Arthritis refers to nearly 100 different rheumatic diseases of the areas in and around the joints. Conditions as different as fibromyalgia, scleroderma and gout have often been included with the classic arthritic conditions: osteoarthritis and rheumatoid arthritis.
Arthritis is now our nation’s leading cause of disability and is projected by the CDC to effect nearly 60 million Americans (20% of U.S. population) by the year 2020. By far the most prevalent type is osteoarthritis, accounting for one half of the 40 million Americans currently suffering from these conditions. Osteoarthritis (OA), often called degenerative joint disease (DJD), is characterized by the degeneration of the cartilage protecting the ends of bones at the joints. We will discuss the underlying problems associated with osteoarthritic joints as well as review the standard of care and natural alternatives.
The term arthritis implies to an inflammatory process; which in fact may not necessarily be involved in many of the cases of osteoarthritis. It is for this reason that many use the term arthrosis or degenerative joint disease (DJD) for this condition. Unlike rheumatoid arthritis, which usually effects the respective joints symmetrically (both knees, both hands etc.), OA often occurs in one joint without similar pathology in its symmetrical equivalent. Osteoarthritis (OA) is characterized by a slow and gradual onset, usually starting with morning stiffness in a few weight-bearing joints (especially the knees). Eventually, pain is associated with movement leading to loss of joint function. Signs include joint tenderness, intermittent inflammation, joint crepitus and Heberden’s nodes (when fingers are involved). X-ray analysis will often show a narrowing in the joint space and irregularity (osteophytes) and increasingly dense bone surface. These findings are the result of the wearing away of the articular cartilage covering the ends of the bones at the joint and the irregular compensation of the bone ends. While not considered inevitable, OA is certainly related to the effects of time and gravity (bats and sloths are the only mammals with no history of OA) and is often called wear and tear arthritis. To protect the integrity of the bones meeting at synovial joints, the ends are covered by articular cartilage. This cartilage is made of collagen fibers, giving it tensile strength, and proteoglycan molecules (especially chondroitin sulfate), to cushion impacting pressure.
The proteoglycan molecules are made from a linear core protein with several hundred molecules of glycosaminoglycans (GAGs, primarily chondroitin sulfate and keratin sulfate) attached at right angles. These protein core molecules are attached to a hyaluronic acid framework, which acts in a network to make up the articular cartilage. This unique structure allows proteoglycan molecules to absorb synovial fluid when uncompressed and then expel the fluid as it is compressed. This compression and decompression of the proteoglycans allows for the exchange of fluids and nutrients in the joints, where a direct blood supply is not available. Active exercise leads to the compression and decompression of the articular cartilage and is beneficial in preventing OA, as inactivity will lead to nutrient and fluid deprivation of the articular cartilage, hastening its degeneration. Properly hydrated articular cartilage is one of the most frictionless surfaces known. Cells known as chondrocytes are responsible for forming articular cartilage. Like CNS and muscle cells, chondrocytes have an extremely long cell cycle and do not divide very often. It may be the triggering of the chondrocytes to divide, and a coordinated osteoblast bone synthesis that may be responsible for many of the hardening and irregularly formed bone ends. Under normal circumstances, chondrocytes produce proteoglycans by polymerization of the monomers derived from glucose (glucuronic acid and N-acetyl glucosamine) and galactose. Modification of enzymes in these pathways, reduced levels of precursors, or preventing those precursors from entering the chondrocyte (sedentary lifestyle) will decrease the formation of articular cartilage and increase the incidence of OA. (The Standard, 1999).
Many people consider OA or DJD to be irreversible. When conservative treatment fails, joint replacement is often necessary. Emerging research has come out lately with various injections into the joint including viscosuplmentatiion, PRP, and as of recently stem cell. While some results are promising more research is needed. There are several pharmacological agents like NSAIDS that help to ease the pain, but studies have shown that they affect cartilage metabolism and are toxic to the liver when used long term. NSAIDS work by blocking the COX 1 pathways, but in the process they really put a big burden on the liver, which leads to more side effects than most people want including stomach bleeding. “One of the interesting findings of the use of aspirin, NSAIDS, and steroid drugs for osteoarthritis is their effect on articular cartilage metabolism. NSAIDS have been shown to suppress proteoglycan synthesis by chondrocytes. To date, contradictory findings show that some NSAIDS block proteoglycan synthesis at certain concentrations while seeming to stimulate synthesis at other concentrations. has been shown to block an enzyme involved in elongation of chondroitin sulfate molecules.
