Osteoarthritis Alternatives

September 22, 2009 Written by JP    [Font too small?]

Osteoarthritis (OA) is a very common consequence of aging in the modern world. On average, we’re living longer than ever and our joints are taking their fair share of the burden as a result. There are many conventional treatments for dealing with the impaired mobility and pain associated with this condition. However, many of us would prefer to avoid taking medications or resorting to surgical procedures unless it’s the only remaining option. In the field of natural medicine field, there are several well known alternatives for OA. The most familiar names are probably glucosamine and chondroitin. This duo is often effective in managing the symptoms of OA and perhaps even in slowing its progression. But they don’t work for everyone. Fortunately, the natural health industry is much like its pharmaceutical counterpart in that it’s always looking for new choices for consumers.

Two recent studies have examined the potential of a “seaweed derived mineral supplement” (Aquamin F) in aiding patients with OA. The theory behind this natural remedy is that a mineral imbalance may contribute to the degeneration of cartilage. The details of the trial are as follows:

  • 29 participants were divided into two groups: Group A received 2,400 mg of Aquamin F. Group B received a similar looking placebo for 12 weeks.
  • Tests measuring pain, range of motion and walking ability were administered prior to and post treatment.
  • All of the patients were gradually asked to reduce their consumption of pain relievers (NSAIDs – nonsteroidal anti-inflammatory drugs) based on their degree of discomfort.

The results of the study were modest, but relatively positive. The subjects using Aquamin F demonstrated improved range of motion and benefits in walking speed. These results were found in patients that had reduced their NSAID intake by 50%. The authors of this trial concluded that this seaweed supplement “may allow partial withdrawal of NSAIDs” and that additional research is warranted. (1)

The first study found that Aquamin was equivalent to the placebo in terms of safety. The same cannot be said for long term NSAID use. Another difference between conventional pain relievers and this seaweed extract is that the latter provides a considerable nutritional punch. In fact, it’s an extremely rich source of calcium and also provides trace minerals, such as boron, that support bone health.

A second study on Aquamin involved 70 patients with “moderate to severe OA”. The participants were divided into four groups: 1) received 1,500 mg of glucosamine sulfate daily; 2) received 2,400 mg of Aquamin; 3) received a combination of both; 4) received a placebo. Both Aquamin and glucosamine improved arthritic symptoms when taken independently. Aquamin outperformed glucosamine in terms of pain, range of motion, stiffness and walking distance measures. An interesting finding is that combining both supplements actually had less favorable results. This indicates that they don’t have a synergistic effect and probably shouldn’t be used together. (2)

Another new supplement on the market is called Natural Eggshell Membrane (NEM). It contains certain building blocks (glycosaminoglycans) that can be used to promote the health of connective tissue and the synovial fluid that lubricates joints. 67 patients with OA were randomly assigned to two groups. The first received one 500 mg NEM capsule per day. The remainder of the participant pool was given a placebo for an 8 week period of time. A diagnostic tool referred to as WOMAC (Western Ontario and McMasters Universities Osteoarthritis Index) was used to quantify the level of function, pain and stiffness throughout this experiment. The most exciting finding in this research has to do with how quickly the study volunteers responded to treatment with NEM. There was a 16% reduction in pain and a 13% decline in stiffness within the first 10 days of the trial. The benefits continued during the remainder of the research at days 30 and 60.

A less reliable form of study, called an “open-label trial”, was also recently used to test this new supplement. In this type of research, a placebo is not used as a control/comparison. A total of 39 participants took 500 mg of NEM for 30 days in this experiment. Improvements in flexibility (28%) were noted by the 7 day mark. By day 30, positive changes in flexibility (44%) and “general pain” (73%) were reported. No significant side effects were found. However, if you have a known allergy to eggs you should probably avoid this supplement. (3,4)

Aquamin F (A) vs. Glucosamine (GS) & Placebo (PBO) in Osteoarthritis Patients
Source: Nutr J. 2008; 7: 9 (link)

An herbal blend that combines extracts of cork tree (Phellodendron amurense) and orange peel (Citrus sinensis) has recently been shown to improve knee OA symptoms in healthy and overweight volunteers. The weight issue is important because obesity adds to the strain placed on cartilage and an increase in inflammatory markers have been associated with a high body mass index (BMI). An 8-week long trial published in August 2009 tested the effects of this herbal combination vs. a placebo in both “normal” and obese OA sufferers. There was a statistically relevant improvement in mobility and pain scores in the patients receiving the herbal remedy – independent of weight. The overweight volunteers also exhibited meaningful drops in C-reactive protein levels (a measure of inflammation). There were a few added bonuses found by the researchers: a) those who were obese “lost an average of 5% body weight after 8 weeks”; b) significant reductions in LDL “bad cholesterol”, triglycerides and an increase in “good” HDL cholesterol; and c) a decline in blood pressure and fasting blood sugar. (5,6)

One final point has to do with improving the efficacy of glucosamine. Earlier in this column, I mentioned that combining seaweed and glucosamine probably wasn’t a good idea. But a new study from Germany does offer some advice about a truly viable adjunct to glucosamine therapy. According to that research, the addition of fish oil to standard glucosamine supplementation may help improve the response rate. It’s important to note that these two ingredients appear to work in different ways. Glucosamine supports the structure of cartilage. Fish oil seems to tame the inflammation that can affect joint function and stability. Therefore, a combination of the two could complement each other quite well. (7)

It’s very common for dozens of prescription medications to address similar health concerns. One reason is because not everyone reacts to medications in the same way. This individualized response relates to both the efficacy of drugs and also the potential side effects. The same is true with natural remedies. Even if you’ve tried other joint supplements and found them ill-suited or lacking, I would suggest not giving up on this entire class of remedies altogether. It could very well be that one or more of the options I’ve highlighted today will be the right fit for you.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Alternative Therapies, Diet and Weight Loss, Nutritional Supplements

29 Comments & Updates to “Osteoarthritis Alternatives”

  1. Stephen Says:

    You mentioned seaweed as a source of minerals. Do you know anything about using purified, desalinized sea water?

