Dr. Phil Hariram's Health Blog

Glucosamine and chondroitin are widely advertised as remedies for osteoarthritis. The benefits, however, are not clear.

A qualitative assessment of various trials were done by T.E. McAlindon et al. to evaluate the benefits of glucosamine and chondroitin products for osteoarthritis of the knee and/or hip.

The studies were randomised, double blind, placebo controlled of four weeks duration. Fifteen studies reached the criteria and were included in the analysis.

Conclusions: Trials of glucosamine and chondroitin products for osteoarthritis of the knee and hip showed moderate to higher effects but there were quality issues and possible bias suggesting that benefits were exaggerated.

They concluded, however, that some degree of benefits appear probable.

A trial by H.Muller-Fassbender et al. in 1994 compared glucosamine sulfate to ibuprofen in osteoarthritis of the knee. The result showed that glucosamine was as effective as ibuprofen but without the potential serious side effects.

Dr. Phil Hariram,

Arthritis Guide.

Glucosamine is an amino acid sugar produced by the body and present in cartilage. It has been widely promoted as a treatment for osteoarthritis.

There is no conclusive evidence that this drug is effective. It is up to you to make your own mind up on it. There are individuals who swear by it and others who have no benefit.

Promoters of glucosamine claim it repairs damaged cartilage. It is derived from shells of shellfish. It is classified as dietary supplement just like chondroitin and its manufacture is not subjected to regulation. Make sure you purchase from a reputable company and check the ingredients.

There are no serious side effects with glucosamine. It is extracted from shells of shellfish so if you are allergic to shellfish be aware of this. If you are a diabetic, remember that glucosamine is an amino acid sugar and can impact on your blood sugar level.

Your family doctor is not likely to recommend glucosamine or chondroitin as an arthritis treatment because there is no clear evidence that they confer greater benefits over placebo in arthritis treatment.

It is, however, a safe medication. If you are on this drug or you are considering taking it, use it for three months before making your evaluation. If you are convinced there is improvement, continue using it as a treatment of arthritis.

Dr. Phil Hariram,

Arthritis Guide.

Chondroitin is a carbohydrate compound and is present in cartilage. It gives the cartilage elasticity. Articular surface of joints are protected by cartilage (articular cartilage) and this cartilage is a tough smooth gristle that reduces friction and protects the underlying bone from wear. Damage and wear of the cartilage is seen on an x-ray as loss of joint space. Cartilage contains both glucosamine and chondroitin.

The rationale for the use of chondroitin and glucosamine as treatment of arthritis is that these two drugs, according to some, will improve the health of affected articular cartilage. Both chondroitin and glucosamine are manufactured by the body.

Chondroitin is considered a dietary supplement and as such the manufacture is not regulated. The quality of products available will vary.

It is available as chondriotin sulphate, obtained from cows’ cartilage. Make sure you purchase a recognised brand from a reputable company and check the label for ingredients. If you are not sure, ask, or consult your doctor. Do not discontinue your on going medication.

According to studies, patients with mild to moderate osteoarthritis had relief on par with NSAIDs such as ibuprofen. Trials, however, are inconclusive and a large placebo controlled trial will one day throw light on whether this drug should be an acceptable arthritis treatment.

There are no serious side effects. Reported side effects are increased intestinal gas and loose stools. It should not be given to children or taken by women considering pregnancy or who are pregnant. It may potentiate the effects of anti-coagulants.

If you are taking this drug or considering taking it in future, make your assessment on its effeciacy after three month. If you feel it is doing you some good, continue.

Dr. Phil Hariram,

Arthritis Guide.

Apart from gout, diet does not have a significant direct impact on arthritis. Diets, vitamins and supplements will not cure your arthritis but altering your diet to maintain or attain the right weight is an important step to reduce the burden of arthritis.

For weight loss, dietary change and the amount you consume is important. Your diet must contain basic nutrients such as minerals and vitamins. Poor diet will impact on your general health and subsequently on your arthritis.

To help your arthritis, ensure your diet is balanced and varied and incorporates vitamins, minerals, anti-oxidants and other essential nutrients. Reduce animal fats and eat more fish. Take plenty of fruit and vegetables.

Omega-3 polyunsaturated fats found in fish oil has been shown to be beneficial in inflammatory arthritis. It is also useful in gout but it has high quantity of purines which in broken down in the body to produce urates and therefore should be avoided in gout.

A balanced and varied diet with more fish, fruit and vegetables is beneficial in all forms of arthritis. Nutritional supplements are available over the counter and are usually costly. Most of the ingredients are present in a balanced diet.

Your weight is important. So what should your weight be? You should use the Body Mass Index (BMI) as a guide to assess whether your weight is acceptable or not. To find out your BMI, first measure your height in metres,(i.e. say 2metres) then multiply it by itself (2×2=4). Check your weight in kilograms (say 80Kg). Now divide your weight in Kg by the first figure (80 divided by 4 =20). That is your Body Mass Index (20). Recommended BMI for most people is between 20 and 25. For your arthritis aim to be within this range if you can.

