 BY DR. GREG FORS, - BOARD CERTIFIED NEUROLOGIST:
According
to the World Health Organization DJD or degenerative joint disease is
one of the top 10 global disease burdens
in the world today. Approximately 1 in 3 adults between 25 to 74 years
old in the US have radiological evidence of Osteoarthritis (OA) in at
least one joint. In the US 25% of all visits to primary care physicians
and half of all NSAIDs prescriptions are for OA.
However, degenerative joint disease is not an inevitable consequence of
growing older. It develops when trauma, and/or biochemical changes trigger a shift between joint
cartilage synthesis and degradation (1). Primarily, when the cartilage
synthesis of any joint cannot keep pace with the background degradation
of the cartilage, the joint will degenerate. Two very important factors
in the joint play a primary role in joint deterioration. The first
factor is the reduction in proteoglycan production in the joint
cartilage. The second factor is the rate of production of inflammatory
catabolic cytokines in the chondrocytes and synovial cells (2). The
driving force behind these two factors is of course multifactorial, but
genetics play a primary role, which is influenced by the quality of the
macro and micro nutrient intake of the individual.
Low vitamin D levels are now linked to multiple health problems,
including degenerative disc disease of the spine (3). A 2006 study
showed that an inherited polymorphism of a vitamin D receptor in the
spinal disc was associated with a high risk of degenerative disc disease
and disc bulge developing, especially in individuals younger than 40
years (4). In a future Clinical Update, I will dedicate an entire issue
to the importance of and clinical use of vitamin D3.
Early Assessment of
Optimal Joint Health
Even in today's "modern medicine", early diagnosis of degenerative joint
disease is still based on keen clinical observation and radiographic
changes. However, when you make the diagnosis at this point, your
patient has already fully developed the disease. There has always been
the hope of finding an inexpensive clinical lab tests that would help
indicate when a patient is heading for degenerative joint disease. From
the previously cited studies, low Vitamin D3 levels may be indicative of
spinal degeneration problems in the future. It may be prudent to keep
your patients serum levels of Vitamin D., 25-hydroxycalciferol above the
40 ng per milliliter.
However, exciting work is now being done on the diagnostic relevance of
high sensitivity C reactive protein to osteoarthritis. New
ultrasensitive methods for C-reactive protein (hsCRP) have improved the
usefulness of this marker, especially in the assessment of systemic
inflammation. One study found that patients with erosive OA averaged
hsCRP levels of 4.7mg/L and individuals with non-erosive OA averaged 2.2
mg/L. (5) What is important to realize here is that both patient groups
were above the threshold for increased risk for systemic inflammation,
and the erosive OA group was well above the significant risk profile.
What is indicated here is that patients well above ideal levels of hsCRP
of 0.5 mg/L may be on the road to the development of osteoarthritis.
Fibrinogen is also an inexpensive clinical marker of low-grade systemic
inflammation in the tissues and may be helpful in assessing the risk for
the development of degenerative joint disease.
Nutritional Support for Healthy Joints
To properly treat the underlying metabolic causes of degenerative joint
disease it is vital to treat the underlying chronic catabolic
inflammation, oxidative stress and poor cartilage repair. For the
management of the inflammatory catabolic cytokines of degenerative joint
disease concentrated standardized herbal extracts of Ginger, Curcumin,
Nettle leaf, and Boswellia have been shown to help manage this
inflammatory cascade. Specifically, standardized extracts of these herbs
have been shown to manage the pro-inflammatory cytokines and
prostaglandins involved in the pain, swelling, and cartilage destruction
of OA. These herbs also reduce oxidative stress and support healthy and
muscle joint tissue function. To help improve your management of
inflammatory catabolic cytokines it is beneficial to combine these
standardized herbal extracts with high levels of EPA/DHA fatty acids.
To help improve proteoglycans production and cartilage synthesis in the
joints supplement 1.5 to 2 g of glucosamine sulfate. Glucosamine sulfate
has been found to stimulate the synthesis of GAGs, proteoglycans, and
collagen within the joint complex. It has also been shown to support
healthy synovial fluid through synthesis of hyaluronic acid, which may
increase the mobility of joints and enhance their lubrication. It may
also assist in the inhibition of many enzymes that break down the
cartilage matrix
For best results always combine nutraceuticals that manage inflammatory
catabolic cytokines and those that promote proteoglycan production and
cartilage synthesis. To be successful make sure these nutraceuticals
sufficient quantities of quality ingredients. Standardized extracts of
ginger should reach 2 g per day and Curcumin a minimum of 1 g per day to
treat clinical results. Research studies also show that glucosamine
should reach levels of 1 to 2 g daily to be effective and chondroitin
should reach approximately 1000 mg. As you can see from these studies,
it is vital to get formulations that are highly concentrated. Both
products should be supplemented for minimum of 12 weeks before the
therapeutic effect can be evaluated.
Copyrighted 2007 by Dr. Greg Fors-Article or portions of this article
cannot be used without the authors permission .
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