  2. JP Says:


    I haven’t studied that topic much. I used to know someone who claimed it was a “miracle worker”.

    I’ll add that to my list of topics to investigate. Thank you for bringing it up.

    Be well!


  3. Anonymous Says:

    Any osteoarthritis treatment plan is patient specific. What works for one person may not work for another even if the same joint is affected. Treatment needs to be a combination of weight control, medication (either prescription, over the counter or natural), hot and cold treatments and stress management. It is a matter of trial and error to see what is most effective for you particular situation.

  4. JP Says:


    Be well!


  5. Anonymous Says:

    As stated above, treatments are specific to the individual. It certainly helps to bring new ideas to the table when you see that others are having results. I have found that my supplement that has glucosamine and chondroitin, along with bone activating proteins has helped more than anything else.

  6. JP Says:

    Thanks for sharing what’s working for you!

    Be well!


  7. JP Says:

    Update: Acupressure reduces knee arthritis pain …


    J Advanc Res. 2014 Mar;5(2):193-200.

    Effectiveness of acupressure versus isometric exercise on pain, stiffness, and physical function in knee osteoarthritis female patients.

    Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability in older adults. Conservative non-pharmacological strategies, particularly exercise, are recommended by clinical guidelines for its management. The aim of this study was to assess the effectiveness of acupressure versus isometric exercise on pain, stiffness, and physical function in knee OA female patients. This quasi experimental study was conducted at the inpatient and outpatient sections at Al-kasr Al-Aini hospital, Cairo University. It involved three groups of 30 patients each: isometric exercise, acupressure, and control. Data were collected by an interview form and the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scale. The study revealed high initial scores of pain, stiffness, and impaired physical functioning. After the intervention, pain decreased in the two intervention groups compared to the control group (p < 0.001), while the scores of stiffness and impaired physical function were significantly lower in the isometric group (p < 0.001) compared to the other two groups. The decrease in the total WOMAC score was sharper in the two study groups compared to the control group. In multiple linear regression, the duration of illness was a positive predictor of WOMAC score, whereas the intervention is associated with a reduction in the score. In conclusion, isometric exercise and acupressure provide an improvement of pain, stiffness, and physical function in patients with knee OA. Since isometric exercise leads to more improvement of stiffness and physical function, while acupressure acts better on pain, a combination of both is recommended. The findings need further confirmation through a randomized clinical trial. Be well! JP

  8. JP Says:

    Update: The right type of exercise benefits cartilage integrity and knee function ….


    Med Sci Sports Exerc. 2015 Feb 9.

    Effect of Exercise on Patellar Cartilage in Women with Mild Knee Osteoarthritis.

    PURPOSE: To investigate the effects of exercise on patellar cartilage using T2 relaxation time mapping of MRI in postmenopausal women with mild patellofemoral joint osteoarthritis (OA).

    METHODS: Eighty postmenopausal women (mean age: 58 y (SD 4.2)) with mild knee osteoarthritis were randomized to either a supervised progressive impact exercise program three times a week for 12 months (n = 40) or to a non-intervention control group (n = 40). The biochemical properties of cartilage were estimated using T2 relaxation time mapping, a parameter sensitive to collagen integrity, collagen orientation and tissue hydration. Leg muscle strength and power, aerobic capacity and self-rated assessment by the Knee Injury and Osteoarthritis Outcome Score (KOOS) were also measured.

    RESULTS: Post intervention the full-thickness patellar cartilage T2 values had medium size effect (d= 0.59; 95% CI: 0.16 to 0.97, p=0.018), the change difference was 7% greater in the exercise group compared to the control group. In the deep half of tissue, the significant exercise effect was in medium size (d= 0.56; 95% CI: 0.13 to 0.99, p=0.013), the change difference was 8% greater in the exercise group compared to the controls. Also, significant medium size T2 effects were found in the total lateral segment, lateral deep and lateral superficial zone in favor of the exercise group. Extension force increased by 11% (d=0.63, p=0.006) more and maximal aerobic capacity by 4% (d=0.55, p=0.028) more in the exercise group than controls. No changes in KOOS emerged between the groups.

    CONCLUSIONS: Progressively implemented high-impact and intensive exercise created enough stimuli and had favorable effects both on patellar cartilage quality and physical function in postmenopausal women with mild knee OA.

    Be well!


  9. JP Says:

    Update: Collagen supplement, typically used to reduce arthritis progression and symptoms, supports exercise recovery …


    Effects of BioCell Collagen® on connective tissue protection and functional recovery from exercise in healthy adults: a pilot study

    Background: The extracellular matrix (ECM) of muscle, tendon, and ligament is sensitive to exercise-induced mechanical stimuli. Exercise-induced muscle damage is associated with not only myofibrillar injury, but also the involvement of connective tissue elements such as collagen, proteoglycans (PG), tendon and ligament. However, little is known about the impact of nutritional agents and metabolic optimization for enhancing adaptation and recovery of the connective tissue elements that support musculoskeletal function. BioCell Collagen® (BCC) is a patented hydrolyzed chicken sternal cartilage extract that contains a naturally-occurring matrix of hydrolyzed collagen type II, and low molecular weight glycosaminoglycans such as chondroitin sulfate and hyaluronic acid. The purpose of this pilot study was to determine the potential impact of daily supplementation with BCC on functional indices and molecular biomarkers of recovery from intense exercise, and identify effect sizes on various outcome measures.

