Natural Health Advisory

Osteoarthritis is the most common type of joint disease, arising from the breakdown of cartilage, bone, and other tissues in the joints.¹ The knees and hips are most commonly affected, followed by the spine, feet, and hands. After age 50, your risk of osteoarthritis increases dramatically. By age 65, 80% to 90% of people have osteoarthritis.¹ 

Description of Condition

The disease’s primary symptom is deep, achy joint pain that is exacerbated by use. In the initial stages of osteoarthritis, joint pain occurs only after the joint has been used and the pain is relieved with rest. In the next stage of the disease, the pain is constant whenever the joint is being used. Eventually, the pain occurs at rest and at night. Range of motion is frequently reduced. Cracking and popping sounds often occur. The affected joints can also become stiff during rest. Morning joint stiffness is often present but usually goes away within 30 minutes.¹

Age; obesity; previous traumatic injury; a history of frequent squatting, stair-climbing, or kneeling; and genetics all play roles in the development of osteoarthritis.¹ Whatever the cause, inflammatory processes get activated within cartilage and a vicious cycle of joint tissue breakdown and inflammation ensues.³

Conventional Treatments Used

There is no cure for osteoarthritis, so the goal of treatment is to control pain and maintain joint function.¹ Conventional treatment guidelines typically recommend a combination of exercise, weight loss, and over-the-counter analgesics like acetaminophen (Tylenol) or NSAIDs (ibuprofen).^4,5 Many conventional doctors only recommend drug therapy despite the risks involved with drug treatment (See the sidebar). Other common treatments include corticosteroid injections and, as a last resort, joint replacement surgery.

Top Integrative Medicine Protocols

There are several effective natural treatments for osteoarthritis.

Glucosamine and chondroitin are glycosaminoglycans, which attract water and are very useful to the body as lubricants and shock absorbers. Glycosaminoglycans are primary components in joint tissue.

The combination of oral glucosamine sulfate and chondroitin sulfate produces a synergistic effect that can alleviate pain and partly restore joint function.⁶ The apparent ability of this combination to slow down the progression of joint destruction, and maybe even help heal and restore healthy joint structure, is what makes this combination unique. No other treatment has shown this ability.

Studies comparing the separate versus combined effects of these two compounds show that the combination leads to better pain relief and reduced joint space narrowing than either ingredient alone.⁶

Research reveals that glucosamine and chondroitin are both slow-acting.⁷ While you may begin experiencing the beneficial effects of this synergistic combination in six months, it could take up to two years to see changes in imaging studies like X-rays and MRIs.^6,7,8

In the latest study to examine the combination, 605 patients with chronic knee pain and evidence of osteoarthritis took glucosamine sulfate 1,500 mg, chondroitin sulfate 800 mg, both supplements, or placebo once daily for two years.⁷ All patients experienced less pain, but only those who took both supplements experienced significantly less deterioration of the knee joint as noted with X-rays.

Another recent study in patients with knee osteoarthritis used MRI imaging to show that the combination prevented the loss of cartilage over a two-year period.⁸

User instructions  

Studies demonstrate that glucosamine sulfate is the preferred form of ­glucosamine for osteoarthritis pain relief, as opposed to less expensive forms of glucosamine such as glucosamine HCl.⁶ Unless you are allergic to shellfish, make sure the supplement you purchase contains glucosamine sulfate.

Take a total of 1,500 mg glucosamine sulfate and 800 to 1,200 mg chondroitin sulfate per day. You can take the entire dose at once and can buy them separately or in a combination pill.

For easily available, high-quality supplements, I like the products GS-500™ and Chondroitin by Enzymatic Therapy and FlexMax Glucosamine Chondroitin by Nature’s Way.

SAM-e (S-Adenosyl-Methionine) 

Much of the research on SAMe has been for the treatment of depression. But during clinical trials in people with depression, some study participants who also had osteoarthritis reported that their joint symptoms improved. Researchers therefore began to investigate SAMe as a possible treatment for osteoarthritis. They found that SAM-e has anti-inflammatory and pain-relieving properties; it also appears to promote the synthesis of new cartilage.⁹ At least six studies have found that SAMe is as effective as NSAIDs and significantly more effective than placebo for decreasing pain and improving joint function in patients with osteoarthritis.¹⁰

In the two studies that compared SAMe to ibuprofen, SAMe was shown to be as (or more) effective in reducing osteoarthritis symptoms like morning stiffness, pain, swelling, cracking sounds, and limited range of motion.^11,12 

Most double-blind trials in patients with osteoarthritis used 1,200 mg of SAM-e per day, although a few have used 600 mg per day and still noted benefits. Because SAMe is expensive, I recommend limiting high doses for flare-ups or for times when you expect to push your joints hard.

Exercise

It may seem counterintuitive, but there is firm scientific evidence of the effectiveness of exercise for pain relief and improvement in everyday physical function in people with osteoarthritis, especially knee osteoarthritis.^13-15 Physical activity stimulates the production of lubricin, a lubricant in joint fluid that is important for healthy cartilage and that delays the development of osteoarthritis.¹⁴

Of all types of exercise, resistance training is the most effective method for pure pain control, while combining strengthening with flexibility and aerobic exercise is the most effective way to reduce pain and improve function.¹³

Studies show that by simply walking more, patients with knee osteoarthritis can gain significant benefits and avoid physical function limitations.¹⁵ The more that people with knee osteoarthritis walk, the smaller the chance for developing future problems with daily physical functioning.¹⁵ Even an increase as small as 1,000 steps per day reduces the chance for developing problems, but you’ll get the most benefit by taking at least 6,000 steps a day.¹⁵  That’s equivalent to about three miles, or one hour, of walking.

