The Center’s Approach to Osteoarthritis

By Neil H. Riordan, R.P.A.-C

Osteoarthritis is very common. At the age of 35, approximately 40% of the population has some form of it, and by age 65, 80% will show some signs of the disease. The disease begins with degeneration of the joint cartilage-particularly the glass-like hyaline cartilage that covers the ends of the bones in joints. Factors that contribute to this disease include increased weight, physical stress, nutrient deficiencies, genetics, and possibly some immunological factors.

Walking is an excellent exercise for knee arthritis.

At The Center, we like to ask ourselves why osteoarthritis is occurring, and what is causing the symptoms. Two factors which contribute to the symptoms are inflammation and secondary oxidation (which causes more inflammation). Inflammation occurs because the cartilage in the joint has been roughed up as it degenerates, causing friction. There are two ways to attack this problem: 1. Stop or slow the inflammation and 2. Repair the cartilage.

To help stop or slow the inflammation we will generally test for, and recommend, appropriate supplementation of some nutrient which can affect oxidation. We test for levels of vitamin C, vitamin E, vitamin D, and fatty acids. Vitamin C is a water soluble antioxidant which helps to suppress oxidation. Vitamin C also helps to rebuild collagen, a vital part of cartilage.

Vitamin E is a fat soluble antioxidant which reduces oxidation at the cell membrane. Fatty acids are precursors to short-lived molecules called prostaglandins which mediate inflammation.

Some fatty acids, such as GLA (gamma linolenic acid), and EPA (eicosapentaenoic acid) inhibit inflammation, while others promote it. If low levels of GLA or EPA are detected they are corrected with supplementation. .

Another way to inhibit inflammation in osteoarthritis joints is to take glucosamine supplements, usually in the form of glucosamine sulfate (GS). Glucosamine comprises one half of the hyaluronic acid (HA) that provides lubrication for the synovial (joint) sac. When there is not enough glucosamine available, the cells will produce poor quality HA with less lubricating ability. One clinical study showed that after two weeks, GS supplementation was more effective (95% response vs. 72% response rate) than non-steroidal anti-inflammatory drugs (NSAIDs) at reducing pain in affected joints. The pain relief in the GS group lasted much longer than the NSAIDs group after discontinuation of the study.

To repair the cartilage, we usually recommend supplementation of a nutrient, chondroitin sulfate. It has been known since 1965 that low levels (2/3 lower than normal) of this molecule are found in degrading cartilage. More recent studies have shown that oral supplementation with chondroitin sulfate can rebuild cartilage in the joint.

Other nutrients that may be considered in the treatment of osteoarthritis are Pycnogenol and other bioflavonoids, boron, niacinamide, and vitamin D. Bioflavonoids have antioxidant capabilities themselves, but have the primary effect of helping to transport vitamin C into the tissues. Six milligrams per day of oral boron significantly improved osteoarthritis symptoms in a clinical study.

In another clinical trial, three thousand milligrams of niacinamide (a form of niacin, vitaminB3) per day for twelve weeks increased joint movement and decreased global arthritis by 29% in the treatment group, while the control group worsened by 10%. We recommend if you take niacinamide to start with a lower dose under your doctor’s care because high doses can adversely affect the liver. Low levels of vitamin D, which helps control how bone is distributed, contribute to the progression of osteoarthritis. One study which compared people with different vitamin D blood levels found that those who were in the lowest 10% blood level group had a greater than 600% increase in risk for osteoarthritis progression compared to those in the highest 10% blood level group.

To prevent further damage to joints, exercise of the muscles below and above the affected joints will improve the strength of the joint, while decreasing the pain. Walking is an excellent exercise for knee arthritis. For the knees in particular, losing excess weight will decrease the amount of friction and decrease the chances of further damage.

In summary, when we see someone with osteoarthritis , we first test for blood levels of those nutrients which contribute to reducing inflammation. We then make supplementation, weight loss , and exercise recommendations that will hopefully begin reversing the causes and stop the progression of osteoarthritis.