    Methods: Eight healthy, recreationally active subjects (29.3 ± 9.2 y, 173.1 ± 8.2 cm, 77.3 ± 13.5 kg) volunteered to participate in this study and were randomized in a double-blind, placebo-controlled fashion to ingest either 3 g of placebo or BioCell Collagen® daily over a 6-week period prior to an upper body muscle-damaging resistance exercise challenge (UBC) on day 43, and a re-challenge on day 46. At the end of the 6-week supplementation period, participants completed a UBC consisting of 8 sets of barbell bench press at 75% of body weight load to exhaustion with a 4/0/X repetition tempo and 90 seconds rest between sets; the UBC exercise challenge was repeated 72 hours later to assess recovery of function. Consent to publish the results was obtained from all participants.

    Results: Daily intake of BCC for 6-weeks attenuated an increase in serum markers for muscle tissue damage in response to bench press exercise, creatine kinase (CK), lactate dehydrogenase (LDH), and C-reactive protein (CRP). Change in CK: +20 U/L (BCC) vs. +4726 U/L (placebo); change in LDH: -3.5 U/L (BCC) vs. +82.9 U/L (placebo); change in CRP: +0.07 mg/L (BCC) vs. +0.7 mg/L (placebo). In terms of performance, the decrement in bench press repetitions to failure was only 49% (day 43) and 43% (day 46) in the BCC group vs. 60% (day 43) and 55% (day 46) in the placebo group.

    Conclusion: The preliminary data of this proof-of-concept study suggests that daily intake of BCC for 6 weeks may favorably impact key biochemical markers of connective and skeletal muscle tissue damage and enhance stress resilience following intense resistance exercise. Supplementation was well tolerated and did not adversely affect markers of health or side effect profiles.

    Be well!


  10. JP Says:

    Update: Glucosamine & chondroitin lower systemic inflammation …


    PLoS One. 2015 Feb 26;10(2):e0117534.

    Randomized trial of glucosamine and chondroitin supplementation on inflammation and oxidative stress biomarkers and plasma proteomics profiles in healthy humans.

    BACKGROUND: Glucosamine and chondroitin are popular non-vitamin dietary supplements used for osteoarthritis. Long-term use is associated with lower incidence of colorectal and lung cancers and with lower mortality; however, the mechanism underlying these observations is unknown. In vitro and animal studies show that glucosamine and chondroitin inhibit NF-kB, a central mediator of inflammation, but no definitive trials have been done in healthy humans.

    METHODS: We conducted a randomized, double-blind, placebo-controlled, cross-over study to assess the effects of glucosamine hydrochloride (1500 mg/d) plus chondroitin sulfate (1200 mg/d) for 28 days compared to placebo in 18 (9 men, 9 women) healthy, overweight (body mass index 25.0-32.5 kg/m2) adults, aged 20-55 y. We examined 4 serum inflammatory biomarkers: C-reactive protein (CRP), interleukin 6, and soluble tumor necrosis factor receptors I and II; a urinary inflammation biomarker: prostaglandin E2-metabolite; and a urinary oxidative stress biomarker: F2-isoprostane. Plasma proteomics on an antibody array was performed to explore other pathways modulated by glucosamine and chondroitin.

    RESULTS: Serum CRP concentrations were 23% lower after glucosamine and chondroitin compared to placebo (P = 0.048). There were no significant differences in other biomarkers. In the proteomics analyses, several pathways were significantly different between the interventions after Bonferroni correction, the most significant being a reduction in the “cytokine activity” pathway (P = 2.6 x 10-16), after glucosamine and chondroitin compared to placebo.

    CONCLUSION: Glucosamine and chondroitin supplementation may lower systemic inflammation and alter other pathways in healthy, overweight individuals. This study adds evidence for potential mechanisms supporting epidemiologic findings that glucosamine and chondroitin are associated with reduced risk of lung and colorectal cancer.

    Be well!


  11. JP Says:

    Update 06/11/15:


    Complementary Therapies in Clinical Practice – June 09, 2015

    Efficacy and safety of topical Matricaria chamomilla L. (Chamomile) oil for knee osteoarthritis: A randomized; controlled clinical trial


    We assessed the efficacy and safety of chamomile oil in knee osteoarthritis.

    We evaluated the patients in the terms of analgesic use, function and stiffness.

    Chamomile oil significantly reduced the patients’ need for acetaminophen use.

    It may show some beneficial effects on function and stiffness of the patients.

    The patients did not report any local or systemic adverse events by using it.

    Be well!


  12. JP Says:

    Update 06/13/15:


    J Rheumatol. 2015 Jun 1.

    Relationship between Serum Magnesium Concentration and Radiographic Knee Osteoarthritis.

    OBJECTIVE: To establish whether there is a relationship between serum magnesium (Mg) concentration and radiographic knee osteoarthritis (OA).

    METHODS: There were 2855 subjects in this cross-sectional study. Serum Mg concentration was measured using the chemiluminescence method. Radiographic OA of the knee was defined as changes consistent with Kellgren-Lawrence (K-L) grade 2 on at least 1 side. Mg concentration was classified into 1 of 4 quartiles: ≤ 0.87, 0.88-0.91, 0.92-0.96, or ≥ 0.97 mmol/l. Multivariable logistic analysis was used to test the association between serum Mg and radiographic knee OA after adjustment for potentially confounding factors. The OR with 95% CI for the association between radiographic knee OA and serum Mg concentration were calculated for each quartile. The quartile with the lowest value was regarded as the reference category.

