Therapy Options for Rheumatoid and Osteoarthritis

Osteoarthritis and Rheumatoid arthritis are debilitating conditions impacting millions of people each year, but also negatively affecting many horses and companion pets.  Both conditions are strongly connected with ongoing or chronic inflammation, which is a fact of life, but often worsened or exacerbated by many other factors including genetics, lifestyle, stress, and excessive wear and tear.  Today’s current therapies offer no real hope in terms of reversal of the problem and often leave much to be desired in terms of pain relief or mitigation.  Unfortunately, with continued use of many of the medications, the risk of side effects is real and patients are left to decide the lesser of two evils; contend with the side effects or succumb to ongoing discomfort.

Given the very close association between inflammation and arthritic conditions, this becomes one of the main approaches to helping to ease patient discomfort.  During the inflammatory process, one has to keep in mind that there are many, practically hundreds, of inflammatory proteins that are released and upregulated in their levels. Many therapies often just target a small portion of these inflammatory proteins, often being just one out of hundreds, with the outcome being a partial response in easing discomfort, but often in exchange for potentially serious side effects.

Treatment or management options don’t just come in the form of a pharmaceutical medication, but there are many proven natural options, shown in research trials to impact the progression of the condition, but also the wellbeing of the patient.  Let’s look at traditional therapy options first.

Non-Steroidal Anti-Inflammatories and Arthritis

This class of medications includes acetominophen, ibuprofen and naproxen sodium, which are all generally available over the counter.  These medications are intended to reduce circulating levels of prostaglandins, which are connected with pain perception.  NSAIDs reduce levels of prostaglandin by inhibiting what is termed the COX enzyme, which actually has two different forms; type I and type II.  Type I or COX-1 is actually involved in many normal pathways within the body, including normal stomach lining and kidney blood flow, while COX-2 is more involved with inflammatory problems and pain.  Many NSAIDs actually block both COX-1 and COX-2, which obviously can create problems including an increased incidence of stomach ulcer and even kidney disease.  Some newer NSAIDs are more selective and inhibit just the COX-2, which has fewer side effects, but in some species such as humans, there can be some cardiovascular problems.  The bottom line is that NSAIDs are the most often chosen and utilized medication for management of OA and RA symptoms.  The results can be very beneficial for some people and even animals, but again, we have to understand that we are only tackling a small pathway in the large picture of inflammation.

Corticosteroids and Impact on Arthritis 

Corticosteroids are a class of medications including prednisone, prednisolone, dexamethasone and many others. These medications impact the production of prostaglandins, very similar to the NSAIDs, but the range of dosing is variable and with increased dose, we impact more damaging pathways associated with inflammation.  One of the main effects of steroids is the negative impact on the immune system, which is good from one standpoint, but the effects can lead to an increased incidence of infection for the patient.  Long term and high dose steroid use is often associated with liver problems, stomach ulcers, weight gain due to water retention, kidney damage and even osteoporosis.  The medications can be taken orally or injected directly into the affected joint.  The long term benefits are considered to be low compared to the high rate of potential side effects.  In some studies, there has been a direct correlation between steroid usage and increased degeneration or catabolic effects on the joint tissue.

Anti-TNF-α Therapy and Arthritis

TNF (Tumor Necrosis Factor) is one of many important inflammatory proteins that is often upregulated in levels during conditions such as RA.  This cytokine is important for several reasons including its direct involvement  in the inflammatory process, but also due to the fact that it also stimulates or signals for the release of other inflammatory proteins.  Therapies targeting the release of TNF, essentially down regulating its production or blocking its attachment to receptors within the body have proven to be of significant value in many research trials.  The down side to these therapies is the potential impact on immune function, which opens the door to increased incidence of infection and even some forms of cancer.  In some studies there has even been mention of concern with the use of anti-TNF therapies and an increased risk of cardiovascular disease.

Herbal and Nutritional Intervention for Arthritis

 

Curcumin:

Curcumin is the main active ingredient from the spice Turmeric, comprising about 2-4% by volume.  There are other curcuminoids present within the Turmeric root, including demethoxycurcumin and bisdemethoxycurucumin, both of which also demonstrate anti-inflammatory properties.  Curcumin has many research proven benefits including potent antioxidant capabilities, which helps to neutralize and reduce the impact of free radicals on various cells, but also Curcumin has been shown to have potent anti-inflammatory properties through the down regulation of the transcription factor NF-ΚB.  Through the downregulation, Curcumin has been down to reduce circulating levels of many inflammatory proteins and enzymes including COX, prostaglandins, various interluekins, MMP’s and even TNF.  Curcumin has been shown in research trials to benefit many chronic degenerative conditions connected with chronic inflammation including joint disorders, cardiovascular and respiratory ailments, metabolic conditions and even cancer. In some arthritic research trials, Curcumin has been shown to have anti-catabolic effects which means that it potentially slows tissue degeneration.

Boswellia serrata:

Boswellia is another herbal extract which is commonly used to help manage pain and joint conditions.  It is common to use along side of curcumin, but can be used alone successfully in many cases.  Boswellia has potent anti-inflammatory properties in many research studies and can impact many areas of your health from mental health to joint health.  In some studies, the usage of Boswellia was as effective if not more effective than standard medications.

Omega-3 Fatty Acids:

Omega-3 fatty acids have been researched heavily in human studies and the overall conclusion has been that their usage can lower levels of various inflammatory proteins tied in with many conditions.  The downside to the studies has been the variability in the dosage used as well as type of omega-3 fatty acids, as there can be a great difference in overall results.  In the end, they do appear to offer some benefit, but studies have not determined an exact dose or type to be used for best results.

Other phytochemicals and plant types impacting inflammation:

• Resveratrol
• Green Tea (EGCG)
• Boswellia serrata
• Protein (many sources)
• Spirulina blue green algae
• Ashwaghanda

In today’s society in which chronic diseases such as osteoarthritis and rheumatoid arthritis are becoming ever more common, we have to look for better ways to slow the onset and improve quality of life for the patient, whether that be a human or animal.  Today’s pharmaceutical options offer hope and relief for some patients, but are plagued with side effects and expense.  The major side effects of concern are the negative impacts on the immune system, which may actually open the door for more health concerns for that patient, including cancer.  We shouldn’t have to give up one disease in exchange for another.

We are pressured as part of today’s society to believe that pharmaceuticals are the best options available, almost as if we suffer a deficiency which must be remedied.  There are many natural and potentially very effective options, including Curcumin, which may be utilized as sole therapies in some cases or along with traditional therapeutics in order to enhance the overall results and potentially mitigate the side effects.  These natural options often come with far more advantages due to impacting many aspects of the inflammatory process, but also have very few disadvantages and minimal to no side effects.  The down side to natural options is not that they do not have significant research data to support their use, and it is by this fact that they are often quickly dismissed by practitioners and people in general. The main reason for this dismissal is what I believe is ignorance in the level of understanding of the capabilities of food, herbs and nutrition in general to impact overall health.

I believe we can do better for ourselves and our patients, but with this, we have to understand that there is no exact dose that will achieve results in all people, pets or horses.  Each person is an individual and thus, in many cases, we have to alter intake until results are evident and the patient’s comfort is improved. As with any health condition, I feel that the earlier the intervention, the better the overall results.

All my best,

Tom Schell, D.V.M., CVCH, CHN

Nouvelle Research, Inc.

 

References:  Aggarwal, B et al. Inflammation, Lifestyle, and Chronic Disease. The Silent Link. 2012, CRC Press.