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 The leading web portal for pharmacy resources, news, education and careers October 21, 2018
Pharmacy Choice - Arthritis Disease State Management - October 21, 2018

Arthritis Disease State Management

Natural Options to Managing Arthritis

Robert Kress, RPh

As functional medicine becomes mainstream, it becomes more apparent that proper disease state management spans from prevention to treatment; inclusive of diet, stress management, exercise, and complementary therapies.

Arthritis is the #1 cause of disability in the United States, affects all ages, gender's and races. Arthritis is expected to skyrocket from 52 million to 78 million by 2040.

The allopathic approach to managing arthritis focuses on symptom management and possibly immune system modification through anti-inflammatories, pain relivers, corticosteroids, DMARD's (disease modifying anti-rheumatic drugs) and biologics.

These drug classes do not come without risk, opening the door for complementary approaches to managing and modifying arthritis.

In 2015, the FDA heightened their warnings for NSAID's and the increased risk for heart disease and stroke, even within a few weeks of starting the medication. In addition, we understand the increased risk for gastric ulcers as well suppression of kidney function. Corticosteroids, DMARD's and biologics increase risk for immune suppression, lymphoma's, as well as impairment of kidney, liver function and more.

Due to the challenges we have seen with medication therapy, having an arsenal of go-to recommendations can enhance your practice and further help your patients.

High quality, clinically backed supplements can fill this need.

Where there are numerous supplements with anti-inflammatory benefits, below I highlight three of the most powerful, for their targeted anti-inflammatory support, immune modulation, as well as other benefits they offer.

Vitamin D provides support for bone, breast, prostate, cardiovascular, colon, cognitive, immune health, and inflammation.

Studies have shown the benefits of Vitamin D on inflammatory markers, such as increasing interleukin 10 (IL-10) (anti-inflammatory cytokine), reducing interleukin 6 (IL-6) (inflammatory cytokine) while preventing further increase of Tumor Necrosis Factor (TNF.) It's important to understand, most benefits come with those already vitamin D deficient, highlighting the importance of measuring one's levels, and optimizing their dosages accordingly.

Curcumin which is derived from turmeric, has shown to support healthy inflammatory balance, immune modulation, and other benefits including digestive, cardiovascular, cognitive, liver, kidney support more. Curcumin has shown to reduce C-Reactive Protein (CRP), erythrocyte sedimentation rate (ESR,) IL-6 and TNF.

Dosages can vary depending on what's being treated as well as the level of bioavailability of the formulation, ranging from 250 mg to over 3000 mg daily.

Boswellia has shown digestive and immune support, as well as similar anti-inflammatory benefits of curcumin, reducing CRP, ESR, and IL-6. Boswellia supports structural integrity, mobility, and comfort of joint cartilage, while inhibiting the cartilage degrading enzyme, matrix metalloproteinase (MMP-3.)

Like curcumin, different boswellia preparations will offer different levels of bioavailability and bioactivity, thus it is recommended to utilize an AKBA-rich boswellia product.

In a study of patients with osteoarthritis, one group received celecoxib at 100 mg twice daily, while the other group received a combination of curcumin and boswellia at 500 mg twice daily.

After 4 months, 93% of the subjects taking the curcumin-boswellia supplement could walk more than 1,000 meters, versus 86% in the celecoxib group. A total of 93% of the herbal group reported improvement in or elimination of pain, versus 79% of the celecoxib group. Additionally, through liver, kidney and blood tests, the herbal preparation shown none of the adverse effects historically associated with NSAID's.

Undenatured Collagen (UC-II) has shown to be effective in promoting joint flexibility and comfort, and regulating the immune system by preventing immune cells from overreacting and attacking proteins normally found in cartilage and joint tissue.

The immune regulating benefits of UC-II were initially discovered in arthritis subjects whose symptoms improved along with the immobilization of overreacting immune cells to sites of inflammation, from the consumption of chicken soup.

The researchers concluded that the collagen from the chicken bones triggered a process known as specific oral tolerance, where killer T-cells would be "re-trained" to treat the body's own collagen as harmless, thus prevent joint destruction.

UC-II can now be found in standardized supplement form at an average daily dose of 40 mg, promoting such specific oral tolerance, reducing the autoimmune response and improving joint comfort.

In one body of research out of Harvard University of 60 patients with Rheumatoid Arthritis (RA), UC-II produced a significant reduction in number of swollen and painful joints within 3 months, while 14% experienced complete remission.

Another larger study of 274 patients with RA provided similar results, while a study on patients with juvenile arthritis experiencing significant improvement in lifestyle and mobility.

In studying 52 patients with osteoarthritis (OA), in just 90 days, UC-II produced a significant enhancement in daily activity suggesting an improvement in their quality of life.

The management of arthritis offers many clinical and outcome based solutions in the realms of natural medicine. Being pharmacists, natural medicine is core to our profession, offering integrative solutions through age old wisdom and modern-day discoveries.
  • "Clinical Evaluation of an Herbal Formulation in the Management of Knee Osteoarthritis." Poster presentation at the Osteoarthritis Research Symposium Internationale (OARSI) Annual World Congress on Osteoarthritis, September 15-18, 2011. San Diego, CA. B. Antony, R. Kizhakkedath, M. Benny, B. Kuruvilla.
  • Trentham DE, Dynesius-Trentham RA, Orav EJ, et al. Effects of oral administration of type II collagen on rheumatoid arthritis. Science. 1993 Sep 24;261(5129):1727-30.
  • Rennard BO, Ertl RF, Gossman GL, Robbins RA, Rennard SI. Chicken soup inhibits neutrophil chemotaxis in vitro. Chest. 2000 Oct;118(4):1150-7.
  • Barnett ML, Kremer JM, St Clair EW, et al. Treatment of rheumatoid arthritis with oral type II collagen. Results of a multicenter, double-blind, placebo-controlled trial. Arthritis Rheum. 1998 Feb;41(2):290-7.

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