ARTH-9 #120 Caps
Glucosamine sulfate (GS), a compound containing both glucosamine and sulfur, is found in and around the tendons, ligaments and connective tissue. Glucosamine, synthesized from the amino acid glutamine and glucose, is one of the building blocks of connective tissue (2). The sulfur component is necessary for the production of the disulfide bonds that are responsible for the rigidity and strength of connective tissue (2). A key factor thought to contribute to the loss of joint function is the inability to manufacture glucosamine. Glucosamine acts as the foundation for cartilage compounds known as proteoglycans and glycosaminoglycans (GAGs) (2). Glucosamine also activates chondrocyte cells in the cartilage which help produce GAGs and proteoglycans (2). GAGs allow the cartilage to hold water so the joints can act as shock absorbers in order to deter the affects of constant pounding.
Many human studies have shown that GS supplementation can reduce pain and inflammation and accelerate the regeneration and repair of cartilage (3,4,8). When GS was given orally it was more effective than a placebo and just as effective as non-steroidal anti-inflammatory drugs in relieving the symptoms of osteoarthritis (1,3-7). The results of a Portuguese multi-center investigation, with 1,208 patients, showed significant pain reduction and improved joint mobility after supplementing with GS daily (5). Another clinical trial was completed comparing oral supplementation of GS with ibuprofen. After 8 weeks both treatment groups showed reduction in pain and inflammation (6). However, the GS group had no side effects, where as the ibuprofen group reported complaints of gastrointestinal disorders. Additional results showed GS was able to stimulate the synthesis of proteoglycans enabling some regeneration of joint cartilage (4). A recent Chinese study also compared GS to ibuprofen and found similar results. In fact, after two weeks the GS treatment group had a stronger therapeutic effect and didn’t have the adverse reactions as did the ibuprofen group (7). In a placebo-controlled double-blind Italian hospital study patients treated with GS experienced a 72% reduction in symptoms of pain and inflammation. A significant number of patients reported to be completely pain-free. It was concluded that GS tends to rebuild the damaged cartilage, thus restoring joint mobility and function (8).
Vitamin C (ascorbic acid) is a very important nutrient in the formation of collagen. Collagen contains about one-third glycine and one-third proline and hydroxyproline. Vitamin C is required for the hydroxylation of proline in collagen synthesis. Hydroxyproline is almost exclusively associated with collagen (9). In a University of Sidney research study vitamin C has been shown to increase collagen and proteoglycan production (10) and at the University of California, San Francisco a study showed the synthesis of glycosaminoglycans increased 30-90% when vitamin C was added to the culture (11). Oxidative stress mediated by reactive oxygen species (ROS) has been implicated in tissue degeneration of osteoarthritis. Antioxidant nutrients such as vitamins C and E are well known to reduce or prevent oxidative stress. A Boston University study showed that osteoarthritis patients with a high intake of vitamin C may reduce the risk of cartilage loss and progression of the disease (12).
Bromelain is a proteolytic enzyme extracted from pineapple plants. For years natives in the tropics have used this plant as a folk medicine (13). Its numerous biological effects include anti-inflammatory action, decreased platelet aggregation, inhibiting tumor cell growth and burn healing (13). More than eight proteolytically active components have been identified in bromelain (14). Two of the main components contain proteins and glucosamine (14) and these nutrients are major constituents of connective tissue (2). The method of action of bromelain appears to be its modulating effects on the arachidonic acid cascade (13,15) and it is well known that elevated arachidonate can lead to increased inflammation. Studies have shown the beneficial effects of bromelain in the treatment of inflammation and soft tissue injuries (16,17). These results suggest that bromelain can be useful in many conditions where inflammation is involved.
Calcium plays a crucial role in the matrix of connective tissue (18) and has been shown to effect the synthesis of chondrocyte cells in the production of collagen (19). Many osteoarthritic patients using NSAID’s for treatment have developed osteoporosis and it is common for people to have both conditions (20). Evidence has shown NSAID’s can contribute to the destruction of bone and interfere with metabolism of articular cartilage (21). Based on these findings calcium can be beneficial for slowing up bone loss and joint degeneration.
Boswellin is a traditional ayurvedic medicine from the Boswellia serrata plant. Boswellic acids, the biologically active ingredients of Boswellia serrata, are shown to be powerful inhibitors of leukotriene production (22). Leukotrienes are potent mediators of inflammation. Another benefit boswellin offers is the ability to reduce inflammation without the gastrointestinal side effects caused by most NSAID’s (23).
Curcumin, another ancient ayurvedic medicine, is the active component of the Curcuma longa plant. Curcumin has the ability to reduce inflammation by inhibiting the production of powerful inflammatory agents such as NF Kappa B, TNF alpha and nitric oxide (24). As an anti-inflammatory, curcumin also compared favorably to the NSAID phenylbutazone and without any gastrointestinal side effects (25). Curcumin has also shown the capacity to enhance tissue repair and wound healing (26). This study also exhibited greater collagen deposition and increased growth factor-beta 1 and fibronectin in curcumin treated animals.
Zinc and Copper have been found to be deficient in patients with rheumatoid arthritis, according to researchers at the Albany NY medical college, and supplementation may be appropriate (27). Reactive oxygen species (ROS) and other pro-oxidant agents can aggravate rheumatoid arthritic inflammation. The zinc and copper containing enzyme superoxide dismutase (SOD) can interact with and neutralize these free radicals, thereby reducing the inflammatory response (28).
Chondroitin Sulphate has compared favorably with the common NAIDS indomethacin and ibuprofen (29). Chondroitin sulphate reduced inflammation by protecting the cells from ROS (29). In a multicenter randomized, double-blind study patients supplementing with chondroitin sulphate had a significant reduction in joint pain and considerable improvement in mobility (30). The benefits of chondroitin sulphate are the tolerability with no dangerous effects on the GI tract or kidneys.