Pine bark naturally reduces osteoarthritis knee pain

Affecting more than 10 million Americans, Osteoarthritis of the knee (OA) is one of the five leading causes of disability among the elderly.

While OA mainly affects most people over 45, it can occur at any age. A double-blind, placebo-controlled study published in the journal Nutrition Research reveals Pycnogenol, (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree, improved physical function by 52 percent in patients suffering from OA.

When OA develops, the cartilage gradually looses elasticity and begins to harden and crack, subsequently becoming more prone to damage and erosion by use or injury and often leads to pain, swelling, a decrease in motion at the joint, stiffness, or the formation of bone spurs (tiny growths of new bone). Current treatments include regular exercise and pain relievers such as NSAIDS and COX-2 inhibitor pills to help ease pain and stiffness. In more severe cases, cortisone shots can help decrease inflammation in the joint and extreme cases consist of joint replacement. There are currently no drugs that treat osteoarthritis directly.

Pycnogenol was chosen due to a history of studies of the extract to alleviate inflammation by inhibiting COX-1, COX-2 and the pro-inflammatory "master-switch" nuclear factor-kappa B,"said lead researcher Dr. Ronald Watson from the University of Arizona. Pycnogenol offers a safe nutritional approach to significantly reduce pain and improve physical function of arthritic joints. It controls inflammation and thus ideally complements existing strategies that comprise delivery of building blocks for replacement of degenerated cartilage.

The study was conducted at the rheumatology department of Mashhad Medical University, Iran. Thirty-five volunteers (average age 42) were randomly assigned a daily dose of Pycnogenol (50mg, 3 times a day) or placebo for three months. Patients were to report arthritic pain using the Western Ontario and McMasters Universities (WOMAC) Osteoarthritis Index after 30, 60 and 90 days. Participants also were instructed to indicate the frequency and dosage of NSAIDS and COX-2 inhibitor usage.

After two months of supplementation, physical function and pain scores improved in the Pycnogenol group. After three months in the Pycnogenol group, there was a reduction of 43 percent in pain, 35 percent in stiffness, 52 percent in physical function subscales and 49 percent composite WOMAC. The placebo group showed no significant scores throughout the entire study. Additionally, further reduction in the number of NSAIDS and COX-2 inhibitor pills and number of days taking medication was noted in the Pycnogenol group.

Pycnogenol's natural anti-inflammatory and antioxidant properties were responsible for delivering these excellent results,"said Watson. This study shows that supplementing with Pycnogenol can fight joint inflammation and soothe the pain and stiffness, thus pave the path for cartilage renewal with substances such as glucosamine.

A previous study on Pycnogenol published in the Journal of Inflammation demonstrated that the ingredient effectively prevented inflammation disorders in patients by moderating the immune system response. While the wear and tear is responsible for the initial degeneration of cartilage, the more advanced stage of osteoarthritis involves inflammation. The cells of the cartilage (chondrocytes) respond to mechanical impact by generating pro-inflammatory molecules (cytokines). This process is initiated by the pro-inflammatory "master-switch" called NF-kappaB. Pycnogenol was shown to lower the sensitivity for NF-kappaB in humans last year.

The cytokines released from chondrocytes recruits immune cells (leukocytes) to the joints where they cause more harm than good. Leukocytes release harmful substances such as free radicals and enzymes that break down connective tissue and speed up the degeneration of cartilage. These processes alike are under control by NF-kappaB, and the effect of Pycnogenol to suppress NF-kappaB will help to limit the damage caused by leukocytes.

Researchers believe this study is the first randomized clinical trial to show Pycnogenol's effectiveness in alleviating the clinical symptoms of knee osteoarthritis. There are several more breakthrough studies on Pycnogenol and osteoarthritis expected to be published next year allowing for development of innovative, natural formulas for joint health.

Additionally, Horphag Research, the exclusive worldwide distributor of Pycnogenol has filed for several patents for Pycnogenol's application for COX-1, COX-2 and treating osteoarthritis.

Supplement 'eases crippling disease

Scientists have produced evidence that a food supplement can help to reduce the long-term suffering associated with the crippling disease osteoarthritis.

Osteoarthritis, or degenerative joint disease, is the most common form of arthritis, most often affecting middle-aged and older people.

The disease, which can cause severe disability and pain, tends to develop in the joints of the neck, lower back, knees, hips and fingers.

However, it may also occur in joints that have been previously injured, or subjected to prolonged heavy use.

Experts estimate that 60% of those aged 65 have moderate to severe osteoarthritis in at least one joint.

It is caused by the degeneration of the cartilage, the protective material that stops bones rubbing together in the joints.

Suffering From Joint Pain?

