Joint pain is extremely common and almost everyone has experienced some degree of joint pain at least once in their lives, whether it be due to an injury or another illness.  Often, the onset of cold weather can worsen joint pain in many people making this a timely topic to discuss.  Joint pain can often be accompanied with inflammation within the joint capsule – inflamed joints are known as “arthritis” (arthr- for joint and –itis for inflammation).  If the inflammation persists, it can lead to chronic joint pain, impact mobility, and negatively affect activities of daily living as well as result in deformed joints.  This is why it is important to attend to an injury involving one or more joints as soon as possible to repair the tissues and strengthen any ligaments involved and reduce any inflammation present.

There are two main types of arthritis – osteoarthritis (OA) and autoimmune-related arthritis which includes rheumatoid arthritis (RA).  Autoimmune arthritic conditions have a slightly different approach to treatment compared to osteoarthritis as they are more systemic in nature.  Arthritis and Arthralgia can also be present without having an autoimmune condition or osteoarthritis.  Some people experience joint pain/inflammation simply because of food sensitivities.


Joint Pain – Osteoarthritis


Knee joint pain

This is the common form of arthritis typically found in the elderly due to age-related changes in the ability to restore and repair normal joint structures (1). It can also occur from an untreated injury to the joint.  It usually manifests in the big joints like the shoulder, hip, and knee. Osteoarthritis involves the destruction of cartilage at the end of two bones in a joint capsule leading to bone on bone grinding which results in clicking sounds as you move the joint.  This generates inflammatory cytokines to the joint space creating inflammation, pain and swollen joints.  Over time, there can be bone spurs that form at the joint creating deformed joints and movement restriction (1).

Pharmaceutical therapy usually aims at reducing the pain and inflammation but is not doing anything to help stop cartilage destruction and rebuild the cartilage.  In order to treat the cause and help regenerate the cartilage, there are lots of joint care supplements on the market.

Glucosamine is something most people with OA have heard of and may even be recommended by family doctors.  Glucosamine helps to re-build the glycosaminoglycan layer by drawing water to the cartilage to help keep it cushion-y.  Some people may find glucosamine doesn’t work but note that one has to take large doses of glucosamine (~1500mg/day (1)) and for a long period of time before they can start feeling relief.  The glucosamine sulphate form is also the best for joint and cartilage repair as it is better absorbed compared to N-acetyl glucosamine (NAG) and has the sulphur molecule to add support to the cartilage and joint(s) (1).

MSM (methylsulfonylmethane) is another compound that is used to help decrease the pain and inflammation on the joint.

Chondroitin sulphate which is essentially cartilage and commonly, comes from shark cartilage helps replace the destroyed cartilage in a joint.

Collagen is gaining a lot of popularity and it does have many benefits to help improve gut health, hair, skin, and nails, and help with strengthening joints as it is connective tissue.

Obesity plays a role in OA! Excess weight puts extra pressure on the joints that compress and wears away cartilage sooner.  Therefore being physically active, although it may be difficult due to the pain, is essential to help maintain a healthy weight.  Swimming is a great exercise with little impact on the joints.  Chiropractors, physiotherapists, and registered massage therapists are great for providing exercise recommendations.


Joint Pain – Autoimmune-related Arthritis


Hand joint pain

Autoimmune means that your immune system makes antibodies that recognize ‘self’ (molecules that your body produces as part of normal physiology) on joints, tissues, and organs.  This results in an immune attack creating inflammation, swelling, destruction of tissues and joints, and/or pain.  Unlike OA, which affects the large joints in the body and can be unilateral, RA and other autoimmune arthritis tend to affect both sides of the body symmetrically and affect the smaller joints in the body like hands, wrists, spine, and feet.  They may affect the large joints as well.

While supplements that help in OA may be beneficial in autoimmune-mediated arthritis, a naturopathic approach would really be targeted at reducing the inflammation, modulating the immune system, and addressing the whole body including gut health.

Immune modulation is important to shift the immune system away from favouring autoimmunity to lower the antibodies produced.  MDs typically prescribe corticosteroids like prednisone or TNF-a inhibitors which suppress the immune system to reduce the production of inflammatory cytokines which will stop the inflammation.  While these are needed for some people if the autoimmune condition is severe or the person is in a lot of discomfort, being on immunosuppressants long term can increase your risk for other infections if your immune system is not functioning due to suppression.  Corticosteroids may also increase your risk of osteoporosis and diabetes and contribute to obesity if used long-term.

Gut Health: Another key component is to treat and heal the gut. Research has shown that the type of bacteria in our digestive tracts is essential to control and minimize rheumatic diseases, specifically ankylosing spondylitis and rheumatoid arthritis (2). Probiotics are just one of the elements required for maintaining good gut health.  A study by Vaghef-Mehrabany et al (2014) found that when people with rheumatoid arthritis took a probiotic supplement, the disease activity, and inflammatory status was significantly reduced.  As there are many probiotic supplements on the market, it is important to consult a regulated healthcare professional to determine which is right for you.

Bacteria in the gut

Aside from adding good bacteria to the gut, healing the gut is very important as leaky gut can be common in autoimmune conditions which will result in bacteria, toxins, food proteins reacting with the immune system and can contribute to joint pain.  Healing the gut can take a minimum of 3 months to 6 months or even a year depending on the extent of the damage.  Consulting with a naturopathic doctor will help guide you on an individualized healing the gut protocol.  The first step is to decrease gut inflammation by removing YOUR inflammatory triggers (food sensitivities, pathogenic bacteria, or treating bacterial overgrowth).  Once this is achieved, gut repair can begin.

Food sensitivities
Food Sensitivity Test

Possible Symptoms That Indicate “Leaky Gut” May Be Present:

  • Bloating
  • Gas
  • Loose stools / diarrhea
  • Constipation
  • Heartburn / acid reflux
  • Nausea / vomiting
  • Feeling unwell after consuming certain foods

If you would like to learn more about the connection between the digestive tract and the immune system, click here.

If you would like to address and get to the bottom of your joint pain and/or have any digestive symptoms, book an initial assessment.

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References
  1. International Centre for Nutritional Research Inc. (2012) Glucosamine sulphate: effective osteoarthritis treatment. Natural Medicine Journal.  Retrieved on Oct 18 2017 from http://www.icnr.com/articles/glucosamine-sulfate-for-osteoarthritis.html
  2. Bedaiwi MK, and Inman RD. (2014 Jul)  Microbiome and probiotics: link to arthritis.  Curr Opin Rheumatol. 26(4):410-5.
  3. Vaghef-Mehrabany E, Alipour B, Homayouni-Rad A, Sharif SK, Asghari-Jafarabadi M, Zavvari S. (2014 Apr) Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. 30(4);430-5.
  4. Rocky Mountain Analytical. (2017). IgG Food Sensitivity Sample Report.  Retrieved on Oct 20 2017 from http://rmalab.com/medical-laboratory-tests/allergy/igg-sensitivity
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