Reducing Pain, Improving Mobility
by David Dunaief
Nov 18, 2020 | 2134 views | 0 0 comments | 275 275 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
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Osteoarthritis has been diagnosed in over 54 million Americans, with 43.5 percent of them reporting symptoms that limit their activities and significantly impact their quality of life. Historically, the disorder was thought to be solely a wear-and-tear degeneration of the joints.

However, osteoarthritis (OA) also involves inflammation with the release of cytokines and prostaglandins — inflammatory factors — which cause joint destruction and pain.

Treatment mainstays include analgesics and COX-2 inhibitors (Celebrex). Common analgesics used are acetaminophen and NSAIDs, such as ibuprofen (Advil) and naproxen sodium (Aleve). A benefit of NSAIDs is that they have anti-inflammatory effects. Meanwhile, COX-2 inhibitors may also improve joint mobility.

There are adverse effects with NSAIDs, including increased gastrointestinal bleed and, with long-term use, an increase in cardiovascular events, such as heart attacks, with the elderly being most susceptible.

Neither medication type, however, slows OA’s progression nor rebuilds cartilage. Are there therapies that can accomplish these feats? We will look at hyaluronic acid, glucosamine, chondroitin, and lifestyle modifications.

Chondroitin sulfate beneficial for hand OA

The results with the use of glucosamine and chondroitin have been mixed, depending on the joints affected. In the FACTS trial, a randomized controlled trial, chondroitin sulfate by itself showed significant improvement in pain and function with OA of the hand.

The dose of chondroitin used in the study was 800 mg once daily. The patients, all of whom were symptomatic at the trial’s start, also saw the duration of their morning stiffness shorten.

There was also a modest reduction in structural damage of hand joints after three months, compared to placebo. The benefit was seen with prescription chondroitin sulfate, so over-the-counter supplements may not work the same way.

Crystalline glucosamine sulfate

In knee OA, crystalline glucosamine sulfate showed pain reduction and functional improvement in a randomized controlled trial. It also slowed the progression of structural damage to the knee joint. The glucosamine formulation may work by inhibiting inflammatory factors.

The trial used 1500 mg of prescription crystalline glucosamine sulfate over a three-year period. Again, it’s not clear whether an over-the-counter supplement works the same way.

Use caution if taking an anticoagulant (blood thinner) like Coumadin, since glucosamine has anticoagulant effects. Also, those with shellfish allergies should not use glucosamine.

Hyaluronic acid

In a meta-analysis of 89 trials, the risks outweighed the benefit of hyaluronic acid, a drug injected into the joint for the treatment of OA.

Viscosupplementation involves a combination of hyaluronic acid types that act as a shock absorber and lubricant for the joints. Some of the studies did show a clinical benefit.

However, the authors believe that adverse local events, which occurred in 30 to 50 percent of patients, and serious adverse events, with 14 trials showing a 41 percent increased risk, outweigh the benefits.

Impact of weight loss and exercise

Obesity treatment with a weight-loss program actually has potential disease-modifying affects with OA. It may prevent cartilage loss in the medial aspect of the knee. The good news is that, a study found that as little as a seven percent weight loss in the obese patient yielded benefits.

The study’s average weight loss was nine to 10 pounds, and results were seen on a dose-response curve — the greater the weight loss, the thicker the knee cartilage.

Writing in “The New England Journal of Medicine,” Dr. David Felson observed there is an inverse relationship between the amount of muscle-strengthening exercise, especially of the quadriceps, and the amount of pain experienced in the knee joint.

It is very important to do nonimpact exercises such as leg raises, squats, swimming, bicycling and elliptical machines.

Fortunately, there are options to prevent, treat and potentially modify the effects of OA. With weight loss in the obese patient, quality of life can dramatically increase.

Glucosamine and/or chondroitin may help, depending on the joints affected. ConsumerLab.com may be a good source for finding a supplement where you get the dose claimed on the box.
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