The MOVES trial tested whether chondroitin sulfate (CS) plus glucosamine hydrochloride (GH) has comparable
efficacy to celecoxib after 6 months of treatment in patients
with painful knee osteoarthritis.
The trial tested 606 patients with moderate-to-severe knee osteoarthritis (OA) based on a WOMAC (Western Ontario and McMaster osteoarthritis index) scale >301 (range is 0-500). Treatment with 400 mg of CS and 500 mg GH three times a day was compared with the effects of Celocoxib 200 mg once a day for 6 months.
The results: Both treatments were equally effective. For CS/GH Vs. Celocoxib, both treatments resulted in decreasing pain by 50% as well as joint swelling.
In summary: Using either Celocoxib or GH/CS had equal effect in decreasing joint stiffness, pain, functional limitations, and joint swelling after 6 months in the treatment of OA of the knee.
Side effects of Glucosamine may be an increase in glucose levels, so be careful if you are diabetic. Also if you have an allergy to shellfish, Glucosamine can be derived from materials in shellfish, so again be careful.
Recommended daily doses of Glucosamine is 1,500 mg ans 1,200 mg of chondroiton.
Glucosamine, Chondroitin Sulfate, and the Two in Combination NEJMGAIT trial < link to gate trial. A prior study in the New Englandd Journal of Medicine had shown results hinting that CS/GH work best in moderate-to-severe disease, but not so much is lesser OA pain.In the study discussion, it was noted: Analysis of the prespecified subgroup of patients with moderate-to severe pain demonstrated that combination therapy significantly decreased knee pain related to osteoarthritis, as measured by the primary outcome or by the OMERACT–OARSI response rate. We did not identify significant benefits associated with the use of glucosamine or chondroitin sulfate alone. Although the results for glucosamine did not reach significance, the possibility of a positive effect in the subgroup of patients with moderate-to-severe pain cannot be excluded, since the difference from placebo in the OMERACT–OARSI response rate approached significance in this group. Treatment with chondroitin sulfate was associated with a significant decrease in the incidence of joint swelling, effusion, or both. We did not find an increased risk of ischemic cardiovascular events among patients who received celecoxib or among patients with diabetes who received glucosamine, but this study was not powered to assess these risks… Our finding is that the combination of glucosamine and chondroitin sulfate may have some efficacy in patients with moderate-to-severe symptoms.
Be certain to lose weight and exercise. Obesity places huge stress on knees and ankles and hips. Supplements should complement these steps.
Arthritis affects millions of individuals, reducing quality of life. There are multiple facets that can be addressed regarding arthritis pain and what to do, but I will address several points:
Exercise added to the daily routine is the best way to help combat arthritis. Unused joint cause increased pain. What type of exercise? Flexibility Exercises, strength training, and aerobic exercises all help combat joint pain. They also help an individual lose weight as well, which increases mobility.
Range of motion exercises can help with stiffness and can improve mobility. Flexibility exercises allow one to do this. Tai chi and yoga are examples.
Preserve your muscle mass with strength training at least three times a week. This also allows one to lose weight and helps maintain mobility. Muscle training helps support the joint structure and function, such as the knees. This decreases joint stress.
Aerobic exercises also add a lot to overall health and diminish joint pain. Swimming is low impact. Walking is another option.
Options to help arthritis pain:
Heat application: Relaxes the muscles and increases blood flow to affected areas, helping provide nutrients and oxygen. This is useful in multiple areas such as knee, neck, and back pain.
Cold Applications: Cold packs can be used acutely after exercise to decrease inflammation, muscle spasms, and pain, especially in the first 72 hours, after which, use heat.
Emotional support: Remember that a large challenge to arthritis is the emotional impact. Cognitive behavioral therapy is an option to help one cope with the pain of arthritis. Remember to keep busy and keep moving. Meditation can help overcome the negative emotions that can actually increase your pain. Pain can increase your anxiety and depression. Insomnia can result from arthritis pain, so the emotional impact is huge as arthritis affects so many facets in one’s life.
Acupuncture: This may be an option in some individuals. Consider going online to find a certified acupuncture specialist near you.
Spinal Manipulation Therapy (SMT): Look at the entire body and evaluate the triggers that aggravate arthritis. SMT can reduce stiffness and help with joint movement. These changes in joint mobility have a local effect on the chemical factors that cause inflammation and pain. The joint may be the culprit in causing stiffness or the muscles surrounding the joint may be inflamed or spastic, resulting in lower mobility and pain.
Physical Therapy: Consult your physician for a PT referral., which can help you find ways to promote strength and flexibility.
Quit Smoking: Smoking lowers bone density.
