Osteoarthritis in the elderly and improvement methods

16/02/2024

Osteoarthritis is a common problem in the elderly, is currently on the rise and has many impacts on the patient’s quality of life. Without timely treatment, the patient may experience numerous inconveniences in life and gradually lose mobility.

1. Basic information about arthritis (osteoarthritis)

Statistics from the Global Burden of Disease Study program show that 528 million people around the world have osteoarthritis in 2019, an increase of 113% compared to 1990. The disease tends to be more common as age increases, most clearly shown in the rate of osteoarthritis in people over 35 years old is 30% and over 65 years old is 60% according to statistics from the Vietnam Musculoskeletal Association.

According to the US National Institute of Osteoarthritis and Musculoskeletal Diseases, osteoarthritis is a joint disease that occurs when tissues in the joints are gradually destroyed over time, causing pain, swelling, inflammation and stiffness, affecting the patient’s mobility.

Symptoms of osteoarthritis often have a slow onset and begin in one or a few joints. Some common symptoms of osteoarthritis include:

– Pain upon joint mobility, this condition can improve with rest. For some people, in the later stages of the disease, the pain may be worse at night, and may be concentrated in one area or spread, often symmetrically on both sides..

– Joint stiffness gradually increases, usually lasting less than 30 minutes in the morning or after being in a state of rest and inactivity for a period of time.

– Joint movements are limited, often with symmetrical pain on both sides.

– Inner swelling and pain and around the joint with little redness or heat, especially after a lot of activity or using that area.

– Feeling of stiff joint and difficult to move or loose joint.

Osteoarthritis symptoms may leave impact on different joint locations. For example:

– Hand joints: changes in shape in the finger joints, metacarpophalangeal joints, wrists… gradually over time deforming the joints, resulting in diamond-shaped fingers and “wind-blown” hands.

Wind-blown hands

– Knee joint: Walking or moving causes clicking sound, muscles and ligaments weaken.

– Hip joint: Pain and stiffness in the hip joint, inner thigh or buttocks. Sometimes, pain from arthritis in the hip can spread to the knee, gradually making it impossible to move the hip with a large amplitude like before.

– Spine: Stiffness and pain in the neck or lower back. Spine changes then makes spinal stenosis development, which can lead to a number other complications.

– In addition, subcutaneous particles are also seen in rheumatoid arthritis: Particles or bumps on the skin surface, firm and immobile, 5 – 10 mm in size, no pain caused, visible and touchable

 Subcutaneous granules in rheumatoid arthritis

Osteoarthritis occurs when cartilage and other tissues in joints break down or have structural changes. Some risk factors that can make a person more susceptible to osteoarthritis include: age, being overweight or obese, a history of joint injury or surgery, performing repetitive joint movements , joints do not develop normally, family history of osteoarthritis.

As the symptoms of osteoarthritis become more severe over time, the patient’s ability to function and move will be greatly limited, such as walking up and down stairs, holding objects moving. The pain and other symptoms of osteoarthritis can make people feel tired, have trouble sleeping, and become depressed if there is no palliative treatment plan.

The quality of life of people with osteoarthritis is affected without timely treatment (Pic: Freepik)

2. Treatment of osteoarthritis

People with osteoarthritis cannot be treated to return their joints to their original healthy state, but can only treat symptoms and slow down the degenerative process. Therefore, arthritis treatment often focuses on the following 4 goals:

– Pain relief

– Joint function enhancement

–  Serious disease progressing prevention

– Quality of life maintenance

To achieve the above 4 goals, patients can consider the following methods to reduce pain, increase mobility, prevent and slow down the process of osteoarthritis..

– Medication: Medication is one of the fastest methods of reducing joint pain. Some medications that can help relieve symptoms of osteoarthritis include medications containing Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) such as celecoxib, diclofenac, ibuprofen, naproxen, piroxicam and sulindac. However, these drugs will have some side effects, for example, drugs containing acetaminophen when used in large amounts can affect the liver, or NSAID drugs can cause stomach bleeding and increases the risk of cardiovascular complications for some patients[4].

