What is osteoarthritis?
Osteoarthritis is the most common form of arthritis, caused by the wear and tear of joint cartilage through natural aging. If we became old enough, all of us will eventually develop some degree of it.

How does osteoarthritis develop?
In normal joints, the ends of opposing bones are covered with a layer of cartilage. This layer has two functions, namely to provide a smooth surface so that one end can glide effortlessly over the other, and secondly, to absorb some of the shock that takes place during the loading of a joint. Cartilage is made up of two major components: the matrix, a plastic-like substance, and live cells called chondrocytes, responsible for the growth and repair of cartilage. These are contained in small pockets within the matrix. The matrix is made from molecules called proteoglycans (PG’s), which provide elasticity and stiffness, as well as fibres called collagen, which give strength and bind the matrix together.

The earliest biochemical change seen in osteoarthritis is an increase in the water content of the matrix. This is due to the disruption of the collagen fibre network that normally keeps the PG’s together and maintains them in a dehydrated state. With an increase in water content, the cartilage softens and offers less resistance to compression.

Damage to the cartilage stimulates the body to release certain inflammatory chemicals and enzymes that unfortunately destroy more cartilage components. With aging, the cartilage cells display a decreased ability to restore and re-synthesize the normal collagen structures. The rate of damage surpasses the rate of repair, resulting in the slow destruction of the cartilage layer. Once the damage is advanced, the normally smooth surface of healthy cartilage becomes rough and now causes excess friction. A vicious cycle of excess friction causing increased damage begins.

In primary osteoarthritis, the degenerative wear and tear process naturally occurs after the fifth and sixth decades, with no other underlying cause or abnormality present.

With secondary osteoarthritis, however, other factors besides natural aging assist with cartilage destruction. These factors include certain birth defects and previous injury to the joint such as a fracture or sprain. Carrying excess weight also aids cartilage destruction. Some people also seem to have weaker cartilage.  All other conditions that cause inflammation within a joint, especially gout, also aggravate the condition. 

What are the symptoms of osteoarthritis?
The symptoms are pain and low-grade inflammation in the weight-bearing joints such as the knees, the hips and the spine. The fingers are usually also involved and large bony protrusions may develop within the small joints of the fingers next to the nails. Movement usually aggravates the joint pain and a grating sound or sensation may be present. Stiffness of the joint is a common feature.

What can I do to improve my osteoarthritis?

Step 1
Lose weight if you need to. Reducing the load on your joints will diminish the friction that ultimately leads to joint destruction. [Read more about our LightHouse weight-loss programme]

Step 2
Avoid food that aggravates inflammation.
Inflammation is a chemical process aggravated by a fatty acid called arachidonic acid, abundantly present in all animal products such a meat and dairy. Junk food usually contains rancid fats with high concentrations of damaging chemicals such as the trans-fatty acids and free radicals, known to cause inflammation.

Step 3
Take glucosamine.
Since cartilage matrix consists largely of proteoglycans (PGs), researchers turned their attention to supplements that could potentially deliver these components. Extracts from green-lipped mussels, animal and shark cartilage have all been investigated. A recent meta-analysis (a statistical analysis that gathers and combines the evidence from several small studies into one large study and looks at them together) showed that PG supplements were superior to a placebo in relieving joint pain as well as joint stiffness.

Two main sources of PG precursors exist, namely glucosamine and chondroitin. The quality of chondroitin however, varies quite considerably, and it is our opinion, gathered from reviewing the current available literature, that most people only require one PG precursor, namely glucosamine. Select a product of reputable quality; an optimal dosage seems to be 1500mg per day.

(Promoters who market MSM, a source of sulphur, frequently lay claim to its ability to alleviate pain and inflammation. Scientific evidence, however, is rather sparse.  Proline, extracted from gelatine, seems only to have benefits if taken in very high doses, i.e. grams, rather than the typical milligram doses delivered by most joint supplements.)

Step 4
Take medication for pain.
Two groups of medication are used, namely painkillers (analgesics) and anti-inflammatory drugs (NSAIDS). The general approach is to use the least amount of medication that will keep your symptoms under control. Living with pain is certainly not pleasant, and it is often not possible for people who suffer from osteoarthritis to live without the regular intake of pain-controlling medication. Your doctor will assist you in this regard, and if you are already taking prescription medication, stay on it.