Strengthening Exercises for the Knee

Strengthening the muscles of the thigh and lower leg is a must for anyone with knee osteoarthritis who is capable. Strong muscles surrounding the joint are necessary to help to reduce stress on the knee joint itself. Strong thigh and lower leg muscles also help to maintain a good knee alignment, which reduces wear and tear. The following four exercises are quick and easy to do at home.

1. Knee extension. Straightening the knee against resistance will strengthen the quadriceps muscles at the front of the thigh. One of the easiest ways involves using a resistance band.

• Sit on a chair with one end of the band tied around your ankle and the other end around one of the chair legs.
• The band should be taut when the knee is bent at 90 degrees. Straighten your knee before slowly bending it and returning the foot back to the floor.
• Perform 10 to 15 repetitions and repeat this two to three times.

2. Knee flexion. Bending the knee against resistance will strengthen the hamstring muscles at the back of the thigh. This can be done using the resistance band.

• Lie on the floor with the band tied around one ankle and the other end attached to something sturdy, close to the floor, such as the leg of a bed or heavy table. The band should be taut when the knee is straight.
• Bend the knee to bring the heel towards the buttock as far as possible, and then slowly straightens the knee back again.
• Perform 10 to 15 repetitions and repeat this two to three times.

3. Calf raise. Rising up on your toes is good for strengthening the gastrocnemius muscle, which is one of the two main calf muscles and the only one that crosses the knee joint.

• Stand with the feet hip-width apart and close to a wall or chair that can be held for balance if required.
• Rise up onto the toes, keeping the knees straight, before slowly lowering the heels back to the floor.
• Perform 10 to 15 repetitions and repeat this two to three times.
• This exercise can be progressed by performing on one leg only.

4. Squats. Squats strengthen all the main muscle groups of the legs and buttocks.

• Stands with the feet shoulder-width apart and back straight.
• Bend as if sitting on a chair.
• The back should remain straight and the knees should not move forward past the toes.
• Perform 10 to 15 repetitions and repeat this two to three times.
• You can start off with very shallow movements and progress until the knees reach a 90-degree angle, at which point you can start holding weights.

Precautions/Drug Interactions

Whichever strategy you choose to try, it’s important to understand potential interactions or contraindications.

Glucosamine and chondroitin. Both glucosamine and chondroitin sulfate are generally very well tolerated, although both may cause mild stomach pain and nausea.^16,17

Theoretically, glucosamine products might cause allergic reactions in people who are allergic to shellfish because some glucosamine sulfate products are made from the shells of shrimp, lobsters, or crabs. But there are no reports of such allergic reactions.¹⁶ Glucosamine sulfate increases the effect of warfarin (Coumadin),¹⁶ which can cause serious bruising and bleeding. Don’t take glucosamine sulfate if you are taking warfarin.

SAMe. Side effects of SAMe are uncommon, and when they do occur they are usually minor problems such as nausea or digestive upsets.¹⁸ In a published review of SAMe’s safety, there was no significant difference between the likelihood of patients taking SAMe and placebo reporting side effects.¹⁹ Theoretically, SAMe may decrease the effects of levodopa (L-dopa), a drug used to treat Parkinson’s disease. It is also possible that SAMe might interact with drugs and dietary supplements that increase levels of serotonin (a chemical produced by nerve cells), such as antidepressants, L-tryptophan, and St. John’s wort, but the evidence for such interactions is very limited.¹⁸

Exercise. Exercise should be balanced with rest and joint care. Always check with your doctor before you start an exercise program. Talk to your doctor if you have new pain or if your pain is worse, since sharp or unusual pain may be a sign of injury. If your joints hurt more than usual or you have redness or swelling, rest your joints, then try a little exercise. You can use heat and cold therapy along with the supplements discussed above to help relieve pain and make it easier for you to exercise and stay active.

You might also think about using assistive devices, such as splints or braces, for a short time to protect your joints.

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5. Osteoarthritis Cartilage. 2014 Mar;22(3):363-88.
6. Maturitas. 2014 May 1. pii: S0378-5122(14)00134-0.
7. Ann Rheum Dis. 2014 Jan 6.
8. Ann Rheum Dis. 2013 Dec 13.
9. Crit Rev Food Sci Nutr. 2008 May;48(5):458-63.
10. Rheumatology (Oxford). 2011 May;50(5):911-20.
11. Int J Clin Pharmacol Res. 1985;5(1):39-49.
12. Am J Med. 1987 Nov 20;83(5A):81-3.
13. BMJ. 2013 Sep 20;347:f5555.
14. Medscape Medical News. 2014 June 13.
15. Arthritis Care Res (Hoboken). 2014 Jun 12.
16. NIH. Medline Plus. Glucosamine sulfate. Accessed June 20, 2014.
17.NIH. Medline Plus. Chondroitin sulfate. Accessed June 20, 2014.
18. NIH. NCCAM. SAMe. Accessed June 20, 2014.
19. J Fam Pract. 2002 May;51(5):425-30.

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