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Arthritis is an umbrella term for different conditions, which cause inflammation of the joints, leading to pain, swelling, stiffness and reduced mobility. They include osteoarthritis, rheumatoid arthritis and gout. Osteoarthritis is by far the most common type. In 2013, for example, over 8 million people were treated for osteoarthritis.[i] On the other hand, rheumatoid arthritis is an auto-immune condition, in which your immune system attacks your joints. It is much rarer, although, like most other auto-immune conditions, the numbers of cases are on the rise.
Most types of arthritis share common characteristics: chronic inflammation, free radical damage and progressive destruction of joint tissue.
We’ve summarised the most key things you can do to support your joints, reduce pain, slow down the damage, and so improve your health in general.
Focus on real, un-processed ingredients, especially vegetables and good sources of protein, such as organic and free-range meat and wild fish. Aim for 7 portions of vegetables a day, ideally of different colours to provide a range of nutrients and antioxidants. Some people may also be sensitive or intolerant to a variety of foods, which can aggravate their arthritis. If you have rheumatoid arthritis in particular, it is commonly advised to avoid gluten containing foods, as well as dairy. In addition, dietary lectins (found in grains and legumes) have been implicated in the damage to the gut wall observed in those with rheumatoid arthritis.[ii] Some people also react to solanine from nightshade vegetables (tomatoes, peppers, potatoes, aubergines and chilli). Although the evidence seems to be anecdotal, many people report improvement of symptoms after following a nightshade-free diet.
Cartilage is composed of specialised cells called chondrocytes, which produce and maintain the cartilaginous matrix. This consists mainly of collagen and specialised molecules called proteoglycans and glycosaminoglycans (GAGs), e.g. glucosamine, chondroitin and hyaluronic acid. Joint degradation is characterised by inadequate GAG, proteoglycan and collagen synthesis to renew tissue in the face of degradation caused by physical stress, trauma, autoimminuty or ageing. Glucosamine can repair ligament, tendon or cartilage tissue. Glucosamine hydrochloride at 1500mg shows improvement of pain in people with rheumatoid arthritis,[iii] while chondroitin sulphate increases cartilage volume,[iv] reduces pain,[v] duration of morning stiffness, and paracetamol use.[vi]
In one study, chondroitin in combination with glucosamine reduced OA symptoms of pain and stiffness from the second week of use.[vii] MSM is a source of sulphur, and involved in pain control and tissue building. Excellent results have been reported for pain relief in those with arthritis who took MSM.[viii] MSM in combination with glucosamine showed even better efficacy in reducing pain and swelling, and function than individual agents.[ix]
Inflammation is what causes pain and swelling and if it’s chronic, it can significantly propagate joint degradation and inhibit natural healing processes. To reduce inflammation, include plenty of ant-inflammatory foods in your diet. These include; oily fish (mackerel, sardines, wild salmon), which contain high level of omega 3 fats EPA and DHA, herbs and spices; especially turmeric, ginger, cinnamon, rosemary, sage and fruit and vegetables; particularly green leafy and cruciferous vegetables and berries.
Supplementation with fish oils can significantly reduce the production of inflammatory molecules in the body[x] and has been shown to reduce joint stiffness[xi] and pain.[xii] Fish oil also increases collagen synthesis.[xiii]
Plant chemicals such as curcumin from turmeric[xiv] or proanthocyanadins from pine bark[xv] also have potent anti-inflammatory properties. Curcumin can provide substantial relief from the joint inflammation and pain associated with RA[xvi] and OA.[xvii]
Low serum levels of vitamin D3 have been found inversely correlated with rheumatoid arthritis. Increased intake of vitamin D is associated with a lower risk of rheumatoid arthritis and significant clinical improvement, likely related to its immunomodulating potential.[xviii] Ideally check your levels and supplement accordingly with a well absorbed, emulsified form of vitamin D.
Impaired protein digestion due to low stomach acid or enzymes could increase the impact of dietary allergens (gluten, dairy) by increasing the likelihood of immune reactions.[xix] Probiotics including Lactobacillus acidophilus[xx] and salivarius[xxi], can reduce inflammatory markers and balance the immune system. Increase your fibre intake to feed the beneficial bacteria in the gut. The best sources are onions, garlic, artichoke, leeks, cabbage and ground flax seeds.
