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Diet against arthritis

What is it?

Arthritis is the general medical term that designates inflammation in the joints or a disorder characterized by such inflammation. Dietary therapies for osteoarthritis (OA) and rheumatoid arthritis (RA) -the two most common forms of arthritis-fall into three main categories:



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The conventional treatment strategy focuses on weight reduction and a balanced diet to relieve the tension of damaged joints and slow down the progression of arthritis.
Some dietary supplements analyzed in clinical trials have been shown to be beneficial for some patients.
Approaches to alternative medicine are supported by dietary adjustments (including elimination diets) and / or traditional plant remedies to treat arthritis.

The role of diet and nutrition in the types of arthritis OA and AR has been studied since the 1930s, but despite this, there is little consensus on the details of adequate dietary therapy for these disorders. What has been clear, after decades of studies, is the importance acquired by the reduction or maintenance of weight for the treatment of patients with arthritis OA. Another of the agreed findings for both types of arthritis is the need to consume a nutritionally balanced diet and follow healthy eating patterns.

What benefits does it provide?

Osteoarthritis

•     The reduction of weight in overweight people and with OA can lead to a remarkable relief of their discomfort and an improvement in the mobility of the affected joints.
•     The benefits of dietary supplement intake vary from one patient to another, depending on the joints specifically affected and the degree of erosion of the cartilage.

Rheumatoid arthritis

•     The benefits of introducing dietary adjustments, or the intake of dietary supplements to alleviate the effects of RA, vary considerably from one patient to another.
•     Maintaining a balanced diet is important in preventing the nutritional deficiencies that sometimes occur in patients with RA due to the side effects caused by the medication.
•     It has been possible to associate a deficiency of vitamin B6 with the development of RA, and supplements of vitamin B6 can reduce the levels of inflammation.

What risks do you pose and what precautions should be taken?

• Before starting any type of diet or supplement regimen it is important to consult with the doctor.
• Before starting any kind of dietary treatment for joint pain, consult a doctor to obtain an accurate diagnosis of the type of arthritis that causes the pain. If there is a suspicion of AR arthritis, it is essential to follow a systemic treatment as soon as possible to minimize potential long-term health damage.
• Check with your doctor before taking any dietary supplement, as it may interact with certain medications (with prescription and without it). Chondroitin sulfate, for example, may prolong the bleeding time in some people, especially if taken with aspirin.
• Buy dietary supplements only from trusted brands that can support the quality of their products.
• Do not stop taking any medication prescribed by your doctor without your consent.
• If you follow a diet fundamentally vegetarian, do not forget that iron deficiency can develop.
• In the case of patients with RA with a healthy weight, it is not recommended to lose weight. Excessive weight loss, especially caused by stopping many foods or following fast diets, can worsen the symptoms of AR arthritis.

Dietary supplements

•     People with diabetes should check their blood sugar levels more often if they take glucosamine, since it is an aminosaccharide.
•     Those who take blood thinning medications should periodically check their blood clotting time if they take chondroitin sulfate.
•     In some people, glucosamine and chondroitin sulfate cause intestinal gas or mild diarrhea. In some people, the unsaponifiables of avocado and soy (ISA), cause nausea and skin rashes.
•     In some people, vegetable oils that contain gamma linolenic acid (FFA) can cause intestinal gas, bloating, diarrhea and nausea. In addition, these oils may interact with other medications, especially blood thinners.
•     Some preparations of borage oil contain ingredients called pyrrolizidine alkaloids (AP); These can damage the liver or worsen liver diseases. Only borage oil should be used with certification that proves to be free of pyrrolizidine alkaloids.
•     Evening primrose oil can interact with a group of tranquilizers used in the treatment of schizophrenia, known as phenothiazines. This group of medicines includes chlorpromazine and prochlorperazine.
•     In some people, fish oil can affect the rate of blood clotting and cause nausea or fishy odor on the breath.
•     Fish oils with high levels of vitamin A can cause vitamin A toxicity in some people.
•     People who take fish oil supplements should normally take them for several months to notice their beneficial effects.

How does it work?

Osteoarthritis

Weight reduction

•     The best dietary recommendation that conventional medicine approves for patients with OA is to maintain a healthy weight. A few extra pounds can increase the pressure on damaged joints.
•     Although some doctors recommend trying a vegetarian or vegan diet as a safe way to lose weight for patients with OA, most of them consider appropriate any low calorie and nutritionally adequate diet that goes well with the particular patient.

Alterations in the diet

•     Some people believe that elimination diets can help reduce the symptoms of OA, although there is no scientific evidence of the effectiveness of any of these diets.
•     Dong's diet requires the patient to eliminate all fruits, red meat, alcohol, dairy products, herbs and all foods containing additives or preservatives from their diet.
•     The belladonna elimination diet requires eliminating all forms of belladonna from the diet, including various herbs, potatoes, tomatoes, peppers and aubergines.
•     There is no clinical evidence that people with OA benefit from the elimination of these foods, and vegetables with belladonna may even help reduce the symptoms of arthritis.

Dietary supplements

To treat the discomfort caused by OA and / or to slow the rate of cartilage deterioration, the intake of some dietary supplements is usually recommended:

•     Chondroitin sulfate is a compound that is naturally present in a protein in the body that provides elasticity to cartilage. The supplement form is a derivative of animal or shark cartilage.
•     Glucosamine is a form of aminosaccharide which is thought to contribute to the formation and repair of cartilage. It can be obtained from the shell of crab, shrimp or lobster.
•     Some naturopaths recommend the ingestion of extracts of cassava, devil's claw, hawthorn berry, cranberry and cherry. It is believed that these extracts reduce inflammation in the joints and promote the formation of cartilage.
•     Some doctors recommend increasing the daily intake of vitamins C, E, A and B6, necessary to preserve the cartilaginous structure.
•     The unsaponifiables of avocado and soy (IAS) are a compound obtained from fractions of avocado oil and soybean oil left over after the soap making process. They contain one part of avocado oil and two of soybean oil.

Rheumatoid arthritis

Dietary treatment of RA mainly accompanies pharmaceutical treatment, since the disease can not be treated by applying only nutritional changes.

Alterations in the diet

•     A well-balanced and healthy diet can help prevent nutritional deficiencies generated by certain medications.
•     There are indications that patients with RA may benefit from reduced consumption of red meat or switch to a vegetarian or vegan diet.
•     Another adjustment in the diet that seems to benefit some people with RA is to stop cooking with oils with a high content of omega 6 fatty acids (which increase inflammation) and replace them with oils with a high content of omega 3 fatty acids (which reduce inflammation). ). The recommended oils are olive oil, rapeseed oil and flaxseed oil.

Dietary supplements

Among the dietary supplements most commonly recommended for patients with RA include:

•     Fish oils Cold-water fish oils appear to reduce inflammation and relieve joint pain in some patients with RA. The recommended daily dose is 1 to 2 teaspoons. Eating fatty fish (such as salmon, trout and sardines) may also help reduce the risk of heart disease, which is higher in people with arthritis.
•     Vegetable oils. Different studies suggest that vegetable oils with a high content of gamma-linolenic acid (GLA) reduce inflammation of the joints. These vegetable oils include evening primrose oil, borage oil and black currant oil. The recommended daily dose is usually 200 to 300 mg (0.2 to 0.3 g).
•     Green Tea. It is believed that the intake of four glasses of green tea a day can benefit people with RA, thanks to the effect it produces in reducing the inflammation of the joints.

What is a typical meal?

• In general, foods to fight arthritis consist of a variety of healthy foods, including different fruits, vegetables, whole grains, semi-skimmed dairy products and lean meats. A healthy meal could include, for example:
• A turkey sandwich with lettuce and tomato on wholemeal bread
• Carrot sticks
• Apple
• Water or skimmed milk

What do the experts think?

