Arthritis Pain Medications Side Effects

Osteoarthritis is perhaps the fastest growing form of arthritis in the United States. According to the Arthritis Foundation, one third of all adult Americans have x-ray evidence of osteoarthritis. Last year over 7 million visits to the doctor were osteoarthritis related which is second to cardiovascular disease in America. As we age this number is going to increase unless we take steps to stop arthritis. Over the years researchers have developed medications to help relieve pain but none have actually addressed the underlying cause of joint destruction. In this article we will take a look at the characteristics of osteoarthritis and the current treatments available. Also, we will look at natural alternatives that can help improve quality of life.

Osteoarthritis is a disorder that involves certain bones and joints in the body. A joint is where two bones are connected and made up of cartilage which is surrounded by muscles and tendons. Some joints have a limited range of motion such as a rib in the rib cage and others have a much wider range of movement like hips, knees, elbows, wrists, and thumbs. The wider ranges of motion joints are called synovial joints. (1) Synovial joints have a unique structure. The bones that are connected to synovial joints are cover in a tough fibrous tissue call cartilage. This tough cartilage tissue between the bones is called the joint capsule. The joint capsule has an inner cavity which is lined with an inner membrane called the synovial membrane. With in this membrane there is fluid called synovial fluid which is a thick, slippery fluid that fills the small places in between and around the two bones connecting. The fluid is filled with a substance that lubricates the joints and eases movement. (1,2)

This joint cartilage serves two purposes. First, it allows for a smooth surface to bear heavy weight and ease joint movement when in motion. Secondly, the joint cartilage absorbs shock and distributes the forces and mechanical stresses out to the bones connected to the joint.

Joint function is under continual mechanical stress while in motion and the joints ability to resist the stress reflects its health. If the mechanical stress becomes to much for the joint, some physical changes occur in the joint cartilage covering the bones. (1,2)

Cartilage is tough and some what elastic in nature comprised of water, collagen and complex proteins called proteoglycans. (3) When osteoarthritis has been diagnosed in a patient, the cartilage has started to weaken and become frayed. Over time the cartilage breaks down exposing the two bones of the joint. When two bones rub together all sorts of damage can happen. Bits of bone and cartilage break off and float around in the joint space. When the joint is bent, one usually experiences a gritty grinding feeling which is painful. Over time tiny bone spurs can grow into the cartilage and surrounding tissue causing a great deal of pain and decrease range of motion in the joint. As the arthritis progresses, the pain and discomfort will increase creating sleepless nights and miserable days.

Even though the exact cause of osteoarthritis is not known, researchers do know that it is not age related. Researchers have observed the disease having the same destructive changes in younger patients diagnosed which haven’t been observed in older individuals who don’t have the disease. (2,4,5) Researchers have observed that certain conditions do seem to trigger the disease or make it worse.

Families who have frequent occurrences of osteoarthritis tend to lean on the idea that it could be a genetic factor. Osteoarthritis of the hands is often seen as genetic. (2) People who are extremely active or have physically demanding jobs have a higher occurrence of developing osteoarthritis. Also, individuals who have certain bone disorders are prone to osteoarthritis as well. Individuals who are over weight are at risk. Because of the excess pounds, these individuals usually develop osteoarthritis in the knees and feet. Over weight individuals usually have denser bones which do not absorb as much shock as thinner bones might causing more damage to joint cartilage.

Currently there is no sure way to prevent osteoarthritis, but slowing the progression may help with some lifestyle changes. The arthritis foundation suggests individuals who are prone to osteoarthritis should maintain a healthy weight and loose weight if needed. They also suggest that these individuals should exercise on a regular basis as a preventative measure. (4) Consumption of Calcium and other vitamins such as vitamin A, C, D, and E can help as well. (6-8)

Treatment of osteoarthritis is usually focused around reducing or relieving the pain an individual experiences and maintain or improve the movement so to reduce any permanent disability. (2) Your Medical practitioner normally prescribes a non-steroidal anti-inflammatory drug (NSAIDs) such as aspirin or ibuprofen which is only effective in pain management. Sadly these NSAIDs have side effects which can be serious. NSAID induced gastrointestinal complications cause more than 100,000 hospitalizations and nearly 16,500 deaths each year in the United States. Long term use of NSAIDs can cause ulcers in the stomach and intestinal tract which product heartburn and abdominal pain. NSAIDs can interfere with blood clotting and even cause kidney damage. Acetaminophen (Tylenol) is some times prescribed for pain relief, but acetaminophen does not reduce inflammation and have the same side effects as NSAIDs plus in large doses can cause liver damage. (9)

Newer medications released to the public are called COX-2 inhibitors which provide pain relief and anti-inflammatory effects with out the side effects of other NSAIDs. (11,12) In some cases, COX-2 inhibitors can cause stomach damage and bleeding. (13,14) All of these medications may help with the pain but does nothing to slow down or stop the osteoarthritis. This medication has no effect on the disease itself. (10)

After reviewing all the side effects from the medications available, some believe that Glucosamine sulfate and Chondroitin Sulfate are better for osteoarthritis because Glucosamine and Chondroitin actually improve synovial joint health without any life threatening side effects. (3)

Glucosamine sulfate and Chondroitin sulfate work so well as treatment for osteoarthritis that even physicians routinely recommend it. Glucosamine sulfate and Chondroitin sulfate are naturally occurring compounds found in human joints. (15,16) When consumed in the right combination can actually reverse the damage in joints affected by osteoarthritis. Glucosamine is a natural substance found in synovial fluid and is the basic building block of proteoglycans, one of the compounds in synovial cartilage. Europeans have been using Glucosamine and Chondroitin sulfate for more than 10 years to help ease joint pain. Only in the past few years have researchers from American and Europe worked together to figure out how this works. Researchers discovered that Glucosamine sulfate reduces synovial joint inflammation which explains why people feel better after taking the supplement.

