Understanding Osteoarthritis: The Breakdown of Joint Cartilage

Osteoarthritis is a common joint condition that happens when the cushioning cartilage in our joints wears down over time. This cartilage is like a smooth, protective layer that helps our bones move easily and supports the weight on our joints.

The cartilage is made up of a special matrix filled with cells called chondrocytes, which work to keep the matrix healthy. Osteoarthritis occurs when the balance between making and breaking down this matrix is disrupted.

Collagen and proteoglycans are important components of cartilage. Collagen provides strength, while proteoglycans help the cartilage resist compression. When there's an imbalance in maintaining these components, it can lead to the breakdown of cartilage, causing pain, stiffness, and joint movement problems.

Understanding how healthy cartilage functions is crucial in recognizing the changes that happen in osteoarthritis. By knowing the normal workings of cartilage, we can better understand the degenerative process of osteoarthritis and the importance of taking care of our joints. [1]

Progression of Osteoarthritis

Early Osteoarthritis

In the early stages of osteoarthritis, this delicate balance starts to shift. Certain inflammatory molecules, like cytokines and enzymes, become overactive and begin to degrade the cartilage matrix. The proteoglycans lose their ability to retain water, causing the cartilage to stiffen and lose its shock-absorbing capacity.

At the same time, the chondrocytes try to compensate by increasing their production of matrix components. However, this repair process is often unable to keep up with the accelerated breakdown. Tiny cracks and fissures start to form in the cartilage surface.

Advanced Osteoarthritis

As osteoarthritis progresses, the cartilage continues to deteriorate. The collagen network becomes disrupted, and the cartilage loses its smooth, gliding surface. Chondrocytes become stressed and start to undergo programmed cell death (apoptosis).

Without healthy chondrocytes to maintain the extracellular matrix, the cartilage thins out and eventually wears away completely. This exposes the underlying bone, which then tries to compensate by growing outward, forming bone spurs (osteophytes).

The exposed bone also becomes inflamed, which can further damage the remaining cartilage. This vicious cycle of cartilage breakdown, bone remodeling, and inflammation drives the advancement of osteoarthritis.

Understanding the molecular mechanisms behind osteoarthritis is crucial for developing new treatments that can effectively slow or even reverse the disease process. By targeting the key pathways and molecules involved, researchers are working to find ways to preserve healthy cartilage and restore joint function for those suffering from this debilitating condition.

Navigating the Supplement Landscape for Osteoarthritis Relief

Osteoarthritis can be a painful and debilitating condition, and many people turn to dietary supplements in search of relief. With so many options available, it can be challenging to know which ones are truly effective. Let's take a closer look at what the research says about some of the most popular supplements for managing osteoarthritis.

Researchers have conducted several comprehensive reviews, known as meta-analyses, to evaluate the available clinical evidence on supplements for osteoarthritis. These studies have primarily focused on assessing the impact of supplements on the key symptoms of osteoarthritis, such as pain, stiffness, and physical function.

The good news is that some supplements do appear to provide benefits for people with osteoarthritis. Several meta-analyses have found that certain supplements can help improve pain, stiffness, and physical function in those with osteoarthritis. For example, the reviews by Aghanohammei et al. [5], Liu et al. [6], and Matthieu et al. [7] all found promising results. 

"some not well-known supplements (Boswellia serrata extract, deer bone extract, extract of the skin of the passion fruit, collagen peptides isolated from pork skin, A. paniculata purified extract, Artemisia annua extract and Pycnogenol) seem to have largest benefits in decreasing pain and improving physical function with negligible adverse events." [5]
- Aghanohammei et al. 2020

 

"Of 20 supplements investigated in 69 eligible studies, 7 (collagen hydrolysate, passion fruit peel extract, Curcuma longa extract, Boswellia serrata extract, curcumin, pycnogenol and L-carnitine) demonstrated large (effect size >0.80) and clinically important effects for pain reduction at short term." [6]
- Liu et al. 2017 

 

"For now, curcumin or ginger supplementation appears to be of the most interest in terms of improving knee osteoarthritis symptoms." [7]
- Matthieu et al. 2022

 

When it comes to the structural outcomes of osteoarthritis, such as changes in joint width and cartilage volume, the evidence is more mixed. While a review by Yang et al. [8] found that a few supplements have shown promising effects, the results are not decisively positive, indicating the need for further investigation.

"Glucosamine and chondroitin yielded statistically significant but clinically questionable long-term benefit on structure and symptoms, though both had favorable safety profiles." [8]
- Yang et al. 2021 

To help you navigate the options, we've put together a condensed table summarizing some of the supplements that demonstrated promising effects in these published meta-analyses [5-8]. This information can serve as a starting point for you to discuss with your healthcare provider and make an informed decision about which supplements, if any, might be worth trying as part of your osteoarthritis management plan.