•     Doctors recommend weight loss as a positive way to decrease joint pain and improve the overall health of people with OA.
•     There are no clinical studies demonstrating that OA patients can benefit from an elimination diet.
•     Regarding dietary supplements, the results are varied. A comprehensive study of glucosamine and chondroitin sulfate supplements, the GAIT study (Glucosamine / Chondroitin Arthritis Intervention Trial), showed that the combination of these two supplements seemed to benefit a small subgroup of patients with OA with moderate pain to severe. In people with mild discomfort only, the glucosamine / chondroitin supplement did not produce pain relief other than a simple placebo effect.
•     After reviewing 35 studies on medicinal herbs used to treat OA, it was concluded that, although the IAS are possibly beneficial, it is necessary to carry out a more exhaustive study that can determine what those benefits are.

Rheumatoid arthritis

•     Few quality studies have been published regarding dietary treatments to treat RA in people.
•     Some studies indicate that patients with RA can benefit from a vegetarian, vegan or Mediterranean diet.
•     It is possible that fish oil supplements are encouraging, however, it is necessary to conduct more studies in this regard. Fish oils appear to reduce the risk of heart attacks in patients with RA, and relieve joint pain and inflammation.
•     It has been discovered that green tea and turmeric help reduce inflammation of the joints in animals, although there are no scientific studies on the subject in humans.

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What to try and what not even treat for arthritis

If you are one of the more than 30 million Americans with osteoarthritis (OA), the most common form of arthritis, you have probably considered treatments in addition to medications to relieve pain . Approximately 40% of people who have arthritis have tried complementary or alternative therapy such as acupuncture or yoga, according to the Centers for Disease Control and Prevention (CDC).



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"When conventional medicine fails for the relief of arthritis pain , many people suffering from this disease look for alternative methods," says Dr. Marvin M. Lipman, MD, chief medical advisor at Consumer Reports. "Not only is there little evidence to support many of these treatments, but some are not even regulated."

Medications that affect your senses

Is there any that is useful? "These do not have a radical effect," says Dr. Richard Panush, MD, a professor at Keck School of Medicine at the University of Southern California. " Some at most may have small effects in some circumstances for some people."

3 that could help

Massage. A review of the studies published in the scientific journal Mayo Clinic Proceedings suggests that massage therapy can relieve the pain and stiffness of OA of the knee. Researchers in one study recommended a weekly 60-minute session with a certified massage therapist. (Look for one at amtamassage.org .)

Tai Chi. The Chinese exercise with its slow and rhythmic movements demonstrated in a review of 54 studies of 2015 that it slightly reduces the pain of arthritis. But it was less effective than aerobic and strengthening exercises. (Get more information on americantaichi.org .)

Yoga. A review of 17 studies published in the journal Musculoskeletal Care found that yoga reduced the pain of OA. Our experts recommend avoiding Bikram (hot yoga) if you have joint problems. The heat can make you feel like you can stretch more than you should, which could further damage your joints.

Acupuncture. Research suggests that this traditional Chinese therapy, which includes inserting thin needles into the body at specific points, reduces the discomfort of OA for some people. One theory is that it can trigger the release of hormones that inhibit pain, called endorphins. Or maybe it could provide a placebo effect, helping you to feel better without a medical reason. Make sure you receive the treatment with a certified professional. (Look for one in mx.nccaom.org/findapractitioner.aspx. )

And 3 therapies that you should avoid

Chiropractic manipulation. Some research suggests that the "realignment" of the spine by a chiropractor can relieve some of the general pain in the back and neck. But a 2012 review, published in the journal Rheumatology, found no evidence that therapy effectively reduces the pain of OA.

Dietary supplements. Some people use supplements such as glucosamine and chondroitin (often together) or fish oil for joint pain. So far, studies have shown that glucosamine and chondroitin are not more effective than a placebo.

High doses of fish oil can relieve joint pain caused by rheumatoid arthritis, an autoimmune condition. But its effect on OA is not clear. In addition, fish oil supplements can cause side effects such as diarrhea and stomach pain. And dietary supplements are not well regulated by the Food and Drug Administration (FDA), so you can not be sure that the one you're taking contains what the label says.

Homeopathy. The principle behind homeopathy is that some highly diluted substances can cure the disease. For example, rhus toxicodendron , made from poison ivy, has been touted as a treatment for OA. But Lipman says there is no good evidence to support the use of homeopathic remedies for arthritis or for any other condition.

Low-fat diets, do they really work?

3 smart strategies

Lose weight if you need it. Work to lose extra pounds. Excess weight puts extra pressure on the ankles, hips and knees, which can severely increase the pain of arthritis.

Do the right type of exercise. Activities that strengthen muscles, improve your range of motion and increase your cardiovascular activity can help. In addition to tai chi and possibly yoga, consider a regular walking or swimming program. Learn more about the right exercises for arthritis at arthritis.org/ living-with-arthritis / exercise.

Talk with your doctor. If you decide to try an alternative therapy, it is advisable to inform your doctor in advance that you can refer you to a trusted professional in the area. Your doctor can also tell you about any potential danger or if there could be interactions with your regular medication.

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Arthritis of the shoulder

In 2011, more than 50 million people in the United States reported that they had been diagnosed with some form of arthritis, according to the National Health Interview Survey. Defined in simple terms, arthritis is the inflammation of one or more of your joints. In a diseased shoulder, inflammation causes pain and stiffness.



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Although there is no cure for shoulder arthritis, there are many treatment options available. Using these options, most people can manage pain and remain active.

Anatomy

Your shoulder is made up of three bones: the upper arm bone (humerus), the shoulder bone (shoulder blade), and the neck bone (clavicle).

The head of the arm bone fits into the rounded cavity of the shoulder blade. This is called the glenoid cavity. A combination of muscles and tendons keeps the bone in your arm centered in the shoulder cavity. These tissues are called the rotator cuff.

There are two joints in the shoulder and both can be affected by arthritis. An articulation is located where the clavicle meets the tip of the scapula (acromion). This is called acromioclavicular joint (AC joint).

The place where the head of the humerus fits into the shoulder blade is called the glenohumeral joint.

• To indicate an effective treatment, your doctor will need to determine which joint is affected and what type of arthritis you have.
• Los huesos y las articulaciones del hombro.
• The bones and joints of the shoulder.
• Reproduced with the permission of J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopedic Surgeons, 2003.

Description

Five main types of arthritis typically affect the shoulder.

Osteoarthritis

Also known as "wear and tear arthritis", osteoarthritis is a condition that destroys the smooth outer covering (articular cartilage) of the bone. As the cartilage wears out, it deteriorates and becomes rough, and the space of protection between the bones decreases. During movement, the bones of the joint rub against each other, causing pain.

Osteoarthritis usually affects people older than 50 years and is more common in the acromioclavicular joint than in the shoulder glenohumeral joint.
( Left ) An illustration of damaged cartilage in the glenohumeral joint. ( Right ) This X-ray image of the shoulder shows osteoarthritis and reduced joint space ( arrow ).
Illustration on the left reproduced with the permission of JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopedic Surgeons, 2010.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic disease that attacks multiple joints throughout the body. It is symmetrical, which means that it generally affects the same joint on both sides of the body.

The joints of your body are covered with a membrane, called the synovium, which lubricates the joint and facilitates movement. Rheumatoid arthritis causes the membrane to swell, which causes pain and stiffness in the joint.

Rheumatoid arthritis is a disease caused by autoimmunity. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection are those that damage normal tissue (such as cartilage and ligaments) and weaken the bone.

Rheumatoid arthritis is equally common in both shoulder joints.

Post-traumatic arthritis

Post-traumatic arthritis is a form of arthritis that develops after an injury, such as a fracture or dislocation of the shoulder.

Rotator cuff tear arthropathy

Arthritis can also develop after a large and prolonged tear of the rotator cuff tendon. The torn rotator cuff can no longer support the head of the humerus in the glenoid, and the humerus can move up and rub against the acromion. This can damage the surfaces of the bones, causing the development of arthritis.
Artropatía del manguito rotador.

Rotator cuff arthropathy.

