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Osteoarthritis and rheumatoid arthritis in women

By Tori Hudson, ND
Source: A Woman's Time Natural Medicine Clinic
Date Published: June 2000

In my women's health practice, we frequently see cases of osteoarthritis, especially in women in their mid forties and older. Although less frequent, we also see patients suffering from rheumatoid arthritis. These diseases have dramatic effects on the quality of the lives of my patients. Joint pain and stiffness can turn otherwise pleasant and enjoyable activities into unpleasant ordeals. Day to day activities can become more and more difficult - for example, kneeling in the garden, opening jars and cans in the kitchen, swinging a golf club, writing letters, playing the piano, knitting, needlework, and other hobbies.

Joint inflammation and/or degeneration are not generally considered "women's conditions". However, arthritis and other joint conditions are far more common in women than in men and are therefore on the top 10 list of health concerns for many women. In fact, nearly twice as many women (26 million) suffer from arthritis than men (14.2 million).

Osteoarthritis, also known as degenerative joint disease, is the most common form of joint disease and is characterized by erosion of the articular cartilage. After the age of forty-five, osteoarthritis is more common in women than in men. Osteoarthritis is associated either with aging and wear and tear of the joint, or due to some predisposing factor including an inherited abnormality of the joint, fractures along the joint surface or previous inflammatory disease of the joints. Osteoarthritis was previously considered a degenerative disorder in which the joint "just wears out". Now we know that the joint cartilage is very active at least in the early part of the disease and continues to repair itself. It is now thought that the disease can be halted and may even be reversible, at least in some individuals.

Rheumatoid arthritis is a chronic inflammatory condition that affects the joints but sometimes other parts of the body as well. Women suffer from rheumatoid arthritis about three times as frequently as men. Rheumatoid arthritis can begin at any age but is usually first diagnosed in women age twenty to forty. The typical onset of rheumatoid arthritis is gradual, but occasionally sudden. Although swollen, stiff, painful joints are the hallmarks of the disease, fatigue, weakness and fever may also precede the joint problems. As the disease progresses, the joints of the hands and feet can become deformed. Rheumatoid arthritis is an autoimmune reaction in which the body produces against the components of joint tissues. Just what triggers this autoimmune reaction remains largely unknown although most likely it is not just any single factor alone.

When I see a woman in my practice with either osteo or rheumatoid arthritis, I advise an eclectic natural medicine approach. My usual recommendations involve not only weight management, exercise, and dietary changes, but very specific nutritional supplements and botanicals to provide pain relief, increase range of motion, prevent further degeneration and hopefully reverse the disease process.

Reducing the weight load
Fundamental to a naturopathic approach to arthritis problems involves the achievement of a normal body weight. Plain and simple, excess body weight causes an increased weight load on the joint. Regular exercise helps to accomplish weight loss and weight control while also improving circulation to the joint and range of motion. Physical activity that does not traumatize the joints is preferential - for example,walking, swimming, and cycling.

The quality and quantity of food in the diet also plays an important role in weight management. In general, I recommend a basic healthy whole foods diet, including complex carbohydrates, fruits, vegetables, legumes, nuts and seeds. The diet should be low in saturated fats and trans-fatty acids (bad fats), while rich in essential fatty acids (good fats) such as fish containing omega-3 oils (salmon, tuna, halibut, sardines, mackerel, herring).

Of additional importance is the detection of food allergies and sensitivities, especially in the case of rheumatoid arthritis. Eliminating allergic foods will very often offer significant benefit to many individuals with rheumatoid arthritis. Almost any food can aggravate rheumatoid arthritis but common offenders are wheat, corn, dairy products, beef, food additives and nightshade-family foods (tomato, potato, eggplant, peppers, tobacco). Avoiding the nightshade family foods also seems to help many women with osetoarthritis. In fact, reducing my own twice weekly intake of "lover's eggplant " at my favorite Chinese restaurant when I was in medical school cured me of my own joint pains. With my patients, I generally find that about one third of them improve with this suggestion.

