Arthritis is group of more than 100 rheumatic diseases and conditions that affect joints, the tissues that surround the joint, and other connective tissue. Arthritis is a chronic, and often debilitating, medical condition. According to the US Centers for Disease Control and Prevention (CDC)'s National Center for Chronic Disease Prevention and Health Promotion, an estimated 50 million US adults (about 1 of 5) report doctor-diagnosed arthritis. As the US population ages, the number of adults with arthritis is expected to increase sharply to 67 million by 2030, and more than one-third of these adults will have limited activity as a result.
People with arthritis may be at increased risk for more serious or acute medical diseases. Solveig Wallberg-Jonsson and colleagues from Umea University (Sweden) report that arthritis sufferers may be at increased risk of heart disease. The team completed a five-year long study which shows that the risk of cardiovascular disease for people with rheumatoid arthritis is due to disease-related inflammation as well as the risk factors which affect the general population. Following over 400 people with RA, 97% of the patients had been treated with disease modifying antirheumatic drugs (DMARDs) after five years, reducing both the chemical markers of inflammation and the physical appearance of their arthritis. The team revealed that a new cardiovascular event such as heart disease, stroke, or deep vein thrombosis could be predicted by intensity of their arthritis and by presence of diabetes, high blood pressure, and the level of triglycerides.
With arthritis causing an estimated 992,100 hospitalizations and 44 million outpatient visits a year in the US alone, natural and accessible interventions may help to curb the projected staggering rise in the numbers of arthritis cases. In this article, we present the latest study findings suggesting nutritional and lifestyle approaches that may help to promote joint health.
Arthritis [Web page]. US Centers for Disease Control and Prevention. http://www.cdc.gov/chronicdisease/resources/publications/AAG/arthritis.htm; accessed 27 June 2012.
Innala L, Moller B, Ljung L, et al. Cardiovascular events in early RA are a result of inflammatory burden and traditional risk factors: a five year prospective study. Arthritis Res Ther. 15 August 2011;13:R131.
Mindfulness Exercises Alleviate Arthritis Symptoms
"Mindfulness" exercises, which focus on experiencing the present moment, no matter how difficult, can help curb the stress and fatigue associated with painful rheumatoid joint disease. Heidi A Zangi and colleagues from Diakonhjemmet Hospital (Sweden) enrolled 73 men and women, ages 20 to 70 years, all of whom had had painful joint disease, caused by rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis for at least a year. Half of them were randomly allocated to scheduled mindfulness exercises – facilitated by health-care professionals and focused on particular topics, such as recognizing individual limitations, and strong emotions, such as anger, joy, and sorrow – which took place in 10 group sessions over a period of 15 weeks, plus a booster session around 6 months after the course had completed. Participants were also given creative exercises, such as guided imagery, music, and drawing, and shared their experiences with other members of the group. The rest of the volunteers randomly allocated to the comparison group were given standard care plus a CD containing similar exercises for use at home, as and when they wanted. Stress levels, coping abilities, and symptom control, including pain and fatigue, were assessed, using validated scores, immediately after all 10 sessions had finished, and again 12 months later. In total, 67 participants completed all the assessments. These showed no differences in pain levels, disease activity, or the ability to talk about feelings. But there were significant differences in levels of stress and fatigue. The number of participants with a high stress score of above 23 in the GHQ-20 questionnaire fell from 13 at the start of the study to 2, just 12 months after the sessions had finished. Comparable figures in the comparison group were 10 and 8, respectively. There was, however, a tangible fall in measured levels of fatigue in the intervention group: no such change was evident in the comparison group. Writing, "The [mindfulness exercise] improved most primary and secondary outcomes," the study authors conclude: "Improvements were maintained at 12 months, suggesting that [mindfulness exercise] is a beneficial complement to existing treatments for patients with inflammatory rheumatic joint diseases."
Zangi HA, Mowinckel P, Finset A, et al. A mindfulness-based group intervention to reduce psychological distress and fatigue in patients with inflammatory rheumatic joint diseases: a randomised controlled trial. Ann Rheum Dis. 20 December 2011.
