Osteoarthrosis (OA) is sometimes referred to as osteoarthritis, degenerative arthritis, or degenerative joint disease. It is characterized by degeneration of the articular cartilage and subchondral bone. It can result in joint deformities, with characteristic Bouchard’s nodes in the proximal phalangeal joints of the fingers and Heberden’s nodes in the distal joints of the fingers. The predictable symptoms include joint pain and stiffness, becoming more chronic over time. Other symptoms commonly included joint swelling, weakness and/or paresthesias in the extremities and decreased range of motion. Typically, joints in the fingers, thumb, knees, spine, and hips can be involved. It can also be the result of trauma to a single joint leading to degeneration of the joint years later. Abnormal cartilage, congenital deformities of joint(s), infection of a joint, crystal deposition and/or other arthritic conditions can lead to OA of the joint. Approximately 27 million people in the U.S. suffer from OA. As people age, the prevalence of OA increases. In people under 45, it’s more common in men. After 45, it is more common in women. The knee is the most common joint to be affected. Conventional treatments include exercise, acetaminophen, NSAIDs, opioids, injecting anesthetics, hyaluronan (hyaluronic acid), or plateletrich plasma, or joint replacement. One peculiar finding is the lack of correlation between the severity of the disease as seen on radiographs and the patient’s symptoms.

Musculoskeletal joint derangement and misalignments have been demonstrated to play a role in the development of OA. In one study involving 230 patients with varus deformities of the knee, the was a four-fold increase in degenerative arthritis in the knee when compared to the general population. Joint alignment, muscle strength nutritional status, previous trauma and mid-stance loads all seem to contribute to the development of OA. Manipulative and manual therapy has both been shown to increase range of motion, decrease pain, and decrease the need for pain medicine. One study concluded that the cost of treatment was reduced when manual therapy and exercise were integrated into the treatment plan. Swimming and isometrics have been identified as superior to other types of exercise for the treatment of OA. Decreased stability and balance have been demonstrated to have a negative effect on OA, particularly in the knee. Conversely, strengthening the muscles controlling the hip and knee is an effective way to mitigate some of the disabling symptoms associated with OA in the lower extremity.

Chondroitin sulfate is a high molecular weight GAG, found naturally as a component of cartilage. It is composed of repeating units of glucosamine sulfate, a GAG that is much smaller than chondroitin sulfate and much better absorbed. Chondroitin sulfate is generally poorly absorbed, anywhere from 0-18% of what is ingested. The research is mixed as far as the results of oral chondroitin sulfate on OA since it has to be partially digested to be absorbed. Administration of low-molecular weight chondroitin sulfate has been demonstrated to have beneficial effects on the alternative complement pathway, thus preserving chondrocytes and preventing damage to cartilage. Immunoassays specific for a peptide of the alpha-helical region of type II collagen 108HRGYPGLDG116 (Coll 2-1) were used to determine the effect of chondroitin sulfate on OA. The authors used visual analog scale to determine pain, and Lequesne's Index to measure function. They concluded that chondroitin sulfate supplements positively affected OA, reducing Coll 2-1 levels, resulting in decreased pain and increased function. Other studies have shown that combining chondroitin sulfate with hyaluronic acid and keratin improved OA. Chondroitin sulfate supplements have been shown to inhibit NF-κB activity, thus preventing further damage to cartilage. Osteoarthritis is a debilitating disease that affects over a third of Americans over the age of 60. Natural approaches to treatment of the disease and its symptoms have been shown to be effective and cost saving. Combining a diet rich in omega-3 fatty acids, flavonoids, and high in fibre with supplements and botanicals, has the potential of halting the progression of the disease and even reversing some of the damage to joints.

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Warm Regards,
Joseph Kent
Journal Manager.