Supplement	Source and/or Active Component [2,3]	Potential Mode of Action [2,4]	Aghamo-hammadi [5]	Liu [6]	Mathieu [7]	Yang [8]
Hyaluronic Acid	Component of synovial fluid. Generally extracted from animal sources such as chicken comb or bacterial ferments.	Chondroprotective Analgesic	NA	NA	NA	NA
Collagen and derivatives	Most abundant protein localized in skins, tendons, cartilage and bone. Generally derived from animal bones and skin.	Anti-inflammatory Chondroprotective	✔	✔	NA	NA
Chondroitin	Component of proteoglycans in articular cartilage Generally derived from pig or cow cartilage	Anti-inflammatory Antioxidant Chondroprotective	✔	½	NA	½
Glucosamine	Component of proteoglycans in articular cartilage. Generally derived from the shells of shrimp or crabs	Anti-inflammatory Antioxidant Immune-modulatory Chondroprotective	X	½	NA	½
MSM	Occurs naturally in small amounts in many living organisms. Commonly synthetically produced.	Anti-inflammatory Chondroprotective	✔	½	NA	NA
L-carnitine	Chemical produced naturally in the human brain, liver and kidney.	Anti-inflammatory Chondroprotective	✔	✔	NA	NA
Turmeric-based	Extracted from turmeric Contains mainly polyphenols.	Anti-inflammatory Antioxidative Chondroprotective	NA	✔	✔	NA
Ginger-based	Extract from ginger root Presence of salicylate and polyphenols.	Anti-inflammatory Antioxidative	NA	NA	✔	NA
Bowellia serata extract	Extract from gum of Boswellia serrata Contains boswellic acids.	Anti-inflammatory	✔	✔	NA	NA
Pine Bark extract	Extract from the bark of Pinus pinaster Contains a range of polyphenols.	Anti inflammation	NA	✔	NA	NA
Chicken comb extract [9]	Extracted from chicken comb Contains sodium hyaluronate (60-75%) and chondroitin sulphate (<25%) [10]	Refer to hyaluronic acid. [9]	✔	NA	NA	NA
Deer bone extract	Extract from deer bone. Contains hydroxyproline, collagen, chondroitin sulfate and ganglioside	Anti inflammatory Chondroprotective	✔	NA	NA	NA

Antioxidant: Reduces cellular damage and collagen degradation
Anti-inflammatory: Reduces inflammation
Chondroprotective: Delays joint space narrowing and protects chondrocytes

✔ - Positive effect
½ - Slightly positive effect
X - No effect
NA - Not assessed in the article

In the coming posts, we'll dive deeper into the research on each of these supplements and what they may (or may not) be able to do for your joint health. Stay tuned for more information to help you make an informed decision about managing your osteoarthritis.

Key takeaways

• When it comes to managing osteoarthritis, the available research has primarily focused on evaluating the impact of supplements on pain, stiffness, and physical function. The good news is that some supplements do appear to provide benefits in these areas.

• The clinical evidence on the chondroprotective, or joint-protecting effects of these supplements is still not conclusive. More clinical research is needed to fully understand their long-term impact on the structural changes associated with osteoarthritis.
  
  
• The cumulative evidence from the published meta-analyses suggests that a few supplements stand out as potentially more helpful for managing the symptoms of osteoarthritis:

• Collagen and derivatives
• Chondroitin
• Turmeric based products
• Boswellia serrata extract
• L-carnitine

• If you're interested in trying one of these supplements, it's recommended to give it at least 10 weeks to assess its potential benefits. [5] However, it's always a good idea to consult with your healthcare provider before starting any new supplement, as they can help you make an informed decision and ensure it's safe and appropriate for your individual needs.

References

1. Fox, A. J. S., Bedi, A. & Rodeo, S. A. The basic science of articular cartilage: structure, composition, and function. Sports Health 1, 461–468 (2009).
2. Colletti, A. & Cicero, A. F. G. Nutraceutical approach to chronic osteoarthritis: from molecular research to clinical evidence. Int. J. Mol. Sci. 22, 12920 (2021).
3. Żęgota, Z., Goździk, J. & Głogowska-Szeląg, J. Efficacy of herbal and naturally-derived dietary supplements for the management of knee osteoarthritis: a mini-review. Wiad Lek. 74, 1975–1983 (2021).
4. Castrogiovanni, P. et al. Nutraceutical supplements in the management and prevention of osteoarthritis. Int. J. Mol. Sci. 17, 2042 (2016).
5. Aghamohammadi, D. et al. Nutraceutical supplements in management of pain and disability in osteoarthritis: a systematic review and meta-analysis of randomized clinical trials. Sci. Rep. 10, 20892 (2020).
6. Liu, X. et al. Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis. Br. J. Sports Med. 52, 167–175 (2018).
7. Mathieu, S. et al. A meta-analysis of the impact of nutritional supplementation on osteoarthritis symptoms. Nutrients 14, 1607 (2022).
8. Yang, W. et al. The efficacy and safety of disease-modifying osteoarthritis drugs for knee and hip osteoarthritis-a systematic review and network meta-analysis. J. Gen. Intern. Med. 36, 2085–2093 (2021).
9. Kalman, D. S., Heimer, M., Valdeon, A., Schwartz, H. & Sheldon, E. Effect of a natural extract of chicken combs with a high content of hyaluronic acid (Hyal-Joint) on pain relief and quality of life in subjects with knee osteoarthritis: a pilot randomized double-blind placebo-controlled trial. Nutr. J. 7, 3 (2008).
10. Chicken comb extract. https://www.tga.gov.au/resources/resource/compositional-guidelines/chicken-comb-extract (2018).