The combination of a large tear of the rotator cuff and advanced arthritis can lead to severe pain and weakness, and the patient may not be able to raise the arm.
Avascular necrosis

Avascular necrosis of the shoulder (AVN) is a painful condition that occurs when the blood supply to the head of the humerus is altered. Bone cells die without blood supply, so AVN can eventually lead to destruction of the shoulder joint and arthritis.

Avascular necrosis develops in stages. As it progresses, the dead head gradually collapses, damaging the articular cartilage that covers the bone and leads to arthritis. Initially, the AVN affects only the head of the humerus, but as the AVN progresses, the collapsed head of the humerus can damage the glenoid cavity.

The causes of AVN include the use of high doses of steroids, excessive alcohol consumption, sickle cell anemia and traumatic injuries, such as shoulder fractures. In some cases, a cause can not be identified, this is called idiopathic AVN.


Pain. It is the most common symptom of arthritis of the shoulder, aggravates with activity and progressively worsens.

•     If the shoulder glenohumeral joint is affected, the pain is centered in the back of the shoulder and may intensify with changes in weather. Patients complain of deep pain in the joint.
•     Arthritis pain in the acromioclavicular joint (AC) is concentrated in the upper part of the shoulder. This pain can sometimes radiate or travel to the side of the neck.
•     A person with rheumatoid arthritis may have pain around the shoulder if both joints, the glenohumeral and the AC joint, are affected.

Limited range of movement. Limited movement is another common symptom. You may find it more difficult to raise your arm to comb your hair or reach a shelf. You may hear squeaks, clicks, or cracks (joint crepitus) when moving the shoulder.

As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping can be difficult.

Medical exam
Medical history and physical examination

After discussing your symptoms and medical history, your doctor will examine your shoulder.

During the physical examination, your doctor will look for:

•     Weakness (atrophy) of muscles
•     Pain on palpation
•     Amplitude of the range of passive (assisted) and active (self-directed) movement
•     Any sign of injury to the muscles, tendons and ligaments that surround the joint
•     Signs of previous injuries
•     Involvement of other joints (an indication of rheumatoid arthritis)
•     Joint crepitus (sensation of noises and irritation within the joint) with movement
•     Pain when pressure is applied to the joint

X-rays

X-rays are tests with the use of images that create detailed figures of dense structures such as bone. They can help distinguish between various forms of arthritis.

The X-rays of an arthritic shoulder will show a narrowing in the joint space, changes in the bone and the formation of bone spurs (osteophytes).
Estos rayos X muestran osteoartritis severa de la articulación glenohumeral.
These X-rays show severe osteoarthritis of the glenohumeral joint.
Reproduced with the permission of Crosby LA (ed): Total Shoulder Arthoplasty. Rosemont, IL, American Academy of Orthopedic Surgeons, 2000, p. 18.

To confirm the diagnosis, your doctor may inject a local anesthetic into the joint. If it temporarily relieves pain, it supports the diagnosis of arthritis.

Treatment
Non-surgical treatment

As with other arthritic conditions, the initial treatment of arthritis of the shoulder is non-surgical. Your doctor may recommend the following treatment options:

•     Rest or a change in activities to avoid causing pain. You may need to change the way your arm moves to do things.
•     Physical therapy exercises that could improve the range of motion in your shoulder.
•     Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may reduce inflammation and pain. These medications can irritate the lining of the stomach and cause internal bleeding. They should be taken with food. Consult your doctor before taking over-the-counter NSAIDs if you have a history of ulcers or are taking blood-thinning medications.
•     Injections of corticosteroids in the shoulder can drastically reduce inflammation and pain. However, the effect is often temporary.
•     Humid heat.
•     Application of ice on the shoulder for 20 to 30 minutes two or three times a day to reduce inflammation and relieve pain.
•     If you have rheumatoid arthritis, your doctor may prescribe a medication that modifies the disease, such as methotrexate.
•     Dietary supplements, such as glucosamine and chondroitin sulfate can help relieve pain. (Note: there is little scientific evidence to support the use of glucosamine and chondroitin sulfate to treat arthritis, and the Food and Drug Administration does not control dietary supplements, which could cause negative interactions with other medications. to your doctor before taking dietary supplements).

Surgical treatment

Your doctor may consider surgery if the pain causes you disability and you have no relief with the non-surgical options.

Arthroscopy Cases of mild glenohumeral arthritis could be treated with arthroscopy. During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera obtains images that are displayed on a television screen and the surgeon uses these images to guide miniature-sized surgical instruments.

Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts) instead of the larger incision needed for standard open surgery.

During the procedure, your surgeon can debride (clean) the inside of the joint. Although the procedure relieves pain, it will not eliminate arthritis from the joint. If arthritis progresses, another surgery may be needed in the future.

Replacement of the shoulder joint (arthroplasty). Advanced arthritis of the glenohumeral joint can be treated with shoulder replacement surgery, in which the damaged parts of the shoulder are removed and replaced with artificial components, called prostheses.

( Left ) A conventional total shoulder replacement ( arthroplasty ) mimics the normal anatomy of the shoulder. ( Right ) In a total inverse shoulder replacement, the plastic capsule is inserted into the humerus and the screws of the hemispherical metal component into the shoulder cavity

Surgical replacement options include:

•     Hemiarthroplasty. Only the head of the humerus is replaced with an artificial component.
•     Total shoulder arthroplasty. The head of the humerus and the glenoid cavity are replaced. A plastic cavity ("cup") fits into the glenoid cavity and a metal hemisphere attaches to the upper part of the humerus.
•     Total reverse arthroplasty of the shoulder. In a total inverse shoulder replacement, the cavity and the metal hemisphere are opposite to a conventional total shoulder arthroplasty. The metal hemisphere is fixed to the glenoid cavity, and the plastic cavity (cup) is attached to the upper end of the humerus. A total reverse shoulder replacement works best for people with arthropathy due to a tear in the cuff because it is supported by different muscles - not the rotator cuff - to move the arm.

Resection arthroplasty. The most common surgical procedure used to treat arthritis of the acromioclavicular joint is a resection arthroplasty. Your surgeon may choose to perform this surgery arthroscopically.

In this procedure, a small amount of bone is removed from the end of the clavicle, leaving a space that gradually fills with scar tissue.

Recovery. The surgical treatment of shoulder arthritis is usually very effective in reducing pain and restoring movement. Recovery time and rehabilitation plans depend on the type of surgery performed

Complications As with all surgeries, there are some risks and possible complications. Potential problems after shoulder surgery include infection, excessive bleeding, blood clots, and damage to blood vessels or nerves.

Your surgeon will discuss possible complications with you before your operation.

Future developments

Research is being done on arthritis of the shoulder and its treatment.

•     In many cases, it is not known why some people develop arthritis and others do not. Research is being done to discover the causes of shoulder arthritis.
•     Joint lubricants, which are currently being used for the treatment of knee arthritis, are also being studied in the shoulder.
•     New drugs are being investigated to treat rheumatoid arthritis.
•     Much research is being done on shoulder joint replacement surgery, including the development of different prosthetic designs for joints.
•     The use of biological materials for the resurfacing of an arthritic shoulder is also being studied. Biological materials are tissue grafts that promote the growth of new tissues in the body and stimulate healing.

Source: Department of Research & Scientific Affairs, American Academy of Orthopedic Surgeons. Rosemont, IL: AAOS; January 2013. Based on data from the National Health Interview Survey, 2008-2011; US Department of Health and Human Services, Centers for Disease Control and Prevention; National Center for Medical Statistics.

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Medications, injections and supplements for arthritis

The pain, swelling and stiffness of arthritis can limit your movement. Medications can help you manage your symptoms so you can continue to lead an active life. Talk to your health care provider about medications that are right for you.



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Over-the-counter pain killers
Over-the-counter pain relievers can help with your arthritis symptoms. "Over-the-counter" means that you can buy these medications without a prescription.

