Osteoarthristis

Osteoarthritisis is “the most frequent cause of physical disability among older adults” in the world, affecting more than 20 million Americans, with 20% of us destined to be affected in coming decades, and “becoming more [and more] widespread among younger people,” as well.

Osteoarthritis is characterized by loss of cartilage in the joint. We used to think it was just mechanical wear and tear, but it’s now generally accepted as “an active joint disease with a prominent inflammatory component” as evidenced by, for example, significantly higher production of inflammatory prostaglandins from tissue samples obtained from the knees of people suffering from the disease.

If the loss of cartilage is caused in part by inflammation, might an anti-inflammatory diet help, like it does with rheumatoid arthritis? Using optimal nutrition and exercise as the “’first-line’ intervention in the management of chronic osteoarthritis could well constitute [the] best medical practice.”

Where’s the best science on what optimal nutrition might look like? The China study is a prime example, showing “the serious health consequences of high consumption of [pro-inflammatory foods,] meat, dairy, fat, and [junk], and low consumption of [anti-inflammatory plant foods,] whole grains, vegetables and fruits,” and beans, split peas, chickpeas, and lentils. The unnatural Western diet “contributes to low-grade systemic inflammation and oxidative tissue stress and irritation, placing the immune system in an overactive state, a common denominator of conditions [such as] arthritis.”

There are phytonutrients in plants that appear to help decrease the degradation of the joint cartilage, the inflammatory activity, the cell death, and oxidative damage. This is based largely on in vitro studies suggesting protective benefits of soy, pomegranates, citrus, grapes, green tea, and the curry powder spice turmeric. But, my patients are people, not petri dishes. What role might the yellow pigment curcumin in turmeric play in the treatment of osteoarthritis?

Well, obesity doesn’t just put more stress on our joints. Fatty tissue inside our joints, like in the kneecap itself, is a “source of pro-inflammatory [chemicals] that…have been shown to increase cartilage degradation.” Curcumin may not only help prevent the release of inflammatory chemicals, but slow the formation of the fat pad in the first place. But, enough with test tubes. There have been two clinical studies published to date.

The latest took “50 patients suffering from mild-to-moderate knee osteoarthritis,” and gave them either the best available medical treatment, which included control with anti-inflammatory drugs and painkillers, or the best available treatment along with some proprietary curcumin supplement. They looked at a number of different outcome measures, including the Karnosfsky scale, which goes up to 100—which is normal, no complaints, no evidence of disease—down to zero, at which you’re dead. The group with the added curcumin did significantly better, and were able to double their walking distance. This is the best medicine had to offer, so Mother Nature made a counteroffer. The curcumin group was able to significantly decrease their drug use, significantly fewer side-effects, less swelling, hospitalizations, and other treatments.

But it doesn’t have to be some fancy proprietary formula. Here’s the other study: the efficacy of turmeric extracts in patients with knee osteoarthritis. About a hundred sufferers were randomized to ibuprofen or concentrated turmeric extracts for six weeks, and the curcumin group did as good or better than the ibuprofen. Even though ibuprofen is over the counter, it can cause ulceration, bleeding, and perforation of the stomach and intestines—can eat right through our stomach wall. And, in fact, that happened to someone in the study. Whereas, what are the side effects of curcumin? Potentially protecting against a long list of diseases.

F. Berenbaum. Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthr. Cartil. 2013 21(1):16 – 21.

T. Neogi, Y. Zhang. Epidemiology of osteoarthritis. Rheum. Dis. Clin. North Am. 2013 39(1):1 – 19.

Y. Henrotin, A. L. Clutterbuck, D. Allaway, E. M. Lodwig, P. Harris, M. Mathy-Hartert, M. Shakibaei, A. Mobasheri. Biological actions of curcumin on articular chondrocytes. Osteoarthr. Cartil. 2010 18(2):141 – 149.

P. G. Bradford. Curcumin and obesity. Biofactors 2013 39(1):78 – 87.

M. J. Benito, D. J. Veale, O. FitzGerald, W. B. van den Berg, B. Bresnihan. Synovial tissue inflammation in early and late osteoarthritis. Ann. Rheum. Dis. 2005 64(9):1263 – 1267.

R. I. Issa, T. M. Griffin. Pathobiology of obesity and osteoarthritis: Integrating biomechanics and inflammation. Pathobiol Aging Age Relat Dis. 2012 2:1-21.

E. Dean, R. G. Hansen. Prescribing optimal nutrition and physical activity as first-line interventions for best practice management of chronic low-grade inflammation associated with osteoarthritis: Evidence synthesis. Arthritis. 2012 2012:560634.

S. C. Gupta, S. Patchva, B. B. Aggarwal. Therapeutic roles of curcumin: Lessons learned from clinical trials. AAPS J 2013 15(1):195 – 218.

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