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The word “arthritis” is derived from arthron, the Greek term for joint, and the suffix itis, meaning disease or inflammation. True to its name, arthritis, comprising more than 100 diseases and conditions affecting joints and tangent tissues, as well as other connective tissues,¹ causes pain and inflammation, and limits mobility. More than 43 million (or approximately one in five) Americans have arthritis or other rheumatic conditions, and another 23 million individuals suffer from chronic joint symptoms but have not been diagnosed with arthritis.² From an economic standpoint, arthritis is the leading cause of disability in the United States, costing $51.1 billion in direct medical-related costs and $35.1 billion in indirect costs or lost wages.³

The two main forms of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). OA is characterized by degeneration of joint cartilage and related bone (most commonly in the hips, hands, spine and knees), which eventually culminates in pain and stiffness. Disease onset is gradual and usually begins after the age of 40. A cure for OA still eludes scientists.

The specific causes of OA are unknown, but are believed to stem from mechanical and molecular events within the affected joint, according to Jason Theodosakis, M.D., M.S., M.P.H., author of The Arthritis Cure (St. Martin’s Griffin). “Several things can cause disease and distress in the cartilage, creating painful movement and possibly leading to OA,” he said. “It may be sudden and severe trauma such as a blow to the knee while playing sports. Or perhaps the trauma is slow and gradual, the built-up effects of hundreds or thousands of tiny injuries. When trauma occurs, the surface of damaged cartilage may become ragged and pockmarked. Without healthy and whole cartilage to cushion them, the bones may begin to rub against each other, causing severe pain. Or small fractures may develop in the cartilage. The body usually responds to this by producing more but inferior cartilage to ‘plug the cracks’. As the joint degenerates, looseness in the joint causes the tendons and ligaments to be abnormally strained. In addition, the joint lining or synovium often becomes inflamed, sending pain messages to the brain. The synovium tries to solve the problem by producing more and more synovial fluid: the slick, watery substance that lubricates and nourishes the cartilage. This sounds like a good idea but the resulting fluid ends up flooding the joint space, causing swelling and perhaps even more pain.”

OA’s sister ailment, RA, is a systemic inflammatory disease primarily affecting the lining of the joints. As with OA, inflammation of the synovium causes pain, swelling, erosions of cartilage and bone, and possibly joint deformity. The affliction is believed to be autoimmune in nature. RA can begin at any age and is associated with fatigue and prolonged stiffness after rest. As with OA, currently there is no cure for RA.

NSAIDs are prescribed to arthritis patients for their potent analgesic and anti-inflammatory effects. However, the Food and Drug Administration (FDA) has issued a public health advisory pertaining to health risks associated with use of these drugs. Specifically, data from recent controlled clinical trials indicates COX-2 selective agents including Vioxx®, Celebrex® and Bextra® may be associated with an increased risk of serious cardiovascular events such as heart attack and stroke, especially when used for long periods of time or in very high risk settings such as immediately after heart surgery.

Fortunately, arthritis patients looking to avoid or reduce use of NSAIDs may find a viable solution in dietary supplements, which provide an effective, safer alternative to prescription drugs, according to Theodosakis. “There are several safe, natural alternatives to find relief, [and] for pain, I’d much rather recommend a supplement or topical than a drug that may lead to other problems such as kidney disease, ulcers, heart attacks and strokes,” he said.

Diet may play a role in the management of OA and RA by providing raw materials necessary for support of joint health, combating symptoms, counteracting sideeffects of therapy and reducing the risk of complications.^4,5 The foundation of a nutritional support program for arthritis patients involves supplementation with vitamins and minerals, some of which fight oxidative damage, which exacerbates inflammation. Vitamin A, vitamin C and selenium may defend against increased oxidative stress associated with arthritis, and supplementation with calcium and vitamin D in patients treated with corticosteroids reduces bone loss.⁶ B vitamins for arthritis patients help reduce excessive serum homocysteine levels elevated by inflammation and conventional medical treatment,⁷ and there appears to be an inverse association between serum vitamin B6 and arthritis disability scores, duration of morning stiffness, degree of pain and inflammatory markers.⁸

Antioxidants are critical for arthritis patients for several reasons. Sufferers appear to have lower plasma levels of alphatocopherol and vitamin C, and decreased activity of endogenous antioxidant enzymes, making supplementation important to tackle free radical generation.^9,10

Supplying important mineral support is also important for both structural integrity and antioxidant impact. SierraSil™, from Sierra Mountain Minerals, is a 65 macro- and trace mineral complex marketed for preventive and therapeutic effects on joint symptoms. “This ingredient works at the level of gene suppression, stopping inflammation and the degradation of cartilage,” said Britney Obstar, spokesperson for Sierra Mountain Minerals. [And], unlike [other arthritis] formulas, which can take months to work, SierraSil has proven benefits for most people in two weeks or less, sometimes even in three to five days.”