Most doctors recommend paracetamol (such as Tylenol) first. It has fewer side effects than other drugs. DO NOT take more than 3 grams (3,000 mg) per day. If you have liver problems, talk to your doctor first about how much paracetamol is right for you.

If the pain continues, the doctor may suggest non-steroidal anti-inflammatory drugs (NSAIDs). Types of NSAIDs include aspirin, ibuprofen, and naproxen.

Taking paracetamol or another analgesic before exercise is OK. But DO NOT exercise excessively because you have taken the medication.

Both NSAIDs and acetaminophen in high doses, or taken for a long time, can cause serious side effects. If you are taking painkillers on most days, tell your provider. You may need to be monitored for side effects. Your provider can monitor you with certain blood tests.

Capsaicin (Zostrix) is a skin cream that can help relieve pain. You may experience a feeling of warmth and itching when you apply the cream for the first time. This sensation disappears after a few days of use. Pain relief usually begins in 1 to 2 weeks.

NSAIDs that come in the form of a skin cream are available over the counter or with a prescription. Ask your provider if these may be appropriate for you.


Steroid injections for arthritis
Medications called corticosteroids can be injected into the joint to help with swelling and pain. The relief can last several months. More than 2 or 3 injections a year can be harmful. These injections are usually applied in the doctor's office.

When the pain seems to disappear after these injections, it may be tempting to return to activities that may have caused pain. When you receive these injections, ask the doctor or physiotherapist for exercises and stretches that decrease the likelihood that the pain will return.

Other injections for arthritis of the knee
Hyaluronic acid is a substance already present in the fluid of the knee. It helps to lubricate the joint. When you have arthritis, the hyaluronic acid in your joint becomes thinner and less effective.

The doctor can inject a form of hyaluronic acid into your joint to help lubricate and protect it. This is sometimes called artificial joint fluid or viscosupplementation.

These injections can not work for all people. When they are effective, relief can last from 3 to 6 months. The use of hyaluronic acid is approved only for knee arthritis.

Supplements
The body produces glucosamine and chondroitin sulfate naturally. They are important to have healthy cartilage in your joints. Both substances come in the form of a supplement and can be purchased without a prescription.

Glucosamine and chondroitin sulfate supplements can help control pain; however, they do not seem to help the joint develop new cartilage or prevent arthritis from getting worse. Some doctors recommend a 3-month trial period to see if glucosamine and chondroitin help.

The s-adenosilmethionine (SAMe for its acronym in English and pronounced as "Sammy") is an artificial form of a natural chemical in the body. The claims that s-adenosylmethionine can help arthritis are not well proven.

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Scientifically proven remedies to relieve arthritis pain

1. Sips of ginger tea

Numerous studies have found that ginger can mimic Non-Steroidal Anti-Inflammatory Drugs, first-line drugs for the relief of arthritis pain. They act practically the same as medicines, but without the side effects. Use ginger powder, fresh, raw or a little cooked in food. Make your own tea: place slices of ginger for 15 minutes in a couple of cups of boiling water, or buy tea bags at the supermarket.



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2. Eat foods that fight inflammation

Forget about fast food, scrap, fried foods or processed foods. A Swedish study of patients with rheumatoid arthritis found that those who changed their style of eating to a more Mediterranean concept (with more fresh fruits, vegetables, whole grains, fish, olive oil, nuts, garlic, onions and herbs) had less inflammation and regained some physical abilities and mobility .

3. Smell fragrant spices

Pleasant scents such as lavender can alter the perception of pain, as some studies reveal. Japanese researchers found that lavender reduces levels of the stress hormone (cortisol), which will make you feel relaxed and less aware of pain .

Korean researchers found that patients with arthritis experienced less pain and felt less depressed when exposed to a variety of spice flavors you can find in the kitchen, including marjoram, rosemary and mint.

For a soothing aromatherapy treatment, add a teaspoon of one of these dried herbs to a quarter cup of vegetable oil and occasionally inhale its fragrance several times.

4. Wash the dishes by hand

It sounds contradictory, but if you have pain in your hands, this simple task can relieve the pain of arthritis . First, submerging your hands in hot water can help relax muscles and joints and relieve stiffness at the same time. Second, exercise will help you keep your hands and fingers moving.

5. Make your own heat pad

Fill a cotton sock with any type of raw rice and seal it. Put it in the microwave at maximum power for about 2-3 minutes. When it cools a little, but it is still warm, place it in a rigid joint in which you have pain to relieve it. It should stay warm for about half an hour. You will love the way the rice molds your body and provides a soft heat . If you have lavender or other aromatic herbs on hand, put a few drops in the sock to get some relaxing aromatherapy.

6. Make your own capsaicin cream

This home remedy reduces the levels of a compound called substance P, which transmits pain signals to the brain. You can do a little mixing a bit of ground cayenne with 3 tablespoons of olive oil. Apply gauze on clean skin to painful joints several times a day. The first dose will cause a mild burning sensation, but you will get used to it after about a week . Just keep it away from the mouth, eyes and other mucous membranes.

7. Apply a patch of chamomile tea

Chamomile tea is an anti-inflammatory that can help relieve arthritis pain . Prepare a strong infusion with four bags of chamomile tea in a cup (or less) of hot water. Let it stand, covered, for 20 minutes, then squeeze and extract the tea bags. Soak a clean cloth in the liquid and apply it to the sore joint.

8. Give a cold-heat treatment to your joints

You need two containers. Fill one with cold water and ice cubes and the other with hot water at a temperature that you can tolerate to the touch. Submerge the joint with pain in the cold water, for a minute, then change to the hot water container and submerge for 30 seconds. Then change the affected joint from cold to warm for about 15 minutes, leaving it in each for about 30 seconds. When finished, leave it submerged in cold water for one minute.

9. Go swimming

Swimming has been recommended for a long time as a good exercise for people with arthritis; the weightlessness of water reduces the impact on the joints . One study found that Taiwanese who rehabilitate themselves in the water significantly improve flexibility in the knees and hips, as well as strength and aerobic capacity.

Another Australian study found that such programs also resulted in decreased pain and better joint function in general. Ask your health center, hospital, or local pool if there are classes designed specifically for people with arthritis.
swim

10. Take 4 cups of green tea a day

Researchers from Case Western Reserve University supplied a group of mice with the equivalent of four cups of green tea a day. They then gave the mice a substance that would normally produce rheumatoid arthritis. Mice that drank green tea were much less likely to develop arthritis than mice that drank only water. Other research found that the antioxidant polyphenols in green tea are anti-inflammatory, improve the immune response related to arthritis and significantly reduce cartilage damage.

11. Add turmeric to your food

It contains a powerful compound called curcumin, which inhibits enzymes and proteins that promote inflammation. Several studies have found that it reduces pain and inflammation in patients with arthritis . In a study of people with osteoarthritis of the knee, those who ate only 2 grams a day (less than a teaspoon) had pain relief and increased mobility equal to those who took 800 milligrams of ibuprofen.

Sprinkle ½ teaspoon of turmeric in your rice or vegetables daily. Another option is to bring some mustard packs in your pocket to add them to your food; they are the perfect dose.

12. Make sure you get enough vitamin C

Vitamin C not only helps produce collagen, a major component of the joints, it also spreads through the body avoiding the damage of destructive free radicals, which are harmful to the joints. One of the most well-known studies looking at the relationship between vitamin C and arthritis, found that people whose diets usually included large amounts of vitamin C, significantly decreased the risk that their arthritis progressed .

Extend consumption throughout the day, because your body does not store vitamin C; Rather, it takes what it needs from the blood at a given moment and eliminates the rest. So a mega-dose in the morning, actually does not do as much good as you might think . It is advisable to enjoy citrus drinks or eat fruits and vegetables rich in vitamin C, such as strawberries or melon, broccoli or sweet peppers throughout the day.

13. Add cloves to your diet

The cloves contain eugenol, a popular anti-inflammatory chemical that interferes with the body process that causes arthritis . A study done with animals, showed that it prevents the release of COX-2, a protein that stimulates inflammation (the same protein in which inhibitory drugs such as Celebrex).