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[i] Arthritis Research UK (2013). Osteoarthritis in General Practice.
[ii] Cordain et al. Modulation of Immune Function by Dietary Lectins in Rheumatoid Arthritis. British Journal of Nutrition. 2000; 83: 207-17.
[iii] Nakamura et al.. Effects of glucosamine administration on patients with rheumatoid arthritis. Rheumatol Int. 2007; 27: 213-8.
[iv] Railhac JJ, et al. Effect of 12 monthstreatment with chondroitin sulfate on cartilage volume in knee osteoarthritispatients: a randomized, double-blind, placebo-controlled pilot study using MRI. Clin Rheumatol. 2012;31(9):1347-57.
[v] Möller I, et al. Effectiveness of chondroitin sulphate in patients with concomitant knee osteoarthritis and psoriasis: a randomized, double-blind, placebo-controlled study. Osteoarthritis Cartilage. 2010;18 Suppl 1:S32-40.
[vi] Gabay C, et al. Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial at a single center. Arthritis
[vii] Puente R, et al. Comparison of the efficacy and tolerability of chondroitin plus glucosamine and D-002 (beeswax alcohols) in subjects with osteoarthritis symptoms. Rev Fac Cien Med Univ Nac Cordoba. 2017;74(2):107-118.
[viii] No author. Methylsulfonylmethane (MSM) monograph. Alt Med Rev. 2003; 8 (4): 1514-22.
[ix] Usha PR, Naidu MU. Randomised, Double-Blind, Parallel, Placebo-Controlled Study of Oral Glucosamine, Methylsulfonylmethane and their Combination in
Osteoarthritis. Clin Drug Investig. 2004;24(6):353-63.
[x] McLean et al. 2007. Effects of omega-3 fatty acids on lipids and glycemic control in Type 2 diabetes and the metabolic syndrome and on inflammatory bowel disease, rheumatoid arthritis, renal disease, systemic lupus erythematosus and osteoporosis. Summary, Evidence Report/Technology Assessment NO 89. Publication NO. 04-E012. Rockville MD: Agency for Healthcare and Quality.
[xi] Kremer JM et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates. Arthritis Rheum. 1995;38(8):1107-14.
[xii] Goldberg, Katz. Meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007; 129: 210-23.
[xiii] Hankenson et al. Omega-3 fatty acids enhance ligament fibroblast collagen formation in association with changes in interleukin-6 production. Proc Soc Exp Biol Med. 2000; 223 (1): 88-95.
[xiv] Hong J et al. Modulation of arachidonic acid metabolism by curcumin and related β-diketone derivatives: effects of cytosolic phospholipase A2, cyclooxygenases and 5-lipoxygenase. Carcinogenesis. 2004; 25 (9): 1671-1679.
[xv] Wen-Guang et al. Anti-inflammatory effect and mechanism of proanthocyanidins from grape seeds. Acta Pharmacol Sin. 2001; 22 (12): 1117-20.
[xvi] Park et al. Curcumin induces apoptosis and inhibits prostaglandin E(2) production in synovial fibroblasts of patients with rheumatoid arthritis. Int J Mol Med. 2007; 20: 365-72.
[xvii] Daily JW et al. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. J Med Food. 2016; 19 (8): 717-729.
[xviii] Kostoglou-Athanassiou I, Athanassiou P, Lyraki A, Raftakis I, Antoniadis C. Vitamin D and rheumatoid arthritis. Therapeutic Advances in Endocrinology and Metabolism. 2012;3(6):181-187. doi:10.1177/2042018812471070.
[xix] Untersmayr E, Jensen-Jarolim E. The role of protein digestibility and antacids on food allergy outcomes. The Journal of allergy and clinical immunology. 2008;121(6):1301-1310
[xx] Resta-Lenert S, Barrett KE. Probiotics and commensals reverse TNF-alpha- and IFN-gamma-induced dysfunction in human intestinal epithelial cells. Gastroenterology. 2006;130(3):731-46.
[xxi] Diaz-Ropero MP et al. Two lactobacillus strains, isolated form breast milk, differently modulate the immune response. J App Microbiol. 2007;102(2):337-43.