Coping with creaky joints.

 

By Dr C.S. FOO


Osteoarthritis, the bane of old age, can be slowed down through various measures.

WOMEN fare badly as far as architecture is concerned (no offense to those in the profession)! What I am referring to is the skeletal scaffolding that upholds the vanity of our body. As the flow from the spring of eternal youth ebbs, the bones and joints crumble, buckle and creak, especially when we move into the fifth decade of senescence.

If Marilyn Monroe were still alive today, those shapely legs would be O-shaped, as the knees would have bowed.

Driving a vehicle downhill is one of those times we treasure our brakes. As we step on it often enough, we would smell the burning of rubber as frictional forces are exerted on the pads. Over time, and with overuse, the brake pads are worn off.

glucosamine and joint pain
Natural predisposition: Almost everyone above the age of 70 has some degree of osteoarthritis, but women are more prone than men.

In the same fashion, our joints become thinned out with repetitive use. As for the car, there are spare parts, but unfortunately, there are none for our joints.

Osteo (bone) arthritis (joint inflammation) was initially thought to be wrongly coined as the earlier definition of creaky joints solely referred to wear and tear or degenerative joint disease.

Now the term has become more apt as researchers have indeed found elements of bone changes and joint inflammation in the midst of mechanical breakdown.

Drying up!

Osteoarthritis is the most common cause of a painful joint, largely affecting the knees. Almost everyone above the age of 70 has some degree of disrepair, but women are more prone than men.

To the lay person, osteoarthritis means age-related “drying up” of joint lubricant. Of course, there’s more than meets the eye. Weight-bearing joints like the knee have a layer of rubbery cartilage that acts like a cushion, dissipating the forces between the thigh and leg bones. Lining the joint cavity is a silky membrane called the synovium, which secretes joint fluid.

The latter is nutritive, protective, lubricating, and acts as “shock absorber”. Enveloping these structures is the protective fibrous covering called the joint capsule.

As the clock ticks, the weatherbeaten cartilage undergoes degradation and loses it sponginess, thinning out until bone rubs against bone.

Like the opening of an old door, the joints creak, crack, and grind each time they bend, causing pain and stiffness, especially in the morning.       

By placing the palm over the affected joint during movement, one can sense a grating vibration (known as crepitus), as the thickened and swollen synovium rubs over itself.

Over time, the effect of body weight causes new irregular bone formation just beneath the cartilage and surrounding the knee, leading to little projections called spurs (osteophytes). Some may break off and become a “loose body” within the joint.

The ligaments and muscles around the joint weakens, giving rise to instability during locomotion. Externally, there is broadening of the knees, and in some cases, deformity ensues.

In our early days of mobility, we can descend a flight of stairs in a heartbeat. As for the sufferer with osteoarthritis, just getting down from the car is agonising. The facial grimaces mirror the excruciating pain tearing the joint, especially after prolonged periods of sitting.

This reflects an underlying inflammation. One literally carries the limb onto firm ground, before the tedious process of mobility can even get started.

The stabbing pain that synchronises with each step worsens with movement, as bone grinds over each other. Soon, the synovial membrane becomes inflamed, swells up, and secretes inflammatory fluid into the joint (effusion), increasing the rigidity of an already inflexible joint.

Invariably, the pain and discomfort is verbalised, quite incessantly, for sympathy and empathy. Every time I meet my old folks, they never fail to describe their misery.

Apart from age, there are other contributory causes of osteoarthritis, namely previous injuries or accidents. Athletes and footballers are prone to ligament and cartilage tears. The weakened structures and abnormal weight bearing renders this group of people more prone to osteoarthritis in later years.

Other causes of joint inflammation, such as rhuematoid arthritis, gout and joint bleeding sets the stage for more trouble.

Obesity, limb deformities and mechanical stress on the major joints also pave the way to the orthopaedic surgeons office.

Hereditary

There is, certainly, a hereditary tendency to develop osteoarthritis as well. I know of a family of sisters who limp into my office, taking turns to get pain relief.

As a matter of fact, I too realised where I got my knobbly fingers from! The little bumps on the end joint of the fingers are known as Herbeden’s nodes, which can at times become tender and swollen.