Lubricating the joints with good fats
In addition to changes in diet and exercise, I usually prescribe a combination of supplements with therapeutic effects for the joints. I commonly start with supplements of essential fatty acid oils - these good fats include borage, evening primrose, black currant, and fish oils. I typically receive good feedback from my patients on these oils, and some even say they just feel like their joints are "better lubricated".

Borage oil, evening primrose oil, and blackcurrant oil contain the omega-6 fatty acid gamma-linolenic acid (GLA). Many studies on GLA have shown that individuals with rheumatoid arthritis experience significant improvements in their symptoms within the first six months of use. They also continue to improve by as much as 50% in the number of tender joints, 54% in the reduction of tender joints, 42 % in the reduction in swollen joints, morning stiffness decreasing by 67%, and overall 27% reduction in pain. , The GLA content in evening primrose, borage and blackcurrant oil seems to be the common thread that explains these benefits. I'm especially drawn to the use of borage oil with my patients, because it is the richest source of GLA - up to 23%. Evening primrose oil contains 8-10% and black currant oil 15-17%. With borage oil, an individual can take fewer capsules to achieve the required dosage, which is usually between 1.4 and 2.8 grams of GLA per day. I generally see significant benefits within 6 months of use.

Although there have been no human trials to date studying the effects of GLA on other forms of arthritis such as osteoarthritis, animal studies do show that GLA supplementation can have anti-inflammatory effects. Again, in my practice, I can report that I do indeed see positive benefits using GLA supplements in women with osteo as well as rheumatoid arthritis.

The studies of fish oil supplementation in the treatment of rheumatoid arthritis may yield better results in some women. More than a dozen studies have consistently demonstrated positive benefits in relieving morning stiffness and joint tenderness. I generally recommend at least 1.8 grams of eicosapentanoic acid (from fish oil) as a supplement.

Quality oils and fats are as important as vitamins and minerals in maintaining our health and in the prevention of many chronic diseases, not only arthritic conditions. They are a valuable addition to any diet but are especially important for people with arthritis.

Combined benefits with additional supplements
In addition to essential fatty acids, I regularly use many other nutritional supplements and herbs for therapeutic benefit - these include niacinamide, glucosamine sulfate, chondroitin sulfate, SAMe, and herbs such as Devil's Claw, Yucca, Curcumin, Ginger and Boswellia.

Niacinimide: Nniacinamide has been used for the treatment of osteoarthritis for more than 50 years. Niacinimide has been shown to increase joint mobility, and improve discomfort, inflammation and pain. I have also observed very good clinical results using niacinamide for patients with rheumatoid arthritis.

Glucosamine sulfate and chondroitin sulfate: Both of these seem to have benefit and it is difficult to come to a clear opinion as to whether one is better than the other. Studies to date indicate that glucosamine sulfate can relieve the symptoms of joint pain, tenderness and swelling, and joint mobility of osteoarthritis, at least as effectively as some of the commonly used NSAIDS. 12,13,14,15,16,17,18    Several clinical trials have demonstrated that chondroitin sulfate either slows the progress of osteoarthritis, reduces pain, improves exercise time, and protects against the development of erosive changes in at least some joints. 19,20,21

In one analysis of several studies, patients supplementing with chondroitin sulfate averaged 50 percent greater improvement than placebo groups after 60 days of treatment. Some clinicians assert that chondroitin sulfate is too large a molecule to be absorbed intact through the intestinal wall. Evidence exists that there is absorption, and other evidence exists that shows no changes in the glycosaminoglycan level in the blood after ingestion of chondroitin sulfate. It appears that the reported clinical benefits of chondroitin sulfate are likely due to an indirect effect and our due to its breakdown products, which includes glucosamine sulfate. The most recent meta-analysis found chondroitin to have nearly 60 percent greater average effects than glucosamine.

SAMe: The use of S-adenosylmethionine (SAMe) for arthritis was actually discovered during a study on depression, its more well known use. Some of the patients studied for depression reported marked improvement in their osteoarthritis. Subsequent extensive scientific study shows that SAMe leads to a reduction in pain, improvement in function, decrease in morning stiffness, and improved mobility. 24, 25, 26     

Herbs for healing
Naturopathic physicians and herbalists have historically used many herbs for the treatment of osteoarthritis. These include Devil's Claw, Yucca, Curcumin, Ginger and Boswellia.