Cloves also contain antioxidants, which are important in delaying cartilage and bone damage caused by arthritis. It is advisable to consume ½ to 1 teaspoon a day .

14. Recharge yourself from omega-3

It is excellent for relieving inflammation and joints. Some fish such as salmon and tuna are some of the best sources of this fatty acid. However, your body may need more omega-3 than you get from consuming only fish, so talk to your doctor about prescribing an omega-3 supplement. And when cooking, always prefer canola oil before corn . Canola contains omega-3, while corn oil contains omega-6, which can actually make the inflammation and pain of arthritis worse.

15. Eat less allergenic foods

Food allergies can play an important role in autoimmune diseases such as rheumatoid arthritis. Researchers at the University of Oslo in Norway found that people with autoimmune diseases had higher levels of antibodies to cow's milk, eggs, cod and pork compared to people who did not have the disease.

In one study, people with rheumatoid arthritis followed a diet where they eliminated the common foods associated with allergies, such as grains (especially products containing wheat gluten), nuts, milk and eggs, after a lapse of 10 to 18 days had a significant improvement in symptoms. When they started eating these foods again, they felt worse. Other studies have found that corn, wheat, oranges, oats, rye, eggs, beef, and coffee can also be problematic foods, because many of these foods help produce arachidonic acid, a chemical in our body linked to inflammation.

16. Make yourself a paste of ginger

Applying crushed ginger to a joint with pain can deplete the body's stores of substance P , a brain chemical that carries pain signals to the central nervous system. A study of 56 people found that ginger relieved the symptoms of people with osteoarthritis by 55% and 74% in people with rheumatoid arthritis .

To make a paste, peel and finely chop a medium piece of fresh ginger. Mix with enough olive oil to form a paste, then apply it to the aching joint. Depending on where the pain is, you may have to wrap the joint with the plaster, using gauze or bandage. Leave on for 10 to 15 minutes.

17. Increase the volume

Listening to your favorite music can relieve pain (usually because it raises hormone levels that reduce your sensitivity to pain). In a Cleveland Clinic Foundation study of people with persistent pain in the back, neck or joints, one group was assigned a playlist of soothing melodies, while a second group chose their own soundtrack, and a third was not prescribed with any music. The two groups that listened to music had lower rates of arthritis pain, depression and disability compared to the group without music, which experienced an increase in pain. The study also indicated that the type of music you listen to does not matter, as long as you like it . People who chose their own melodies experienced greater reduction in pain, depression and disability than those who listened to generic relaxing music.

18. Goodbye to shoes

Walking naturally reduces the load on the knee joints, which minimizes the pain and disability caused by osteoarthritis by 12% compared to when walking with shoes on, according to a study by Rush University Medical Center. to 75 people with osteoarthritis. When you have to wear shoes, look for those who intend to imitate the natural contour of the heel and arch and avoid the heels, because they only generate more pressure on the joints. Orthopedic shoes can also be another good option.

19. Opt for spicy food

Spices such as cayenne pepper, ginger and turmeric contain compounds that reduce inflammation and block brain chemicals that transmit pain signals . Eat some Mexican, Indian and Thai recipes (or always keep a bottle of hot sauce on the table!)

20. Increase your calcium intake

Taking too little calcium increases the risk of osteoporosis, a disease in which the bones become brittle, and which accelerates if you have rheumatoid arthritis. All women should consume about 1,200 milligrams of calcium per day after 50 years of age. Dairy is the most famous source of calcium, but cooked milk-based foods can be a very good source as well (a large cookie can contain up to 12% of the recommended daily intake of calcium). Calcium is also found in vegetables such as cauliflower, cabbage, Brussels sprouts, kale, broccoli and turnip. These foods have less calcium than dairy products, but they contain it in a way that the body can absorb it much more easily.

21. Sunbathe

Many people with arthritis have a deficiency of vitamin D, which plays an important role in the production of collagen in the joints. Studies have found that generating more vitamin D can protect the joints from the damage of osteoarthritis. To increase your vitamin D levels, just take the sun for 10 to 15 minutes, two or three times a week. That's all your body needs to raise the vitamin D it needs. Dairy products are also a great source of this vitamin.

22. Get a massage with spices from your pantry

Add a little pepper, rosemary or thyme to ½ cup of olive or vegetable oil and use it for a relaxing massage. It will be very healing, since all these herbs have soothing properties.

23. Take these supplements into account

Ask your doctor if any of these supplements may be right for you.

Ginger extract twice a day . Researchers from the University of Miami found that ginger significantly reduced knee pain in patients with osteoarthritis , and that it contributed significantly to improving mobility since ginger has anti-inflammatory effects, which work in the body such as ibuprofen.

Fish oil capsules. A British study found that 86% of people with arthritis who took cod liver oil had far fewer harmful cartilage enzymes, compared to those who only received a placebo. In addition to that, there was also a decrease in the enzymes that cause pain . Cod liver oil is an oil of natural origin, so its use as a supplement does very well.

Vitamin E with pure alpha-tocopherols. A German study found that taking 1,500 IU of vitamin E daily, significantly reduces stiffness and pain and improves grip strength in people with rheumatoid arthritis, as do some prescription medications.

Glucosamine / chondroitin . This combination of supplements can provide long-term pain relief and delay cartilage degeneration . (Tends to help some patients and others do not, if it works for you, you should experience relief within two to three months, but if you do not see a benefit by then, it's probably not going to work for you.). It has also been found that glucosamine and chondroitin, can actually repair damaged cartilage.

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Glucosamine in the treatment of osteoarthritis

Arthrosis is a degenerative disease of the articular cartilage that affects almost 50% of those over 65 years of age 1 . Of the total affected, approximately 20% will develop symptoms such as joint stiffness, pain and functional impotence. This disease is responsible for 30% of visits to the general practitioner in older adults and the second cause of disability in the elderly after cardiovascular disease. It also represents an important cause of work absenteeism.



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The key site of the damage is the articular cartilage, where a progressive degeneration associated with a chronic inflammation that causes stiffness and pain occurs. The cause of joint deterioration is not known but certain predisposing factors such as advanced age and obesity have been identified.

The classic treatment has been aimed at improving symptoms, generally using anti-inflammatory drugs such as NSAIDs and other important measures: weight control, exercise, kinesiotherapy and local treatments with capsaicin and infiltrations with corticosteroids. These measures are effective in controlling pain in the medium term but chronic therapy with NSAIDs can cause gastrointestinal and renal adverse effects that limit their use.

In recent years, drugs have appeared that act at the level of cartilage, interacting with components such as proteoglycans and interfering with the oxidative mechanisms dependent on free radicals, which are thought to be related to the state of inflammation and chronic degeneration. Among them is Glucosamine Sulfate, a compound derived from glucosamine which is a normal component of cartilage and joint fluid. This drug is postulated as a disease modifier, since it interferes with the aforementioned degenerative mechanisms and could alter the long-term prognosis in addition to alleviating the symptoms.

The evidence on this compound has been increasing, and there are currently three published systematic reviews and a three-year follow-up clinical trial that provide data in favor of the efficacy of 1500 mg daily of this drug. These four works are summarized in the following table.

• RCT = Controlled and randomized clinical trial ; NS = Not significant; IC = Confidence interval; RA = Absolute risk; RR = Relative risk; RRA = Absolute risk reduction; NNT = Number needed to treat
• 1 Evaluated by validated scales; 2 The results were reported in this paper as a difference in effectiveness between interventions.
• 0 = no difference 0.5 = mild efficacy 1 = moderate efficiency 1.5 = important efficacy
• 3 Effectiveness is reported as effect size
• 0 = effect equal to placebo 0.2 = mild effect 0.5 = moderate effect 0.8 = important effect

Both meta-analyzes found methodological difficulties in the studies that evaluated chondroitin, so it is difficult to interpret the results related to this drug (they are not included in the table)

4 It was used as a measure of joint structural change. The cutoff point for a significant reduction was 0.3 mm.

In the three meta-analyzes 2-3-4 , similar results were obtained regarding the efficacy of glucosamine; it was mild or at best moderately better than Aines or placebo to control pain, joint stiffness and improve overall function. It is convenient to consider, however, that rescue studies were allowed in most studies, so the efficacy to reduce pain and improve joint function is difficult to evaluate. It should also be noted that the studies that evaluated chondroitin (another compound frequently used and that comes from the articular cartilage) included few patients and in the majority significant methodological flaws were detected that prevent valid conclusions.

