Micronutrient therapy
| Summary | |
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Osteoarthritis is a chronic, non-inflammatory, age-related, degenerative disease of the musculoskeletal system and belongs to the rheumatic system.(1)(2) The clinical picture of osteoarthritis is mainly characterized by joint pain and loss of function in the later stages of the disease, even during periods of immobility, but is initially asymptomatic due to pain during movement or prolonged loading of the affected joint. (3)(4)(5) Risk factors for the development of osteoarthritis include age, female gender, familial predisposition, obesity, muscle weakness, joint injury, and joint overload due to deformity or unilateral loading and immobilization. (6) Although any joint can be affected by osteoarthritis, hip and knee osteoarthritis are among the most commonly diagnosed.(7) In terms of therapy, both pharmacologic and nonpharmacologic treatment options are available, with medications being used when lifestyle modifications and physical measures do not achieve the desired goal. (8)(9) As a last resort, joint fusion or an artificial joint may be considered.(10) Worldwide, osteoarthritis affects millions of people, predominantly women, and the incidence increases with age.(11) The prognosis of the disease in patients depends on which and how many joints are affected, the extent of symptoms, and the degree of functional impairment(s). |
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| Causes | |
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The cause of osteoarthritis is attributed to an interaction of several factors, including risk factors such as age, female gender, obesity, anatomical factors, muscle weakness, lack of exercise and joint injuries (occupation, sports), as well as overloading and misalignment of the joints. (7) Due to this, there is a disturbed balance of the degrading and regenerating processes of the cartilage, which results in a decrease in the thickness of the cartilage tissue.(13) Basically, it can be observed that the first arthritic changes are irregularities and erosions on the articular cartilage. The erosions continue to expand and extend to the bone.(14)(15) After cartilage injury, damage to the collagen matrix, proliferation of chondrocytes and clustering can be seen under the microscope. The chondrocytes become hypertrophic and cause cartilage outgrowths that form osteophytes and ossify.(16) Depending on the damage to the collagen matrix, more or fewer chondrocytes become apoptotic.(16)(17) Insufficiently mineralized collagen causes thickening of the subchondral bone (subchondral sclerosis); bone cysts sometimes occur in advanced disease. To some extent, there is also inflammation and hypertrophy of the synovial membranes, although unlike inflammatory arthritis, this is not the precipitating factor.(18). |
| Symptoms | |
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The course and appearance of osteoarthritis vary from person to person. However, the disease manifests itself in most people through joint pain and restricted movement; but the joint spaces themselves can also be sensitive.(20) Joint pain is mostly dependent on the stage of the disease and whether activated osteoarthritis is present. Whereas pain in the early stages of osteoarthritis depends on physical activity - including pain on onset, exertion, and fatigue - and resolves with immobility, prolonged pain occurs as osteoarthritis progresses, such as pain at rest, at night, and persistent pain. At first, these only interfere with daily activities, but can then lead to severe limitations in function and severely affect the patient's quality of life. (21)(22) From a medical point of view, osteoarthritis usually affects either the upper or lower extremities, and there it mainly affects the distal interphalangeal joints (Heberden's arthrosis with Heberden's nodes), the proximal interphalangeal (PIP) joints (Bouchard's arthrosis with Bouchard's nodes at the finger middle joints), the carpometacarpal joint (rhizarthrosis or thumb saddle joint arthritis with swelling of the base of the thumb and predominant pain on grasping and turning), the hip (coxarthrosis or hip joint arthritis), the knees (gonarthrosis or knee joint arthritis), the metatarsophalangeal joints (hallux ridigus or Osteoarthritis of the metatarsophalangeal joint (hallux ridigus or arthritis of the metatarsophalangeal joint), the shoulder (omarthrosis or arthritis of the shoulder joint), and the joints of the lower cervical and lumbar spine.(23)(24)(25)(26)(27)(28)(29) In addition, osteoarthritis may be monoarticular (affecting one joint) or polyarticular (affecting several joints).(30) |
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| Diagnostics | |