Scientific studies have discovered that Glucosamine sulfate can help stimulate cartilage cell growth, inhibit proteoglycans breakdown, and rebuild the damage done by osteoarthritis. (17,18) Glucosamine Sulfate not only helps your feel better but also repairs the damage that’s all ready done. The only Glucosamine used in all the studies was Glucosamine sulfate. When the body digests Glucosamine sulfate the sulfate separates and forms a ion salt called a sulfate ion. This sulfate ion is critical for the body to synthesize proteoglycans. (17)

Researchers believe that Chondroitin sulfate works in a similar way to Glucosamine sulfate and should be consumed along with Glucosamine sulfate. Several studies investigated the action of Chondroitin sulfate and determined for best results one should take them both together. However, if your health care practitioner suggests taking only one or the other it is best that you follow your practitioners advice.

Other vitamins and minerals are beneficial to individuals suffering from osteoarthritis. Suck as, folic acid and B12 may increase joint mobility and vitamins A, C, D, and E may prevent the progression of the disease as well as prevent osteoarthritis all together. (8,19,20) Several clinical studies used the herb Boswellia serrata which help with swelling and yielded good results as well. Cayenne or capsaicin ointment can help elevate the pain associated with osteoarthritis. Cayenne pepper depletes the nerves of a neurotransmitter called substance P. This substance P transmits pain messages to the brain, so cayenne is very effective in relieving osteoarthritis pain.

Along with supplements, exercise is an important to help keeps joints mobile and healthy. For those suffering from osteoarthritis, water aerobics might be an option because it is low impact and gives one the ability to flex their joints with out applying much weight on the joints.

It is easy for those who don’t feel well to self diagnose. If you suspect that you have a joint health issue, get evaluated by a licensed health care provider before taking any steps to get better on your own. Some of these same symptoms can be related to other illnesses which require different treatment. Only a health care provider can be certain one has osteoarthritis. With proper exercise and supplements one can reduce the constant stiffness and pain associated with osteoarthritis and this can lead to a healthier pain free life. All the supplements mentioned can be found at your local or internet health food store.

References:

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2. Bancroft DA, Pigg JS. Osteoarthritis syndromes. In: Porth CM. Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998: 1133-1138.

3. McCarty MF. Enhanced synovial production of hyaluronic acid may explain rapid clinical response to high-dose glucosamine in osteoarthritis. Medical Hypotheses 1998;50,507-510.

4. Arthritis Foundation. Osteoarthritis. Available at: www .arthritis .org/answers/diseasecenter/oa. Accessed June 26, 2001.

5. National Institutes of Health. Osteoarthritis. Available at: www .nih .gov/niams/healthinfo/osteoarthritis /osteohandout_breaks.html. Accessed July 3, 2001.

6. Tiku ML, Shah R, Allison GT. Evidence linking chondrocyte lipid peroxidation to cartilage matrix protein degradation. Possible role in cartilage aging and the pathogenesis of osteoarthritis. J Biol Chem. 2000;275:20069-20076.

7. Sowers M, Lachance L. Vitamins and arthritis. The roles of vitamins A, C, D, and E. Rheum Dis Clin North Am. 1999;25:315-332.

8. McAlindon TE, Jacques P, Zhang Y, et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996;39:648-656.

9. Graumlich JF. Preventing gastrointestinal complications of NSAIDs. Risk factors, recent advances, and latest strategies. Postgrad Med 2001 May;109(5):117-20, 123-8. Complete article available online at: www .postgradmed .com/issues/2001/05_01/graumlich.htm.

10. Lehne RA. Acetaminophen. In: Pharmacology for Nursing Care. 3rd ed. Philadelphia, Pa: W.B. Saunders; 1998: 705-706.

11. Ballinger A, Smith G. COX-2 inhibitors vs. NSAIDs in gastrointestinal damage and prevention. Expert Opin Pharmacother. 2001;2:31-40.

12. Goldstein JL, Correa P, Zhao WW, et al. Reduced incidence of gastroduodenal ulcers with celecoxib, a novel cyclooxygenase-2 inhibitor, compared to naproxen in patients with arthritis. Am J Gastroenterol. 2001;96:1019-1027.

13. Colville-Nash PR, Gilroy DW. Potential adverse effects of cyclooxygenase-2 inhibition: evidence from animal models of inflammation. BioDrugs. 2001;15:1-9.

14. Laudanno OM, Cesolari JA, Esnarriaga J, et al. Gastrointestinal damage induced by celcecoxib and rofecoxib in rats. Dig Dis Sci. 2001;46:779-784.

15. Uebelhart D, Thonar EJ, Zhang J, Williams JM. Protective effect of exogenous chondrotin 4,6-sulfate in the acute degradation of articular cartilage in the rabbit. Osteoarthritis Cartilage. 1998;6:6-13.

16. Leeb BF, Schweitzer H, Montag K, Smolen JS. A meta-analysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol. 2000;27:205-211.

17. Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am. 1999 May;25(2): 379-95.

18. Glucosamine sulfate. Monograph. Altern Med Rev. 1999;4:193-195.

19. Adebowale AO, Cox DS, Liang Z, et al. Analysis of glucosamine and chondroitin sulfate content in marketed products and the Caco-2 permeability of chondroitin sulfate raw materials. JAMA. 2000;3:37-44.

20. Crolle G. D’Este E. Glucosamine sulphate for the management of arthrosis: a controlled clinical investigation. Curr Med Res Opin. 1980;7:104-109.