Joint pain can be caused by any number of things. It can be the result of an injury or overuse of the joint. If your joint pain is caused by arthritis, you will need to begin your search for an effective way to treat it. But, in order to do that, you need to know the symptoms of arthritis. All forms of arthritis share the common symptoms of severe pain, loss of range of motion, and a diminished quality of life. What you will find is that this painful, life altering condition can be found in any individual at any time of their lives. But, there are joint pain treatments that can be effective.

The first thing to do when you have joint pain is to go to a doctor. Symptoms of arthritis include severe pain in the joints and other factors as mentioned above. If your pain is accompanied with fever, the advice of a doctor is urgent because this specific type of arthritis can be deadly. Arthritis can be brought on by any number of things including overuse of the joint, sports, injury, and degeneration of the joints through time. In any case, it is important to relay to your doctor when it was first noticed, any related injuries you may have had, and what types of activities you perform on a regular basis. Your doctor will determine if the pain is arthritis through x-rays and blood tests. Once the doctor knows which type you have, treatments can begin.

For instance, the joint pain caused by rheumatoid arthritis is a function of the immune system destroying the cartilage in the joints affected. Cartilage is what keeps the bones
from grinding against each other. As your immune system eats away at your joint cartilage, pain is brought on by the formation of nerve endings in the affected area. Eventually, the pain is so sever that mobility in those joints is virtually impossible.

What is ankylosing spondylitis?

Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. The sacroiliac joints are located in the low back where the sacrum (the bone directly above the tailbone) meets the iliac bones (bones on either side of the upper buttocks). Chronic inflammation in these areas causes pain and stiffness in and around the spine.

Over time, chronic spinal inflammation (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis. Ankylosis leads to loss of mobility of the spine.

Ankylosing spondylitis is 2-3 times more common in males than in females. In women, joints away from the spine are more frequently affected than in men. Ankylosing spondylitis affects all age groups, including children. The most common age of onset of symptoms is in the second and third decades of life.

Ankylosing spondylitis is also a systemic rheumatic disease, meaning it can affect other tissues throughout the body. Accordingly, it can cause inflammation in or injury to other joints away from the spine, as well as other organs, such as the eyes, heart, lungs, and kidneys. Ankylosing spondylitis shares many features with several other arthritis conditions, such as psoriatic arthritis, reactive arthritis, and arthritis associated with Crohn's disease and ulcerative colitis. Each of these arthritic conditions can cause disease and inflammation in the spine, other joints, eyes, skin, mouth, and various organs. In view of their similarities and tendency to cause inflammation of the spine, these conditions are collectively referred to as "spondyloarthropathies." For more information, please read the following articles; Psoriatic Arthritis, Reactive Arthritis, Crohn's Disease and Ulcerative Colitis.

Managing Musculoskeletal Injuries and Arthritis

Wayne McIlwraith, BVSc, PhD, FRCVS, DSc, DrMedVet (hc), Dipl. ACVS, Barbara Cox Anthony Chair and Director of Orthopaedic Research at Colorado State University, spoke on current and new therapeutic options to manage musculoskeletal injuries and osteoarthritis at the AAEP Focus meeting in Ft. Collins, Colo., on July 29.

He reminded the veterinary audience that interleukin-1 (a deleterious cytokine) is at the head of the inflammatory cascade, leading to a breakdown in the cartilage matrix through signaling factors that alter regulation and effect of inflammatory biochemical mediators. The goals of therapeutic intervention focus on returning a joint to normal as quickly as possible, when possible, and to prevent the occurrence and severity of osteoarthritis in an injured joint.

McIlwraith discussed intervention that targets management of capsulitis (joint capsule inflammation) and synovitis (inflammation of the synovial membrane lining the joint), since these tend to occur in advance of degenerative joint disease. One strategy that merits more investigation is physiotherapy, such as swimming or underwater treadmill therapy. This might be cutting-edge therapy, but more research and data is necessary to determine the extent of its value. One point McIlwraith made of great interest is the recent finding that two-thirds of the force across the carpus (knee) at the trot comes from muscle forces, rather than ground reaction forces as previously believed.

McIlwraith mentioned that extracorporeal shock wave therapy (ESWT) significantly reduces lameness and synovial fluid parameters as compared to control horses (those not receiving treatment) in the study; these findings support a pain and inflammatory mechanism of action that elicits lameness.

The clinicians in the panel discussion were also favorably impressed with the use of ESWT, particularly for injuries at a soft tissue and bone interface, such as in the distal (lower) joints of the hock and in the rear third of the heel associated with soft tissue trauma. Back pain was another suggested use of ESWT; however, it was felt if the back could readily be injected, there was no sense in spending the money on repeated shock wave treatments. One clinician said shock wave might be especially useful to apply to capsulitis and soft tissue damage in joints that are not amenable to intra-articular (IA) treatment.

