Arthritis is the #1 disabling disease in medicine. Conventional medical and surgical therapies have the potential for side effects, permanent damage, and even death. As many as 80% of patients use various alternative and complementary therapies for arthritis symptoms, yet less than 1/3 even mention those to their health care providers.
The classic signs of inflammation include pain, heat, redness, and swelling. Traditional medicines, including steroids (e.g. cortisone, Medrol) and stronger remittive medicines for Rheumatoid Arthritis, Crohn’s and Ulcerative Colitis, and others are NOT the focus of today’s discussion.
Aspirin and Non-Steroidal Anti-Inflammatory Drugs (NSAID’s) are commonly used, as they block inflammatory prostaglandin production. Many are available in over-the-counter dosing ( e.g. ibuprofen or Advil, naproxen or Aleve). The use of NSAID medicines is not without major side effects, however. Gastrointestinal (GI) irritation with ulcers and/or bleeding, salt retention and leg swelling, kidney issues, and numerous interactions with blood-thinners, heart and seizure medications (1) have been reported. The National Kidney Foundation estimates 10% of kidney failures per year are directly correlated to substantial overuse of NSAID’s. Increasing use of NSAID’s, as indicated by an NIH survey, found 13% of adults in the USA were taking these meds 3x per week for at least 3 months, a 40% increase from the previous 5 years. One study estimated some 100,0000 patients per year went to emergency rooms with serious NSAID-induced GI bleeds, with 17,000 deaths. 80% of those patients had no premonitory symptoms of a serious problem (2).
Safe, alternative therapies for arthritis include:
- Boswellia- from trees located in India, Ethiopia, Somalia, and the Arabian Peninsula, they produce a gum resin known as frankincense. The resin reduces inflammation, is anti-arthritic, analgesic, and lowers white blood cell counts in joint fluid; Boswellia has shown comparable benefits to diclofenac (Voltaren), the world’s #1 -selling NSAID, for treating active knee arthritis;(2). Daily dose 200-333 mg 2-3x/day; take with fatty foods to increase absorption, reduce nausea.
- Curcumin- from the ginger plant family, derived from Turmeric; used as a flavoring spice in food, with anti-inflammatory, anti-oxidant, and some anti-cancer benefits; look for curcumin formulas with black pepper extract (Bioperine) to increase its gut uptake by 2000% over Turmeric, of which some formulations have only 3% absorption; dosing is 400-600mg 2-3x/day. Use caution with prolonged use to avoid stomach irritation, and inquire about interactions with anticoagulants (blood-thinners). May be safe when taken for short periods with lower doses of NSAID’s, if needed.
- Green tea- long recognized for its anti-cancer and cardiovascular benefits, more recently for treating arthritis. Its polyphenol compounds have both anti-inflammatory and chondro -(cartilage) protective effects, the latter working through inhibition of an enzyme that degrades cartilage. (Recall that cartilage is the smooth, white coating at the end of bones that allows joints to glide smoothly, but also is the reason arthritis develops when the cartilage breaks down or softens, i.e. chondromalacia). Green tea research has been called the “Asian Paradox”, stating increased consumption may have cardiovascular, neuroprotective, and cancer-prevention properties (3). Usual dosing is 3-4 cups of tea per day. A green tea extract can also be used at 300-400mg/day. There is also caffeine present, though the polyphenol content of decaffeinated tea is less known.
- Omega-3 EFA (fish) oils- traced to the 18th century, when cod liver oil went rancid after air exposure. Oxygen-free encapsulation now provides odorless, tasteless improvements. Dose 1.5-5grams per day.
- Glucosamine/Chondroitin- usually paired together, one Belgian study (4) showed delay of knee arthritis progression on XRays after 3 years of a quality brand vs placebo. Glucosamine comes from the exoskeleton of shellfish, so those allergic take note. Chondroitin is derived from bovine cartilage, so may be an issue with strict vegan diets.
- Methylsulfonyl Methane (MSM)- usually added to Glucosamine/Chondroitin or Boswellia mixes. Safe, also for muscle soreness after exercise. Max dose per FDA is 4800mg/day.
- Others may be helpful but in a later blog: CBD oils, Ashwagandha, Collagen, White Willow Bark, Pycnogenol, Tart Cherry Juice, Resveratrol, Cat’s claw, Capsaicin.
Finally, in the USA, the FDA does not regulate the herbal/vitamin industry (5) , and only requires the contents have 15% of what the label states. Thus, there are a few ‘Red Flags’ to watch for when buying herbal remedies, supplements, and vitamins. Be wary of :
‘Proprietary blends’, or ‘formulas’- they may contain very little of the primary ingredient you want and a lot of other less useful contents.
‘Contains clinically tested ingredients’- meaningless claim, as it doesn’t mean it’s ‘proven’ to work, or has the proper dose worth using.
‘Claims to cure or treat a disease’- supplements are not legally considered drugs and cannot claim to cure or treat a disease. It is ok to claim to reduce the risk of a disease, e.g. Vit D and Calcium to prevent osteoporosis.
‘Uncertain certification’- the FDA in the USA does not confer ratings on pharmacies or supplement companies. Don’t rely on “Quality-tested” or ” Third-Party tested”. Reliable sites DO include USP.org and ConsumerLab.com
‘High prices Do Not mean better Quality’- A newspaper investigation into a popular mall nutrition store found large amounts of sawdust in many bottles of expensive ‘supplements’.
Finally, if whatever brand you are using does not provide the desired results in 6 weeks, either its a poor quality therapy or perhaps it isn’t optimal for the problem you are having. There are no treatments that are 100% beneficial. (6)
Dr. Urse is a Board-certified Orthopedic surgeon for the past 35 years in Dayton, Oh. Served on the White House Committee for Alternative Medical Therapies 1996-2000. Dr. Urse utilizes standard, alternative, and complementary therapies in practice.
References:
- Farquahr, B, et al: Anti-inflammatory drugs, kidney function, and exercise. Sports Science Exchange. 1997; SSE #67 11 : Article 4.
2. Badria, FA, et al: Boswellia-curcumin preparation for treating knee osteoarthritis: A Clinical Evaluation. Alt Complement Ther. 2002; 8:341-8.
3. Tijburg LB, et al: Tea flavonoids in cardiovascular diseases. A review. Crit Rev Food Sci Nutr. 1997; 37: 771-85.
4. Reginster, J. et al: Glucosamine/chondroitin compounds structure-modifying drugs in the treatment of osteoarthritis. Curr Opin Rheumatol. 2003 Sep; 15 (5): 651-5.
5. Andrews, KW, et al: Analytical ingredient content and variability of adult multivitamin/mineral products: national estimates for the Dietary Supplement Ingredient Database. Am J Clin Nutr 2017 Feb; 105 (2):
526-37.
6. Maroon, JC, et al: Natural anti-inflammatory agents for pain relief; Surg Neurol Int. 2010; 1:80
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