Early OA - Any suggestions?

[Teddy1]

Dear Canuck Physio & Friends, Thank you for the reply. I'm from Ont but live in the UK so it sounds that we might have a similar history? I've got a few questions regarding your reply.

*I'm trying glucosamine sulfate. Is there any evidence that chondroitin is impt? Hard to see how such a large molecule like chondroitin would work? Similarly is there any evidence/reference for MSM, and cetyl myristoleate?

*Can you recommend book or type of professional for nutritional aspects of OA?

Thank you. Happy to hear from others too.

Ted

I would be inclined to mention that it may be useful to look into nutritional supplements. Although there is much debate about this, glucosamine sulfate and chondroitin appear to at the very least delay the onset of OA. Additionally synergy may be created when MSM, and cetyl myristoleate are added.

However, I believe that you may want to look at your general nutritional status. There are many factors related to proper nutritional status and certain nutritional compounds that may aid in delaying the progression of OA. Examples include low levels of Vitamin D.

Additionally I believe it is necessary to adopt an appropriately tailored physiotherapy based exercise resistance program. Mal-alignment is known to contribute to medial or lateral progression of the disease. JAMA 2001 Aug 15;286(7):792.

I believe that these 2 key aspects (nutrition & muscular balance and strength) are interventions that you can consult about with appropriately qualified professionals in your area so that you can manage your problem, and continue doing what you love to do.

Regards

[Canuck Physio]

Hello again,

Eyap, hows those Sens eh?

Like I mentioned there appears to be some debate about the supplements mentioned. The problem stems from our current capacity to measure the microscopic changes that occur with chronic degenerative diseases. Outcome measures use to analyse the effects of such supplements usually involve subjective pain scales, not entirely accurate for a clinical decision to be made. However, there appears to be clinical results that suggest certain therapies, or supplements do work for people.

Here is a summary of some recent studies into the supplements mentioned:
1. Glucosamine: Glucosamine Sulfate as opposed to Glucosamine HCL appears to be effective. Overall there is still much ongoing debate in regards to this.
Arthritis Rheum. 2007 Jul;56(7):2267-77.
Glucosamine for pain in osteoarthritis: why do trial results differ?

2. Same idea for Chondroitin: for Dr's their thinking is if some patients believe it works for them (placebo?) they don't see constant prescription as a faux pas.

3. MSM:MSM (3g twice a day) improved symptoms of pain and physical function during the short intervention without major adverse events.

Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial
L.S. Kim , L.J. Axelrod , P. Howard , N. Buratovich , R.F. Waters
Osteoarthritis and Cartilage- 2006 March (Vol. 14, Issue 3, Pages 286-294,

4. Cetyl Myristoleate appears to help certain patients, however, research which has previously been done has not been followed up on this compound.

The key here is, if you can afford it, it may be beneficial for you to try these and see if they are effective for you. The problem is there is in fact conflicting evidence in regards to their effectiveness because studies almost always examine the subjective pain experience of the individual. Scientific equipment is not yet available for measuring and tracking the changes within the joint surfaces, although this may change in the future with recent advances in tracer technology.

The point of me mentioning these is that if you do go see a local nutritionist, you can at least be informed about the key compounds that are being touted as beneficial. If someone tries to hard line you on a certain compound, at least you are now aware. That is not to say a nutritionist probably will have an awareness of what compounds can improve bone health. Some of these include calcium, vitamins, and more recently evidence into creatine.

Most importantly, and I'd be amiss if I didn't mention this, Physical Therapy is probably your very best bet for maintaining joint integrity for years to come:

Deyle, Gail D, Allison, Stephen C, Matekel, Robert L, Ryder, Michael G, Stang, John M, Gohdes, David D, Hutton, Jeremy P, Henderson, Nancy E, Garber, Matthew B
Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program
PHYS THER 2005 85: 1301-1317

Physical therapy, including strength and muscle balance exercises as well as education about biomechanics of joint movement and ergonomics will probably be your best preventive course of action.

Best thing is too probably find yourself a Physiotherapist, and as well a Nutritionist who can sort out some preventative treatment program.

[Teddy1]

Dear Canuck, Thank you very much for the detailed reply. It's given me much to follow up. I've got a physio to give me a programme which I'm excited about and will start the hunt for a nutritionist. I'm excited about the potential to improve things or at least get healthy trying. Best wishes for Christmas to you. I hear there is lots of snow back home. Cheers! Ted