radioactive solution that is bound to a calcium-like material. After a period of 3 hours of “normal activity” the patient returns to the radiologist and a machine scans their skeleton for the gamma radiation. The scan shows where the calcium was distributed in the patient over that period. The appearance of “hot spots” indicates where active bone formation is taking place, generally a location of injury or inflammation. This can identify specific sites of pain, and rule out “referred pain”. The lack of distribution to a region would indicate a circulation problem, possibly leading to necrosis.
- Measurement of Bone Density
DEXA scan (dual energy X-ray absorptiometry Measurement expressed as a number relative to the average for your age (Z score) and to a person in their early thirties (T score). A positive value means bone density is greater than the average, and negative means less dense than average. The value is number of standard deviations plus or minus. A T score of -2 or lower is considered a sign of osteoporosis. The level of bone density and its distribution may be used by your surgeon to determine which hip prosthesis is best for you.
Temporary Treatments and Alternative Surgeries
- Cortisone Injection
Cortisone, a powerful steroid, can be injected into the joint to relive pain and encourage cartilage growth. Cortisone in a patient with active arthritis is often a temporary solution and many patients find a reduced effect with the second and subsequent injections to the same site. Heavy use of steroids can lead to avascular necrosis.
- Cartilage Lubricant Injections
A substance which increases the elasticity of cartilage can be injected into the knee joint. Arthritic cartilage can become dry and brittle. The body naturally produces a substance known as hyaluronic acid that lubricates and hydrates cartilage. Pharmaceutical companies have developed artificial forms of hyaluronic acid that are sold under trade names Synvisc (also known as Hylan-20g, made by `Genzyme Corp.) Supartz (by Smith and Nephew) and Hyalgan (by Sanofi-Synthelabo) and injected into the afflicted joint.These products are FDA-approved for use in the knee joint, though you may find some orthopedic specialists who have tried it in “off-label” use for the hip. The idea is give relief to the joint and give the natural cartilage a chance to rebuild and repair itself during this respite from the damaging effects of bone-on-bone weightbearing.Because the lubricant is eventually metabolized by the body, Obtaining long-term relief depends on have healthy production of natural cartilage and lubricant, this is less likely if there has already been damage to the subchondral bone, the live bone just under the cartilage layer.To date there has been no evidence that taking hylaronic acid orally can be delivered to where it can be useful, it must be injected in the site.
Dr. Robert Klapper