17. MUSCULOSKELETAL HEALTH Flashcards
(102 cards)
1
Q
What is the definition of arthritis?
A
Joint inflammation with pain, encompassing over 100 conditions affecting joints.
2
Q
What are the common types of arthritis?
A
- Osteoarthritis
- Rheumatoid arthritis
- Gout
- Fibromyalgia
- Ankylosing spondylitis
- Psoriatic arthritis
3
Q
What is osteoarthritis?
A
Degenerative arthritis of the articular cartilage, typically affecting weight-bearing joints.
4
Q
What are the signs and symptoms of osteoarthritis?
A
- Joint pain
- Joint stiffness
- Joint swelling
- Deformity
- Crepitus
- Heberden’s nodes
5
Q
What is the extracellular matrix (ECM)?
A
A non-cellular component of connective tissue.
Protein and Carbs- Its is the Structural and Biochemical support
6
Q
What is the role of chondrocytes in cartilage?
A
They synthesize extra cellular matrix (ECM) components and proteolytic enzymes responsible for breakdown.
Chondrocytes synthesize and maintain the cartilage extracellular matrix, ensuring its structural integrity and function.
7
Q
What is the pathophysiology of osteoarthritis?
A
- Proteolytic breakdown of cartilage matrix
- Release of pro-inflammatory mediators
- Loss of cartilage integrity
- Erosion of cartilage leading to bone exposure
Osteoarthritis (OA) is like that cushion gradually wearing away and becoming rough.
Here’s how it happens using the above points
Cushion Breakdown (Proteolytic breakdown of cartilage matrix): Think of tiny Pac-Man-like enzymes going wild and eating away at the smooth cartilage. This makes the cartilage thinner and less effective as a shock absorber.
Angry Signals (Release of pro-inflammatory mediators): As the cartilage breaks down, it sends out “ouch!” signals (pro-inflammatory mediators). These signals cause swelling, pain, and further damage in the joint.
Cushion Crumbles (Loss of cartilage integrity): The cartilage loses its smoothness and strength. It becomes uneven, cracked, and can’t do its job properly anymore.
Bone on Bone (Erosion of cartilage leading to bone exposure): Eventually, the cushion can wear away completely, leaving bone rubbing directly against bone. This causes significant pain, stiffness, and difficulty moving the joint.
So, in short, osteoarthritis is a process where the smooth cartilage in your joints gets eaten away, causing angry signals, losing its structure, and eventually leading to painful bone-on-bone contact.
8
Q
What are the common causes/risk factors for osteoarthritis?
A
- Increasing age
- Previous joint trauma
- Overweight/obesity
- T2DM
- Genetics
- Drivers of chronic inflammation
- Nutritional deficiencies
9
Q
What are the key x-ray findings for osteoarthritis?
A
- Joint-space narrowing
- Osteophytes
- Subchondral sclerosis
Subchondral sclerosis is the hardening and increased density of the bone tissue located just beneath the cartilage in a joint.
10
Q
True or False: There is a strong correlation between x-ray severity and pain in osteoarthritis.
A
False
11
Q
What is the main conventional medication used for osteoarthritis?
A
NSAIDs
12
Q
What are the functions of glucosamine sulphate?
A
- Stimulates proteoglycan synthesis
- Inhibits cartilage degrading enzymes
- Provides sulphate ions for chondroitin sulphate synthesis
13
Q
Fill in the blank: Chondroitin sulphate increases the amount of _______ in joints.
A
hyaluronic acid
hyaluronic acid in the synovial fluid. It reduces friction between the bones and is a shock absorber.
14
Q
What is the role of vitamin C in osteoarthritis management?
A
Required for chondrocyte protein synthesis and reduces impact of ROS.
1- 5000 mg/day- required for collagen syntesis- anabolic effect on cartillage. Antioxidant reduce impact of ROS.
15
Q
What is methylsulfonyl-methane (MSM) used for?
A
Has anti-inflammatory effects (NF-KB inhibition) and free radical scavenging and stimulates proteoglycan & hyaluronic acid synthesis.
1g /day building to 3-4 /day
Proteoglycans are essential molecules in the extracellular matrix that act like water-absorbing, space-filling, and pressure-resisting components, crucial for the structural integrity and function of tissues, especially cartilage
16
Q
What is the significance of vitamin D in osteoarthritis?