In 2001, a clinical trial was published in the Lancet 5 that evaluated 212 patients over 50 years of age with osteoarthritis of the knee randomized to receive glucosamine sulphate versus placebo, with three years of follow-up. This study is important because until then there was only data from a few weeks of follow-up. The primary end point was the average width of the joint space in the medial compartment of the knee, which they used as a measure of structural change in the joint. The limit of 0.3 mm was taken as a limit of significant reduction of the joint space. Another final point was the change in scales of pain, rigidity and functional limitation, items evaluated at the beginning of the study, the year and the three years.

At the end of the study, the average decrease in joint space of the glucosamine group was not significant, while those assigned to placebo showed an average decrease at three years of 0.31 mm (CI -0.48 to -0.13). .

Treating 1500 mg of glucosamine daily for three years resulted in an absolute risk reduction of joint space narrowing of 16% and it would be necessary to treat 6 patients for three years to prevent a significant decrease in joint space (NNT). 6).

The patients assigned to glucosamine had a mild to moderate improvement in the symptoms at three years and those who received placebo did not present changes in relation to the basal scales. There were no differences in the stiffness scales and the two groups consumed the same amount of rescue Aines. There were also no differences in relation to the adverse effects and these were mild and not clearly related to the treatment. The authors concluded that long-term glucosamine treatment can prevent structural changes related to osteoarthritis of the knee and significantly improve symptoms.

The most recent meta-analysis 4 was published in July of this year and included 15 studies that evaluated the efficacy in controlling symptoms and modifying the joint structure of both glucosamine and chondroitin. This review found that glucosamine treatment had a significant effect on the articular cartilage modifier compared to placebo, but not chondroitin. Also those treated with glucosamine improved the symptoms in relation to the placebo (see table).

According to the information provided by these four studies, glucosamine can be considered a valid and safe option for the symptomatic treatment of patients with osteoarthritis, and there would also be a modifying effect of the joint architecture, although there is still no clear the utility of this parameter in the evaluation of the effectiveness of the treatment. It is not possible to say the same about chondroitin; Studies with more patients are required, longer follow-up and better methodological quality to draw conclusions about this drug.

While these studies show that glucosamine improved symptom scores, the changes were at best moderate and it is not clear yet what the actual clinical translation of this difference is.

In addition, we must bear in mind that glucosamine treatment is more expensive than using some NSAIDs; the approximate monthly cost of a treatment with 1500 mg daily of glucosamine is $ 57, four times more expensive than paracetamol and almost twice as much as ibuprofen at adequate doses. Another point to consider is that glucosamine takes a little more than a month to start acting, so it is not recommended as rescue medication, and the actual amount of glucosamine that exists in commercial preparations is not completely clear. that it comes in the form of salt and there is a lot of variability between the different preparations.

For these reasons, the US NIH study that is already in the patient recruitment phase will be very welcome; this work will compare glucosamine sulphate with placebo and other long-term Aines and hopefully clarify these unresolved points.

As a practical conclusion, we have good quality evidence to indicate 1500 mg daily of glucosamine to a patient who has contraindicated Aines or in whom these drugs have not been effective, although the role of glucosamine as the first line of Treatment is not yet clear, especially due to the lack of long-term efficacy and safety studies and their high cost.

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Alternative treatments for arthritis: What works and what does not

According to the latest estimates , more than 91 million adults in the United States may suffer from arthritis, mainly osteoarthritis, which can cause pain and damage the joints. If you are one of them, you may have considered alternative treatments for arthritis.



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According to the Centers for Disease Control and Prevention (CDC) almost 40% of those suffering from arthritis have tried an alternative or complementary therapy such as acupuncture or yoga.

"When conventional medicine fails to relieve pain, many seek alternative methods," says Marvin M. Lipman, MD, chief medical consultant for Consumer Reports. "But not only is there very little evidence to support many of these treatments, some are not even regulated."

Do any of them work? "These really do not cause a radical change," says Richard Panush, MD, a professor at the Keck School of Medicine at the University of Southern California. "For some people, at best, these alternatives may have a slight effect under certain circumstances."

Below you will find what the investigations showed.

4 Alternative treatments for arthritis that can help you

Massage. A review of studies published in the Mayo Clinic Proceedings journal indicates that massage therapy can help relieve the pain and stiffness of knee osteoarthritis. In one study, the researchers recommended a 60-minute session per week with an accredited massage therapist. (Find one in American Massage Therapy Association ).

Tai Chi. A review of 215 out of 54 studies indicated that this Chinese exercise , which is slow and with rhythmic movements, slightly decreases the pain caused by arthritis. But, it was less effective than aerobic and strength exercise (For more information visit the American Tai Chi and Qigong Association ).

Yoga. A review of 17 studies published in the Musculoskeletal Care journal indicated that yoga decreases the pain of osteoarthritis. But our experts recommend avoiding Bikram (hot yoga) if you have joint problems. The heat can make you feel that you can stretch more than you should, which could cause damage later in the joints.

Acupuncture. Research suggests that for some people, this traditional Chinese therapy that involves inserting fine needles into certain points of the body, decreases the discomfort of osteoarthritis . One theory is that it can trigger the release of hormones called endorphins that inhibit pain. Or it can simply cause a placebo effect, making you feel better without any medical reason. If testing, be sure to be treated by an accredited professional. (Find one in the National Certification Commission for Acupuncture and Oriental Medicine ).

3 therapies you should avoid

Chiropractic manipulation. Some research suggests that the "realignment" of the spine by a chiropractor can improve some neck and back pain . But, in a 2012 review published in the journal Rheumatology we found no evidence that the therapy effectively decreases the pain of osteoarthritis.

Dietary supplements. Some people take supplements such as glucosamine and chondroitin (often together) or fish oil for joint pain. So far, studies have shown that glucosamine and chondroitin are not more effective than a placebo. Some research suggests that high doses of fish oil can help improve the joint pain of rheumatoid arthritis, an autoimmune condition. But the effects on osteoarthritis are not very clear. In addition, fish oil supplements can cause side effects, such as diarrhea and stomach pain. And dietary supplements are not well regulated by the Food and Drug Administration (FDA), so you can not be sure if what you take is what the label says. (See our report " Supplements can make you sick ").

Homeopathy. The underlying principle of homeopathy is that certain very dilute substances can cure diseases. For example, rhus toxicodendron, made from poison ivy, is marketed as a treatment against osteoarthritis. But Lipman says there is no evidence to support the use of homeopathic remedies for arthritis or any other condition.

3 Smart strategies

Before taking any alternative treatment for arthritis, Lipman recommends that you try to combat the known factors that contribute to the pain and aches of the musculoskeletal system.

Lose weight if you need it. Excess weight adds pressure on the ankles, hips and knees, which increases the intensity and pain of arthritis.

Do the right kind of exercise. The activities that strengthen the muscles and improve your range of movement and stimulate your cardiovascular activity can help you. In addition to taichi and possibly yoga, consider walking regularly or a swimming program. To learn more about the exercises that help with arthritis, click here .

Check with your doctor. If you decide to try an alternative therapy, tell your doctor before you start. You can refer to a reliable professional. Your doctor can also tell you about the potential dangers or if the therapy can interact with your usual medications.