Age and acceleration of degenerative changes open up a pandora’s box for a host of other painful situations apart from the knees.

“Pain in the neck” symptoms are often due to a condition known as cervical spondylosis. The condition is often triggered by awkward positioning of the neck and prolonged postural strain, precipitating the sharp, lightning pains and numbness that may shoot down the arm. This is due to little spurs that pinch on the nerves coming out from the spine.

Diagnosis of osteoarthritis is confirmed through radiologic studies or specific scans. Blood tests are unhelpful.

Treatment of osteoarthiritis is as recurrent as the symptoms are. Most times, the only offering on the table is pain relief. Other times, another type of furniture beacons ... the operation table!

Physiotherapy and strengthening exercises are helpful for some. A new approach is the injection of a “joint lubricant” (viscosupplementation), which offers temporary relief.

Various types of surgery are available, and the ultimate changeover is joint replacement.

The realm of treatment is necessarily condensed as they are in the hands of well qualified professionals.

What is more pertinent are measures one can adopt to reduce the burden of painful creaky joints. It is necessarily DIY, as certainly no one can do it for us.

The direct link to food is weak, but generally, it is good sense to adopt an “anti-inflammatory” diet, which essentially includes high fibre, low glycaemic carbohydrates.

Plant-based proteins and fatty fish are healthy choices, unless they are deep frozen, canned, or preserved. Good fats (mono and polyunsaturated fats), especially a dose of omega-3 fatty acids through fish oil supplementation and flax seed oil, keep the joints greased and “cool” (the anti-inflammation effect).

Obesity, being an aggravating factor, should be taken by the horns as the damaged joints are carrying the weight of more than one person. Dietary modification veer towards healthy weight management.

Many nutrients have purported effects that minimise the inflammation and pain of osteoarthritis. As degradation of cartilage is a destructive process, free radicals accumulate and increase the oxidative stress level within the joint.

Dietary vitamins A, C, and E are the primary antioxidants. Minerals such as manganese and selenium have regenerative function for natural or endogenous antioxidants. Ginger and tumeric extracts have been used with variable results.

The hottest cake with candles lighting on and off is glucosamine. Although the verdict is not unanimous, chondroitin has joined the bandwagon.

The glucosamine / chondroitin story

Glucosamine made its entry into mainstream medicine 20 years ago, amidst great resistance from doctors like yours truly, who had little faith in nutritional approaches then. Reluctantly, doctors began to take notice when patients reported improvements.

Today, there is hardly any osteoarthritic sufferer who walks into a consultation room and exit without a prescription for glucosamine.

Glucosamine is a simple amino-sugar which is derived from the exo-skeleton of crustaceans and is the building block for cartilage. Its mode of action is the retardation of the thinning of cartilage and apparently reduces the pain in some patients.

There are various forms of glucosamine, and the most researched is glucosamine sulphate.

Chondroitin is a natural component of cartilage that keeps it supple. Commercially, it is sourced from animal or shark cartilage. The evidence on osteoarthritis is a little erratic, with some studies implicating benefit while others point out that it is no better than placebo.

Study design, materials used, and interpretation of results, can be confusing even to the scientific community.
Conflicting reports tend to cast doubts on the efficacy of nutritional supplements.
In the absence of side effects, if one finds glucosamine or chondroitin beneficial,
why not try it?

During a spell of poor judgement, I jogged and jiggled with two dumbbells every morning and developed a painful swollen knee. As I am not a great fan of drugs, I opted for nature’s healing, without much resolution.

Finally, reluctantly, I opened a bottle of glucosamine sulphate for the acid test.
The result was better than I expected at the end of three weeks.

Anecdotal again, but I have learnt to trust the endpoint more than any meta-analysis.

The hypothetical question is: Can we prevent osteoarthritis?

With positive pessimism, the answer is we can slow down the onset through a healthy lifestyle, with emphasis on maintaining ideal body weight, balanced nutrition, and the right choice of supplements.

The wear and tear will come as sure as age, but we can choose not to be one of the statistics before our time is up.

Unfortunately, most of us treat our body like a machine, visiting the mechanic in a white coat only when the spare parts squeak, squeal,
or fall apart.

Dr C.S. Foo is a medical practitioner. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any
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to the content appearing in this column.
The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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