A
Prevents articular cartilage erosion and regulates collagen II turnover.
2000- 4000 iU and K2 50- 100 mcg as it inhibits K- dependent protein in joints- inhibits cartillage calcification
17
Q
What natural herbs are considered for osteoarthritis management?
A
- Turmeric- 500-2000mg
- Boswellia- 300mg x3 daily
- Devil’s Claw- 100-1000 split dose
- Ginger- 500- 1000 mg
- Turmeric- Inhibits NF-KB activation and proinflammatory cytokines IL-1B and -6
- Boswellia- Inhibits 5-LOX and Inhibits MMP release
- Devil’s Claw- 100-1000 split dose- Reduce IL-6, IL-1B and TNF- &
- Ginger- 500- 1000 mg - Inbibits TNF-& and PGE2 through COX-2
Matrix Metalloproteinase (MMP’s) are enzymes that break down the structural proteins of the tissues surrounding cells, contributing to tissue remodeling and, when overactive (MMP-1, MMP-9, and notably MMP-13), damage like cartilage loss in osteoarthritis.
18
Q
What is rheumatoid arthritis (RA)?
A
A chronic inflammatory autoimmune disease characterized by synovial joint inflammation.
19
Q
What are the signs and symptoms of rheumatoid arthritis?
A
- Symmetrical polyarthritis
- Hand deformities
- Subcutaneous nodules
20
Q
What is the role of RANKL in rheumatoid arthritis?
A
Regulates osteoclast activity.
In rheumatoid arthritis (RA), RANKL (Receptor Activator of NF-κB Ligand) is excessively produced by inflammatory cells and synovial fibroblasts in the inflamed joint, driving the formation and activation of osteoclasts, which are responsible for the bone erosion characteristic of the disease
21
Q
What is citrullination?
A
Conversion of arginine to citrulline, which is recognized as foreign by the immune system.
22
Q
What genetic factors are associated with rheumatoid arthritis?
A
- HLA-DRB1 alleles
- PTPN22 SNP
23
Q
Which bacteria is linked to rheumatoid arthritis due to its role in citrullination?
A
Porphyromonas gingivalis
Porphyromonas gingivalis is a gum disease bacterium linked to rheumatoid arthritis because it makes an enzyme that can trigger the body’s immune attack on joints.
24
Q
What are common blood test findings in rheumatoid arthritis?
A
- Raised inflammatory markers (ESR/CRP)
- Rheumatoid factor
- Anti-citrullinated protein antibodies
25
What is the Pathology for rheumatoid arthritis?
Citrullination Triggers Recognition: Proteins in the joints undergo citrullination, a process driven by genetics and environment, making them appear foreign and triggering immune recognition.
Immune Response and Autoantibodies: Immune cells recognize these citrullinated proteins, activating T-cells and B-cells, leading to the production of autoantibodies like ACPAs and rheumatoid factor targeting these modified proteins.
Inflammation Fuels Damage: Activated T-cells stimulate the release of inflammatory cytokines in the joints, driving the inflammatory process.
Destructive Joint Changes: These cytokines cause cartilage breakdown by enzymes and promote bone erosion through increased RANKL, ultimately leading to joint damage.
## Footnote
RANKL (Receptor Activator of NF-κB Ligand) is excessively produced by inflammatory cells and synovial fibroblasts in the inflamed joint, driving the formation and activation of osteoclasts, which are responsible for the bone erosion characteristic of the disease
26
What are the blood test findings indicative of Rheumatoid Arthritis?
Raised inflammatory markers (ESR / CRP), Rheumatoid factor (RF) in 70% of cases, Anti-citrullinated protein antibodies (ACPAs) can be present up to 10 years before symptoms.
## Footnote
RF is an IgM antibody that targets the constant region of IgG antibodies.
27
What are common conventional treatments for Rheumatoid Arthritis?
DMARDs (e.g., methotrexate), NSAIDs, corticosteroids, biologics (e.g., infliximab).
| Disease-Modifying Antirheumatic Drugs
## Footnote
Treatment response is highly variable and often includes side effects.
28
What dietary changes are recommended in the natural approach to manage Rheumatoid Arthritis?