    RESULTS: Significant association between serum Mg concentration and radiographic knee OA was observed in the model after adjustment for age, sex, and body mass index, as well as in the multivariable model. The multivariable-adjusted OR (95% CI) for radiographic knee OA in the second, third, and fourth serum Mg concentration quartiles were 0.90 (95% CI 0.71-1.13), 0.92 (95% CI 0.73-1.16), and 0.72 (95% CI 0.57-0.92), respectively, compared with the lowest (first) quartile. A clear trend (p for trend was 0.01) was observed. The relative odds of radiographic knee OA was decreased by 0.72 times in the fourth serum Mg quartile compared with the lowest quartile.

    CONCLUSION: Serum Mg concentration may have an inverse relationship with radiographic OA of the knee.

    Be well!


  13. JP Says:

    Updated 08/18/15:


    Complement Ther Med. 2015 Aug;23(4):570-6.

    A supplemental report to a randomized cluster trial of a 20-week Sun-style Tai Chi for osteoarthritic knee pain in elders with cognitive impairment.

    OBJECTIVE: This was a secondary data analysis of a cluster-randomized clinical trial that tested the efficacy of a 20-week Sun-style Tai Chi (TC) program in reducing pain in community-dwelling elders with cognitive impairment and knee osteoarthritis (OA). The study also examined whether elders’ level of cognitive function was related to the outcomes of the TC program.

    METHOD: Elders (N=55) were recruited from 8 study sites. Each site was randomly assigned to participate in either a 20-week TC or an education program. Verbal report of pain was measured by a Verbal Descriptor Scale (VDS) at weeks 1, 5, 9, 13, 17 and 21 (designated as times 1-6). Pain behaviors and analgesic intake were also recorded at times 1-6.

    RESULTS: At post-test, scores on the VDS and observed pain behaviors were significantly better in the TC group than in the control group (p=0.008-0.048). The beneficial effects of TC were not associated with cognitive ability.

    CONCLUSION: These results suggest that TC can be used as an adjunct to pharmacological intervention to relieve OA pain in elders with cognitive impairment.

    Be well!


  14. JP Says:

    Updated 09/05/15:


    Complement Ther Clin Pract. 2015 Aug;21(3):181-7.

    Efficacy and safety of topical Matricaria chamomilla L. (chamomile) oil for knee osteoarthritis: A randomized controlled clinical trial.

    OBJECTIVE: To assess the efficacy and safety of topical Matricaria chamomilla (Chamomile) oil in patients with knee osteoarthritis.

    METHOD: Patients were randomized and treated with topical chamomile oil, diclofenac or placebo, 3 times/day for 3 weeks. They were allowed to use acetaminophen as analgesic. The patients were asked about their total acetaminophen use. Moreover, they were assessed in the terms of pain, physical function and stiffness by using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire at the enrolling and weekly.

    RESULTS: Chamomile oil significantly reduced the patients’ need for acetaminophen (P = 0.001) compared with diclofenac and placebo. However, there were no significant differences in WOMAC questionnaire domains. The patients did not report any adverse events by using chamomile oil.

    CONCLUSION: Chamomile oil decreased the analgesic demand of patients with knee osteoarthritis. In addition, it may show some beneficial effects on physical function, and stiffness of the patients.

    Be well!


  15. JP Says:

    Updated 09/22/15:


    Ann Rheum Dis. 2015 Sep 9.10.1136/annrheumdis-2014-207169.

    Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus high dose.

    OBJECTIVES: To determine whether high-dose fish oil is superior to low-dose supplementation for symptomatic and structural outcomes in knee osteoarthritis (OA).

    METHODS: A randomised, double-blind, multicentre trial enrolled 202 patients with knee OA and regular knee pain. They were randomised 1:1 to high-dose fish oil (4.5 g omega-3 fatty acids) 15 mL/day or (2) low-dose fish oil (blend of fish oil and sunola oil; ratio of 1:9, 0.45 g omega-3 fatty acids) 15 mL/day. The primary endpoints were Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score at 3, 6, 12 and 24 months, and change in cartilage volume at 24 months. Secondary outcomes included WOMAC function, quality of life, analgesic and non-steroidal anti-inflammatory drug use and bone marrow lesion score.

    RESULTS: Although there was improvement in both groups, the low-dose fish oil group had greater improvement in WOMAC pain and function scores at 2 years compared with the high-dose group, whereas between-group differences at 1 year did not reach statistical significance. There was no difference between the two groups in cartilage volume loss at 2 years. For other secondary endpoints, there was no difference between the two groups at 2 years.

    CONCLUSIONS: In people with symptomatic knee OA, there was no additional benefit of a high-dose fish oil compared with low-dose fish oil. The combination comparator oil appeared to have better efficacy in reducing pain at 2 years, suggesting that this requires further investigation.

    Be well!


  16. JP Says:

    Updated 1/30/16:


    Nutr J. 2016 Jan 29;15(1):14.

    Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study.

    BACKGROUND: Undenatured type II collagen (UC-II) is a nutritional supplement derived from chicken sternum cartilage. The purpose of this study was to evaluate the efficacy and tolerability of UC-II for knee osteoarthritis (OA) pain and associated symptoms compared to placebo and to glucosamine hydrochloride plus chondroitin sulfate (GC).

    METHODS: One hundred ninety one volunteers were randomized into three groups receiving a daily dose of UC-II (40 mg), GC (1500 mg G & 1200 mg C), or placebo for a 180-day period. The primary endpoint was the change in total Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) from baseline through day 180 for the UC-II group versus placebo and GC. Secondary endpoints included the Lequesne Functional Index (LFI), the Visual Analog Scale (VAS) for pain and the WOMAC subscales. Modified intent-to-treat analysis were performed for all endpoints using analysis of covariance and mixed model repeated measures, while incremental area under the curve was calculated by the intent-to-treat method.

