Osteoarthritis, also called degenerative joint disease (DJD) or "wear and tear arthritis", currently affects over 30 million US adults. With this type of arthritis, the protective cartilage that normally cushions the joint gradually wears away, leading to inflammation of the synovial membrane, pain, stiffness, decreased range of motion, and joint swelling. The hands, hips and knees are the most commonly affected joints.

Arthritis is a leading cause of work disability, and may also increase one's risk for falls and fall-related injuries.

The risk of developing osteoarthritis increases with age, as well as with repetitive joint stress and injuries. Osteoarthritis is more common in post-menopausal women and in people who are overweight or obese, due to additional stress on weight bearing joints.1

Natural therapies may provide an important adjunct to traditional rehabilitation, medications, and surgical strategies for osteoarthritis.  Nutraceuticals for joint health have two main uses: improving joint comfort and function; and promoting healthy cartilage. In this post, we will examine some of best researched nutrients and botanicals for modulating joint inflammation, including Omega-3 fatty acids, Curcumin, Boswellia, Bromelain and Quercetin.

Omega-3 fatty acids; such as the EPA and DHA found in fish oil, are polyunsaturated fatty acids (PUFAs) which help stabilize cell membranes and shift the body's production of immune messenger molecules toward anti-inflammatory cytokines. Omega-3 fatty acids appear to play a role in controlling inflammation and improving joint recovery, which may help slow the progression of osteoarthritis. In vitro studies suggest Omega-3 fatty acids may have synergistic effects with Curcumin, enhancing antioxidant properties and inflammatory cytokine modulation.2

Curcumin is a bright yellow compound extracted from the Indian spice, Turmeric. In vitro studies show it has anti-inflammatory effects, inhibiting the activity of COX-2 and 5-LOX enzyme and protecting cartilage cells from the negative effects of interleukin IL-1β.  Curcumin also appears to have antioxidant properties.  It reduces oxidative stress and inflammatory signaling and increases Glutathione activity.  Curcumin appears to be well-tolerated at doses of 2–10 g daily, but should be used with caution in individuals on antiplatelet and anticoagulation therapy.3

One particular form of Curcumin, known as Curcumin-Phosphatidylcholine Complex or Curcumin Phytosome, has been evaluated for the treatment of osteoarthritis in two clinical trials. In the first, 50 patients with osteoarthritis of the knee were randomly assigned to receive the best available treatment as defined by their practitioner, either with or without Curcumin Phytosome for three months.  The Curcumin Phytosome group showed significantly greater improvement in treadmill walking performance, decreased use of pain medication, decreased gastrointestinal complications, and a 49% decrease in management costs related to their arthritis.4  In a second, similar study enrolling 100 patients with knee osteoarthritis for eight months, the Curcumin Phytosome group showed statistically significant improvements in treadmill walking; scales of pain, stiffness, and physical function; and several blood markers of inflammation.5

Boswellia (Boswellia serrata) is a tree used medicinally in the Ayurvedic tradition.  The oleoresin, a natural mixture of essential oils and resin, from the Boswellia serrata tree is rich in the active constituents boswellic acids, which exhibit anti-inflammatory properties.  Boswellia appears to inhibit production of pro-inflammatory cytokines including 5-lipoxygenase. Randomized clinical trials suggest the oleoresin from Boswellia serrata seems to improve pain, mobility, and swelling in patients with knee osteoarthritis.2

Bromelain is a mixture of digestive enzymes derived from the stem of the pineapple plant. It appears to inhibit synthesis of kinin compounds that increase edema and pain. Bromelain may also interfere with the arachidonic acid cascade, impeding the formation of inflammatory eicosanoids and resulting in reduced pain and inflammation associated with surgery, arthritis, trauma, or sports injury. It reduces edema by inhibiting formation of fibrin within damaged tissue, improving circulation of blood and lymph to injured or inflamed tissue.2

Some preliminary clinical evidence suggests Bromelain reduces mild acute knee pain in healthy adults. Bromelain in combination with trypsin and rutin has been demonstrated to be as effective and well-tolerated as the NSAID drug diclofenac sodium in short-term management of osteoarthritis of the knee and hip.2

Quercetin and other naturally occurring flavonoids: Flavonoids are polyphenols extracted from plants, especially fruits and vegetables such as onions, apples, grapes, berries and cruciferous vegetables. Studies suggest they have anti-inflammatory and antioxidant properties. Quercetin and other flavonoids may modulate some of the metabolic and biochemical processes involved in the development and progression of osteoarthritis by inhibiting production of proinflammatory cytokines and nitric oxide, and neutralizing free radicals including superoxide, a reactive oxygen species involved in promoting inflammatory gene expression.2

In conclusion, research has shown that specific nutrients and botanicals may help alleviate symptoms associated with osteoarthritis and improve joint function. Since most are well-tolerated with low toxicity, these nutraceutical compounds may prove a valuable addition to more conventional treatment options.


References:

1. https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

2. Castrogiovanni P, et al. Nutraceutical Supplements in the Management and Prevention of Osteoarthritis  Int J Mol Sci. 2016 December; 17(12): 2042. Published online 2016 December 6. doi: 10.3390/ijms17122042PMCID: PMC5187842

3. Kuptniratsaikul V, et al.  Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clin Interv Aging. 2014 Mar 20;9:451-8. doi: 10.2147/CIA.S58535. eCollection 2014

4. Belcaro G, Cesarone MR, Dugall M, et al.  Product-Evaluation Registry of Meriva®, a Curcumin-Phosphatidylcholine Complex, for the Complementary Management of Osteoarthritis.  Panminerva Medica. 2010 June; (52)Suppl.1 to No. 2:55-62.

5. Belcaro G, Cesarone MR, Dugall M, et al.  Efficacy and Safety of Meriva®, a Curcumin-phosphatidylcholine Complex, during Extended Administration in Osteoarthritis Patients.  Alt Med Review. 2010; 15(4):  337-344.