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Glucosamine and chondroitin to treat osteoarthritis

Glucosamine and chondroitin sulfate are found naturally in the connective tissues of the human body, such as those that cover the ends of bones in the joints. But while glucosamine is extracted from animal tissues such as crabs, lobsters, or shrimp shells, chondroitin sulfate is found in animal cartilage such as tracheae or shark cartilage. Both commonly taken as dietary supplements (also known as nutritional supplements).



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It is believed that glucosamine sulfate can aid in the formation and repair of cartilage in people with arthritis . In fact, some laboratory tests show how this substance protects articular cartilage by limiting its decomposition and helping to build new parts of it. Glucosamine hydrochloride, another form of glucosamine, is considered equally effective as in the sulfate form. However, it is more easily absorbed by the body and can be taken in lower doses and with the same efficacy as glucosamine sulfate.

On the other hand, chondroitin sulfate is part of a protein molecule that helps give the cartilage its elastic properties and is believed to also have anti-inflammatory effects, which can help reduce painful swelling in the joints, which occurs when the bones, exposed by the wear of the cartilage, rub against each other. In addition, chondroitin sulfate can also help delay the disintegration of the cartilage and restore its growth, which is a better mattress for the joints.

Conventional medicine does not yet have a proven treatment to stop or slow the progression of osteoarthritis , so the nutritional supplements of glucosamine and chondroitin sulfate have become an alternative treatment for some patients suffering from this disease.

Perhaps the most important aspect of glucosamine and chondroitin supplements is that they are believed to help decrease or prevent the degeneration of joint cartilage, the underlying cause that causes the pain of osteoarthritis, therefore, these dietary supplements can also help relieve existing joint pain It is currently believed that, unlike many other medications available to treat the pain of arthritis and inflammation, glucosamine and chondroitin supplements have very few side effects.

However, glucosamine and chondroitin nutritional supplements do not offer the same relief results for all patients with osteoarthritis. At the time of writing, the benefits and risks of taking glucosamine and chondroitin sulfate had not been definitively tested, since long-term studies are needed to better understand their effects.

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Glucosamine and chondroitin to treat arthritis

Osteoarthritis (OA), the most common type of arthritis, is a degenerative disease of the joints. Although it is sometimes able to cause acute inflammation, it is more commonly a "wear and tear" disease that involves the degeneration of articular cartilage and the formation of bone spurs within several joints. Joint trauma, repetitive occupational use and obesity are risk factors. The majority of people over 60 years of age have this condition to a certain extent, with approximately 16 million patients requiring medical attention. The main goal of treatment is to relieve pain.



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Glucosamine and chondroitin have been widely promoted as a treatment for OA. It is believed that glucosamine - an amino sugar - promotes the formation and repair of cartilage. Chondroitin, a carbohydrate, is a cartilaginous component that is believed to promote water retention and elasticity and inhibit the enzymes that break down cartilage. Both compounds are manufactured by the body. Glucosamine supplements are derived from seafood shells; Chondroitin supplements are usually made from cow's cartilage.

Results of the investigation

Laboratory studies suggest that glucosamine can stimulate the production of proteins that form cartilage. Other research suggests that chondroitin could inhibit the production of enzymes that destroy cartilage and also fight inflammation. Some studies in humans have found that either can relieve the pain and stiffness of arthritis with fewer side effects than conventional arthritis medications. Other studies have not shown any benefit. As the research accumulates, the expert review bodies have been cautious because, although the positive reports outnumber the negative ones, the studies with negative reports have been larger and better designed [1]. In addition, it has not been determined whether glucosamine offers any advantage over established medications, such as paracetamol, traditional non-steroidal anti-inflammatory drugs (NSAIDs) or selective Cox-2 inhibitors [2].

The largest and best designed clinical trial is the Arthritis Intervention Trial with Glucosamine / Chondroitin (GAIT), funded by the National Institutes of Health of the United States. So far, the GAIT has produced two sets of negative results. In 2006, the researchers reported on a 24-week study involving 1,583 patients randomly assigned to receive 500 mg of glucosamine hydrochloride three times a day, 400 mg of sodium chondroitin sulfate three times a day, 500 mg of glucosamine plus 400 mg of chondroitin sulfate three times a day, 200 mg of celecoxib (Celebrex) daily, or a placebo. The study found that glucosamine and chondroitin, alone or together, did not reduce knee pain from osteoarthritis more effectively than placebo. These two drugs reported approximately 17% better than the placebo group in the case of moderate pain [3].

The aforementioned report was accompanied by an editorial that concluded:

[Based on this study], it seems prudent to tell our patients with symptomatic osteoarthritis of the knee that neither glucosamine hydrochloride nor chondroitin sulfate alone have been shown to be more effective than placebo for the treatment of knee pain. If patients choose to take food supplements to control their symptoms, they should be advised to take glucosamine sulfate instead of glucosamine hydrochloride and, for those with severe pain, taking chondroitin sulfate with glucosamine sulfate may have an additional effect. Three months of treatment is a sufficient period for the evaluation of effectiveness; if there is no clinically significant decrease in symptoms at this time, the supplements should be discontinued. In addition, there is no evidence that these agents prevent osteoarthritis in healthy people or in people with knee pain but with normal radiographs [4].

In 2007, another well-designed study involved 71 patients with osteoarthritis of the knee who were followed for a year. The study found no significant differences in function and pain between the treatment and placebo groups [5]. Later that year, a meta-analysis concluded: "Methodologically adequate trials on a large scale indicate that the symptomatic benefit of chondroitin is minimal or non-existent.The use of chondroitin in routine clinical practice should, therefore, be discouraged." [6]

To study whether glucosamine or chondroitin could decrease the structural damage of osteoarthritis, GAIT patients were offered the opportunity to continue their original treatment for an additional 18 months, for a total of two years [7]. Approximately 570 patients were enrolled. In 2008, the researchers reported that none of the treatment groups showed a significant structural benefit (slowing of joint space narrowing). The researchers expressed the hope that further research may find that a subset of patients not yet defined may benefit, but I do not share their optimism.

Two studies reported in 2010 that patients with chronic pain experienced no benefit from taking 1,500 mg a day of glucosamine. One study involved 250 adults with chronic low back pain and degenerative osteoarthritis who were followed for one year. Half of the patients took glucosamine and half received a placebo. The group to which glucosamine was administered did not have significant improvements with respect to the group that received placebo [8]. The other study included 662 GAIT participants with moderate to severe knee osteoarthritis, who received glucosamine (500 mg three times a day), chondroitin sulfate (400 mg three times daily), glucosamine, and chondroitin sulfate combined (same doses) , celecoxib (Celebrex, 200 mg once a day) or a placebo. There were no statistically significant differences between the groups [9].

Another study reported in 2014 found no evidence that glucosamine and chondroitin are effective in relieving knee symptoms or slowing the development of the disease among patients with osteoarthritis. Over a period of 4 years, the researchers followed 1,625 patients, 18% of whom started using glucosamine or chondroitin during the study period. Users had no improvement over patients who did not use it [10].

products

In the United States (and Mexico) glucosamine and chondroitin products are marketed as "food supplements". Glucosamine is available in many forms, including glucosamine sulfate, glucosamine hydrochloride (HCl) and N-acetylglucosamine (NAG), and may also contain potassium chloride or sodium chloride salt. However, there is no conclusive evidence that one presentation is better than another. Chondroitin is typically sold as chondroitin sulfate.

In December 1999 and January 2000, ConsumerLab.com tested 25 brands of glucosamine, chondroitin and combination products and discovered that 10 glucosamine-only products passed the test, but only 2 with only chondroitin and 6 of 13 with combination products did not pass the tests. tests because their chondroitin levels were too low. In January 2001, one of the combined products was eliminated because its manganese level was considered too high [11]. The latest ConsumerLab report indicates that 8 products of 8 tested glucosamine-only, contained the amount shown on the label, but 2 products of 2 analyzed chondroitin-only did not contain the same amount shown on the label [12].