    RESULTS: At day 180, the UC-II group demonstrated a significant reduction in overall WOMAC score compared to placebo (p = 0.002) and GC (p = 0.04). Supplementation with UC-II also resulted in significant changes for all three WOMAC subscales: pain (p = 0.0003 vs. placebo; p = 0.016 vs. GC); stiffness (p = 0.004 vs. placebo; p = 0.044 vs. GC); physical function (p = 0.007 vs. placebo). Safety outcomes did not differ among the groups.

    CONCLUSION: UC-II improved knee joint symptoms in knee OA subjects and was well-tolerated. Additional studies that elucidate the mechanism for this supplement’s actions are warranted.

    Be well!


  17. JP Says:

    Updated 03/07/16:


    J Am Coll Nutr. 2016 Mar 2:1-7.

    Effects of l-Carnitine Supplementation on Serum Inflammatory Factors and Matrix Metalloproteinase Enzymes in Females with Knee Osteoarthritis: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.

    OBJECTIVE: Considering the importance of inflammation in the pathogenesis of osteoarthritis (OA) and induction of pain, this study was aimed to investigate the effect of L-carnitine supplementation on serum inflammatory mediators and OA-associated pain in females with knee OA.

    METHODS: In this clinical trial, 72 females with mild to moderate knee osteoarthritis started the study, divided into 2 groups to receive 750 mg/day L-carnitine (n = 36) or placebo (n = 36) for 8 weeks. Serum levels of Interleukine-1β (IL-1β), high-sensitivity C-reactive protein (hs-CRP), matrix metalloproteinases (MMPs)-1 and -13, and visual analog scale (VAS) for pain were assessed before and after supplementation. Data were analyzed by t test, Wilcoxon signed rank test, Mann-Whitney U test, and analysis of covariance.

    RESULTS: Only 69 patients (33 in the L-carnitine group and 36 in the placebo group) completed the study. L-Carnitine supplementation decreased serum IL-1β and MMP-1 levels significantly (p = 0.001 and p = 0.021, respectively); however, serum hs-CRP and MMP-13 levels did not change significantly (p > 0.05). In the placebo group, serum IL-1β levels increased significantly (p = 0.011), whereas other studied biomarkers did not change significantly. The mean VAS score decreased significantly in the L-carnitine and placebo groups by 52.67% and 21.82%, respectively (p < 0.001). Significant differences were only observed between the 2 groups in serum IL-1β (p < 0.001) and MMP-1 (p = 0.006) levels and mean VAS score (p = 0.002) after adjusting for baseline values and covariates. CONCLUSION: Despite observed beneficial effects of short-term supplementation of L-carnitine in decreasing serum inflammatory mediators and improving pain in knee OA patients, further studies are needed to achieve concise conclusions. Be well! JP

  18. JP Says:

    Updated 07/16/16:


    J Tradit Complement Med. 2015 Jan 28;6(3):199-203.

    Effect of ginger powder supplementation on nitric oxide and C-reactive protein in elderly knee osteoarthritis patients: A 12-week double-blind randomized placebo-controlled clinical trial.

    There is limited evidence that ginger ( shēng jiāng) powder consumption can relieve pain and inflammation because of its special phytochemical properties. This study is aimed at investigating the effect of ginger powder supplementation on some inflammatory markers in patients suffering from knee osteoarthritis. This is a double-blind randomized placebo-controlled clinical trial with a follow-up period of 3 months that was conducted on 120 outpatients with moderately painful knee osteoarthritis. Patients were randomly divided up into two groups: ginger group (GG) or placebo group (PG). Both groups received two identical capsules on a daily basis for 3 months. Each ginger capsule contained 500 mg of ginger powder; the placebo capsules had 500 mg of starch in them. Serum samples were collected prior to and after the intervention and were stored at -70 °C until the end of the study. Serum concentration of nitric oxide (NO) and hs-C reactive protein (hs-CRP) were measured using enzyme-linked immunosorbent assay kits. There was no significant difference between the two groups in terms of inflammatory markers (i.e., NO and hs-CRP) prior to the intervention. However, after 3 months of supplementation, serum concentration of NO and hs-CRP decreased in the GG. After 12 weeks, the concentration of these markers declined more in the GG than in the PG. Ginger powder supplementation at a dose of 1 g/d can reduce inflammatory markers in patients with knee osteoarthritis, and it thus can be recommended as a suitable supplement for these patients.

    Be well!


  19. JP Says:

    Updated 08/27/16:


    J Nutr Gerontol Geriatr. 2016 Jul-Sep;35(3):209-218.

    Effect of Ginger Supplementation on Proinflammatory Cytokines in Older Patients with Osteoarthritis: Outcomes of a Randomized Controlled Clinical Trial.

    There is limited evidence that ginger powder consumption can relieve pain and inflammation due to specific anti-inflammatory phytochemical constitutents. This study investigates the effect of ginger supplementation on proinflammatory factors in participants (n = 120) of a randomized double-blind placebo-controlled 3-month clinical trial investigating knee osteoarthritis. Patients were randomly assigned to one of two groups: the ginger group (GG) or the placebo group (PG). Administered daily for 3 months, participants in the GG intervention received capsules containing 500 mg of ginger powder, while PG participants received capsules filled with 500 mg starch. Serum samples collected at baseline and 3 months were analyzed for serum levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β). At baseline, proinflammatory cytokine concentrations did not differ by group. However, at 3 months, both cytokines decreased in the GG relative to the PG. The results of this study indicate that ginger supplementation may have a promising benefits for knee osteoarthritis and may, therefore, may warrant further study.