Remember that muscles support your bones, and it is important to increase your muscle mass as it provides numerous benefits in addition to supporting your joints and your back. The back, in particular, with it’s discs and small facets, is affected over time by pressure, which can be unloaded by stretching and strengthening the spinal muscles through basic exercises like:
Pelvic tilt exercises:
One -legged wind releasing
You need core muscle strength and flexibility to help preserve your back. The hip muscles need to have flexibility maintained as well for better back health. Consider doing this through the 4.hammerstring stretch:
Chikungunya is making headlines again as a million cases have occurred this year. We covered Chikungunya virus in a prior article http://www.insanemedicine.com/?p=69 in insanemedicine.com.
As a refresher, Chikungunya virus is an arbovirus endemic to Wet Africa that produces fever and arthritis in multiple locations. It is spread by the Aedes mosquito to humans, with primates as reservoirs. Aedes aegypti is one vector, that is present in the U.S. Southeast and lives in urban areas, frequenting small puddles of water. Aedes albopictus (Asian Tiger mosquito) is the other vector, and it spreads yellow fever, west nile, japanese encephalitis virus, and eastern equine encephalitis virus as well. It is found in the southeastern and mid-atlantic states areas.
A person who gets Chikungunya fever from the bite of one of these mosquitos develops fevers of three to five days duration and about two to five days after this, the patient develops polyarthralgias (arthritis pains) in the hands, wrists, and ankles most commonly. This arthritis can cause sever pain that lasts days to months. Rash also occurs about three days after onset of illness and is small and flat in nature. In severe cases, death can result. Respiratory failure, encephalitis (brain infection), hepatitis, renal failure, myocarditis (heart inflammation) have been associated with severe infection.
What is so special about this tropical infection in the United States? First, There is no immunity to this disease in the Americas, so it can spread rapidly. Secondly, 1.03 million people have contracted the disease, with 155 dying, especially in Martinique and Guadeloupe. There have been 11 cases in Florida.
The economic impact of this disease are significant with many having chronic arthritis, unable to walk due to the pain. 20-30 % have chronic rheumatological symptoms. This results in disability and missed work.
There is no specific treatment or cure. There is no vaccine available as of 2014.
The best treatment for this disease is prevention, through the use of insect repellent and extermination of mosquitoes by removing their breeding grounds (areas of standing water) and through the use of insecticide.
There have been 11 cases of Chikunguya virus in the U.S., and 1900 cases or so that have been imported to the U.S. through traveling. This number will probably rise over the next year.
If you are traveling to South America or the Caribbean, be certain to carry insect repellent.
Passiflora edulis has shown to reduce joint pain and stiffness by close to 20% when the passion fruit peel (150 mg a day) was taken for two months.
Passion fruit has flavonoids with anti-oxidant and anti-inflammatory ability. It may also be helpful in reducing blood pressure and asthma.
You can add this fruit to your well-rounded diet. It comes in many forms including puree, concentrate, or as the fresh fruit itself.
In addition to passion fruit for your pains, incorporate other avenues of treatment including appropriate exercise and stretching exercises. Increase your vegetable intake for the anti-inflammatory component, as well as spices such as tumeric and ginger, for their inflammation-fighting abilities. Don’t forget the omega-3 fatty acids found in fish and walnuts, which can help reduce your pain as well!
Chikungunya Virus was first found inTanzania in 1952. It is an RNA virus of the alphavirus genus and the Togaviridae family.
It is primarily found in Western Africa, similiar to where ebola is currently found this year. It is endemic in West Africa, but in 2103, it was found in the Caribbean, including St. Martin and Puerto Rico. Two mosquitos, Aedes aegypti and Aedes albopictus (African tiger mosquito) are the mosquito vectors for the disease. The Aedes albopictus mosquito can carry Yellow fever and Dengue fever as well as Chikungya.
The virus causes crippling arthralgias and fever. The illness can result in a rash. It lasts for several months, with the arthritis pain being prolonged and severe. Hence, the name Chikungunya, which in Tanzania means ”stooped over.’
The initial fever lasts 7-10 days and there may be swelling if the fingers and toes. In severe cases, a person can get an inflamed heart muscle, known as myocarditis and kidney failure.
Similar viruses include O’nyong-Onong (Central Africa), Baima-Ross River virus, Semili Virus, Mayaro virus (South America), and the Sindbis group virus. All of them cause severe arthritis.
Treatment – supportive care only, Fluids and pain management are cornerstone to treatment. There is no vaccine currently available. The best treatment is prevention – prevent mosquito bites by wearing long clothes and lots of bug spray! If you are traveling to the Carribbean, be certain to wear bug spray to prevent infection.
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