Focus on reducing inflammation: no refined sugar, trans fats, dairy, limited red meat; high omega-3; abundant antioxidants (rainbow diet).
## Footnote
RA sufferers typically have low serum levels of antioxidants.
29
What is the autoimmune protocol (AIP) in relation to Rheumatoid Arthritis?
Focus on Gut Health: A central tenet is that gut dysbiosis (imbalance of gut bacteria) and leaky gut contribute to autoimmunity. The AIP aims to heal the gut lining and promote a healthy microbiome.
Inflammation Reduction: The primary goal is to reduce systemic inflammation, which is a key driver of RA symptoms and joint damage.
Immune System Modulation: By removing potential triggers, the AIP seeks to calm and rebalance the overactive immune system in RA.
Lifestyle : stress management techniques, gentle exercise, and targeted supplementation.
Key Components of the Elimination Phase:
Food groups are typically removed from the diet:
Grains: All grains, including wheat, rice, oats, corn, and pseudo-grains like quinoa and buckwheat.
Legumes: All beans, lentils, peas, and peanuts.
Nightshade Vegetables: Tomatoes, potatoes (except sweet potatoes), eggplant, peppers (all types), goji berries, ashwagandha.
Dairy: All dairy products from cows, sheep, and goats.
Eggs: Especially egg whites.
Nuts and Seeds: All nuts and seeds, as well as oils derived from seeds.
Refined and Processed Foods: Including processed sugars, refined oils, and artificial additives.
Processed Meats: Many contain additives and inflammatory oils.
Alcohol:
Coffee:
Chocolate:
Non-Nutritive Sweeteners: Artificial sweeteners and some natural sweeteners.
Emulsifiers and Food Additives: Many common additives are avoided.
Foods Typically Emphasized During the Elimination Phase:
Quality Meats and Poultry: Grass-fed, pasture-raised, and organic when possible.
Organ Meats: Nutrient-dense and encouraged.
Fish and Seafood: Wild-caught and fatty fish rich in omega-3s.
Vegetables: A wide variety of non-nightshade vegetables (leafy greens, cruciferous vegetables, root vegetables like sweet potatoes and carrots).
Fruits: In moderation.
Healthy Fats: Avocado, olive oil, coconut oil.
Fermented Foods: To support gut health (e.g., sauerkraut, kimchi, kombucha - ensuring they don't contain eliminated ingredients).
Bone Broth: Rich in collagen and gut-healing properties.
Herbal Teas: Avoiding those with potential immune-stimulating effects.
The Reintroduction Phase:
This is a systematic and gradual process of reintroducing eliminated food groups one at a time, typically every 5-7 days.
The individual carefully monitors their body for any signs of a reaction or symptom flare-up after reintroducing a food.
This helps identify specific food sensitivities that may be contributing to their RA symptoms.
Important Considerations (Naturopathic Perspective):
## Footnote
Gluten is a key food source of molecular mimicry.
30
What role does Vitamin D play in managing Rheumatoid Arthritis?
A potent inhibitor of Th17 pathogenicity and promotes Treg differentiation; shown to lower RANKL levels.
## Footnote
Vitamin D levels should be tested and optimized.
31
What is the function of Omega-3 in the context of Rheumatoid Arthritis?
Has anti-inflammatory effects, reduces Th17 cells and IL-17 levels, inhibits PGE2, NFκB, TNF-α, and Interleukin-6.
## Footnote
Recommended dosage is 1 g+ of actual EPA.
32
What are the benefits of GLA (Gamma-Linolenic Acid) in Rheumatoid Arthritis treatment?
Shown to reduce pain, stiffness, and swelling in RA by being converted to DGLA, which forms anti-inflammatory PGE1.
## Footnote
Recommended dosage is 1–2 g daily of borage oil.
33
What is the role of Resveratrol in managing inflammation in Rheumatoid Arthritis?
Reduces Th17 cells; downregulates NF-KB and COX-2.
## Footnote
Recommended dosage is 200 mg/day.
34
How does Quercetin contribute to inflammation management in Rheumatoid Arthritis?
Inhibits NF-kβ and COX-2, as well as various inflammatory cytokines like IL-17 and TNF-α.
