Without a skeleton the human body would have no more form than that of a jelly fish. It could neither stand, walk, nor grasp instruments.

The skeleton is a bony frame linked together by joints which enables the human to carry out all its sophisticated movements, while at the same time providing protection for vulnerable organs, such as the brain, heart and lungs. Groups of muscles are attached to the bones and are arranged in opposition to each other around a joint so that as one group contracts the other relaxes. As a result of this synchronised action joints move easily and smoothly, and while the person is still young, and hasn’t been subjected to heavy wear or abnormal stresses or strains, it moves without any difficulty, such as pain or stiffness. In time appreciable wear erodes the once healthy joint surface. In the well functioning joint any possible friction between the ends of the bones in the joints is reduced by cartilage. Cartilage is a glistening, slippery tissue, which covers the surfaces of the bones within the joint and act as a cushion and washer between the bone ends. Once the cartilage has been worn away as happens once there is osteoarthritis, every movement becomes increasingly painful and the movements more stiff so that eventually they become agonising. The cartilage is assisted in its friction-reducing role by the synovial fluid in the joint. This clear fluid has the same role as lubricating oil in a machine allows repeated movements of the joint, and the articulated limbs to bear someone’s weight without any resulting damage. The joints are held together, and kept correctly aligned by strong ligaments, tough bands of fibrous material, which add to the strength of the joint capsule.

Osteoarthritis is a degenerative joint disease in which wear and tear has slowly eroded the cartilage. It affects every mammal from early middle age onwards other than whales, which have their weight born by water, and lemurs, which hang from the trees. Although joints don’t wear out at a uniform rate there are at any one time in the United Kingdom more than four million people suffering some degree of inconvenience as the result of osteoarthritis. In many hundreds of thousands of people the pain and limitation of movement induced by osteoarthritis makes normal activities, both professional and domestic impossible. Osteoarthritis is a frequent cause of sleeplessness and is often the reason why surgical relief is sought.

The most common sites of osteoarthritis, when it gives to severe disability, are knees, hips, spine, and hands. Although this degenerative disease attacks both sexes there is more osteoarthritis in men’s hips, knees and spine, whereas in women the knees and hands are the most frequently affected. This gender difference is thought to be related to physical activity, men are more likely to undertake hard manual work, which involves knees, hips and back. Conversely women, certainly women in an earlier age, were more likely to be involved in work which needed the constant use their hands and in consequence their joints have more wear and tear. Both knees and hips suffer if someone, whatever their sex, is overweight but knees wear out appreciably more often than hips.

When there is abnormal or excessive wear and tear a person is likely to develop osteoarthritis earlier. Even when allowance is made for any tendency to inherit the build and physique of a parent, and the increased probability that children will have a similar lifestyle to parents, it is still apparent from studying family’s medical histories that when people develop osteoarthritis early there is frequently a genetic factor which is important in the development of osteoarthritis.

Excessive, prolonged or abnormal use of a joint initially affects the cartilage, the joint’s cushion, which is slowly worn down. The bone underlying the cartilage may develop cysts and as it is worn down the repairing process results in the formation of a very hard bone, which may project as bony spurs from the joint edges. These often protrude from the edges of the joint where they can damage surrounding tissue and increase the inflammation of the joint, which is already present.

The routine treatment of osteoarthritis usually involves a step-by-step regime. Initially simple analgesics are used which progress to more complex and powerful non-steroidal anti-inflammatory agents. The older agents came with a high incidence of serious gastrointestinal adverse effects, the more modern COX 2 inhibitors while not being free of this trouble are a great deal safer.

Nutritional supplements have never figured widely in the average doctor’s medicine bag, but nevertheless have been of apparent use to countless thousands of patients with osteoarthritis. As time has passed these stories, which were initially rejected as being no more than anecdotal evidence, have come to be accepted as having a real value, even though the way they worked has in some instances never been determined. Obvious examples are fish and cod liver oil, traditional remedies which have been demonstrated to have strong anti-inflammatory powers. New Zealand green lipped mussels have been shown to have a medicinal value because of COX 2 anti-inflammatory action. Likewise ginger, which has been a favourite remedy for arthritic conditions since the days of ancient Chinese medicine is now making a comeback.

Patients, too, have for many years been frequently been telling their doctors that glucosamine, which is found in chitin, one of the constituents of the shells of lobsters, crabs and prawns, has an effect on osteoarthritis. Doctors greeted patients’ enthusiasm for glucosamine with some scepticism. Recent research has added strength to the patient’s opinion.

Glucosamine is produced in two forms, either glucosamine sulphate or glucosamine hydrochloride. Glucosamine sulphate, the preferred preparation, has come in from the therapeutic cold and is now being more readily accepted in established medical circles. In particular there is data showing that glucosamine is particularly likely to be of help in osteoarthritis. The average dose is 500 mgs. three times a day. Glucosamine is encouragingly free of adverse reactions. Some people will notice an increase in indigestion – this has been particularly noticeable in those taking water pills – diuretics. Not surprisingly as glucosamine sulphate is processed with salt and derived from fish shells it has a relatively high salt content. There have also been reports that it may increase insulin resistance although in one trial when it was given to patients with known diabetes it had no effect on their condition, nor in those without diabetes did it seem to trigger it.

Another anti-inflammatory preparation, ArthroColl, has also been the subject of a double blind trial. ArthroColl is composed of collagen and chondroitin sulphate. Both constituents are derived from joint cartilage. The mechanism by which they work is uncertain but there is some evidence that it may stimulate synthesis of cartilage as well as reduce the damage old cartilage suffers from fair wear and tear.

Neither glucosamine, nor ArthroColl are destined to cure a severely arthritic hip or knee but the evidence is that both may ease these problems and may compliment other treatment, which has been given on prescription.

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