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In addition to anamnesis, the diagnosis of osteoarthritis usually consists of imaging procedures and, if necessary, a blood test to exclude diseases with similar symptoms, such as rheumatoid arthritis, on the basis of various blood parameters, including rheumatoid factor, erythrocyte sedimentation rate, and antinuclear antibodies. Osteoarthritis is suspected when the patient is over 45 years of age, complains of pain that worsens with activity and improves at rest, bony joint enlargement is noted, and range of motion is limited. (31)(32) Radiography may reveal findings suggestive of osteoarthritis, including uneven joint space narrowing due to decrease in cartilage thickness, marginal osteophytes, compaction of bone tissue in the form of subchondral sclerosis, and subchondral cysts. (33) Sonography is another way to identify osteophytes and inflammation of the synovial membrane that may be associated with osteoarthritis.(34) There are several classification systems for osteoarthritis that incorporate stage and radiographic appearance, including the Kellgren-Lawrence classification and the American College of Rheumatolgy classification.(35)(36) |
| Therapy | |
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The treatment of osteoarthritis is primarily aimed at relieving pain and restoring the function of the joint or minimizing its limitation. Non-pharmacological and pharmacological therapies are used for osteoarthritis. For patients with mild symptoms, nonpharmacologic therapy is the first choice; for patients with an advanced form, a combination of both is required.(9)(10) The most important nonpharmacologic therapies include avoidance of activities that exacerbate pain or lead to joint overload, dosed targeted muscle-strengthening exercise, and weight loss for overweight and obesity. (37) The latter is essential, as each kilogram of body weight increases the load on the joint many times over.(38) Physical therapy can assist the patient with targeted exercises, and aerobic exercise and strength training have also been shown in studies to help reduce pain and improve physical function.(39)(40) Joint deformities should be corrected with mechanical means such as orthoses and knee braces. On the pharmacological level, peripherally acting analgesics such as acetaminophen as well as nonsteroidal anti-inflammatory drugs (NSAIDs) represent the most popular agents of choice, but opioid analgesics are also used. In addition, glucocorticoids may be injected intra-articularly in severe cases of osteoarthritis.(9)(41) If neither non-pharmacological nor pharmacological therapy is effective, joint replacement (endoprosthesis) or surgical joint fusion (arthrodesis) may be a last resort.(42) |
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| Relevant micronutrients |
| Promote formation of synovial fluid |
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Glucosamine sulfate, chondroitin sulfate and hyaluronic acid are the classics in the nutritive accompanying arthrosis therapy. As natural joint building blocks, they help to form the synovial fluid. Through their water-binding capacity, the substances ensure the elasticity and suppleness of the cartilage, the optimal viscosity of the synovial fluid and thus a better buffer function, which reduces pain. In addition, the substances contained in the synovium serve as a substrate for the chondrocytes, which must be regularly regenerated. Native type II collagen is an essential component of cartilage tissue. Only native type II collagen possesses the special triple helix necessary for tear-resistant collagen fibers. As a catalyst, native type II collagen also stabilizes tendons and connective tissue. Vitamin C also plays a significant role in the maintenance of collagen. Calcium and vitamin D are key micronutrients in bone metabolism and thus important for stabilizing joints. Manganese is a coenzyme of glycosyltransferase. This is involved in the biosynthesis of proteoglycans of cartilage and connective tissue. Furthermore, as an antioxidant component, manganese can positively influence the inflammatory process via superoxide dismutase. |
| Supply antioxidants |
| Patients with osteoarthritis exhibit increased oxidative stress systemically and locally. Reactive oxygen species (ROS), which are generated as a result of abnormal chondrocyte metabolism, lead to increased oxidative stress. The increased occurrence of ROS can accelerate the destruction of tissue structures and promote inflammation. The supply of antioxidants as well as integral trace elements (copper, manganese, selenium) and antioxidant enzymes can reduce further oxidative damage as well as have a positive effect on the inflammatory process.
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| Reduce inflammation and pain |
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Frankincense extract (Boswellia serrata) contains boswellic acids, triterpenic acids as well as terpene alcohols and is particularly suitable for the treatment of acute and chronic pain caused by inflammatory processes in joints, muscles and the spine. |