The topic of non-steroidal anti-inflammatory drugs (NSAIDs) has been one of great interest to horse owners because of their value in managing pain and inflammation, yet the well-known adverse effects of gastric ulcer syndrome preclude long-term use of NSAIDs. There has been an in vitro study from some years ago suggesting that phenylbutazone might be injurious to joint cartilage, but McIlwraith noted there is no data or clinical evidence to support this claim in the live horse. With the introduction of a new cyclooxygenase-2 (COX-2, an enzyme that causes inflammation and pain) inhibitory drug (Equioxx) on the market, some information has come to light: If COX-2 mediators are completely suppressed, it is possible to get an up-regulation of interleukin-1, this being counterproductive to managing pain and inflammation. McIlwraith stressed that we should keep an open mind about the advantages of this newly released medication.

Another common joint therapy uses intra-articular (IA) steroid injections. McIlwraith revisited the pros and cons of various corticosteroid drugs, noting that not all of these are created equal in regard to how effective they are and their role in protecting the cartilage. The use of hyaluronic acid (HA) in conjunction with IA steroid treatment has been well-applied in the veterinary world for years. HA is no longer thought to have a primary function as a joint lubricant, since its anti-inflammatory effects are more important. One study mentioned by McIlwraith was that of improvement in lameness of horses injected only with 2 mL of sterile saline, the mechanism as yet undetermined. In moderate to severe cases of osteoarthritis, intra-articular therapy should include both steroids and HA.

Intravenous (IV) treatment with HA labeled for this use (Legend) has had marked favorable effects of decreasing synovial effusion in an injured joint, with therapeutic effects persisting for 44 days following the third weekly treatment. There is common usage of IV HA as a prophylactic medication in normal horses without lameness, and data thus far has not verified this to improve a horse's gait.

McIlwraith reported that oral HA seems to have some positive effect, with some ingredient remaining active in the molecule or fragment of the molecule after it passes through the intestinal tract.

Polysulfated glycosaminoglycans (PSGAGs) are considered to be "disease-modifying osteoarthritic drugs," and although they might be slow acting, they are cartilage modifying. Most of the favorable studies in using Adequan come from its intra-articular use. Studies on IM Adequan have given equivocal effects in one study, yet positive anecdotal reports abound.

A new product called pentosan polysulfate is soon to be licensed in the United States. This substance, made from beechwood hemicelluloses, seems to be a disease-modifying osteoarthritis drug, but it's without any pain-relieving activity such as seen with NSAIDs. Lameness is not improved, but progression of cartilage deterioration might be abated by correcting biologic imbalances in an osteoarthritic joint. Pentosan polysulfate exerts anabolic effects on cartilage precursor cells to decrease erosion of cartilage.

Oral supplements and nutraceuticals have been a hot topic in the horse world for some time. McIlwraith describes these as materials that are fed to heal the lame or make a chronically unsound horse become sound. They are used with the intention of preventing joint problems from occurring. However, McIlwraith points out that if a product is not licensed as a drug, then the manufacturer of such a food product cannot make medical claims as to its efficacy. There are no criteria for licensing these products, and, hence, there is often misrepresentation of advertising. In addition, there is no regulation to ensure the ingredients claimed by the label to be in the bucket are actually present in the bucket.

More specifically, McIlwraith discussed glucosamine salts that in theory are building blocks for articular cartilage. In one Virginia study, he said less than 6% of the material fed was actually bioabsorbed from the intestinal tract. In a Canadian study, following administration of glucosamine via stomach tube, very low levels showed up in the joints. McIlwraith said in one investigative report, fewer than a third of nutraceutical products contained less glucosamine in the container than what was listed on the label. In addition, he asked the audience, how do we even know the correct dose for a horse?

Chondroitin sulfate is absorbed well, but as McIlwraith pointed out, this does not prove effectiveness in the horse. Another study showed a joint-protective effect of a combination of glucosamine and chondroitin sulfate (Cosequin by Nutramax), but no anti-inflammatory effect. Other studies looked at the use of nutraceuticals on joint health, and either the studies did not have sufficient numbers of horses to be scientifically sound, or the data was flawed. When reading the results of studies, it is important to identify who is funding the study, since a company's vested interest could skew the results.

Some research has proven efficacy of the use of omega-3 fatty acids to inhibit enzymes that break down the cartilage matrix. In a three- to four-month period, horses supplemented with omega-3 fatty acids seemed to have less stiffness and pain related to osteoarthritis.

Finally, McIlwraith touched on the supplement with unsaponified avocado and soy, which is thought to somewhat decrease interleukin-1 levels and cartilage disease scores. This might be a useful product to add to a nutraceutical supplement, and more research should be pursued.