Osteoarthritis

Question 1

Osteoarthritis (OA)

Answer 1

Degenerative arthritis of the articular cartilage, typically affecting the weight bearing (larger) joints and seen mostly over the age of 45 years

Question 2

Osteoarthritis: Signs and Symptoms

Answer 2

• Joint pain (e.g., knee, hip) with a gradual onset unilaterally. Often worsened by activity and relieved by rest.
• Associated joint stiffness.
• Joint swelling , deformity (due to osteophytes), crepitus.
• Heberden’s nodes: Swelling at the distal interphalangeal joints.

Question 3

Articular cartilage composition

Answer 3

• Extracellular matrix (water, collagen, proteoglycans) and chondrocytes.
• The normal turnover of matrix components is mediated by chondrocytes, which synthesise ECM components and the proteolytic enzymes responsible for their breakdown.
• Proteoglycans are formed of glycosaminoglycan (GAG) chains such as chondroitin sulphate , which is bound to hyaluronic acid . This provides osmotic properties critical to resist compressive forces.

Question 4

Osteoarthritis: Pathophysiology

Answer 4

• Proteolysis
• Enzymes such as collagenase degrade the extracellular matrix, releasing fragments into synovial fluid → inflammation (e.g., IL-1β, TNF-α).
• As the level of proteoglycans drop, the cartilage softens, thins and loses elasticity, compromising joint surface integrity.
• The loss of cartilage results in loss of joint space. Erosion of the damaged cartilage in an osteoarthritic joint progresses until the underlying bone is exposed.
• Subchondral bone responds with bone thickening (‘eburnation’) and bone spurs (osteophyte formation)

Question 5

Osteoarthritis: Causes and risk factors

Answer 5

• Increasing age
• Previous joint trauma
• Overweight / obesity
• T2DM
• Genetics
• Inflammation
• Nutrient deficiencies: Vit D

Question 6

Osteoarthritis: Supplements

Answer 6

Glucosamine sulphate
Chondroitin sulphate
MSM
Vitamin C
Vitamin E
Vitamin D
Tart cherry
Vitamin K2

Question 7

OA: Glucosamine sulphate

Answer 7

Dose: 500mg 3x/daily

• GAG synthesis, also stimulates chondrocyte production of collagen.
• A provider of sulphate ions for the synthesis of the chondroitin sulphate.
• Inhibits: MMPs (e.g., collagenase) reducing cartilage degradation; COX-2, PGE2 and downregulates NF-kB in chondrocytes.

Question 8

OA: Chondroitin sulphate

Answer 8

Dose: 200 - 400mg/day

• Chondroitin increases the amount of hyaluronic acid in joints keeping synovial joints lubricated.
• Inhibits many cartilage degrading enzymes.

Question 9

OA: MSM

Answer 9

Dose: 1g - 3/4g/day

• NF κB inhibition and free radical scavenging.
• Stimulates proteoglycan and hyaluronic acid synthesis; inhibits proteolytic enzymes.

Question 10

OA: Vitamin C

Answer 10

Dose: 1 -5000mg/day

• Anabolic effect on cartilage; required for chondrocyte protein synthesis (e.g., collagen)
• Antioxidant properties reduce impact of ROS on genomic stability in chondrocytes.

Question 11

OA: Vitamin E

Answer 11

Dose: 200 - 400 IU/day

Synergistic with vitamin C. Antioxidant, inhibits lysosomal enzymes, increases proteoglycan deposition.

Question 12

OA: Vitamin D

Answer 12

Dose: 2000 - 10,000iu depending on levels

• Prevents articular cartilage erosion by regulating
  collagen II turnover and bone metabolism.

Question 13

OA: Tart cherry

Answer 13

Dose: up to 3000mg/day

• Rich in anthocyanins and other flavonoids.
• Anti-inflammatory
• Reduces pain and hsCRP

Question 14

OA: Vitamin K2

Answer 14

Dose: 50-100mcg

Inhibits cartilage calcification

Question 15

OA: Herbs

Answer 15

Turmeric
Boswellia
Devil’s Claw
Ginger

Question 16

OA: Turmeric

Answer 16

Dose: 500 - 2000mg

Inhibits NF-kB and pro-inflammartory cytokines

Question 17

OA: Boswellia

Answer 17

Dose: 300 mg x 3 daily

• Inhibit 5 LOX and hence leukotriene formation.
• Inhibits MMP release.

Question 18

OA: Devil’s Claw

Answer 18

Dose: 100 - 1000mg

Reduces the pro- inflammatory cytokines including
IL 6, IL 1β and TNF α.

Question 19

OA: Ginger

Answer 19

Dose: 500 - 1000mg

Inhibits TNF-α and PGE2 through inhibition of
COX 2 and reduces inflammatory joint pain.

Question 20

OA: Other

Answer 20

Hydrotherapy
Tissue salts
Acupuncture/osteopath
Exercise
Topical applications:
* Devil’s Claw or MSM
* Warming oil blend, e.g., rosemary, ginger, cayenne (used cautiously) to encourage vasodilation / blood
* Essential oils, e.g., peppermint, wintergreen, frankincense, basil.
* Anti-inflammatory blood circulation promoting and muscle relaxing effects.