In 2001, Consumer Reports evaluated 19 products and reported:

They were reasonably well standardized, delivering at least 90 percent of the amount of glucosamine or chondroitin promised on the label, thus meeting a new standard for supplements proposed by the US Pharmacopoeia. UU., Which sets standards for medications and proposes them for supplements. However, four products, glucosamine and chondroitin "Double Strength", glucosamine chondroitin "ArthxDS", the glucosamine chondroitin complex "Solgar Extra Strength" and chondroitin sulfate "Now", did not meet this standard. Two products: the glucosamine chondroitin complex "Solgar Extra Strength" and Twinlab CSA (chondroitin sulfate) recommended very few pills per day to supply the dose used in successful clinical trials. Many others listed the recommended amount of pills as a range that allows consumers to take a dose that may be inadequate [13].

Security considerations

So far, no studies have found serious side effects of glucosamine or chondroitin. The most common side effects are increased intestinal gas and loose stools. However, studies in animals have suggested the possibility that glucosamine may worsen insulin resistance, one of the main causes of diabetes. So far, studies in humans have not corroborated this risk. However, people with diabetes who use this nutritional supplement should closely monitor their blood sugar level. No allergic reactions have been reported to glucosamine, but because it is obtained from seafood shells, people who are allergic to shellfish should exercise caution when using it paying attention to the signs of a reaction, or better yet, avoid it altogether . As for chondroitin, it can cause bleeding in people who have a bleeding disorder or who take an anticoagulant medication.

In 2001, Vital Nutrients recalled two products (Vital Nutrients Joint Ease and Verified Quality Joint Comfort) in which they were found to contain aristolochic acid, a substance that can cause kidney toxicity and cancer [14].

In 2008, a Scottish newspaper reported the death of several people due to liver failure within a few weeks of taking glucosamine [15]. Although the cause and effect could not be proven, local doctors issued a warning.

In conclusion

Chondroitin seems to have no effect. Whether glucosamine is useful or not is more complicated, but better designed studies indicate that it is not. This usually means that the negative evidence at the end will be conclusive. Given the scant evidence, the decision to use glucosamine is based on information that is less complete than desirable. In addition, the quality control of the product can be a problem in many cases. This is my advice:

1.     The first step in seeking care for arthritis symptoms should be to obtain a diagnosis by a competent doctor.
2.     The next step is to discuss with the doctor the pros and cons of the different treatment options.
3.     If you decide to try glucosamine, do so taking into account the latest information about it. Consumer Reports, ConsumerLab.com or your doctor can help you choose the right product.
4.     Consider that chondroitin could represent a useless expense.
5.     Ignore any doctor or salesperson who tells you that you have a "miracle cure" for arthritis.
6.     Never buy a dietary supplement just because you saw a radio or television ad.
7.     Beware of the price. The Puritan's Pride mail order division, which frequently has "5x2" and "3x1" offers, sells products that cost between $ 4 USD and $ 5 USD per month. (Be sure, of course, to ignore the misleading advertising that the company does, you should not rely on any vendor of food supplements, herbs or homeopathic remedies to obtain information about whether they are useful or not).

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Glucosamine treatment osteoarthritis

General description

Glucosamine is a natural compound found in cartilage, the tough tissue that cushions the joints.

In the form of a supplement, glucosamine is obtained from the shell of shellfish or manufactured in a laboratory. There are several forms of glucosamine, for example, glucosamine sulfate, glucosamine hydrochloride and N-acetylglucosamine. These supplements are not considered interchangeable.

Oral glucosamine sulfate is used to treat a painful condition caused by inflammation, breakdown and, ultimately, loss of cartilage (osteoarthritis).



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Evidence

Research on the use of glucosamine for specific conditions demonstrates the following:

•     Osteoarthritis. The use of oral glucosamine sulfate could produce pain relief in people with osteoarthritis of the knee, or with osteoarthritis of the hip or spine.
•     Rheumatoid arthritis. Early research suggests that the use of oral glucosamine hydrochloride could reduce pain related to rheumatoid arthritis when compared to placebo, an inactive substance. However, the researchers did not see improvements in inflammation or in the number of painful or swollen joints.

When choosing glucosamine, read the product labels carefully to make sure you choose the correct form. Although the use of glucosamine sulfate for the treatment of arthritis has been studied, there is no clinical evidence to support the use of N-acetylglucosamine to treat this disease.
Our recommendation
Green light: Generally safe
Generally safe

Glucosamine sulfate may produce pain relief in people with osteoarthritis. The supplement appears to be safe and could be a useful option for people who can not take nonsteroidal anti-inflammatory drugs. While the results of the studies are contradictory, it may be worthwhile to try glucosamine sulfate.

Safety and side effects

When taken in adequate amounts, glucosamine sulfate appears to be safe. The use of glucosamine sulfate by mouth can cause the following:

•     Sickness
•     Heartburn
•     Diarrhea
•     Constipation
•     Drowsiness
•     Skin reactions
•     Headache

Because glucosamine products could derive from the shell of shellfish, there is concern that the supplement may cause an allergic reaction to people allergic to shellfish.

Glucosamine may make asthma worse.

Glucosamine sulfate may affect blood sugar levels, which could interfere with blood sugar control during and after surgery. Stop taking glucosamine sulfate two weeks before undergoing elective surgery.

Interactions

Some of the possible interactions are the following:

•     Acetaminophen / acetaminophen (Tylenol, others). Taking glucosamine sulfate in combination with paracetamol (acetaminophen) may reduce the effectiveness of the supplement and the medication.
•     Warfarin (Coumadin, Jantoven). Taking glucosamine alone or in combination with the chondroitin supplement may increase the effects of warfarin anticoagulant. This can increase the risk of bleeding.

Liquid Health K9 Vegetarian Glucosamine - 8 oz

Glucosamine therapy for the treatment of osteoarthritis

To answer this question, the scientists found and analyzed 20 research studies. The studies evaluated more than 2,500 people with osteoarthritis of the knee or hip. Most studies lasted two to three months. People received glucosamine (in tablets or injection) or were part of another group receiving a pill or a fake injection or a nonsteroidal anti-inflammatory drug (NSAID) to assess which was more effective. This Cochrane Review offers the best evidence that exists today.



Liquid Health K9 Vegetarian Glucosamine - 8 oz

What is osteoarthritis and glucosamine?
Osteoarthritis (OA) is one of the most common forms of arthritis and can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the end of the bones is broken, causing pain and inflammation. Pharmacological and non-pharmacological treatments are used to relieve pain and inflammation. Glucosamine can be found naturally in the body and is one of the fundamental substances of cartilage. It is believed that glucosamine supplementation decreases destruction and increases cartilage synthesis and reduces inflammation. But there is a discussion about its effects.

How well does glucosamine work?
Pain: High-quality studies showed that the pain improved to the same extent when people received glucosamine or fake tablets. If all studies are analyzed (including low-quality studies and previous studies), then glucosamine improves pain to a greater extent than fake tablets.
The pain improved 13 more points on a scale of 0 to 100 with glucosamine than with the fake tablets.

Function: High-quality studies showed that glucosamine improved pain to a greater extent than fake tablets when measured by one type of scale, but improved to the same extent as fake tablets when measured with another scale. This result is the same when all the studies are analyzed (including the low quality studies and the previous ones).

Studies evaluating only the Rotta brand of glucosamine (including low-quality and previous studies) showed that glucosamine improved pain to a greater extent than fake tablets. Glucosamine improved function to a greater extent than fake tablets when measured by one type of scale but improved to the same extent as fake tablets when measured by another type of scale.

What security do you have?
The number of people who received glucosamine and had side effects was almost equal to the number of people who received fake tablets. Side effects included mainly upset stomach and other joint pains.

What conclusion can be established?
In a previous Cochrane review it was shown that glucosamine administered for six weeks reduces pain and improves function (physical capacity) in people with osteoarthritis.

Compared to the previous review, this review that analyzes the newer studies and more high-quality studies shows that there is "platinum" level evidence that pain does not improve greatly when glucosamine is administered for two to three months . According to the scale used to measure the function (physical capacity), the function may not improve completely or to a large extent.