Medical Moment: Joint Pain, What You Can Do

06 Dec Medical Moment: Joint Pain, What You Can Do

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Dr. Sharon Grundy

Dr. Sharon Grundy answers this week’s question: What can I do about joint pain?

Arthritis is inflammation of one or more of your joints. Most people develop pain and stiffness of a joint at some point in their lives; it’s typically worse with age.

Osteoarthritis and rheumatoid arthritis are the two most common forms of arthritis: 50 million adults in America have been told by a doctor they have arthritis. As the population ages, this number will go up. It is estimated there are over 27 million people in United States diagnosed with osteoarthritis and 1.5 million with rheumatoid arthritis.

The total cost to the health care system reported in 2003 was in the $128 billion range.

Medications for osteoarthritis such as Tylenol, ibuprofen, aspirin, naproxen (all known as NSAID non steroidal anti-inflammatory drugs) and Celebrex can help decrease pain; however these drugs have associated side effects such as stomach ulcers, gastritis, kidney damage and increase risk of bleeding.

Rheumatoid arthritis medications are often need to control this aggressive form of arthritis, but are also fraught with significant side effects. There are supplements we can take and lifestyle changes that can help reduce the use of these medications for pain and help prevent the inflammation.

Here’s what can help:

Life style and prevention

1.     Avoid refined foods such as white bread, pasta, sugar.

2.     Diet with lean proteins not high in saturated fats. Less red meat.

3.     No trans fats used in processed foods to help increase shelf lives.

4.     Diet high in Omega 3 fatty acids (fish, walnuts,  flax seeds, etc.).

5.     Limit alcohol and coffee.

6.     Hydrate. The body needs water to improve lubrication of the joints , 8 8 oz. glasses a day.

7.     Exercise 30 minutes about 5 X/week.

8.     Maintain a healthy weight.

Commons supplements that may have benefit for pain and prevention of arthritis

1.     Turmeric and Curcumin: This is the yellow powder from the dried root of the plant Curcuma longa used in Curries and mustards. It is known for its ability to act as an anti-inflammatory and anti-oxidant in the body. The mechanism of action is blocking the COX-2 receptor that medications like Ibuprofen, aspirin, naproxen and Celebrex block. There have been two small studies that have demonstrated turmeric in a moderate to high dose has equal effects as these medications for joint pain in both OA and RA. Turmeric/Curcumin can be used in cooking or taken by concentrated supplements. Recommended dose is up to 1,200 mg/day. There are supplements out there that improve bioavailability or take turmeric with a “fatty meal” (i.e. cooking with olive oil, in a smoothie with yogurt, or coconut oil, avocado, animal fats). The fat helps absorb the turmeric systemically so the effects can reach your joints and not just your intestines. Side effects are minimal: theoretical risk of increased bleeding and GI upset at very high does.

1.     Ginger: The root of the ginger plant (Zingiber officinale). This can be used as the fresh root in cooking, brewed in teas, or as powder in a supplement from. Studies are limited, but a few have shown efficacy similar to the over-the-counter arthritis meds listed above. Two studies demonstrated decrease in use of pain medications and the other showed effects similar to Ibuprofen. The recommended dose is 250 mg up to 4 times/day or 1 gram total throughout the day. One should not exceed 4 grams due to theoretical risk of bleeding.

2.     Fish Oil or Omega-3 fatty acids: Omega -3 fatty acids have been shown to alter the production of prostaglandins which helps with some forms of inflammation. There are multiple small trials for both RA and OA. Taking a supplement or eating fish high in omega 3 fatty acids can be helpful. Recommended dose is 1000 mg total of a mixture of EPA and DHA. Over 3000 mg of omega-3 fatty acids has an associated risk of bleeding. Natural sources other than from fish are walnuts, chia seeds, flax seeds, and supplements made form an algae oil.

3.     Glucosamine, Chondroitin and MSM: All three are naturally occurring substrates in the body. The supplements containing Glucosamine and Chondroitin come from shells of shrimp or crabs and pig or cow cartilage. MSM is synthetically derived. NIH looked extensively at Glucosamine/Chondroitin for arthritis. It was noted to potentially help patients with severe pain form OA. MSM has limited studies preformed and none have demonstrated it works better than placebo. All are safe to use unless you have a diagnosis of diabetes or pre-diabetes. Glucosamine and Chondroitin have the potential to raise blood sugar levels therefore diabetics should monitor their sugars if they are considering taking these two supplements. Glucosamine/Chondroitin is recommended at 500/400 mg 3 X/day. MSM recommended use is 1,000 mg to 4,000 mg/day. None of the above will prevent arthritis, but they may help with arthritis pain. Consider a trial for 4-8 weeks to see if there improvement with pain.

4.     Vitamin D3: There are a few studies with Vitamin D supplementation and OA of the knee. These small studies did show improved pain with patient who had OA of the knee. This is a safe supplement and recommended are 1,000-2,000 units/day especially in winter.

5.     SAM-e (S-adenosyl-methionine): This is a naturally occurring compound found in all cells of the body. It comes from the essential amino acid Methionine and is the precursor for neurotransmitters and cartilage. There are a few studies comparing SAM-e to NSAID drugs. Sam-e had similar efficacy as Ibuprofen with fewer side effects. Recommendation is 200-400 mg, 2x/day.

All of the above supplements can interact with anticoagulation medications and should be reviewed with a doctor.

I recommend patients with osteoarthritis read “The Arthritis Cure” by Jason Theodosakis, M.D. For patients with Rheumatoid Arthritis “The Immune System Recovery Plan: A Doctor’s 4-Step Program to Treat Autoimmune Disease” by Susan Blum.

Dr. Sharon GrundyDr. Sharon Grundy answers this week’s question:Editor’s note: The Telluride Medical Center is the only 24-hour emergency facility within 65 miles. As a mountain town in a challenging, remote environment, a thriving medical center is vital to our community’s health.

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