It starts as a little stiffness when you roll out of bed in the morning. And, while it may be easy to ignore at first, it isn’t long before the stiffness turns to pain that can turn even everyday activities — taking a walk, climbing the stairs — into a challenge.
If you suffer from osteoarthritis (OA), you aren’t alone. In fact, OA is one of the most prevalent chronic health problems in the United States today, affecting more than 20 million people. And the numbers are rising. According to the Centers for Disease Control and Prevention, that number is expected to rise to 20 percent — about 60 million people — as baby boomers come into their golden years.
Although conventional medicine seemed to have the weapons to stem this growing tide, two popular arthritis drugs, Vioxx and Bextra, were recently pulled from the market after studies linked them to an increased risk of heart attack and stroke. To make matters worse, the U.S. Food and Drug Administration has ordered that 19 other pain relievers — from Celebrex to naproxen — carry tough new label warnings alerting users that these drugs may also cause serious cardiovascular problems and gastrointestinal bleeding, leaving arthritis sufferers wondering where they can turn to safely keep pain at bay.
Understand Inflammation
OA is a degenerative disease that affects the joints, the places where bones come together to allow coordinated movement. There are 206 bones in the human skeleton, and the vast majority of them come together in joints, where a cavity filled with fluid separates the bones from each other. Cartilage (spongy tissue on the end of each bone) cushions the connection and helps keep everything moving smoothly. In OA, however, cartilage begins to break down, causing bone to rub against bone. The result is inflammation, pain and stiffness.
Inflammation, in and of itself, is not bad. In fact, inflammation is part of the body’s automatic healing and repair process. The trouble starts when COX-2 — the enzyme that triggers inflammation — malfunctions.
COX-2 is shorthand for cyclooxygenase-2, an enzyme that turns a stored fat, called arachidonic acid, into prostaglandins, which inflame injured areas. When cartilage is damaged, the body sends out chemical messages for help. COX-2 gets the message and starts to burn arachidonic acid. This process releases byproducts known as prostaglandins that go to the injured area, where they break down the damaged cartilage and begin building new cartilage, as though a demolition crew were tearing down an old wall with the bricklayers right behind them building a new one.
Problems occur when the process gets out of hand. As we age, our body’s ability to repair damage diminishes, so the injured joint never fully recovers. The body keeps sending out its SOS signals — and prostaglandins keep coming to the rescue — but now, instead of healing the injury, they create excessive inflammation. When this happens, the COX-2 byproducts actually destroy what they were meant to protect.
Since the safety of prescription COX-2 inhibitors has come under fire, many people with OA have turned to over-the-counter pain relievers like aspirin, naproxen and other nonsteroidal anti-inflammatory drugs. But these drugs are exceptionally hard on the gastrointestinal system and long-term use can result in stomach upset, peptic ulcers and intestinal bleeding. Fortunately, there are safer ways to relieve the aches of arthritis.
Soothe with Smart Supplements
Two popular supplements, glucosamine and chondroitin, have a proven track record not only for relieving the symptoms of OA but for their ability to actually improve joint health. One of the natural components of cartilage, glucosamine has been examined in numerous studies with repeatedly impressive results. In one large multicenter trial involving 252 physicians and 1,208 arthritic subjects, researchers found that glucosamine was more effective in reducing pain from exertion and decreasing limitations on active and passive movement than all of the other treatments tested. Other studies have found that glucosamine reduces inflammation and joint space narrowing without any adverse side effects.
Glucosamine often is combined with chondroitin, a compound derived from animal cartilage. Chondroitin works by attracting fluid into the weblike cartilage that covers the bones of the joint. The fluid attracted into the cartilage provides shock absorption for surrounding bones and supplies nutrients to the cartilage, thus supporting its regeneration and growth. While much of the research on chondroitin had been limited to animal and test-tube studies, a recent clinical trial involving 120 people with knee OA found that this supplement not only reduced pain and improved mobility, it actually had a beneficial impact on the structure of the affected joints.