A recent mechanism of action study found SierraSil suppresses cartilage degradation and inflammation when used alone or in conjunction with Vincaria®, a cat’s claw extract.¹¹ A human pilot study showed SierraSil alone and in combination with Vincaria safely provided significant improvements in pain, stiffness and inflammation in 100 percent of test subjects with previously diagnosed OA of the knee. And a double blind, randomized, placebocontrolled study of more than 100 OA patients published in the Journal of Inflammation showed SierraSil at three different doses significantly reduced pain, stiffness and inflammation, and improved joint functionality one month of therapy, with symptom improvements evident within one to two weeks from baseline.¹²

Polyunsaturated fatty acids (PUFAs), including omega-3s (n-3s) and omega-6s (n- 6s) comprise another class of ingredients of value to arthritis patients.

Fish oil, rich in the n-3s eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), has been shown beneficial in RA, possibly by suppressing autoimmune activity of cytokines.¹³ Studies demonstrate a dose of up to 2.6 g/d fish oil, equivalent to about 1.6 g/d eicosaepentoic acid (EPA), produce dose-dependent, moderate but consistent improvement of clinical findings and laboratory parameters in patients with RA; EPA produced the greatest inhibition of cytokines and decrease in induction of proinflammatory adhesion molecules.¹⁴

Another fatty compound derived from n- 3s and of benefit to arthritis patients is comprised of esterified fatty acid carbons (EFACs). “Esterifying these fatty acids makes them stable and prevents them from reacting with oxygen, making them particularly effective in treating the pain and inflammation of arthritis,” said Theodosakis. “Esterified fatty acid carbons are believed to work by beneficially altering the body’s production of chemical mediators that lead to inflammation and pain. The result is improved function and less pain for those who suffer with arthritis.”

In one study, administration of EFACs (as Celadrin®, a complex of EFACs and other active synergists, from Proprietary Nutritionals) produced a significant increase in knee flexibility and overall function.¹⁵ The ingredient appears to work both orally and topically, producing activity in the blood and showing significant localization of absorption in topical application.¹⁶ In fact, topical application of Celadrin has improved range of motion of knee OA patients in a series of physical tests, whereas no difference was observed in the placebo group.¹⁷

Gamma-linolenic acid (GLA), a concentrated source of n-6s, acts as a precursor of prostaglandin E1, which may account for its reported ability to ameliorate arthritis symptoms.¹⁸ Black currant seed oil—a rich source of GLA and alpha-linolenic acid (ALA)—reduced signs and symptoms of RA disease activity in one 24-week trial.¹⁹ And borage, another good source of GLA, has been found to improve joint tenderness and joint swelling versus a cottonseed oil placebo.²⁰

Since excessive intake of n-6s can increase formation of the pro-inflammatory cytokines TNF-alpha and interleukin-6, and of reactive oxygen species (ROS), a marker of oxidative stress,²¹ it is important for arthritis patients to consume a balance of n-3s and n- 6s, according to Ian Lucas, executive vice president of global marketing with Ocean Nutrition Canada. “In the North American diet, the ratio of n-3 to n-6 is about 16-to-1,” he said. “Excessive n-6 causes a build-up of arachadonic acid, a precursor of inflammation. This can be combated by intake of EPA, which is the most powerful natural anti-inflammatory agent.”

Among the joint health powerhouses are glucosamine, an endogenous amino sugar, and chondroitin sulfate, a constituent of proteoglycans, hydrophilic protein molecules in cartilage, both which are natural substances found in and around the cells of cartilage. Glucosamine may halt or reverse joint degeneration by acting as an essential substrate for, and stimulating the biosynthesis of, structural molecules known as glycosaminoglycans as well as the hyaluronic acid framework needed for support of the structural matrix of joints.²² And, chondroitin sulfate provides other substrates for the formation of proteoglycans, protein molecules comprising a healthy joint matrix.²³

The combination of glucosamine and chondroitin sulfate has been shown to help arthritis patients in a number of clinical trials. A double blind, placebo-controlled clinical trial conducted in Zurich investigated the efficacy and tolerability of a twice yearly, three-month, intermittent treatment with oral chondroitin sulfate (800 mg/d, as CSb™ Bio- Active, from Bioiberica) in 120 symptomatic knee OA patients, and found supplementation significantly improved functionality and disease parameters.²⁴ In addition, after one year, the placebo group showed significantly decreased joint space whereas patients on the CS had no change. Perhaps the most definitive—and most controversial—research on the combination, however, is the National Institutes of Health (NIH)-funded, multicenter, double blind, placebo- and NSAID-controlled Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), which evaluated the efficacy and safety of glucosamine and chondroitin versus celecoxib (Celebrex) and placebo as a treatment for knee pain from OA.