## Footnote
Recommended dosage is 1.5–3 g/day.
35
What are the common symptoms of Gout?
Monoarticular arthritis, pain, swelling, redness, heat, shiny skin, inability to use the joint during symptomatic episodes.
## Footnote
Most commonly affects the 1st metatarsophalangeal joint (big toe).
36
What is hyperuricaemia and its role in Gout?
Raised serum uric acid; it is a key risk factor for gout and a prerequisite for MSU crystal formation.
## Footnote
Uric acid is the final breakdown product of purine metabolism.
37
What are common causes of uric acid overproduction leading to Gout?
Dietary purines (meat, seafood), high cell turnover disorders, chemotherapy, fructose consumption.
## Footnote
Fructose can increase ATP degradation to AMP, a uric acid precursor.
38
What are the risk factors for underexcretion of uric acid in Gout?
Medication side effects, renal insufficiency, alcohol consumption, genetics, obesity, dehydration.
## Footnote
Diuretics and low-dose aspirin can increase urate renal retention.
39
What is the gold standard for diagnosing Gout?
Synovial joint microscopy showing urate crystals.
## Footnote
Presence of hyperuricaemia alone does not equate to a diagnosis.
40
What dietary recommendations are made for managing Gout?
Avoid alcohol, fructose-containing beverages, pro-inflammatory foods; follow a low purine diet.
## Footnote
Minimum of 2L of water daily is recommended to dilute urine.
41
What is the role of Quercetin in managing hyperuricaemia and Gout?
Inhibits xanthine oxidase and promotes activity of urate excretion transporters; has anti-inflammatory activity.
## Footnote
Recommended dosage is 200-400 mg x 3 daily.
42
What is the function of EPA in the context of Gout treatment?
Inhibits urate transporter 1 (URAT1), increasing renal urate excretion; has anti-inflammatory effects.
## Footnote
Recommended dosage is 3 g daily.
43
What are the benefits of tart cherry extract for Gout?
Inhibits COX-1, COX-2, NFκB, and IL-1β; reduces uric acid levels through XO inhibition or increased renal clearance.
## Footnote
Recommended dosage is up to 3000 mg/day.
44
What nutrient is shown to inhibit xanthine oxidase (XO) with high affinity for the binding site for the enzyme’s cofactor?
High dietary folate
## Footnote
Folate is involved in various biochemical processes including DNA synthesis and repair.
45
What is the daily extract dosage of tart cherry recommended?
Up to 3000 mg / day extract
## Footnote
Tart cherry is known for its anti-inflammatory properties.
46
Which polyphenols in tart cherry are credited with its health benefits?
Anthocyanins
## Footnote
Anthocyanins are known for their antioxidant effects.
47
What are the key actions of tart cherry?
* Inhibit COX-1, COX-2, NFκB and IL-1β
* Reduce uric acid levels
* Reduce oxidative stress
## Footnote
These actions contribute to its anti-inflammatory effects.
48
What herb is known to reduce uric acid through inhibition of xanthine oxidase (XO) activity?
Celery (Apium graveolens)
## Footnote
Celery also has flavonoids that contribute to its health benefits.
49
What are the main symptoms of fibromyalgia (FM)?
* Chronic widespread pain
* Fatigue
* Sleep disturbance
* Stiffness
* Headaches
* Bowel disturbances
* Anxiety and depression
## Footnote
FM involves abnormal pain-processing mechanisms.
50
What are the American College of Rheumatology diagnostic criteria for fibromyalgia?
A WPI score of 7+ and SS score of 5+, or WPI score of 4–6 and SS score of 9+
## Footnote
Symptoms must last at least three months.
51
What are common causes or risk factors for fibromyalgia?
* Trauma (physical and emotional)
* Adversity in early life
* Disrupted cortisol levels
* Hypothyroidism
## Footnote
These factors can alter pain responses.
52
Which gut condition is highly prevalent in fibromyalgia?
SIBO (Small Intestinal Bacterial Overgrowth)
## Footnote
SIBO can correlate with pain intensity in FM patients.
53
What nutritional deficiencies may be associated with fibromyalgia?
* Vitamin D
* Vitamin B12
* Magnesium
* Gluten reactivity
## Footnote
These deficiencies can affect pain processing and inflammation.
