Turmeric, Diet, and Boswellia for Arthritis

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I decided to write a post on arthritis because this is a condition I live with every day. Some days are better than others. I have done plenty of research on arthritis with the hope of improving my quality of life and I will share with you what I have learned about medications, foods, and natural supplements. I hope you never have to deal with this on a personal level but if you do, perhaps what I have learned over the last few years will help relieve some of your pain.  

              This figure represents alterations that occur in the joints during the onset of Oseteoarthritis1

Overview

Osteoarthritis (OA) is the most common joint disorder in the United States.2

 

It is also known as degenerative joint disease or “wear and tear” arthritis. This most often occurs in the joints of the hands, knees and hips. Osteoarthritis affects 32.5 million adults in the United States.3

 

OA is characterized by joint stiffness, swelling, pain and loss of mobility resulting from the breakdown of articular cartilage and synovial inflammation.

 

Here are a few facts about OA:

 

88% of OA patients are 45 or older and 43% are 65 or older. 62% are women and 78% are non-Hispanic Caucasians.4

 

OA patients experience more pain and have more activity limitations than other people in their age group. They are also more prone to fatigue and disability.5

 

One-third of those with arthritis over the age of 45 suffer from anxiety or depression. 

Approximately one million knee and hip replacement surgeries are completed each year due to OA.6

 

By 2040, approximately 11.4% of all adults will have some activity limitations as a result of arthritis.7

 

Risk Factors

                    8

Medications

Like most other ailments, osteoarthritis is initially treated by modifying risk factors. Losing weight, eating healthier foods and exercise are all excellent strategies. It may also help to optimize your workspace, especially if you sit for long periods of time. When these fail, medications may be necessary to relieve pain and inflammation. Most of the medications listed should only be used when symptoms are present since none of these agents have been shown to modify disease progression.

 

Topical NSAIDs – This class is the starting point, especially when few joints are affected. These work well in arthritis occurring in the hands and knees. They have similar efficacy to oral NSAIDs and have a better safety profile.9

 

The drug most utilized in this class is diclofenac gel (Voltarentm.) This medication is only available by prescription.

 

Oral NSAIDs – The next step is to utilize oral NSAIDs. Medications in this class include ibuprofen (Motrintm), naproxen (Alevetm), piroxicam (Feldenetm), and others. 

Caution must be exercised as these agents can cause GI bleeding, kidney disease and cardiovascular complications.  COX-2 inhibitors, such as celecoxib (Celebrextm) may also be used.

 

Duloxetine (Cymbaltatm) – This is an antidepressant medication known as an SNRI (serotonin-norepinephrine reuptake inhibitor.)  These drugs increase the amount of serotonin and norepinephrine available in the brain. My physiatrist (pain specialist) informed me that 90% of his patients responded to duloxetine. It works very well for both nociceptive and neuropathic pain.

 

Glucocorticoid (Steroid) intra-articular injections – Steroid injections are sometimes utilized for OA of the knee. These have a short duration of action (approximately four weeks) and may have adverse effects on the hyaline cartilage.10

 

 

Opiates – Due to the recent changes in opiate use guidelines, these drugs should generally not be used for arthritis. Opiates have many side effects, including increased risk of falls, sedation, nausea and dizziness. They are also habit-forming and may cause hyperalgesia leading to an increased sensitivity to pain. 

Effect of Vitamins and Diet

Arthritis is associated with inflammation, so foods known to decrease inflammation should help relieve pain due to this disease. My recommendation is to stick with the Mediterranean diet as much as possible. This diet has the most evidence to support various health-related benefits.  

 

Many of the foods that help with inflammation are part of the Mediterranean diet. Some examples of these include broccoli, tomatoes, whole grains, nuts, blueberries, avocados and many others. You can learn more about this diet by reading my post at the link below.

 Mediterranean vs Ornish Diet

 

Nightshades – Some people with arthritis believe eating plants from the nightshade family worsen arthritis pain. Nightshades contain solanine, which is a neurotoxin at high doses. Some examples of nightshade foods include white potatoes, eggplant, tomatoes and bell peppers. There is no scientific evidence to support the notion that eating plants from this family makes arthritis symptoms worse. If, however, you notice a negative change when eating these foods, you should avoid them. 

Natural Supplements

Turmeric – The only two nutritional supplements recommended by UpToDatetm at the current time are curcumin, the active ingredient in turmeric, and Boswellia serrata.  Curcumin has been used in Ayurvedic medicine for thousands of years for arthritis, respiratory infections, GI problems and even cancer treatment.   

A review of the efficacy of curcumin in the treatment of osteoarthritis was published in The Journal of Evidenced-Based Complementary & Alternative Medicine in 2017. The conclusion was that curcumin-containing products demonstrated statistically significant improvements in osteoarthritis compared to placebo in four out of five studies.11

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Boswellia serrata – A randomized, double-blind placebo-controlled study of 30 patients with osteoarthritis was published in 2003. The investigators found a statistically significant improvement in knee pain, knee flexion and increased walking distance in patients receiving Boswellia extract compared with placebo. Swelling in the knee joints was also improved. There were no changes that could be seen on x-rays. The Boswellia extract was well tolerated, with the exception of minor GI symptoms. 15

Vitamin K2 – There is some evidence suggesting vitamin K may be important in preventing arthritis. A longitudinal study compared patients with vitamin K deficiency to those who had adequate levels. The vitamin K deficient group had a 56% higher risk of developing knee osteoarthritis than the control group. 16

Vitamin K2 supplementation may also reduce inflammation in rheumatoid arthritis by lowering CRP levels.17

Ashwagandha

Ashwagandha is frequently used to treat both osteoarthritis and rheumatoid arthritis in Ayurvedic medicine.  Several anti-inflammatory pathways may be affected by withanolides, the active ingredients in ashwagandha.18

Arthritis and the Weather

We have all known people who believe they can predict the weather based on their arthritis pain. Scientists have been searching for a link between the weather and arthritis pain for years. Unfortunately, no definitive results have been obtained.

 

Colder weather may cause people to be less active and this may lead to stiffer joints. Lower barometric pressure may cause the nerve endings in joints where cartilage is worn away due to arthritis to be more sensitive, resulting in increased pain.

 

Finally, these changes in barometric pressure could cause expansion and contraction of scar tissue, muscles, and tendons leading to increased pain in these areas. Even though there hasn’t been any scientific proof, my arthritis pain is worse during the winter months. As long as I don’t try to lift heavy items, or cause increased strain on my back, I have very little pain during the summer months.

Arthritis is a painful disease affecting millions of people in the United States alone. It is a common cause of disability and has been linked to anxiety and depression. This condition not only causes pain but can limit physical activity as well. I have experience with this disease myself. 

 

I suffered for years before finally visiting a pain specialist.  Presently, my pain is under control most of the time as I have learned several things over the years that have helped. I try to get up to walk around often, I sit in comfortable chairs, and when my pain flares up, I take a turmeric supplement. 

 

If the pain gets worse, I take naproxen but try to limit its use. I watch what I eat and have found that if I sleep too long the pain is worse. I have also learned some exercises that relieve the pain.  

 

My pain seems to be worse in the winter months which may lead to our family relocating to a warmer climate in the future. Although science has not found a direct link between the weather and arthritis pain, I can feel a difference based on the temperature. When it is cold, my pain is worse!

 

If you have any questions regarding this subject, I would be happy to answer them. Stay safe, stay healthy and follow your dreams!

 

 

 

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.