Natural Ways to Combat Arthritis
By Stephen Holt, MD
There are approximately 55 million Americans who are familiar with the pain and debilitating effects of arthritis. Is it any wonder why the topic of treatment is of such great interest to so many people?
The most common type of arthritis is referred to as osteoarthritis, which is often associated with osteoporosis. The cause of many types of arthritis remains unknown, but common features of the arthritic disorder include pain, joint stiffness and restrictive mobility of joints which are associated with damage to cartilage and joints and ongoing inflammation.
The most commonly used drugs to treat arthritis belong to a class of pharmaceuticals called non-steroidal anti-inflammatory drugs, commonly known as NSAIDs. But for several reasons, many people are seeking alternatives to standard drug treatments for arthritis.
Fortunately, modern nutritional technology is providing ways to assist with chondro protection (protection of cartilage in joints) and reducing inflammation using several botanical or herbal agents. The most advanced dietary supplements for the management of bone and joint health include chondro-protective agents such as high-quality glucosamine. Glucosamine has often been identified as the most important chondro-protective agent known in natural medicine.
This short article emphasizes the importance of combining these approaches in dietary supplement. The use of glucosamine, with or without chondroitin, has been superseded by the use of natural agents that can inhibit key enzymes that cause inflammation, such as the cyclooxygenase enzymes COX-1 and COX-2.
Concerns about NSAID use
For three decades, medical literature has issued warnings about the adverse affects of NSAIDs. These drugs are associated with more than 60% of all cases involving life-threatening bleeding from the upper digestive tract. They also contribute to lower gastrointestinal bleeding. The dangers of NSAID use become acutely apparent when one recognizes that they are the most common reason for adverse drug side effects reported to the FDA.
The morbidity and mortality from NSAID use are most apparent in the elderly—the principal and most vulnerable target population for NSAID use. Mature individuals invariably complain about “thin bones and creaky joints.”
Over the last 20 years, the “me-too” category of NSAIDs has seen new product introductions, which represent variations on a standard pharmacological (drug) theme of COX inhibition. COX enzymes catalyze prostaglandin production and occur in at least two isoforms, COX-1 and COX-2. Traditional NSAIDs inhibit both isoforms of cyclooxygenase, whereas newer forms of NSAIDs (e.g. Rofecoxib or Celecoxib) more selectively inhibit COX-2.
The notions that COX-1 plays an essential role in the normal gut and platelet function, and COX-2 is induced by inflammatory processes, afforded medical practitioners a “new promise” for the enhanced safety, but not necessarily the efficacy, of NSAIDs that only work on COX-2. The new promise has not been realized: Vioxx, for example, was removed, then reintroduced to the market in association with its identification as a cause of stroke and heart attacks.
NSAIDs that inhibit COX-2 enzymes are not completely friendly. They can cause peptic ulcers and gastrointestinal bleeding. Recent studies confirm that COX-2 inhibition causes significant decreases in renal function at least equivalent to, if not greater than, regular NSAIDs. One may anticipate that liver impairment could occur in some patients taking COX-2 inhibition. Thus, the massive swing towards the human prescription use of COX-2 NSAIDs, compared with regular NSAIDs (inhibition of COX-1 and COX-2) may not be as reassuring as previously believed. As with all new classes of drugs, time will tell and there are some unexplored worries about COX-2 inhibition.
Natural approaches to COX-2 inhibition
Inhibiting the COX-2 enzyme in a potent manner using a drug is associated with unwanted side effects. However, there are naturally occurring compounds found in herbs and botanicals that show an ability to inhibit COX-2, apparently without the side effects experienced with COX-2 inhibitor drugs. Examples of these agents include barberry bark, goldenthread, feverfew, ginger root, green tea, tulsi leaves, hops, oregano, Rosemary leaf, skullcap, turmeric, nettle leaves and polygonum cuspidatum. One interesting herb is phellodendron amurense, which has been produced in an extract form with clear COX-2 inhibiting activity.
Given the outcome of some uses of COX-2 inhibitor drugs, one may conclude that inhibiting COX-2 should be avoided. But nature appears to provide a mechanism to inhibit COX-2 in a beneficial manner that is safe, effective and gentle. Much more research is needed to define the role of “natural” COX-2 inhibition.
Can we live without NSAIDs?
So pernicious are the problems of NSAID usage, and so common are bone and joint problems, that many consumers are asking about alternative, natural remedies. People with arthritis often self-medicate and have come to rely on the over-the-counter availability of NSAIDs is in its old, “regular” format (non-specific COX-1 and COX-2 inhibition). The iatrogenic (healthcare or medical practitioner-induced) diseases caused by NSAIDs should encourage patients, physicians and pharmacists to avoid their use. Nevertheless, NSAIDs remain the most commonly used drugs of all pharmaceutical categories.
I believe we have some real options in natural therapies to at least reduce the need for NSAIDs and, on occasion, completely eliminate their use. We have discovered several bone-and-joint nutritional supplements for which there is mounting evidence of efficacy and clear advantages in terms of safety over NSAID usage.
With the possible exception of ayurvedic tree resins (Boswellic acids and Guggulsterones), most orally administered natural remedies for joint disorders take many days, or sometimes weeks, to be completely effective. For example, the natural anti-inflammatory actions of glucosamine and chondroitin can take as long as 12 weeks before maximal benefits are achieved.
However, no drug therapy to date has been shown to significantly alter the natural history (overall outcome) arthritis progression. In contrast, I believe that nutritional approaches will both help prevent arthritis and alter its clinical course.
Using topical, natural pain-suppressing ointments and creams can reduce the need for NSAID use and provide some relief for the user while the effects of natural joint supplements start to work.
Controlled, comparative clinical studies of certain NSAIDs and glucosamine show that NSAIDs are favored with respect to symptomatic relief early in treatment, but the long-term benefits of glucosamine equilibrate with those of NSAIDs and result in better treatment outcome. In fact, we know that while certain NSAIDs may damage cartilage, glucosamine and other natural substances have cartilage regenerative powers.