– Physical exercises: Exercise is able to reduce joint pain and stiffness, while increasing flexibility, muscle strength and endurance. Patients with osteoarthritis can consult their doctor about some supplementary exercises such as: mobility and stretching exercises to keep joints flexible; strengthening exercises performed with weights or exercise bands to strengthen the muscles that support joints affected by arthritis; Water exercises allow pressure reduction on joints during exercise; Balance and speed exercises help maintain daily living skills. It should be noted that these exercises need to have a moderate level of activity, not putting too much pressure on the joints, specifically walking, cycling, swimming, tai chi, water aerobics or other gentle aerobics exercises3.

– Weight improvement: Weight control can also help reduce pressure on joints. Especially for people who are overweight or obese, losing weight may enable pain relief, better prevent injuries, and increase joint mobility. This can be especially helpful for weight-bearing joints such as the knee or hip3.

– Natural active ingredients:

If NSAIDs and acetaminophen often leave some side effects that influence the digestive system and cardiovascular system of many people with osteoarthritis, then natural active ingredients such as Glucosamine, Chondroitin and Collagen is much safer, while providing effective pain and inflammation relief4.

Glucosamine exhibits therapeutic effects through its anti-inflammatory properties by reducing the concentration of inflammatory factors (such as tumor necrosis factor-alpha, interleukin-1 and interleukin-6) and enhancing proteoglycan synthesis, Slows down cartilage degeneration and improves joint function. In addition, Glucosamine improves cellular redox status, reduces arthritis-mediated oxidative damage, scavenges free radicals, upregulates levels of antioxidant proteins and enzymes, and inhibits the production of antioxidants. reactive oxygen species and induce autophagy to delay arthritis pathogenesis[5]. According to a 12-week study by Nicola Giordano and colleagues in 2009, supplementation with 1500 mg of Glucosamine sulphate statistically significantly reduced pain and improved motor function, while also helping to reduce consumption of analgesics, compared with placebo use in patients with knee arthritis[6]. Another study in Japan also showed that taking N-acetyl Glucosamine (another form of Glucosamine) at doses of 500 and 1,000 mg/day also helped improve cartilage metabolism, supporting the treatment of osteoarthritis.

 Glucosamine is an important nutrient that supports the treatment of osteoarthritis (Pic: Freepik)

To supplement Glucosamine, patients can refer to the nutritional product Nutricare Bone – researched and produced by Nutricare and Nutricare Medical Nutrition Institute – USA (NMNI-USA). The product is a nutritional solution that supports strong bones and joints, strengthens muscle mass, and is suitable for Vietnamese people’s physical condition, contributing to caring for and improving the health of millions of Vietnamese families. Nutricare Bone supplemented with Glucosamine from the US has the role of increasing joint fluid and cartilage cells to help lubricate joint cartilage, increasing the toughness and flexibility of joints. Glucosamine has been clinically proven to reduce joint pain. In particular, Nutricare Bone provides Calcium with a high content of 1800mg, helping to support the prevention of osteoporosis; Vitamin D3 increases Calcium absorption in the intestines and Vitamin K2 helps transport and increase the density of Calcium attached to the skeleton, maximizing the body’s efficiency in using Calcium, strengthen bones; 50 essential nutrients including plant protein and Whey protein from the US help strengthen muscle mass for adults.

Similar to Glucosamine, Chondroitin therapeutic benefits are also related to three main mechanisms: stimulation of extracellular matrix production by chondrocytes; Inhibits inflammatory mediators; and inhibit cartilage degeneration. In a double-blind, placebo-controlled randomized clinical study by Zegel and colleagues in 2013, using Chondroitin sulphate at a dose of 1200 mg/day (divided into three doses or taking the entire dose in one dose) had clinical effects. Significant clinical reduction in pain (through VAS score) and improvement in Lequesne index (index to assess the severity of osteoarthritis)[8].

Meanwhile, Collagen is the main component of joints. Collagen supplementation can help promote the synthesis of connective tissue, especially cartilage[9]. Besides, natural Type II Collagen also creates an immune-mediated response and according to this mechanism of action, Natural Type II Collagen will reduce the autoimmune reaction against endogenous Collagen at the articular cartilage level[10]. The benefits of Collagen have been proven through many clinical studies, as shown by a 2018 meta-analysis of randomized placebo-controlled trials on the effects of Collagen supplementation on osteoarthritis symptoms by Juan et al. This comprehensive research article has shown that clinical studies with oral collagen supplement doses of 2 – 10 g/day significantly improve osteoarthritis-related indices such as the WOMAC index ( Western Ontario and McMaster University Osteoarthritis Index) and VAS (Visual Analog Scale).

