Nutrition and Arthritis

by Margaret Rayman (Univ. of Surrey, Guildford, UK); Alison Callaghan (Queen Elizabeth The Queen other Hospital, Kent, UK)

• ISBN13: 9781405172875
• ISBN10: 1405172878
• Format: eBook
• Copyright: 2008-04-01
• Publisher: Wiley-Blackwell

Summary

Arthritis affects millions of people throughout the world and while its treatment is usually medical or surgical, there exists an increasingly large body of evidence concerning the positive effects of nutrition on the condition.There are over two hundred forms of rheumatoid disease, with conditions varying in prevalence. In this important title the authors have focussed on osteoarthritis (OA) and rheumatoid arthritis (RA), the most common arthritic diseases with the largest body of dietary data. Including coverage of disease incidence and prevalence, pathology, aetiology and measures of disease assessment and dietary risk factors, Nutrition and Arthritis is a clear, concise and user-friendly book gathering the latest research to bring the reader state-of-the-art information on:Micronutrients (e.g. vitamins C, D and selenium), food supplements and their potential to ameliorate arthritis Polyunsaturated fatty acids, with particular attention paid to n-3 fatty acids Glucosamine and chondroitin The value of exclusion, vegetarian, vegan and other dietary approachesNutritionists and dietitians, including those working in the health services, rheumatologists, orthopaedic surgeons, general practitioners, osteopaths and commercial organisations involved in the formulation of dietary supplements will find this book an important and practical reference source. Libraries in medical schools and universities and research establishments where nutrition, dietetics and food science are studied and taught will find it a valuable addition to their shelves.

Table of Contents

Acknowledgements

Abbreviations

Introduction

The range of rheumatic diseases

Rheumatoid arthritis (RA): description

Osteoarthritis (OA): description

4 Incidence and prevalence

Mortality

Morbidity

Economic cost of arthritis

The aim of this book

Classification, Pathology And Measures Of Disease Assessment

Classification of OA

Classification of RA

Pathology of OA

General features of OA

Cartilage degradation

Nitric oxide synthesis damages chondrocytes

Sulphation pattern of GAGs in articular cartilage

Bone changes

Inflammation

Angiogenesis

Oxidative stress

Structure of cartilage

Pathogenesis of OA

Pathology of RA

General features of RA

Immunopathogenesis and production of inflammatory mediators

Autoantibodies: rheumatoid factor

Glycosylation patterns of IgG and complement activation

Dietary lectins, gut translocation and the shared epitope

Abnormal gut microflora

Reactive oxygen and nitrogen species involved in damage to the rheumatoid joint

Phagocytosis

Hypoxia-reperfusion injury and joint pH

Involvement of nitric oxide and peroxynitrite

Consequences of the production of reactive oxygen and nitrogen species in the RA joint

Lipid abnormalities and cardiovascular risk in RA

C-Reactive Protein (CRP)

Dyslipidaemia

Endothelial dysfunction

Oxidised-LDL in the joint and the formation of fatty streaks

Adhesion molecules

Haemostatic changes

Elevated homocysteine and vitamin B6 status

Elevated homocysteine and impaired sulphur metabolism

Insulin resistance

Angiogenesis

Osteoporosis

Assessment of severity of RA and OA

Outcome measures for rheumatoid arthritis

Patient's global assessment

Pain

Disability

Swollen and tender joint counts

Acute phase reactants

RA Quality of Life Index

Radiological assessment

Some outcome measures for OA

Patient global assessment

Pain score

New joint score

Severity score

Disability

Radiological assessment

Aetiology And Risk Factors For Rheumatoid Arthritis And Osteoarthritis

Introduction

Genetic risk factors

Age

Gender

Biomechanical factors as risk factors for OA

Occupation, sport and physical activity

Joint trauma and surgery

Load distribution and malalignment

Muscle weakness

Obesity

Smoking

Dietary factors

Olive oil

Fish and n-3 PUFA

Meat

Fruit and Vegetables

Antioxidants

Vitamin C

b-Cryptoxanthin

Beverage consumption

Coffee and tea

Alcohol 3.10 Hormones, OA and RA 3.11 Medical risk factors for RA

Infection and microorganisms 3.11.2 Blood transfusions

Haemochromatosis

Current Management Of Osteoarthritis And Rheumatoid Arthritis

1 Overview of current treatment

Medication

4.2.1.Analgesia

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

4.2.3Disease Modifying Anti-Rheumatic Drugs (DMARDS)

4.2.4Biological agents (anti-cytokine therapy)

4.2.5Glucocorticoids4.3 Surgical management

Preventative

Preservative

Corrective

Salvage

Physiotherapy and occupational therapy management

Physiotherapy

Occupational therapy

Acupuncture

Nutritional Status And Adequacy Of The Diet In Rheumatoid Arthritis And Osteoarthritis

Introduction

2 Body mass index (BMI)

Low BMI and rheumatoid cachexia

High BMI

Malnutrition and malnutrition screening

Macronutrient intake

Micronutrient intake and deficiency in RA

Importance of individual assessment

Drug nutrient interactions

Popular Dietary Approaches

Introduction

Well-known popular diets

Food avoidance

4 Supplements

Exclusion, Vegetarian, Vegan And Other Dietary Approaches In Rheumatoid Arthritis

