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Arthritis and Chondroitin
Chondroitin gives structure to the cartilage. It is one of the few arthritis medications that can help rebuild the cartilage and reverse some of the damage done to the joints.
Of the more than 100 types of arthritis, the most common ones are osteoarthritis, rheumatoid arthritis, gout arthritis, septic arthritis and psoriatic arthritis.
Joint pain is the main complaint of arthritis. This pain is caused by the degeneration of joint tissue as a result of disease, inflammation or regular straining of the joint muscles. Besides pain and inflammation, stiffness and restriction in movement are the other features of all forms of arthritis.
Although arthritis can affect people of all ages, it mostly affects the elderly. It also affects women more than men.
Arthritis is the most common cause of disability worldwide. Because it reduces the range of motion and the extent of movement of those it affects, arthritis may trigger other health complications such as obesity, heart disease and depression.
Osteoarthritis is the most common form of arthritis. It is caused by the result of daily wear and tear of joints which shows with age although it may also be a result of injury to the joint.
Osteoarthritis affects the joints that bear the body’s weight. This means that it can be caused and worsened by obesity and a sedentary lifestyle. It usually worsens after exercising.
Osteoarthritis is usually situated at the pelvic, back and spine joints. It also affects post-menopausal women more than men or younger women.
Treatment options for osteoarthritis include pain relievers to reduce pain; physical therapy to improve muscular strength and flexibility of the joints; and surgery if the joints are too bad to respond to conventional treatments.
In rheumatoid arthritis, the cartilage is eroded by autoimmune attack rather than daily wear and tear. Therefore, rheumatoid arthritis can affect people of all ages.
It is mostly situated at the joints of the fingers, wrists, elbows and knees. Therefore, it causes stiffness in these joints and may cause deformities if left untreated. The pain and stiffness of rheumatoid arthritis are at their worst in the morning.
Early diagnosis and treatment of rheumatoid arthritis can produce remarkable results.
The drugs of choice are corticosteroids to reduce joint inflammation and monoclonal antibodies to reduce the autoimmune attack causing the degeneration of the joints.
Gouty arthritis involves the deposition of crystals of uric acid in the joints of the toe, ankles, knees and elbows. This causes pain and inflammation and may lead to the crippling of the limb attached to the joint.
Chondroitin is one of the drug options used in the treatment of osteoarthritis.
Compared to conventional arthritis medications such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs), chondroitin produces lesser side effects and is safe for long-term treatment.
Chondroitin is part of a proteoglycan that gives structure to cartilage.
It is a glycosaminoglycan which is capable of bonding to structural proteins. Basically, chondroitin is a family of sulfated sugars of varying lengths. The sugars making up the structure of chondroitin are the monosaccharides, D-glucuronic acid and N-acetyl-D-galactosamine.
These sugars are alternated into straight, unbranched polysaccharides of different lengths. Each sugar in the chain can be left without a sulfate group or with one or two sulfate groups attached.
Chondroitin sulfate is one of a group of proteoglycans called aggrecan.
Aggrecans, such as chondroitin sulfate, aggregate together tightly but are highly charged. Because they carry the same electrical charge, chondroitin molecules generate electrostatic repulsion which provides a force of resistance in the cartilage of the joint against compression. This repulsive force is responsible for the cushioning effect of the cartilage.
Besides its structural function, chondroitin also plays a regulatory role in the central nervous system.
In the brain, it helps stabilize the synapses of the neurons. It is also produced in increased amounts after injury to the central nervous system to protect the damaged nerve endings.
However, the chief medical use of chondroitin is to treat osteoarthritis by contributing to the structural repair of the cartilages.
In the US, chondroitin is sold as a dietary supplement for the purpose. However, in other countries especially in Europe, chondroitin sulfate is recognized as an osteoarthritis drug and classified as a slow-acting medication to relieve the symptoms of the disease.
Chondroitin is commonly formulated and sold in combination with glucosamine.
Chondroitin sulfate is available as capsules, tablets and powder forms. The dose for this oral formulation of the drug is 800 to 1200 mg taken 2 – 4 times daily.
Chondroitin produces no serious side effects even during long-term treatments. The most common side effects of chondroitin are gastrointestinal upsets, gas, nausea, diarrhea and constipation. Even these side effects mostly occur at very high doses (10 g daily) of the drug.
Rare and theoretical side effects of the drug include headache, hair loss, edema, chest pain, high blood pressure, bone marrow depression and bleeding. Chondroitin may also trigger allergic reactions in a few people especially in asthmatics.
Allergic reactions to chondroitin should be treated as medical emergencies.
In addition, chondroitin is not recommended for pregnant and lactating women since its effects during pregnancy and breastfeeding are not well studied. Furthermore, people who have a high risk of developing prostate cancer are not advised to use the drug because a preliminary study indicates a possible link.
Since chondroitin is similar in structure to anticoagulants such as heparin and warfarin, it may also inhibit blood clotting. Therefore, it should not be taken alongside these drugs.
In spite of these side effects and contraindications, chondroitin is considered a very safe drug for treating osteoarthritis. In fact, it causes no drug-drug interactions since it is not metabolized by cytochrome P450, the enzyme family responsible for drug metabolism.
Therefore, there is no safer alternative to chondroitin sulfate in the management of osteoarthritis.
Because chondroitin also relieves arthritic pain, the doses of NSAIDs, such as ibuprofen, are reduced when taken together. This is beneficial because it means that patients will experience fewer side effects of NSAIDs while still experiencing the same level of pain relief.
Different studies have identified the therapeutic benefits of chondroitin in the treatment of osteoarthritis especially when the arthritis affects the hip or knees. The efficacy of chondroitin is further improved when combined with glucosamine.
Researchers have determined that chondroitin sulfate has multiple mechanisms of action in the treatment of osteoarthritis. There are 3 main focus by which chondroitin provides relief for the pain and swelling associated with this degenerative disease.
First, chondroitin has been shown to have anti-inflammatory activity especially at the joints.
At the same site, it promotes the synthesis or proteoglycans and hyaluronic acid. This means that when chondroitin is taken orally, it can stimulate the production of new chondroitin to strengthen the cartilages of the joint.
Lastly, chondroitin reduces the destructive action of chondrocytes.
To do this, it inhibits the production of nitric oxide, enzymes that split structural proteins into peptides, and other substances known to kill off chondrocytes and damage the cartilage.
To protect the chondrocytes from self-destruction, chondroitin sulfate inhibits the relocation of a specific nuclear factor (nuclear factor-kB) in the chondrocytes.
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