Another organic compound thought to support cartilage growth and repair is MSM (methylsulfonylmethane), a readily-available source of sulfur, an essential component of cartilage. Administration of 3 g MSM (as OptiMSM®, from Cardinal Nutrition) twice daily to 50 men and women with knee OA pain for 12 weeks produced statistically significant decreases in pain and significantly improved patients’ ability to perform daily activities.²⁵ “In low-dose (less than 1,000 mg per day), MSM can help offset some of the loss of sulfur that occurs in OA and in people who take pain medications such as acetaminophen or aspirin,” said Theodosakis. “In higher doses—1,500 mg and above— MSM also has a beneficial effect on pain.”

Another cartilage support ingredient shown to combat arthritis symptoms is chicken collagen.

An independent proprietary study from BioCell Technology, hydrolyzed type II collagen from chicken sternum (as BioCell Collagen II™) was pronounced a safe and effective dietary supplement for the adjunctive treatment of OA. In the randomized, double blind, placebocontrolled trial, 16 age-, race- and genderbalanced subjects with OA of the knee or hand and who were taking COX-2 inhibitors or NSAIDs were randomized to receive the active treatment or placebo for 2 months. The group receiving hydrolyzed type II collagen experienced a significant improvement in all WOMAC subscales and in total WOMAC score when compared to placebo.

InterHealth’s UC-II® is an undenatured or intact form of type II collagen found in the cartilage of joints that has been shown clinically to improve joint flexibility and arthritis symptoms. According to a review, several studies have shown significant improvement in symptoms when patients were supplemented with undenatured type II collagen, including improved joint mobility and flexibility, reduced joint pain, and in some patients, complete remission of symptoms.²⁶ The researchers noted undenatured type II collagen’s ability to enhance immune function could be useful in reducing inflammation associated with OA. According to a study from Harvard Medical School, six of 10 RA patients taking undenatured type II collagen for three months showed substantial improvement; of these, one patient recovered completely.²⁷

Milk protein concentrate (MPC) has also been shown clinically to provide benefits to arthritis patients. OA patients with daily joint pain, stiffness and immobility who took MPC (2,000 mg twice daily), glucosamine sulfate (500 mg three times daily) or placebo for six weeks in a recent study reported significant improvement in pain, stiffness and mobility when taking MPC.²⁸ Further, administration of an MPC- and multivitamin and -mineral-fortified drink also produced significant improvements in symptom scores among OA patients.²⁹

According to the CDC, arthritis education has been shown to help reduce pain, yet only one in 10 arthritis patients have taken such courses, and health-care providers and persons with arthritis are missing opportunities to improve health through recommending or participating in arthritis education.³⁰ Retailers are another group that could benefit from arthritis education, first by educating themselves, then educating their customers.

“The success of the natural product retailer, demonstrated by percentage gain in market share against the mass market, I believe is firmly grounded in education,” said Eric Anderson, brands manager with P.L. Thomas. “Understanding the product offerings in the category and especially the benefits and attributes are important to help a consumer make a product choice that is satisfying.”

Carole Ruhnke, senior marketing manager with InterHealth Nutraceuticals Inc., agreed with the assessment: “The most effective way retailers can market any nutraceutical product is to keep abreast of consumer concerns and ongoing scientific developments, and to become an information resource for their customers.

Providing thorough explanations and information, such as differentiating premium ingredients from lower-quality knock-offs, and OTC and prescription products from natural products, is of great help to consumers. This added value instills confidence in consumers and leads to increased and repeat sales.”

David Lakey, president of Cardinal Nutrition, stressed the importance of shelf presentation. “Joint health is a unique health condition where there are few substitute nutritional products,” he said. “Therefore, it’s important to create a ‘joint health’ section on the shelf so products are easy to find and the customer can more easily evaluate dosage forms, daily doses, cost per day, etc., in one place. Joint health is also one of the few segments (other than multivitamins) with strong brands and brand loyalty. Enough space should be allocated to the fastest moving ingredients and brands in order to avoid costly out-of-stocks that can also destroy store loyalty. Look for opportunities to educate consumers about clinical studies and also that they need to take these products religiously for weeks or months to reach the desired effect. Because joint health gets lots of traffic from your most profitable customers, look for ways to ‘upsell’ customers into higher counts; put floor displays or bins near the area.”

Overall, the future of the joint health industry looks bright for retailers, according to Anderson. “The joint health category continues to be quite vigorous, and widespread complex phenomena such as joint pain, deterioration of joint tissues and limited flexibility will continue to present quality of life challenges, particularly for the aging baby boomer population,” he said. “This dynamic market attracts therapeutic approaches from many different nutritional technologies, targeting differing mechanisms of action.”

Ruhnke agreed, citing an abundance of potential customers. It is helpful for retailers to understand the [significant] extent to which consumers—even relatively young consumers—are concerned about bone and joint health and are willing to use supplements to treat related problems,” she said.

Armed with an arsenal of researchbacked compounds, retailers possess the unique opportunity to help their customers control joint pain, possibly without using potentially harmful NSAIDs or perhaps with more judicious use of these compounds, and spread awareness about arthritis.

For a complete list of references to this story, visit www.hsrmagazine.com after June 1st, or e-mail hgranato@vpico.com.

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