Curcumin Relieves Pain with Osteoarthritis
Curcumin, the compound that gives the spice turmeric its bright color, mixed with soy phospholipids, helps to relieve pain and increase mobility in people with osteoarthritis. Gianni Belcaro and colleagues from Chieti-Pescara University (Italy) assessed the effects of a mixture containing 20% natural curcuminoids, 40% soy phosphatidylcholine, and 40% microcrystalline cellulose, against a NSAID. Subjects in the active group received a daily dose of 1000 mg of the curcumin mixture, providing a daily curcumin dose of 200 mg. After 8 months, scores on a standardized osteoarthritis assessment decreased by 9.3 points among those receiving the curcumin mixture, while no change was observed in the control group. Furthermore, scores for stiffness decreased from 7.4 to 3.2 in the curcumin-supplemented group, with again no significant changes in the control group. Writing that the data "Evaluate(s) the clinical efficacy and safety of curcumin as an anti-inflammatory agent," the team concludes: "Significant improvements of both the clinical and biochemical end points were observed … coupled with an excellent tolerability, [this] suggests that [a curcumin-phosphatidylcholine mixture] is worth considering for the long-term complementary management of osteoarthritis."
Belcaro G, Cesarone MR, Dugall M, et al. Efficacy and safety of a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients. Altern Med Rev. Dec. 21, 2010;15.4.
Chondroitin Alleviates Pain and Improves Function in Hand Arthritis
Six months of chondroitin supplementation can significantly alleviate pain and improve function among patients with hand osteoarthritis. Cem Gabay and colleagues from the University of Geneva School of Medicine (Switzerland) enrolled 162 subjects, mean age 83 years, with severely symptomatic OA, assigning each to receive either 6 months of daily chondroitin (800 mg; as purified chondroitin sulfate derived from fish sources) or placebo. Global hand pain rated on a 100 mm visual analog scale fell by 20 mm for patients taking chondroitin, as compared with 11.3 mm for patients receiving placebo. As well, scores on the 30-point Functional Index for Hand OA decreased by 2.9 points in the chondroitin group, compared with 0.7 points in the placebo group. A secondary outcome favoring chondroitin was duration of morning stiffness, which decreased by 4.8 minutes in the active treatment group but increased by 0.3 minutes in the placebo group. The study authors conclude: "This study demonstrates that [chondroitin sulfate] improves hand pain and function in patients with symptomatic OA of the hand and shows a good safety profile."
Gabay C, Medinger-Sadowski C, Gascon D, Kolo F, Finckh A. Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis: A randomized, double-blind, placebo-controlled clinical trial at a single center. Arthritis Rheum. 28 October 201;63:3383–3391.
Regular Physical Activity Alleviates Arthritis Symptoms
While a number of studies suggest a substantial therapeutic role for physical activity in alleviating the symptoms of osteoarthritis, Northwestern University Feinberg School of Medicine (Illinois, US) researchers warn that more than half of women and 40% of men with arthritis are inactive. Postulating that physical activity can help people with arthritis better control and lower pain and improve general function, and that some studies indicate exercise may delay or even prevent disability in people with arthritis, Dorothy Dunlop and colleagues asked 1111 adults with knee osteoarthritis, aged 49 to 84 years, to wear an accelerometer (a small, sophisticated device that looks like a pedometer) to measure their physical activity for one week during waking hours. The team found that only 40.1% of men and 56.5% of women met the federal guidelines recommending that adults with arthritis participate in 150 minutes per week of moderate-intensity, low-impact activity. Writing, "Despite substantial health benefits from physical activity, adults with knee [osteoarthritis] were particularly inactive" and "the percentages of men and women who met public health physical activity guidelines were substantially less than previous reports based on self-reported activity in arthritis populations," the team urges: "These findings support intensified public health efforts to increase physical activity levels among persons with knee [osteoarthritis]."
Dunlop DD, Song J, Semanik PA, et al. Objective physical activity measurement in the osteoarthritis initiative: Are guidelines being met? Arthritis Rheum. 26 July 2011.
The nation's most common cause of disability, arthritis had a total cost of $128 billion, including $81 billion in direct costs (medical) and $47 billion in indirect costs (lost earnings; 2003 figures). Certainly, an important interventive role exists for nutritional and lifestyle approaches that effectively address arthritis and combat it in its earliest stages.
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