It seems that the very drugs used to mask the pain caused by articular cartilage loss, may be preventing the joints from effectively replacing it.” (The Standard, 1999).
So what do we do?
You have heard of glucosamine correct? Most people have, but usually it is from a mass marketed retail product with poor quality raw materials.
The product that I personally love and use regularly is Chondro-Flx from Ortho Molecular Products. I really believe in the research behind it, and also believe its leaps and bounds superior to other glucosamine/chondroitin products out in the retail and professional channel today.
Chondro-Flx combines glucosamine sulfate, chondroitin sulfate, vitamin C and bromelain, all of which have a long history of use and a large body of research highlighting their role in supporting joint health. As the key precursors to cartilage formation, the ingredients in Chondro-Flx provide full support for joint integrity and movement and a normal inflammatory balance. The formula also includes bromelain to enhance the absorption of chondroitin and vitamin C, an antioxidant that reduces free radicals and is a cofactor to enzymes critical for the synthesis of new collagen.
Glucosamine sulfate is a naturally occurring precursor for collagen synthesis and is a basic building for the smaller structures in joint tissue like glycolipids, glycoproteins, hyaluronate, and proteoglycan. What we have known about the science behind glucosamine is now showing up in the research: In early double blind, placebo-controlled studies with 80 participants with OA, the group with glucosamine improved 71% over the placebo group. Lastly, a 2013 study of data from a French database of 11,772 adults taking a glucosamine supplement showed a significant positive effect in joint health, functional limitation and quality of life.
As the major glycosaminoglycan associated with articular cartilage, chondroitin sulfate (CS) is designed to draw water into the joint tissues and hydrate them, allowing for compression when pressure is put on the joint and to rehydrate when the pressure is released. There is a growing body of research supporting the benefits of chondroitin for joint discomfort. A review of seven clinical trials (327 total patients in which CS compared with placebo for 120 days or more) revealed it to be significantly superior to placebo. Key research in the use of chondroitin sulfate confirmed the use for knee, and finger joint benefits. A one year, randomized, double-blinded, placebo-controlled study of patients with knee discomfort showed a significant positive effect in joint health and mobility in patients taking CS (800 mg/day) compared to placebo. CS has also been shown to maintain normal inflammatory balance, with an affinity to synovial cartilage and to have metabolic effects on synthesis of hyaluronate and cartilage proteoglycans. CS has also been shown to inhibit cartilage degrading enzymes (collagenase, elastase, proteoglycanase). (Uebelhart D)
It is well established the size and weight of chondroitin sulfate are very important is absorption of chondroitin. A study at the University of Maryland examining random retail chondroitin sulfate products showed that the majority of products use large molecular weight, acid-hydrolyzed chondroitin particles. These are inconsistent in size and too large to be absorbed in the intestine.
The chondroitin sulfate in Chondro-Flx is enzymatically processed providing consistently small, highly absorbed chondroitin molecules ensuring the best results.The analogy I like to use for most retail brands of chondrotin is that they use a Acid Hydrolysis process, (Imagine hitting a rock with a sledge hammer and seeing all the pieces you get from hitting it), enzymatically processed creates uniformity in size, like perfect pearls in a sequence, which particle do you think gets absorbed better? Ortho Molecular gets it Chondrotin Sulfate from Bioiberica (SPAIN), which is one of the top raw material suppliers of CS in the world.
Now there have been multiple studies about numerous chondroitin sources, and how they do no meet label claim. They looked at the 32 manufactures of chondroitin and looked at all the materials. A material or the top quality had very little variance, and the highest permeability, while the others showed much less permeability and much higher variance, basically a crap shoot. Most of the competitors come from china and are bigger size and do not get through the caco 2 cell membrane, and also use the hammer and rock process of acid hydrolysis that I described earlier.
Now we know about the effects of bromelain and that is comes from pineapples, but bromelain also aids in increasing the absorption of chondroitin sulfate, and it also acts as a natural anti-inflammatory.
Vit C is also added at a low dose because studies have shown that together all of these materials combined can have a synergistic effect.
Dosing is 3 capsules per day and research now shows you can take them all at once or separate them 3x per day and still have the same absorption. It is recommended to take on a empty stomach, as bromelain is also a proteolytic enzyme
You can find Chondro-Flx at a functional/integrative medical clinic, or independent pharmacy near you.
If you do not have provider you can find it at our store (link below) under the MSK protcols tab. us.fullscript.com/welcome/fredrickson
Uebelhart D et al. Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study.
Osteoarthritis and Cartilage 1998; 6(Suppl A):39-46.
Thomas Williams: Osteoarthritis a Natural approach 1999.