2007-2009. For men and women, the prevalence of age-adjusted arthritis increased significantly with increasing BMI (P <.001 for trend). The age-adjusted prevalence of OA among people who were obese (25.2% for men and 33.8% for women) was nearly double that of people who are underweight/normal weight (13.8% for men and 18.9% for women). Source: CDC. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation— United States, 2007-2009. MMWR. 2010;59(39):1261-1265.
Treatment options for OA
In patients with knee OA, my approach tends include shoe inserts. These are good adjuncts to supplements, laser, Deep Muscle Stimulation (DMS), injectables, taping, and exercise therapy. I recommend swimming, recumbent bicycles, rowing machines and elliptical trainers. I teacgh my clients a lot of low load, easy to do stretches and strenghtening exercises. Weight loss is really important here.
On laser therapy for treating patients with knee OA: It depends on the patient and the severity of his or her OA. For example, if the patient is older and has a severely arthritic knee, a total knee replacement will probably be necessary. If a patient has OA and joint effusion, I might recommend laser, aspiration and corticosteroid injection.
If I have a patient with symptoms of OA who may have incurred an injury such as an ACL tear, I will use warm laser and DMS.
If you have undergone an arthroscopic procedure, but not yet fully out of pain, I will use laser.
I often use glucosamine and chondroitin sulfate with high dose omega 3’s.
I like topical menthol products such as BioFreeze. These have evidence of efficacy.
There are dangers of using cortisone, which has been administered for years as an injection in the joints. If any of my patients ask for cortisone because it worked when administered to them 10 years ago, I would educate them on safer long-term options. The most common recommendation I have for most of my patients is to eat less carbs and exercise more. I love the anti-inflammatory diet coupled with UltraInflamX by Metyagenics and high dose omega 3 fish oils. Through weight reduction and a low-impact exercise program, many patients will achieve dramatic improvements in their arthritis pain.
My goal for patients is to decrease pain and inflammation, maintain or improve function and retard disease progression if possible. In this regard, preventing damage to subchondral bone, cartilage, joint space narrowing and osteophyte formation is the goal.
The contraindications for NSAIDs include gastrointestinal (GI) bleeding or adverse effects to the kidneys or liver. Some patients worry about taking a glucosamine product because they have diabetes, but I inform them no data support this concern.
I might recommend UltraInflamX by Metagenics alot. I like garlic, ginseng and gingko — but these affect bleeding time. If used in conjunction with NSAIDs, the risk of GI problems increases.
On his DVD How to Treat Multiple Sclerosis with Diet, Dr. Cordain thoroughly explains the dietary mechanisms of autoimmunity in MS which are almost the same for all autoimmune diseases, including RA. These include: increased intestinal permeability, increased passage of luminal antigens into peripheral circulation, molecular mimicry and genetic susceptibility (genes encoding for the HLA system), among other factors.
In recent years, new substances have been discovered which might be responsible for increased intestinal permeability – namely saponins – found in legumes, potatoes, soya, quinoa, amaranth, alfalfa sprouts or tomatoes. If you’ve seen Dr. Cordain’s scientific paper entitled “Modulation of immune function by dietary lectins in rheumatoid arthritis”, I am sure you are aware of the role lectins play in autoimmunity.
Adjuvants are used by immunologists in order to boost the immune system and induce immune response. It turns out that certain foods possess bioactive compounds that have adjuvant-like activity. This is the case for tomatoes or quillaja (a foaming agent used in beers and soft drinks).
Gliadin is a prolamine found in wheat which has been shown to increase intestinal permeability, and hence the risk of suffering from an autoimmune disease. While several clinical trials conducted have shown promising results, unfortunately they have used a gluten-free diet or vegan diet instead of a whole paleolithic diet, which is probably superior.
In the vegan diets, authors often claim that the benefits cited might be due to the lack of meat, but what if the positive effects relie on the lack of diary proteins and gluten. Meat has historically been seen as the “bad guy” of inflammation, but the data to support that notion is not sufficiently compelling.
Listed below are some references that may be helpful.
- Modulation of immune function by dietary lectins in rheumatoid arthritis. Cordain L, Toohey L, Smith MJ, Hickey MS. Brit J Nutr 2000, 83:207-217.
- Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized study. Elkan AC, Sjöberg B, Kolsrud B, Ringertz B, Hafström I, Frostegård J. Arthritis Res Ther. 2008;10(2):R34. Epub 2008 Mar 18.
- A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Hafström I, Ringertz B, Spångberg A, von Zweigbergk L, Brannemark S, Nylander I, Rönnelid J, Laasonen L, Klareskog L. Rheumatology (Oxford). 2001 Oct;40(10):1175-9.
Your medical doctor can prescribe the latest pain relievers (with side effects!). But many of my patients are getting better long-term results by eating the right FOODS and taking the right SUPPLEMENTS and learning proper EXERCISES. The nutritional and exercise work I am doing with patients is exciting and involves educating patients to the proper diet and which supplements to take. Keep reading through the website and you will see many articles and posts that can help you decide if this approach is right for you. Call me at 310-473-2911 for specific questions regarding your individual case.
European Journal of Clinical Nutrition Published online ahead of print.
A daily dose of vitamin B-6 at the current upper tolerable levels may reduce amounts of inflammatory compounds in people suffering from rheumatoid arthritis, a new study says.
Levels of the pro-inflammatory compounds interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) significantly decreased following 12 weeks of supplementation with 100 mg of vitamin B-6, according to findings published in the European Journal of Clinical Nutrition.
However, scientists from Chung Shan Medical University in Taiwan said that no changes were observed for pyridoxal-5-phosphate (PLP), the active form of vitamin B-6, in relation to levels of C-reactive protein (CRP), another marker of inflammation.
After 12 weeks of supplementation with B6, significant decreases in levels of IL-6 and TNF-alpha were observed.
“A large dose of vitamin B-6 supplementation (100 mg per day) suppressed pro-inflammatory cytokines (that is, IL-6 and TNF-alpha) in patients with rheumatoid arthritis,” the researchers concluded.
Vitamin B-6, a water-soluble vitamin that exists as pyridoxine, pyridoxal and pyridoxamine is found in beans, meat, fish and some fruits and vegetables, like spinach and avocado. I recommended UltraInflamX medical shakes from Metagenics as a great source of B6 and other i,portant nutrients for RA and other inflammatory conditions. www.DrJeffreyTucker.meta-ehealth.com to purchase UltraInflamX.
June 30, 2010 — Cardiorespiratory aerobic exercise may be safe and modestly beneficial in patients with rheumatoid arthritis (RA), according to the results of a meta-analysis of randomized controlled trials (RCTs) reported in the July issue of Arthritis Care & Research.
“Several lines of evidence have emphasized an improvement in aerobic capacity and muscle strength after physical exercise programs in …RA patients,” write Athan Baillet, MS, from University of Grenoble Medical School in Grenoble, France, and colleagues.
Benefits associated with the exercise intervention included improved postintervention quality of life, better HAQ score, lower pain VAS scores and less radiologic damage.
“Cardiorespiratory aerobic conditioning in stable RA appears to be safe and improves some of the most important outcome measures,” the review authors write.
“Besides the positive effect of the intervention on patients’ psychological well-being, aerobic exercise should be considered as a safe therapy, the efficacy of which has been underestimated,” the review authors conclude.
Arthritis Care Res. 2010;62:984-992.
Dr. Tucker’s comment: In my experience in working with RA patients, the key to successful exercise therapy is training patients in low load body weight exercises – these are gentle repetitive movements. Proper training avoids overloading the joints and does not hurt. UltraInFlamX medical food shakes are part of the program when I work with RA patients.
First off, did you know the FDA annnouced that dicoflenac gel (brand name Voltaren Gel) — often prescribed for arthritis pain –is linked to severe liver damage… and it can happen within the first month of use!
According to the FDA, this topical gel has been reported to cause liver necrosis (death of liver cells), jaundice, and liver failure!
Despite these horrible side effects, dicoflenac gel remains very much on the market.
Don’t risk your life to erase arthritis pain. Natural alternatives I recommend are over-the-counter Capsaicin cream (apply it 4 times a day) or Coolsens from Xymogen. Both are very helpful for arthritis pain relief. Just make sure you use it consistently for 3 weeks to get the best results.