Are there any supplements you could take that will help strengthen cartilage or help with arthritis?
There are several different types of arthritis, each of which develops in a different way. Three common types of arthritis are:
- rheumatoid arthritis, in which a person's immune system attacks his or her joints; rheumatoid arthritis can attack people of any age;
- osteoarthritis, the common type of arthritis of older people, which appears to be due to wear and tear on the joints, with virtually no involvement of the immune system;
- psoriatic arthritis, which occurs in people who have psoriasis, a skin disease characterized by large areas of raised, scaly, itchy skin.
Salicin and aspirin
Over the centuries, many herbal medicines have been used for arthritis. The most commonly used herbs, such as willow bark, contain salicin, which is a chemical relative of aspirin. Aspirin was developed, in fact, through a search for a more effective and less toxic form of salicin. Salicylates work by inhibiting the formation of prostaglandins. Prostaglandins are family of chemicals produced in the body, some of which help promote the inflammation and pain that are associated with arthritis. Certain prostaglandins are also involved in clotting processes, which explains why aspirin and related chemicals can stop clot formation, for example the clots which lead to heart attacks. However, other prostaglandins are needed to protect the stomach lining from the acid the stomach makes to digest your food. This is why many people develop stomach upsets and bleeding when taking aspirin, and even more so when taking salicin.
Further research on salicylates (the family of drugs to which salicin and aspirin belong) led to the development of drugs such as ibuprofen. Collectively, aspirin, ibuprofen, naproxen, indomethacin, and similar drugs are called non-steroidal anti-inflammatory agents (NSAIDs) because they inhibit inflammation, but they are not corticosteroids (we discuss corticosteroids below). These drugs are sold without prescription, and are effective in reducing the pain of arthritis. In the case of rheumatoid arthritis, they also slow down the rate of deterioration of the joints. However, these drugs can have undesirable side-effects, because they inhibit all prostaglandin formation, and not just prostaglandins involved in the pain and inflammation of arthritis.
Drugs which selectively inhibit the formation of the prostaglandins specifically involved in pain and inflammation have recently been developed and placed on the market. They are called COX-2 inhibitors because they inhibit the activity of and enzyme called cyclo-oxygenase-2 or COX-2.
Cyclo-oxygenase enzymes are responsible for the formation of prostaglandins. There are two forms of the enzyme, COX-1 and COX-2. COX-1 makes the day-to-day forms of the enzyme, which is reponsible for forming the prostaglandins needed to protect your stomach lining. COX-2 is formed in the parts of the body which are inflamed, and forms the prostaglandins which cause pain and inflammation. The standard NSAIDs and salicin inhibit both forms of COX, but COX-2 inhibitors work mainly on COX-2. So if you take a COX-2 inhibitor, you are less likely to dvelop gastrointestinal trouble, because the drug does not affect COX-1 at the doses normally used. The COX-2 inhibitors are prescription drugs, and will continue to require a prescription until there is more experience with them.
We also should point out that there are a number of foods which contain natural salicylates, including oranges, raspberries, tomatoes, and many different spices. There are a number of food additives, designed to retard spoilage, which are salicylates as well. Certain researchers have suggested that one reason the rate of heart attacks has declined since World War II is that people are eating more salicylates, due to the increased use of food additives!
To learn more about aspirin, its history and its uses, you may want to read the US government publication on aspirin., and visit Steve Silverman's Useless Information page on aspirin (actually has much useful information about aspirin's history!).
Glucosamine
Glucosamine has been promoted as a treatment for arthritis in a book entitled "The Arthritis Cure : The Medical Miracle That Can Halt, Reverse, and May Even Cure Osteoarthritis" by Jason Theodosakis, Barry Fox, and B. Adderly, published originally in 1997. Glucosamine is a normal chemical of the body, which is involved in maintaining and repairing cartilage. It has been used extensively in veterinary practice to help in the healing of osteoarthritis in dogs.
There have been a few small (few subjects) short-term (four to sixteen weeks) controlled trials of glucosamine in osteoarthritis in humans, comparing it to either placebo or an NSAID. Glucosamine seems to be about as effective as the standard drugs, and better than the placebo. It also seems to have relatively few side-effects, although people have experienced nausea, vomiting and abdominal pain with the drug.
It would seem then that glucosamine is worth a try if you have osteoarthritis.
Chondroitin sulfate
Chondriotin sulfate is often packaged with glucosamine, and it is used this way in the treatment of osteoarthritis in dogs. Like glucosamine, chondroitin is a normal component of joint cartilage. When given orally, we can absorb about 12 to 15% of the dose. Chondroitin seems to home in preferenntially into joints, where it seems to reduce the concentration of destructive enzymes, and increase the concentration of constructive enzymes.
In European studies, chondriotin sulfate has been found to be equal to NSAIDs for osteoarthritis, and is definitely better than placebo, in improving joint function. Chondroitin sulfate does not stop joint degeneration completely, but it does seen to slow it down. The beneficial effect seems to last for several months after treatment has stopped.
Type II Collagen
Another dietary supplement that could potentially relieve the effects of rheumatoid arthritis is Type II collagen from chicken. Type II collagen is a type of protein found in cartilage, and is one of the proteins that are under immune attack in rheumatoid arthritis. By taking Type II collagen by mouth your immune system may become tolerant to the Type II collagen in your body, and stop attacking it. Preliminary studies in juvenile rheumatoid arthritis conducted by a group at Harvard University (for a pharmaceutical company involved in oral tolerance studies) look promising, and the National Institutes of Health are involved in a study at this time.
Note that one of the forms of collagen that are sold over-the-counter is shark collagen rather than chicken Type II collagen. Chicken Type II collagen is closer in structure to human cartilage than shark collagen, and therefore more likely to be effective in rheumatoid arthritis. However, most of the over-the-counter products contain other components of cartilage in addition to Type II collagen.
In addition most over-the-counter products are mixtures made from joint cartilage rather than purified Type II collagen. Type II collagen is the protein which is under attack in rheumatoid arthritis, so eating the collagen may turn off the immune attack. But the mixtures may contain components which the immune system has not "learned" to attack -- taking the mixtures may "teach" the immune system to attack these new components. As a result you may develop an allergy to the mixture, or your immune system may attack the corresponding components in your joints.
The kind of Type II collagen used in the treatment studies will not be an available medication until the FDA reviews it (possibly in late 1999).
Corticosteroids
Corticosteroids (not to be confused with anabolic steroids which are abused for muscle building) are sometimes used for treatment of severe symptoms of arthritis, when other treatment has failed, or when the complications of the arthritis threaten a vital organ. For example, corticosteroids are used for an eye condition, uveitis, which can lead to blindness in people with rheumatoid arthritis.
Corticosteroids, which include prednisone, prednisolone, and dexamethasone, are useful drugs because they can calm down the manifestations of inflammation, including pain and stiffness. They also produce euphoria, which is a feeling of happiness beyond what events warrant. But they have side-effects which range from the unpleasant to the dangerous (including diabetes and osteoporosis), and should never be taken internally without medical supervision. Furthermore, they may make a person feel better, but have little if any effect on the underlying process of joint destruction.
There are a number of Asian herbal medicine preparations which contain corticosteroids. These "feel-good" medicines may seem effective, but in fact they are very toxic. The Food and Drug Administration has issued an import ban on a number of them, including Chuifong Toukuwan and Black Pearl.