Methylsulfonylmethane (MSM), a naturally occurring sulfur-containing compound, is a favored supple- ment for arthritis. It’s been popularized by the wealth of anecdotal evidence surrounding its use (it seems to work well in conjunction with glucosamine to diminish pain and inflammation), but very little research has been conducted on the supplement. One preliminary report, published in the International Journal of Anti-Aging Medicine, found that MSM, in the amount of 2,250 mg daily, reduced pain after six weeks.
Another supplement that can take the edge off OA is S-adenosylmethionine (SAMe). Often used to treat depression, SAMe is an important biological agent normally produced from the amino acid methionine found in protein-rich foods. In one recent double-blind trial at the University of California, Irvine, 61 patients with arthritis of the knee took either 1,200 mg of SAMe or 1,200 mg of Celebrex for 16 weeks. Although the patients taking Celebrex got faster relief, by the end of the study, both groups experienced the same amount of pain reduction and improvement in joint function.
Find Herbal Relief
Herbs also can help reduce the pain and stiffness of OA. Long before modern pharmaceuticals, indigenous people relied on a variety of botanicals to tame both inflammation and pain. Their effectiveness was mostly anecdotal until scientists began unlocking their medicinal secrets. Today, research shows that the following herbs can indeed ease the agony of OA. These herbs can be taken alone or in combination with one another.
Boswellia (Boswellia serrata). An Ayurvedic herb that has been used in India for centuries to treat inflammatory diseases, boswellia inhibits the synthesis of leukotrienes, the agents responsible for inflammation. Not only has boswellia withstood the test of time, there is strong scientific evidence supporting its use. In a double-blind placebo-controlled study conducted earlier this year, 30 patients were given either boswellia or a placebo for eight weeks. By the end of the study, those taking the herb not only reported a reduction in pain and inflammation, they also experienced an increase in flexibility and walking distance. Most studies use 450 mg of boswellic acid, divided into three doses per day. Check the label for the amount of boswellic acid to calculate the amount needed.
Cat’s claw (Uncaria tomentosa). Grown in the Andes, this popular South American folk remedy has recently gained a lot of attention for its impact on inflammation. Not only is it effective, it works quickly. In fact, one study found that pain was significantly reduced in as little as one week. Scientists credit cat’s claw’s potent antioxidant properties for its ability to tackle the pain triggered by inflammation. Although much of the research on cat’s claw is preliminary, most alternative practitioners suggest taking 500 to 1,000 mg per day. Do not take the herb if you are pregnant or if you suffer from an autoimmune disease or tuberculosis.
Devil’s claw (Harpagophytum procumbens). Researchers point to the iridoid glycosides in devil’s claw for the herb’s anti-inflammatory and pain-relieving effects. One clinical trial of 75 patients with arthritis of the hip or knee found that those taking 2,400 mg of the herb for 12 weeks resulted in a 28 percent reduction in pain and 22 percent less stiffness. Better yet, the patients experienced significantly more mobility in the affected joint. For moderate pain and stiffness, most herbalists recommend taking 100 to 250 mg three times a day. Although research shows that devil’s claw is considerably safer than allopathic treatments for OA, do not take this herb if you suffer from ulcers or gallstones, or if you are taking warfarin.
Ginger (Zingiber officinale). According to investigators at Johns Hopkins University Hospital, ginger extracts work by blocking the activation of pro-inflammatory mediators. In fact, several clinical trials have found that the gingerols in ginger are just as effective as ibuprofen for relieving the pain of OA. The typical dose for OA is 2,000 to 4,000 mg a day. While ginger is extremely safe, some people do experience mild gastrointestinal upset. And patients taking anti- cancer drugs called cyclophos- phamides and certain blood-thinning medications should consult their health-care providers before taking ginger.
Turmeric (Curcuma longa). Curcumin, the pigment that gives turmeric its deep yellow color, thwarts inflammation by directly inhibiting the COX-2 enzyme and the formation of prostaglandins. Better yet, German scientists recently found that curcumin actually protects the cells that make up the cartilage in joints. The recommended dose is 250 to 500 mg of a standard curcumin supplement three times a day. However, high doses should not be taken during pregnancy and people with gallstones should check with their doctors before taking this herb.
Kim Erickson is the author of Drop-Dead Gorgeous: Protecting Yourself from the Hidden Dangers of Cosmetics (Contemporary Books, 2002) and a frequent contributor to Herbs for Health.
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