Introduction

Exclusion diets

Vegan and vegetarian diets

The Mediterranean diet

Elemental diets

Summary of dietary findings

Possible mechanisms by which exclusion, elemental, vegan and vegetarian diets may exert their effects on RA

Food allergy or intolerance

Alteration of gastro-intestinal permeability

Effect of lectins

Alteration to gut flora: pre- and pro-biotic dietary components

Weight reduction and associated immunosuppression

Placebo effect

Risks of undertaking dietary modifications

Role Of Micronutrients In The Amelioration Of Rheumatoid Arthritis And Osteoarthritis

Introduction

2 Antioxidants in the body

3 Vitamins A, C and E and b-carotene and their role in RA and OA

Description and functions of vitamins A, C and E and b-carotene

Studies of vitamins A, C and E and b-carotene in RA and OA

Conclusions and recommendations from these studies

Selenium in RA and OA

Functions of selenium relevant to RA and OA

Selenium status in OA and RA patients

Prospective and intervention studies with selenium

Recommendations for selenium intake

Copper, zinc and RA and OA

Functions of copper and zinc relevant to RA and OA

Copper and zinc status in OA and RA patients

Intervention studies with copper and zinc

Recommendations for intake of copper and zinc in RA and OA

6 Iron in RA and OA

Functions of iron relevant to RA and OA

Iron status in OA and RA patients

Effect of resolution of anaemia on RA symptoms and quality of life

Recommendations for iron intake

7 Vitamin D in OA and RA

Role of vitamin D in relation to OA and RA

Studies looking at the relationship between vitamin D and arthritis

Vitamin D status

Recommendations for vitamin D intake

Boron and arthritis

Magnesium

Potassium

Recommendations for micronutrient use in RA and OA

How should these recommendations best be achieved - dietary intake, fortification, or supplementation?

Polyunsaturated Fatty Acids In The Treatment Of Arthritis

Essential fatty acids and their nomenclature9.2 Role of fatty acids: relevance to arthritis

Metabolism of polyunsaturated fatty acids

Conversion to long-chain PUFAs

Formation of eicosanoids from PUFA precursors

Inflammatory potential of eicosanoids

Eicosanoids in arthritis

Rationale for the use of specific PUFAs in the treatment of arthritis

Beneficial effects of GLA, DGLA and n-3 PUFAs

Effects on eicosanoids

Effects on cytokine production

Effects of fish oils on cytokine production depend on genotype

Effects on lymphocyte proliferation

Effects of n-3 PUFA on cartilage integrity

Epidemiology of n-3 PUFA and arthritis

Interventions with GLA and DGLA in arthritic patients

Interventions with fish oil in RA patients

Interventions with fish oil in RA patients with reduced n-6 PUFA intake

Limitations of human intervention studies with PUFAs

Recommendations for PUFA intake in inflammatory arthritis

Current intakes of PUFAs

How to achieve an anti-inflammatory intake of PUFAs

Oily fish

Fish-oil supplements

Animal sources of n-3 PUFAs: grass-fed meat and game

Sources of short-chain n-3 PUFA

Direct long-chain n-3 PUFA sources for vegetarians or non-fish eaters

Practical guidelines for vegetarians

Reducing n-6 PUFAs in the diet

Collateral benefits of increasing the intake of long-chain n-3 PUFAs

Reduced risk of cardiovascular mortality

Reduced requirement for NSAIDs or other drugs

Safety issues

Contraindications for cod liver oil supplements

Side effects of n-3 PUFAs

Peroxidation issues related to increased n-3 PUFA intake

Effects on immunity of increased n-3 PUFA

Contamination with dioxins and dioxin like PCBs

Fish contamination with mercury

Ethical issues: fish stocks

Conclusion

Glucosamine And Chondroitin In Osteoarthritis

Introduction

2 What are glucosamine and chondroitin?

Sources of glucosamine and chondroitin

Bioavailability10.5 Postulated mechanism of action

6 Trials of glucosamine and chondroitin and their efficacy in OA

Meta-analyses of glucosamine and chondroitin trials

Long-term glucosamine trials

Combination trials including manganese

Glucosamine trials with negative findings

Possible reasons for conflicting trial results

Topical treatment

Comparison with NSAIDs

Safety issues

Adverse events

Contraindications

Caution with usage

Further studies

Preliminary results from GAIT

Conclusions and recommendations for glucosamine and chondroitin use

Supplements of glucosamine sulphate and chondroitin available

Other Foods Or Supplements Marketed For Arthritis Relief

Introduction

Green tea extracts

Ginger

New-Zealand green-lipped mussel

Methylsulfonylmethane (MSM)

Noni Juice

Shark Cartilage

Herbal remedies

Conclusion

Assessment Of Level Of Evidence For Nutritional Recommendations And Suggestions For The Future

Summary of nutritional factors that may affect risk of RA and OA

Level of evidence for nutritional recommendations in RA and OA

Suggestions for the future

Appendices

How to interpret the statistical data on studies quoted in this book

Malnutrition Universal Screening Tool - MUST

Table of UK and USA dietary reference values for vitamins, minerals and trace elements

Elimination diet for rheumatoid arthritis

Glossary

Index

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