More help for sore joints

From supplements to extracts from your own body, the range of joint treatments is growing.

Mind you, if your OA is crippling, this won’t apply. You’ll be seeing a specialist. This is about what might work for mild, moderate or occasional OA symptoms.

The easiest and most obvious place to start could be anti-inflammatory creams or gels or paracetamol. Have a chat with your pharmacist about the best options.

Cartilage, like tendon and ligament, is notoriously slow to heal, so most measures, if they work, take time. The advantage of these over-the-counter products is that if they’re going to provide relief, it’ll happen fairly quickly.

OA Supplements

The best-known are probably glucosamine, chondroitin and green-lipped mussel. They’re used to reduce pain and repair cartilage.

Glucosamine is extracted from the shells of crustaceans but is also listed in supplements as eggshell membrane.

A recently published study using data collected in 2007 from over 10,000 Australian women aged 55-60 years showed that of those who said they had OA, 32 per cent used glucosamine.

But that was 16 years ago. Today those women are in their 70s and it’d be useful to know how many still use it — or how many more use it — and how effective they think it’s been.

Some supplements combine glucosamine with other anti-inflammatory ingredients such as Boswellia (a herbal extract from the resin of the Boswellia tree) and curcumin (the active ingredient in turmeric). Pharmacy staff who sell this kind of product report good customer feedback.

Sometimes glucosamine is paired with chondroitin, which is collected from animal cartilage and thought to help rehydrate cartilage.

Green-lipped mussel, from New Zealand, also has anti-inflammatory properties. The mussel contains chondroitin as well as omega-3 fatty acids. You can even buy it in pet food for your dog or cat.

And the anti-inflammatory supplement list doesn’t end there. For example, Bob Hawke said he drank tart cherry juice for his arthritic pain.

How much hard evidence is there for any of them? Not much, as you probably guessed. But a lot of people have been using products like these for a long time, and presumably they’ve been getting relief.

Other anti-inflammatory measures

Namely sleep, stress reduction and an anti-inflammatory diet. Again, there’s no concrete evidence that getting to bed at a decent hour or swapping sugar and processed food for a well-balanced diet with plenty of fruit and veg will change the way your joint feels, but it makes sense in the big picture of inflammation.

I recently heard an interview with an American orthopedic surgeon — a woman in her mid-50s who’d had joint issues herself. She recommended paying attention to what we eat. When an orthopedic surgeon advocates dietary changes rather than lining up for a metal knee, it could be worth taking notice.

Injecting damaged joints to aid the body’s own healing

This is called ‘prolotherapy’. One form uses dextrose (or sugar). The theory is that dextrose is an irritant that stimulates new cell growth in the cartilage.

Another form uses platelet-rich plasma (PRP) from the patient’s own blood. Pla Platelets are cells in the blood that contain growth factors and help to form clots, and plasma is the liquid part of blood (without red blood cells to give it colour, it’s pale yellow). PRP aims to reduce inflammation and, again, promote new call growth.

Yet another therapy uses bone marrow extract. This is called bone marrow aspirate concentrate (or BMAC). Stem cells, along with a range of other cells and proteins, are collected from a patient’s bone marrow with a syringe and injected into the joint. Stem cells are signalling cells, so the idea is that they signal to other cells around the damage to turn on and kickstart the healing process.

In addition to OA, these procedures are used to treat injuries such as tennis elbow or rotator cuff tears. In this country they’re most likely to be practised at sports medicine or musculoskeletal clinics.

Two downsides are that they’re slow (patients are told not to expect improvement for several weeks) and expensive (no Medicare or health insurance rebates either). Plus, there’s the question of how well they work.

To date high-quality evidence is scant. A study by Melbourne and Sydney Universities a couple of years ago compared the outcome of 12 months of three-weekly PRP injections with the same frequency of saline injections to people with mild to moderate knee OA. Saline was the placebo, and neither patients nor doctors knew who was getting what.

After 12 months there was no difference between the two groups. Interestingly, though, pain levels improved significantly, regardless of which type of injection a person had received.

And that’s the thing with OA. Short of surgery, there’s only good evidence for the effects of weight loss or aerobic and resistance exercise. Yet people continue to benefit from a range of (so far) unproven sources.

Every remedy, it seems, works for some.

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