Thursday, July 16, 2009

Joint Health


Joint Health Information You Need to Know

One of the most common prescribed treatments for joint pain are NSAID medications. In my opinion these medications should only be used for a short period of time, and only in acute situations. Lets consider why I make this statement, with the alternatives that are available.


To get an idea of just how serious the sides-effects of NSAID medications are, consider the following statement from The American Journal of Medicine in the July 1998 issue, and a citation from the British Journal of Medicine.

“Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.”

Singh Gurkirpal, MD, “Recent Considerations in Nonsteroidal Anti-Inflammatory Drug Gastropathy”, The American Journal of Medicine, July 27, 1998, p. 315

“If deaths from gastrointestinal toxic effects from NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain mainly a “silent epidemic,” with many physicians and most patients unaware of the magnitude of the problem. Furthermore the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDS.”

Wolfe M. MD, Lichtenstein D. MD, and Singh Gurkirpal, MD, “Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs”, The New England Journal of Medicine, June 17, 1999, Vol. 340, No. 24, pp. 1888-1889

NASID can make the problem worse

What is really interesting is that NSAIDs have been shown to inhibit cartilage repair and intensify cartilage destruction. So essentially they only mask the symptoms in addition to increasing joint destruction.
Brooks PM, Potter SR and Buchanan WW: NSAID and osteoarthritis -- help or hindrance. J Rheumatol 9:3-5, 1982.
Newman, NM, Ling, RSM: Acetabular bone destruction related to non-steroidal anti-inflammatory drugs. Lancet: ii; 11-13, 1985.
Solomon L: Drug induced arthropathy and necrosis of the femoral head. J Bone Joint Surg 55B:246-51, 1973.


Glucosamine a Great Alternative

Glucosamine: What is it and how does it work? Glucosamine is the best-studied of these aforementioned joint-support supplements, serving the needs of both young and old, athletic and arthritic or injured. Glucosamine is an amino sugar used to create cushioning fluids and tissues around joints. It also repairs damaged arthritic joints, reduces pain, and builds synovial fluids. It is easily absorbed into the bloodstream, and is necessary in the formation of skin, eyes, bones, tendons, nails, ligaments, and parts of the heart.

Glucosamine is also referred to as an aminomonosaccharide, meaning that it is the product of the synthesis between glucose and an amino acid -in this case glutamine. This enzymatic process is called glucosamine synthetase. Most glucose and nearly half of all amino acids are obtained through dietary sources, but the aminomonosaccharides found in our bodies are formed internally, and dietary sources for them are negligible. Glucosamine is produced naturally in the body by chondrocytes in cartilage to help maintain and build healthy joint tissue. The main basic purpose of glucosamine is to create long chains of modified disaccharides called glycosaminoglycans (GAGs), which the joints and cartilage require for repair. The GAGs are the main component of proteoglycans (PGs), which along with chondrocytes and collagen, make up cartilage. Glucosamine is also converted in the body to N-acetyl-glucosamine, which in turn is critical to the formation of hyaluronic acid. Hyaluronic acid is the central component of synovial fluid which acts as a lubricant in the joints.

In cellular studies, specific doses of glucosamine alter gene expression in chondrocyte cells to lead to an increased production of specific components of cartilage matrix, such as aggrecans and collagen type II. In this way, optimal amount of glucosamine can preserve cartilage tissue and promote its repair if it is damaged.

Tissue Repair In the treatment of degenerative joint diseases, the research conducted with glucosamine sulfate is extensive. With respect to osteoarthritis alone, there have been 20 randomized controlled trials involving a total of 2570 patients. The collective results displayed a 28% (change from baseline) improvement in pain and a 21% (change from baseline) improvement in function for those patients supplementing with glucosamine over the control (placebo) groups. Glucosamine has been found to be effective both in short term and long term studies. Some trials suggest that glucosamine is helpful in rheumatoid arthritis as well. Full Article

Keep your joints healthy: A complete guide to staying strong (CNN.com - complete article)

Keep your joints in top shape
You can't bring back cartilage that's already lost. However, there are several common-sense steps you can take to either prevent the wear or reduce the pain associated with osteoarthritis.

Maintain a healthy weight. 
It's the best thing you can do to preserve your joints. Keeping your weight down will help reduce those small tears that break down cartilage. In fact, a weight loss of as little as 11 pounds can reduce arthritis pain by 50 percent for many women. Weight loss may also help slow the progression of osteoarthritis over time.

Vary your exercise. Working out helps reduce stiffness in the joints. Kolasinski recommends varying your exercise routine -- low- or no-impact aerobic exercises (swimming, walking, or cycling) twice a week, strength exercises (lifting light weights or household items) twice a week, mixed with stretching and relaxation exercises.

Keep your muscles in mind. Weight training helps strengthen the muscles and ligaments surrounding joints, protecting them from damage. Modify muscle-building moves so they don't strain the joint of the part you're exercising.

Add ice. Icing your joints after exercise can help you manage pain and prevent swelling. When you exercise, you draw a lubricant called synovial fluid to your joints. But if the fluid sticks around too long after exercise, it can cause cracks in the cartilage. "Ice gets the fluid out of the joint and into the lymphatic system, the garbage disposal of the body.

Eat beneficial foods. Studies show the omega-3 fatty acids found in fish can help not only reduce symptoms associated with joint pain but also change the levels of inflammation that may be causing some of the pain. Fish oil slows the production of inflammation-signaling cells. The best sources are fish such as salmon and tuna. Research shows vitamin D may help protect your joints, too, via an anti-inflammatory effect. Make sure you get 400 to 800 International Units of vitamin D daily; one cup of milk contains 100 IUs, and three ounces of salmon has 300-650.
My advice is to discuss these alternatives with your physician, and always consult with your doctor before you reduce or change any medications.
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