Joint pain is a very common complaint that can have a variety of different aetiologies. Osteoarthritis (OA) is the most prevalent reason for chronic joint pain, and its prevalence is continuing to increase year by year. 87% reported that they had experienced joint pain in a global online survey of over 24,000 people across 24 countries. And WHO estimates that by 2050, 130 million people worldwide will suffer from osteoarthritis. Joint pain becomes more common with increasing age. Highest prevalence of joint pain and osteoarthritis is observed among those aged > 55 years old. The proportions of men to be affected with OA is lower than women, due to the menopausal age of women (1).
Joint pain involves the progressive loss of cartilage, changes to the structure and function in the joint, as well as damage to ligaments and bone. Appropriate management of joint pain can help control symptoms and reduce disability.
Risk factors for osteoarthritis
OA has multifactorial aetiologies. Although there is no known cause, numerous risk factors have been identified (2). Some of the most common risk factors for OA:
1. Age
OA is directly connected to wear and tear on joints. It becomes more common as people get older. However young adults can develop OA too.
2. Obesity
Excessive weight can put stress on joints and promote cartilage damage. People who are overweight or obese are particularly susceptible to OA in the:
Knees
Hips
Spine
The excess adipose tissue produces humoral factors, altering articular cartilage metabolism, and together with leptin system, which could be a link between metabolic abnormalities in obesity and increased risk of OA.
3. Family history
OA sometimes run in families. If your parents or siblings have OA, you are more likely to have it as well. The genetic influence of this disease is estimated between 35% and 65%. Several responsible genes are linked for its occurrence, including the genes that code for structural proteins of the extracellular matrix of the cartilage. Alteration in this gene are responsible for the degeneration of the joints during OA. Others including gene that codes for vitamin D, which polymorphisms in the gene could lead to the susceptibility of developing OA in different joints.
Treatment for osteoarthritis
There is no cure for OA, but medication, nondrug methods, assistive devices can help to ease pain. A damaged joint can be surgically replaced with a metal, plastic or ceramic one in the worst scenario.
Medications
Pain and anti-inflammatory medicines for OA are available as pills, syrups, patches and cream. Examples of the common medications used for treatment are such as NSAIDS, analgesics and corticosteroids.
Over-the-counter pain medications, such as acetaminophen, ibuprofen or naproxen sodium can help relieve occasional pain triggered by activity your muscles and joints aren’t used to – such as gardening. Cream containing capsaicin may be applied to skin over a painful joint to relieve pain (3).
More than one pain treatment might be needed - Non-pharmaceutical dietary supplement
Additional support might be needed to cover pain flares. Complementary and alternative medicine (CAM) are increasingly used to treat joint pain. Some of the examples are supplements, herbal remedies, and acupuncture. Arthritis is among the top 6 conditions for which CAM is used. We will focus on some of the supplements used to treat arthritis:
1. Undenatured collagen type II (UC-II)
The undenatured form of type II collagen (UC-II), a nutritional supplement, is derived from chicken sternum cartilage and is a powdered, glycosylated shelf resistant component. Studies have showed that UC-II can reduce pain when was given 40 mg of UC-II daily. UC-II is believed to activates immune cells and trigger the secretion of anti-inflammatory molecules which then reduce joint inflammation and promotes cartilage repair (4).
2. Hyaluronic acid (HA)
Also known as hyaluronan is naturally present throughout the human body. In the joints, natural hyaluronic acid (HA) has several functions, which includes lubrication, helps in the growth of cartilage and bone, as well as reducing joint inflammation and pain caused by injury or tissue degeneration. Consumption of hyaluronic acid (HA) helps to lubricate joints to move smoothly (5).
3. Bromelain
An extract from pineapple plant, bromelain has been demonstrated to show anti-inflammatory and analgesic properties and may provide a safer alternative or adjunctive treatment for osteoarthritis. Bromelain reduces pain by mediating bradykinin and prostaglandin levels, which play a role in arthritis (6).
4. Vitamin C
A growing body of research has suggested that vitamin C may ease pain and protect against cartilage damage associated with osteoarthritis. Besides that, vitamin C also act as a co-factor for collagen synthesis, promoting the proper folding of the stable collagen triple-helix conformation (7).
Maintaining a healthy lifestyle may help prevent osteoarthritis. Eating nutritious food, maintaining a healthy weight, exercising regularly can protect the joints and reduce risk of developing osteoarthritis.
References:
1. Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G Osteoarthritis Cartilage. 2005 Sep; 13(9):769-81
2. Blagojevic M, Jinks C, Jeffery A, Jordan KP. Osteoarthritis Cartilage. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. 2010 Jan; 18(1):24-33.
3. Osteoarthritis, 2020. Retrieved from: https://www.mayoclinic.org/diseases-conditions/osteoarthritis/diagnosis-treatment/drc-20351930.
4. Crowley DC, Lau FC, Sharma P, Evans M, Guthrie N, Bagchi M, Bagchi D, Dey DK, Raychaudhuri SP. Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: a clinical trial. Int J Med Sci. 2009 Oct 9;6(6):312-21. doi: 10.7150/ijms.6.312. PMID: 19847319; PMCID: PMC2764342.
5. Oe M, Tashiro T, Yoshida H, Nishiyama H, Masuda Y, Maruyama K, Koikeda T, Maruya R, Fukui N. Oral hyaluronan relieves knee pain: a review. Nutr J. 2016 Jan 27;15:11. doi: 10.1186/s12937-016-0128-2. PMID: 26818459; PMCID: PMC4729158.
6. Brien S, Lewith G, Walker A, Hicks SM, Middleton D. Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evid Based Complement Alternat Med. 2004 Dec;1(3):251-257. doi: 10.1093/ecam/neh035. Epub 2004 Oct 6. PMID: 15841258; PMCID: PMC538506.
7. DePhillipo NN, Aman ZS, Kennedy MI, Begley JP, Moatshe G, LaPrade RF. Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review. Orthop J Sports Med. 2018 Oct 25;6(10):2325967118804544. doi: 10.1177/2325967118804544. PMID: 30386805; PMCID: PMC6204628.
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