Note:
* Vitamin D- optimise - modulates central pain processing- reduce inflammatory cytokines and PGE2
* Vitamin B12, B6, B9, Choline, betain and Zn to support- Support methylation
* Magnesium (malate or citrate)
* Vitamin B6- 50- 100mg daily- needed for conversion of glutame to GABA
54
What is the role of magnesium in fibromyalgia management?
Blocks N-methyl-D-aspartate (NMDA) receptor channels leading to anti-nociceptive and analgesic effects
## Footnote
Magnesium helps reduce pain sensitivity.
55
What is balneotherapy?
The practice of immersing a subject in mineral water
## Footnote
Balneotherapy is researched for its benefits in fibromyalgia.
56
What are the key recommended supplements for Fybromyalgia and what dosage
Note:
* Vitamin D- optimise - modulates central pain processing- reduce inflammatory cytokines and PGE2
* Vitamin B12, B6, B9, Choline, betain and Zn to support- Support methylation
* Magnesium (malate or citrate) - 200-500/day blocks NMDA - anti-nociceptive and analgesic effect.
* Vitamin B6- 50- 100mg daily- needed for conversion of glutame to GABA
*COQ10- 300mg - antioxidant, mitochondrial function, Electron Transport Chain
* 5HTP- 100-300 mg/day - precursor to serontonin and supports melatonin
57
Which herbal medicine is known for its anti-nociceptive effects and supports restorative sleep?
Ashwagandha (Withania somnifera)
## Footnote
It influences GABA and the HPAA.
58
What percentage of back pain is classified as non-mechanical?
A smaller percentage
## Footnote
Non-mechanical back pain can be due to systemic diseases.
59
What are the common causes of mechanical back pain?
* Muscle strains
* Facet joint issues
* Intervertebral disc problems
* Vertebral fractures
## Footnote
Mechanical back pain is often associated with movement.
60
What is the global prevalence of lower back pain (LBP)?
About 8%
## Footnote
Up to 60% of adults are expected to experience LBP at some point.
61
What lifestyle practices can improve pain perception in fibromyalgia?
* Regular aerobic exercise
* Tai Chi
## Footnote
These practices should avoid high intensity.
62
What is a common example of systemic disease causing non-mechanical back pain?
Ankylosing spondylitis
## Footnote
Systemic diseases can lead to non-mechanical back pain.
63
Name two conditions that are considered non-mechanical back pain.
*Systemic diseases (e.g., ankylosing spondylitis).
*Fibromyalgia.
*Endometriosis.
*Renal disease (e.g., infection / stones).
*Shingles.
*Malignancy —often secondary in the vertebral column from other sites.
*Osteomyelitis (bone infection).
64
What dietary components are emphasized in the CNM Naturopathic Diet for reducing inflammation?
* No refined sugar
* No trans fats
* Limited red meat
* High omega-3
65
What diet has studies highlighted as beneficial in reducing musculoskeletal pain?
Mediterranean diet
66
What nutrient is shown to block NMDA-receptor channels and reduce neuropathic pain in chronic LBP?
Magnesium
67
Fill in the blank: Omega-3 fatty acids have shown significant improvements in LBP through inhibition of the _______ pathway.
PGE2
68
What is the recommended dosage of phosphatidyl-serine for chronic neuropathic LBP?
200–400 mg
69
True or False: Proteolytic enzymes like serrapeptase and bromelain have been shown to benefit LBP patients.
True
70
List three nervine herbs that can help reduce muscle tension.
* Lemon balm- 300- 600 mg- Raises GABA
* Passionflower- 1tsp dried herb infused 2-3x daily- Modulates GABA pathway
* Chamomile- 1 tsp dried herb infused - Binds to GABA and anti inflammatory COX2 and NF-KB
71
What is the male-to-female ratio for ankylosing spondylitis?
~ 3:1
72
What are the extra-articular manifestations of ankylosing spondylitis?
* Uveitis (~25%)
* Psoriasis (~10%)
* Inflammatory bowel disease (~6.5%)
73
What is the primary cause identified for chronic inflammation in ankylosing spondylitis?
Dysfunction of the IL-23 / Th17 signalling axis
74
Fill in the blank: HLA-B27 is present in over _______ of ankylosing spondylitis patients.