    Be well!


  20. JP Says:

    Updated 09/27/16:


    J Ayurveda Integr Med. 2016 Sep 16.

    Efficacy and tolerability of an aqueous extract of roots and leaves of Withania somnifera in a randomized, double-blind, placebo-controlled clinical study in patients with knee joint pain and discomfort.

    BACKGROUND: Root extracts of Withania somnifera (Ashwagandha) are known to possess analgesic, anti-inflammatory and chondroprotective effects. An aqueous extract of roots plus leaves of this plant has shown to yield higher percentages of withanolide glycosides and, accordingly, may possess better analgesic, anti-inflammatory and chondroprotective effects than root alone extracts.

    OBJECTIVES: To evaluate efficacy and tolerability of a standardized aqueous extract of roots plus leaves of W. somnifera in patients with knee joint pain and discomfort.

    MATERIAL AND METHODS: Sixty patients with knee joint pain and discomfort were randomized in a double-blind manner to W. somnifera 250 mg, W. somnifera 125 mg and placebo, all given twice daily. Assessment was done by Modified WOMAC, Knee Swelling Index (KSI), Visual Analogue Scale (VAS) at baseline and at the end of 4, 8, 12 weeks. Tolerability was assessed by incidence of adverse effects in treatment groups. Student’s ‘t’ test and ANOVA were used to compare mean change from baseline within and between the study groups. A p < 0.05 was considered significant. RESULTS: At the end of 12 weeks, compared to baseline and placebo, significant reductions were observed in mean mWOMAC and KSI in W. somnifera 250 mg (p < 0.001), W. somnifera 125 mg (p < 0.05) groups. VAS scores for pain, stiffness and disability were significantly reduced in W. somnifera 250 mg (p < 0.001), W. somnifera 125 mg (p < 0.01) groups. W. somnifera 250 mg group showed earliest efficacy (at 4 weeks). All treatments were well tolerated. CONCLUSIONS: Both the doses of an aqueous extract of W. somnifera produced significant reduction in outcome variables, with the 250 mg group showing significantly better response. In addition, the therapeutic response appears to be dose-dependent and free of any significant GI disturbances. Be well! JP

  21. JP Says:

    Updated 10/20/16:


    Nat Prod Res. 2016 Oct 13:1-5.

    The effect and safety of highly standardized Ginger (Zingiber officinale) and Echinacea (Echinacea angustifolia) extract supplementation on inflammation and chronic pain in NSAIDs poor responders. A pilot study in subjects with knee arthrosis.

    The study aimed to evaluate the effect of Zingiber officinale and Echinacea angustifolia extract supplementation (25 mg of ginger and 5 mg of Echinacea) for 30 days on inflammation and chronic pain in knee osteoarthritis (OA). Consecutive nonsteroidal anti-inflammatory-drugs (NSAIDs) poor responders with chronic inflammation and pain due to knee arthrosis were assessed (15 subjects, age: 67.2 ± 7.9, body mass index: 30.6 ± 7.1, men/women:2/13). The primary endpoint was to determine pain improvement from baseline to Day 30 by Tegner Lysholm Knee Scoring. The secondary endpoints were the assessment of Visual Analog Scale for Pain, health-related quality of life, by the ShortForm36 (SF-36), anthropometric parameters, hydration. After supplementation, a significant improvement of 12.27 points was observed for Lysholm scale score (p < 0.05), SF-36 (p < 0.05), and a decrease in -0.52 cm in knee circumference (left) (p < 0.01). This pilot study provides feasibility and safety data for the use of highly standardised ginger and Echinacea extract supplementation in people with knee OA.

    Be well!


  22. JP Says:

    Updated 04/28/17:


    J Nutr Health Aging. 2017;21(5):562-566.

    Effect of a Mediterranean Type Diet on Inflammatory and Cartilage Degradation Biomarkers in Patients with Osteoarthritis.

    OBJECTIVES: To investigate the effects of a Mediterranean type diet on patients with osteoarthritis (OA).

    PARTICIPANTS: Ninety-nine volunteers with OA (aged 31 – 90 years) completed the study (83% female).

    SETTING: Southeast of England, UK.

    DESIGN: Participants were randomly allocated to the dietary intervention (DIET, n = 50) or control (CON, n = 49). The DIET group were asked to follow a Mediterranean type diet for 16 weeks whereas the CON group were asked to follow their normal diet.

    MEASUREMENTS: All participants completed an Arthritis Impact Measurement Scale (AIMS2) pre-, mid- and post- study period. A subset of participants attended a clinic at the start and end of the study for assessment of joint range of motion, ROM (DIET = 33, CON = 28), and to provide blood samples (DIET = 29, CON = 25) for biomarker analysis (including serum cartilage oligomeric matrix protein (sCOMP) (a marker of cartilage degradation) and a panel of other relevant biomarkers including pro- and anti-inflammatory cytokines).

    RESULTS: There were no differences between groups in the response of any AIMS2 components and most biomarkers (p > 0.05), except the pro-inflammatory cytokine IL-1α, which decreased in the DIET group (~47%, p = 0.010). sCOMP decreased in the DIET group by 1 U/L (~8%, p = 0.014). There was a significant improvement in knee flexion and hip rotation ROM in the DIET group (p < 0.05). CONCLUSIONS: The average reduction in sCOMP in the DIET group (1 U/L) represents a meaningful change, but the longer term effects require further study. Be well! JP

  23. JP Says:

    Updated 04/30/17:


    Nutrients. 2017 Apr 28;9(5).