Timely nutritional intervention combined with exercise and necessary nutrient supplementation helps slow down the process of joint degeneration, so that older people can “age healthily” (Pic: Freepik)

Thus, osteoarthritis or degenerative joint disease is a common disease among the elderly, causing many inconveniences in daily activities, affecting the patient’s quality of life. Therefore, in order to “age healthily”, each of us needs to pay more attention to diet, exercise and supplement necessary nutrients to slow down the degenerative process of joints and make joints stronger.

References:

1. GBD 2019: Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. https://vizhub.healthdata.org/gbd-results/.

2. https://tytphuongphuthohoa.medinet.gov.vn/giao-duc-suc-khoe/thoai-hoa-xuong-khop-som-neu-ban-thuong-xuyen-co-nhung-thoi-quen-nay-cmobile8161-88341.aspx

3. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Overview of Osteoarthritis.

https://www.niams.nih.gov/health-topics/osteoarthritis#:~:text=Osteoarthritis%20is%20a%20degenerative%20joint,a%20short%20period%20of%20time.

4. Vo, Nam Xuan, Ngan Nguyen Hoang Le, Trinh Dang Phuong Chu, Huong Lai Pham, Khang Xuan An Dinh, Uyen Thi Thuc Che, Thanh Thi Thanh Ngo, and Tien Thuy Bui. 2023. “Effectiveness and Safety of Glucosamine in Osteoarthritis: A Systematic Review” Pharmacy 11, no. 4: 117.

5. Al-Saadi, Hiba Murtadha, Kok-Lun Pang, Soelaiman Ima-Nirwana, and Kok-Yong Chin. 2019. “Multifaceted Protective Role of Glucosamine against Osteoarthritis: Review of Its Molecular Mechanisms” Scientia Pharmaceutica 87, no. 4: 34.

6. Giordano N, Fioravanti A, Papakostas P, Montella A, Giorgi G, Nuti R. The efficacy and tolerability of Glucosamine sulfate in the treatment of knee osteoarthritis: A randomized, double-blind, placebo-controlled trial. Curr Ther Res Clin Exp. 2009 Jun;70(3):185-96.

7. Kubomura D, Ueno T, Yamada M, Tomonaga A, Nagaoka I. Effect of N-acetylGlucosamine administration on cartilage metabolism and safety in healthy subjects without symptoms of arthritis: A case report. Exp Ther Med. 2017 Apr;13(4):1614-1621.

8. Kubo M, Ando K, Mimura T, Matsusue Y, Mori K. Chondroitin sulfate for the treatment of hip and knee osteoarthritis: current status and future trends. Life Sci. 2009 Sep 23;85(13-14):477-83.

9. Zegels B, Crozes P, Uebelhart D, Bruyère O, Reginster JY. Equivalence of a single dose (1200 mg) compared to a three-time a day dose (400 mg) of Chondroitin 4&6 sulfate in patients with knee osteoarthritis. Results of a randomized double blind placebo controlled study. Osteoarthritis Cartilage. 2013 Jan;21(1):22-7. doi: 10.1016/j.joca.2012.09.017. Epub 2012 Oct 8. PMID: 23059756.

10. Walrand S., Chiotelli E., Noirt F., Mwewa S., Lassel T. Consumption of a Functional Fermented Milk Containing Collagen Hydrolysate Improves the Concentration of Collagen-Specific Amino Acids in Plasma. J. Agric. Food Chem. 2008;56:7790–7795.

11. Park K.-S., Park M.-J., Cho M.-L., Kwok S.-K., Ju J.H., Ko H.-J., Park S.-H., Kim H.-Y. Type II Collagen Oral Tolerance; Mechanism and Role in Collagen-Induced Arthritis and Rheumatoid Arthritis. Mod. Rheumatology

12. García-Coronado JM, Martínez-Olvera L, Elizondo-Omaña RE, Acosta-Olivo CA, Vilchez-Cavazos F, Simental-Mendía LE, Simental-Mendía M. Effect of collagen supplementation on osteoarthritis symptoms: a meta-analysis of randomized placebo-controlled trials. Int Orthop. 2019 Mar;43(3):531-538. doi: 10.1007/s00264-018-4211-5. Epub 2018 Oct 27. PMID: 30368550.

 

 

 

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