Devil's Claw: Devil's claw has been traditionally used for a number of conditions, including arthritis. Modern scientific confirmation has demonstrated an anti-inflammatory action of Devil's claw, and mild improvement has been observed in a small study. We will hope to have expanded scientific exploration into this herb that has been used for arthritic pains since the early 20th century.

Boswellia: In a variety of animal model studies, Boswellic acid extracts have demonstrated the ability to inhibit inflammatory mediators, prevent a decrease of cartilage synthesis and improve blood supply to the joint tissues. , Herbal formulas using Boswellia have consistently produced good results with patients who either osteoarthritis or rheumatoid arthritis. A common dosage for boswellic acid is 400 mg three times daily.

Ginger: Patients who have been treated with ginger show substantial improvement in pain, joint mobility, swelling and morning stiffness. 29, 30     Ginger is one of my favorite herbs for its antioxidant effects, ability to inhibit the formation of inflammatory compounds, as well as its direct anti-inflammatory effect.

Curcumin: Curcumin, a pigment found in turmeric, has potent anti-inflammatory and antioxidant effects. In human studies, curcumin has been able to produce improvements in morning stiffness, walking time and joint swelling.31   I often use curcumin when an individual is having an acute flare-up of their joint inflammation.

Capsicum: Numerous herbal topical preparations exist that can affect the nerve fibers that transmit pain messengers. Capsicum (cayenne, containing capsaicin), is probably the most popular. Other menthol-based preparations may also be helpful in relieving joint pain, especially pain due to osteoarthritis.

Vitamins and minerals: Vitamins play an important role in the normal turnover of joint cartilage. Vitamins E and C function as important antioxidants and provide some anti-inflammatory activity. Low blood levels of vitamin D may be associated with an increased risk of developing osteoarthritis, especially of the hip. Boron supplementation may be helpful for those individuals with osteoarthritis who have a dietary deficiency of boron. Manganese plays a role in the synthesis of chondroitin sulfate, a component of joint cartilage. Pantothenic acid levels may be lower in patients with rheumatoid arthritis and correction of those low levels may bring about alleviation of symptoms.

Treating both osteoarthritis and rheumatoid arthritis requires patience and a multi-faceted approach. Often, this also involves using some of the conventional pharmaceutical medications, even if only intermittently. And don't forget - nutritional and herbal supplements are very useful in both kinds of arthritis, but they are not "magic bullets". Always remember the fundamentals of diet, exercise and weight management. Although additional research is needed in the area of alternative treatments for joint disease, the evidence that we do have is very encouraging. My own observations and experience in clinical practice are also very rewarding in terms of patient feedback. Their improved quality of life, increased activity, and improvement in many of their day to day symptoms, is a frequent reminder of the wisdom of nature and the ability of the body to heal.

About Tori Hudson, ND

Dr. Tori Hudson, N.D., is a well-known author and regular contributor to the Journal of Naturopathic Medicine and HealthNotes Online. She has been featured in over 70 magazines including Women's World, McCalls, Redbook, Prevention, Time, and Healthy Living. Her new book "Women's Encyclopedia of Natural Medicine, Alternative Therapies and Integrative Medicine", received a five-star rating at the popular website Amazon.com. She is also a nationally recognized lecturer for both professionals and the general public and has appeared on many local and network radio and TV programs including appearances on "Good Morning America", PBS's "Healthy Living Series", and Lifetime's "New Attitudes." She also serves as "Naturopath on Call" for Prevention Online.

Hudson graduated from the National College of Naturopathic Medicine, in Portland, Ore., in 1984. Since that time Hudson has served as Medical Director, Associate Academic Dean and Interim Academic Dean as well as a professor at the college. In 1999 she was named the "Physician of the Year" by the American Association of Naturopathic Physicians (AANP) and in 1990 Hudson was awarded the President's award for research in the field of women's health by the AANP.

Hudson is also the Medical Director at the Institute of Women's Health & Integrative Medicine and is part owner of A Woman's Time, a Menopause Options and Natural Medicine clinic in Portland.

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