    Distribution of Constituents and Metabolites of Maritime Pine Bark Extract (Pycnogenol®) into Serum, Blood Cells, and Synovial Fluid of Patients with Severe Osteoarthritis: A Randomized Controlled Trial.

    The present randomized controlled study aimed to investigate the in vivo distribution of constituents or metabolites of the standardized maritime pine bark extract Pycnogenol®. Thirty-three patients with severe osteoarthritis scheduled for a knee arthroplasty were randomized to receive either 200 mg per day Pycnogenol® (P+) or no treatment (Co) over three weeks before surgery. Serum, blood cells, and synovial fluid samples were analyzed using liquid chromatography coupled to tandem mass spectrometry with electrospray ionization (LC-ESI/MS/MS). Considerable interindividual differences were observed indicating pronounced variability of the polyphenol pharmacokinetics. Notably, the highest polyphenol concentrations were not detected in serum. Catechin and taxifolin primarily resided within the blood cells while the microbial catechin metabolite δ-(3,4-dihydroxy-phenyl)-γ-valerolactone, ferulic, and caffeic acid were mainly present in synovial fluid samples. Taxifolin was detected in serum and synovial fluid exclusively in the P+ group. Likewise, no ferulic acid was found in serum samples of the Co group. Calculating ratios of analyte distribution in individual patients revealed a simultaneous presence of some polyphenols in serum, blood cells, and/or synovial fluid only in the P+ group. This is the first evidence that polyphenols distribute into the synovial fluid of patients with osteoarthritis which supports rationalizing the results of clinical efficacy studies.

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  24. JP Says:

    Updated 11/26/17:


    Res Theory Nurs Pract. 2017 Nov 1;31(4):379-392.

    Effects of Self-Knee Massage With Ginger Oil in Patients With Osteoarthritis: An Experimental Study.

    BACKGROUND AND PURPOSE: The purpose of our study was to assess the effects of self-knee massage with ginger oil on pain and daily living activities in patients with knee osteoarthritis.

    METHODS: Participants (N = 68) were asked about their sociodemographic characteristics, pain level in the last week using the Visual Analog Scale (VAS), and functionality in activities of daily living with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Standard treatment prescribed by a physician was given to the patients with osteoarthritis. In addition to the standard treatment, self-knee massage with ginger oil twice a week was recommended to the intervention group (n = 34). At the end of the first and fifth week, participants in both groups were assessed regarding pain and functional state.

    RESULTS: The mean VAS Pain scores of the intervention group were significantly lower at the end of the first and fifth weeks (p< .05). The mean total scores and mean Function subscale scores of the WOMAC were significantly lower in massage group in the first- and fifth-week assessments (p < .05). IMPLICATIONS FOR PRACTICE: Self-massage of the knee with ginger oil may be used as a complementary method to standard medical treatment. Nurses can easily train patients and their caregivers on knee massage, and the intervention can be implemented by patients at home without any restrictions on location. Be well! JP

  25. JP Says:

    Updated 09/27/18:


    Evid Based Complement Alternat Med. 2018 Aug 30;2018:7683897.

    Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT).

    Objective: Disease-modifying treatments for OA remain elusive, and commonly used medications can have serious side effects. Although meditation and music listening (ML) have been shown to improve outcomes in certain chronic pain populations, research in OA is sparse. In this pilot RCT, we explore the effects of two mind-body practices, mantra meditation (MM) and ML, on knee pain, function, and related outcomes in adults with knee OA.

    Methods: Twenty-two older ambulatory adults diagnosed with knee OA were randomized to a MM (N=11) or ML program (N=11) and asked to practice 15-20 minutes, twice daily for 8 weeks. Core outcomes included knee pain (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Numeric Rating Scale), knee function (KOOS), and perceived OA severity (Patient Global Assessment). Additional outcomes included perceived stress (Perceived Stress Scale), mood (Profile of Mood States), sleep (Pittsburgh Sleep Quality Index), and health-related quality of life (QOL, SF-36). Participants were assessed at baseline and following completion of the program.

    Results: Twenty participants (91%) completed the study (9 MM, 11 ML). Compliance was excellent; participants completed an average of 12.1±0.83 sessions/week. Relative to baseline, participants in both groups demonstrated improvement post-intervention in all core outcomes, including knee pain, function, and perceived OA severity, as well as improvement in mood, perceived stress, and QOL (Physical Health) (p’s≤0.05). Relative to ML, the MM group showed greater improvements in overall mood and sleep (p’s≤0.04), QOL-Mental Health (p<0.07), kinesiophobia (p=0.09), and two domains of the KOOS (p's<0.09).

    Conclusions: Findings of this exploratory RCT suggest that a simple MM and, possibly, ML program may be effective in reducing knee pain and dysfunction, decreasing stress, and improving mood, sleep, and QOL in adults with knee OA.

    Be well!


  26. JP Says:

    Updated 10/14/18:


    Arch Phys Med Rehabil. 2018 Oct 10.

    Immediate effects of transcutaneous electrical nerve stimulation on pain and physical performance in individuals with pre-radiographic knee osteoarthritis: a randomized controlled trial.

    OBJECTIVE: To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and comprehensive physical function in pre-radiographic knee osteoarthritis.

    DESIGN: A single, participant-blinded, randomized controlled trial with pre-post design SETTING: University research laboratory PARTICIPANTS: Patients with knee pain belonging to Kellgren-Lawrence grade 0 or 1 (n = 50; aged 50-69 years) were randomly assigned to the TENS (n = 25) and sham-TENS groups (n = 25).

    INTERVENTIONS: All participants wore the TENS device under the patella of the symptomatic knee. After measurement, the TENS devices in the TENS group were turned on, and those in the sham-TENS group were not connected.