90%
75
What dietary approach has shown potential benefits for ankylosing spondylitis?
Low starch diet
76
What type of therapy is often recommended for back pain recovery?
Movement therapy (e.g., Pilates, yoga)
77
What are the signs/symptoms of osteoporosis?
* Asymptomatic until a fracture occurs
* Common fracture locations: vertebrae, hip, distal radius
78
What is the primary hormone involved in bone remodeling?
Parathyroid hormone (PTH)
79
What condition is characterized by low bone mass and increased fracture risk?
Osteoporosis
80
What are two significant risk factors for osteoporosis?
* Increasing age
* Female / post-menopause
81
True or False: Smoking has no effect on osteoporosis.
False
82
What type of imaging is commonly used to measure bone mineral density?
Dual energy x-ray absorptiometry (DEXA)
83
What are common dietary recommendations for osteoporosis management?
* Avoid dairy products
* Limit carbonated beverages
* Include anti-inflammatory foods
84
What is the role of vitamin D in bone health?
Facilitates intestinal calcium absorption
85
Fill in the blank: Chronic inflammation has been linked to _______.
Osteoporosis
86
What types of beverages should be limited for health?
Carbonated beverages, coffee, alcohol
## Footnote
Limiting these beverages can help in managing health conditions.
87
What are examples of anti-inflammatory foods to include in a diet?
High omega-3 foods, flax seeds, chia seeds, turmeric, ginger
## Footnote
These foods can help reduce inflammation in the body.
88
What are the benefits of green leafy vegetables?
Abundance of minerals and vitamins for bone health, e.g., calcium, magnesium, boron
## Footnote
They are essential for maintaining strong bones.
89
What should post-menopausal individuals consider including in their diet?
Phytoestrogens, e.g., organic fermented soy
## Footnote
These can help balance hormones in post-menopausal women.
90
What is the recommended protein intake for supporting bone framework?
1.0‒1.2 g / kg of body weight / day with at least 20‒25 g of high-quality protein at each main meal
## Footnote
Adequate protein is necessary for collagen support.
91
True or False: A high-protein diet decreases urinary excretion of calcium.
False
## Footnote
A high-protein diet increases urinary calcium excretion.
92
What factors should be addressed to reduce osteoporosis risk?
Stop smoking, support gastric HCl / digestion, optimise body weight, support the gut microbiome
## Footnote
These lifestyle changes can help manage osteoporosis risk.
93
What are some food sources of calcium?
Dark green leafy vegetables, sardines, sesame seeds, tahini, almonds
## Footnote
Calcium is crucial for bone mineralisation.
94
What is the recommended daily intake of calcium if supplementing?
500 mg / day
## Footnote
This helps ensure adequate calcium levels for bone health.
95
What is necessary for calcium absorption in the intestines?
Calcium must be ionised
## Footnote
This process depends on gastric HCl.
96
What effect does salt have on urinary calcium loss?
Increases urinary calcium loss by 4‒5 % for each 500 mg of sodium ingested
## Footnote
High salt intake can negatively impact calcium levels.
97
What role does Vitamin D play in bone health?
Facilitates calcium absorption and is involved in bone turnover
## Footnote
Low levels of Vitamin D are associated with bone loss.
98
What is the recommended intake of Vitamin K2?
50‒100 mcg
## Footnote
Supports osteocalcin production, which is important for calcium incorporation into bones.
99
What is magnesium's role in bone health?
Co-factor for alkaline phosphatase and conversion of Vitamin D
## Footnote
Magnesium is essential for bone mineralisation.
100
What are some nutritive herbs beneficial for bone health?
Horsetail, Nettle
## Footnote
These herbs are rich in nutrients that support bone mineralisation.
1 tsp tea infusion 2-3x day
101
What are the recommended exercises to promote bone health?
Weight-bearing exercises, e.g., walking, weight training, stair climbing, dancing, yoga, Pilates, Tai Chi, hiking
## Footnote
These activities promote osteoblast activity and help prevent falls.
102
What is the minimum recommended frequency and duration of exercise for bone health?
3 times weekly, 30 minutes per session
## Footnote
Regular exercise is crucial for maintaining bone density.