From childhood I have been told that calcium is good for my bones. Lack of calcium may lead to osteoporosis especially in arthritic patients. Vitamin D is also important for bone formation. The commonest source of calcium is in milk. If you are on skimmed milk as part of your low fat and calorie controlled diet be assured that skimmed milk has more calcium in it that full fat milk. Daily recommended intake of calcium in under 60s is 1000mg and over 60s -1500mg.

During the summer your body manufactures vitamin D through the sunlight on your skin and you do not need to worry about Vitamin D intake. You, therefore, need to be more vigilant in winter. Older arthritic patients may need supplements.

In case of gout, you should be careful with certain foods. Foods high in purines such as meat and fish should be consumed with care. Avoid or reduce alcohol.

Fish liver oil contains both omega-3 fatty acids and Vitamin D. it is a useful supplement but care should be taken in women thinking of starting a family or already pregnant. It also contain Vitamin A and is not recommended in pregnancy because of potential harm to the foetus. Avoid fish liver oil or vitamin A supplements. It is better to take pure fish oil (high in omega-3 but has no Vitamin A) rather than fish liver oil.

Dr. Phil Hariram
Arthritis Guide.

Exercise is good for arthritic joints. Exercise keeps the joint flexible and the muscles strong. Inactive muscles tend to waste and become thin. Make sure you know what to do and do not overdo it. Exercise also makes you feel generally better.

Resting an inflamed joint will help it to improve and prevent further damage. If you are not sure ask a professional. Resting a joint is fine as long as you do not rest it too long. Combine it with some stretching exercise after some time.

If you are overweight, losing weight will help your arthritic joint. By losing weight you are putting less pressure on the joint. With arthritis a person may be inclined to reduce activity or in some case cut down considerably. This could end with weight gain if the calorie intake remains the same. It is best to aim for your ideal weight.

It is not clear whether special diets have any effect on arthritis. I feel it does not. However, fish oils and vegetables are supposed to reduce slightly joint inflammation. Alcohol does not affect arthritis but be aware that it could interact with over the counter treatment or prescribed medications. Make sure you are aware of this. If in doubt ask you doctor.

Arthritis that causes persistent pain and discomfort could lead to anxiety and depression. Get professional help if this happens. These conditions can increase your perception of pain and increase the intensity. Learn relaxation techniques and get help if you cannot control your anxiety. Any treatment that will create a positive attitude to your arthritis will impact very well on your general well being.

I strongly believe that a positive mental attitude will help you enormously in coming to terms and living with arthritis.

Dr. Phil Hariram

Arthritis Treatment.

There are certain arthritic conditions that we know a specific cause for. Gout, for example, we know is caused by a lack of an enzyme, xanthine oxidase, and as a result the level of uric acid in the blood is higher than normal. This high level results in crystals separating out and being deposited in joints and other areas of the body.

In most cases of arthritis there are more than one factors involved. Some people have a genetic risk that leaves them susceptible to arthritis. Some arthritis runs in families but the precise genetic link is not yet clear.

Environmental factors contribute to arthritis. Individuals involved in repetitive high physical demand in a particular joint will be prone to arthritis. Injury can cause damage or mis-alignment of the joint leading to undue wear.

Infections in the joint (septic arthritis) can lead to arthritis. Some general infections can cause joint pains but this goes away when the infection subsides.

There is no clear evidence that climate contributes to arthritis. These joint problems are worldwide. I know a lady with osteoarthritis. She could tell with reasonable accuracy the weather outside when she wakes up in the morning by the level of stiffness and pain.

Another patient who endures regular winter aches and pain in UK, was remarkably pain free during a winter spent in the Spain where the weather in mild and the sky is blue. Pain is subjective and the intensity does not necessarily depend on the severity of arthritis. Of course, winters in UK are cold, damp and gloomy and the sky usually grey.

Dr. Phil Hariram.

Arthritis Guide.

Related articles by Zemanta

• Telegraph Christmas Charity Appeal: ‘Arthritis Care shows me I’m not a victim’

Patients visit their family doctor or specialists for arthritis treatment mainly because of pain level and restriction to their lives. Most osteoarthritic patients control their pain by using simple analgesics such as paracetamol or whatever is available over the counter.

Stronger analgesics are obtained from their GPs. Non-steroidal anti-inflammatory drugs (NSAID) has been used quite extensively in the past when analgesics did not control pain adequately and was prescribed on its own or in conjunction with analgesics.

They have gastric side effects and care must be taken if these drugs cause indigestion or if there is a past history of ulcers. Some of these drugs are available over the counter. They are sold at a lower dose. Make sure you do not exceed the recommended dosage. The newer COX2 inhibitors are NSAIDs that are not as harsh on the gastric lining and therefore less likely to cause gastric problems.