    MAIN OUTCOME MEASURES: The primary outcome measures included the stair climb test, timed up and go (TUG) test, 6-minute walk test (6MWT), and knee pain evaluated using the visual analog scale (VAS) for stair climb test, TUG test, and 6MWT. Secondary outcomes included knee extensor strengths and the two-step test and stand-up test from the locomotive syndrome risk test.

    RESULTS: Multiple regression analysis revealed that TENS intervention significantly improved the walk distance and VAS score of the 6MWT, after adjusting for pre-measurement data (distance; p = 0.015, VAS; p = 0.030).ain and the distance walked in.

    CONCLUSIONS: Use of TENS improved the VAS score for p the 6MWT for individuals with Kellgren-Lawrence grade 0 or 1 of the knee. Thus, TENS may be effective for long-distance walking in patients with pre-radiographic knee osteoarthritis.

    Be well!


  27. JP Says:

    Updated 11/27/18:


    Gerontologist. 2018 Nov 26.

    Fit & Strong! Plus Trial Outcomes for Obese Older Adults with Osteoarthritis.

    Background and Objectives: We compared the effectiveness of standard Fit & Strong! (F&S!; targets physical activity [PA]) to Fit & Strong! Plus (F&S! Plus; targets PA and dietary weight loss) on weight, diet quality, and PA outcomes.

    Research Design and Methods: We randomly assigned 413 overweight older adults with OA to the F&S! or F&S! Plus programs and assessed outcomes at 2 and 6 months.

    Results: The F&S! Plus group lost -2.0 ± 0.2 kg (mean ± SE, 2% of starting weight) at 2 months that was maintained at 6 months. Two- and 6-month BMI and waist circumference improved significantly in the F&S! Plus group (p < .001). Diet quality at 2 months showed greater improvement in the F&S! Plus group: 4.6 ± 0.7 versus 2.0 ± 0.7, p = .006, with no significant difference between groups at 6 months. The F&S! Plus group differentially improved on PA engagement at 2 months and at 2 and 6 months in joint pain (6-month mean ± SE: -1.5 ± 0.3 vs -0.6 ± 0.3, p = .02), function (-4.7 ± 0.9 vs -1.5 ± 0.9, p = .01), and 6-min walk test (29.5 ± 5.1 m vs 14.1 ± 5.2 m, p = .04). Discussion and Implications: Adding a dietary weight loss component to F&S! achieved weight and waist circumference benefits that were maintained at 6 months. Importantly, the weight loss was accompanied by clinically meaningful improvements in OA symptoms and mobility. Future work should investigate minimum thresholds for weight reduction that improve long-term function in this population. Be well! JP

  28. JP Says:

    Updated 12/17/18:


    Evidence-Based Complementary and Alternative Medicine

    Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT)

    Objective. Disease-modifying treatments for OA remain elusive, and commonly used medications can have serious side effects. Although meditation and music listening (ML) have been shown to improve outcomes in certain chronic pain populations, research in OA is sparse. In this pilot RCT, we explore the effects of two mind-body practices, mantra meditation (MM) and ML, on knee pain, function, and related outcomes in adults with knee OA. Methods. Twenty-two older ambulatory adults diagnosed with knee OA were randomized to a MM (N=11) or ML program (N=11) and asked to practice 15-20 minutes, twice daily for 8 weeks. Core outcomes included knee pain (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Numeric Rating Scale), knee function (KOOS), and perceived OA severity (Patient Global Assessment). Additional outcomes included perceived stress (Perceived Stress Scale), mood (Profile of Mood States), sleep (Pittsburgh Sleep Quality Index), and health-related quality of life (QOL, SF-36). Participants were assessed at baseline and following completion of the program. Results. Twenty participants (91%) completed the study (9 MM, 11 ML). Compliance was excellent; participants completed an average of 12.1±0.83 sessions/week. Relative to baseline, participants in both groups demonstrated improvement post-intervention in all core outcomes, including knee pain, function, and perceived OA severity, as well as improvement in mood, perceived stress, and QOL (Physical Health) (p’s≤0.05). Relative to ML, the MM group showed greater improvements in overall mood and sleep (p’s≤0.04), QOL-Mental Health (p<0.07), kinesiophobia (p=0.09), and two domains of the KOOS (p’s<0.09). Conclusions. Findings of this exploratory RCT suggest that a simple MM and, possibly, ML program may be effective in reducing knee pain and dysfunction, decreasing stress, and improving mood, sleep, and QOL in adults with knee OA.

    Be well!


  29. JP Says:

    Updated 12/19/18:


    Minerva Endocrinol. 2019 Mar;44(1):97-101.

    Pycnogenol®: supplementary management of symptomatic osteoarthritis with a patch. An observational registry study.

    BACKGROUND: The aim of the present observational registry study was to evaluate the efficacy of a thin polycarbonate patch of Pycnogenol® in alleviating symptoms of knee arthrosis, in comparison to the standard management usually applied to treat osteoarthritis (OA).

    METHODS: A total of 67 subjects were included in the registry: 34 formed the control group, and 33 entered the active management group in which the Pycnogenol® patch was used. Two Pycnogenol® patches were used every day for three weeks. Each patch contains 110 mg Pycnogenol®. All patients included in this registry suffered from osteoarthritis of the knee.

    RESULTS: Results from this study show that Pycnogenol® patch allows faster improvement in OA symptoms, with a decrease in the use of non-steroidal anti-inflammatory drugs and other painkillers. Pycnogenol® patch significally reduced C reactive protein and ESR.

    CONCLUSIONS: Pycnogenol® patch was effective in controlling mild to moderate pain and inflammations and its related symptoms in subjects with knee OA over a period of three weeks.

    Be well!


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