Recently, however, they have been linked to heart disease. Recent research also suggests that higher than recommended doses of ordinary NSAIDs ie ibuprofen, increase the risk of heart attacks. There is no evidence that this group of drugs for the treatment of osteoarthritis have any affect on progression. Use this group of drugs carefully if you have to.

Topical NSAIDs are effective in smaller joints and at times are as effective as the oral alternative, and much less likely to produce side effects. Topical capsaicin is also effective in controlling pain and is an effective arthritis treatment.

Intra-articular steroid injections are used very effectively in osteoarthritis. Hyaluronic acid drugs are also effective as intra-articular injection and their effect are longer lasting that cortisone and other fluorinated corticosteroids.These intra-articular injections are used in uncomplicated osteoarthritis and is an alternative arthritis treatment when surgery is contraindicated or not recommended.

Dr.Phil Hariram,

Arthritis Guide

There are ways you can help osteoarthritis treatment. Lifestyle changes can make a significant effect on your condition. Obesity affects the bio-mechanics of weight bearing joints. Maintaining the correct weight (BMI) will reduce progression of arthritis especially in the knees.

Maintain a good level of activity and improve on exercise. This improves the strength of the muscles and wasting, and has a positive benefit on osteoarthritic joints and general well being.

If there in deformity of the knees such as valgus then insoles and patello-femoral strapping will help. Using shoes with softer soles help spread the load and absorb impact. Use trainers when you can instead of hard sole shoes. Walking stick helps distribute the load.

It is important that osteoarthritic patients remain positive about their condition. A positive mental attitude is an invaluable tool when addressing the level of pain and disability.

A patient with osteoarthritis should pay particular attention to potential problems and hindrance at work, home or when going out and look at ways to overcome them.

Drug treatment of osteoarthritis have possible side effects and although maybe necessary, lifestyle modification is an important aspect of osteoarthritis treatment. In addition you feel a lot better being able to control your symptoms yourself rather than rely on drugs etc. as the only treatment for osteoarthritis.

Dr. Phil Hariram,

Arthritis Guide.

You can break this into symptoms, signs and impairment of function.

Pain develops around the osteoarthritic joint. The severity of pain and impairment depends largely on the individual. This can be influenced by expectation and state of mind. Anxiety and depression will influence pain perception. Level of satisfaction and success especially at work and home impacts on pain level and much as the personality profile.

A placebo surgery trial on osteoarthritic knee where no corrective surgery occurred produced significant improvement on pain level and functional impairment. Expectation was responsible for the improvement.

Crepitus (grating noise) is present in osteoarthritis. You can hear the noise as the joint is moved. Bony enlargement can occur and often the joint looks mis-shapened. Restricted movement is not uncommon. The joint may feel warm or swollen (effusion) following synovitis. Weakening of supporting muscles and wasting can follow.

Remember osteoarthritis is not only due to wear and tear. There may be other underlying problems associated wirth arthritis. Conditions such as fibromyalgia, gout and sepsis must be considered when having treatment for osteoarthritis.

If you suspect you have osteoarthritis, make sure you see your family doctor. Accurate assessment, diagnosis and investigation of potential associated illnesses will help both in the short and long term when having osteoarthritis treatment.

Dr. Phil Hariram.

Arthritis Guide.

Osteoarthritis can be grouped into two types, primary and secondary.
In primary, the cause is generally unknown and in secondary it can develop following damage to the joint or mis-alignment.

When osteoarthritis develops the surface of the cartilage splits, and focal erosions develops leading to exposure of the underlying bone. The exposed bone becomes worn and smooth. This is called eburnation. The synovial fluid can enter the exposed bone and if this happens, cysts (subchondrial cysts) can develop.

Osteophytes develop around the joint margin. The joint becomes unstable as the capsule becomes lax and muscles wasting develops. Effusion and inflammation may be due to trauma or irritation.

Primary Osteoarthritis: The cause is unknown but factors such as ageing, cartilage wear, obesity, metabolic disturbance, bone wear and genetic factors should be considered. It is most common in the elderly but can develop in young people. Obesity is an important factor. Additional weight will create extra pressure on joints and lead to wear. In primary osteoarthritis the ankle joints are spared.

Secondary Osteoarthritis: Damage or mal-alignment following trauma can lead to premature wear of joints.

Trauma: This can be intra-articular fracture and can cause mal-alignment, in the lower limb or a shorter leg. All these can contribute to extra wear. Occupation also contribute to trauma ie footballers are likely to have ankle injuries.

Genetic: These include bone and cartilage dysplasia, congenital dislocation of the hip, Perthe’s disease, slipped femoral epiphysis, and hypermobility joints.

Inflammation: Includes septic arthritis, rheumatoid arthritis and gout.

Bone Disorder: Aseptic Necrosis and pagets’ disease.

Other Conditions: Haemophilia can lead to osteoarthritis.

Dr. Phil Hariram

Arthritis Treatment.