using nutrition to ease the pain of osteoarthritis - HillsVet

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nutrition myths and truths, facts and fallacies break down cartilage matrix faster than new matrix can be produced. The products of cartilage breakdown are antigenic and provoke synovitis. Synovial macrophages and leukocytes are abundant sources of cytokines, procoagulant factors, proteinases and oxygen-derived free radicals including nitric oxide (NO-). Interleukin-1-beta (IL-1) and tumor necrosis factor-alpha (TNF-) are the predominant proinflammatory cytokines synthesized during the OA process. IL-1 stimulates the breakdown of matrix proteins and the accumulation of degradation products. TNF- appears to drive the inflammatory process. Both substances induce articular cells to produce other cytokines and increase their own production, as well as stimulate production of proteases and prostaglandin E 2 (PGE 2 ). Numerous other cytokines and growth factors are also involved in OA pathophysiology. These inflammatory cytokines contribute to the perpetuation and progression of arthritis by sustaining catabolic processes. Once initiated, these molecular and cellular pathways form a self-perpetuating cycle. Clinical Presentation Signalment: A patient’s breed, age, gender and body weight provide valuable information when assessing the patient’s relative risk for osteoarthritis. Rapidly growing large breed dogs, for example, are often affected with developmental orthopedic conditions that can lead to OA. Older dogs often demonstrate signs of OA. Obese animals appear more susceptible to OA and, because of their added weight, may be more debilitated by the disease. One long term study has documented that the prevalence and severity of osteoarthritis is greater in dogs with body condition scores above normal. Over the life span of these same dogs, the mean age at which 50% of the dogs required long-term treatment for clinical signs attributable to osteoarthritis was significantly earlier (10.3 years, p
nutrition myths and truths, facts and fallacies hip joint KNEE joint healthy hip joint arthritic hip joint healthy knee joint arthritic knee joint Figure 2: Radiographic images of healthy and arthritic hip and knee joints demonstrating typical changes thickening of the joint capsule, sclerosis or erosion of the subchondral bone, periarticular osteophyte formation, enthesiophytes, and joint mice (Fig. 2). Arthrocentesis and synovial fluid analysis: Synovial fluid collected from affected joints is examined for volume, color, clarity, viscosity, cytology, and biochemical analysis. Fluid from patients with OA may be clear or pale yellow and slightly turbid due to an increase in inflammatory cells. It typically contains synovial cells and less than 5 x 10 3 /L mononuclear cells (and a few red blood cells may also be present). Polymorphonuclear cells typically constitute 0-12% of cells. Synovial fluid analysis alone may not differentiate OA joints from normal joints (particularly in the early stages of OA), but is valuable in ruling out septic and immune-mediated arthritis. Physical Rehabilitation NSAID Adjunct Multimodal Osteoarthritis Management Weight Control and Exercise EPA-rich Diet Figure 3: Multimodal management of osteoarthritis Chondroprotectant Treatment Of OA Multimodal medical treatment is recommended for OA, including weight reduction, proper nutrition, exercise control, physical therapy, and the administration of anti-inflammatory medications, analgesics, and osteoarthritis disease modifying agents (Fig. 3). Exercise and Physical Rehabilitation: Exercise and physical therapy are often used as part of the treatment for OA in humans and dogs. Exercise reduces obesity (a primary contributor to the progression of OA) and controlled exercise may help improve strength and range of motion in joints. Exercise may also reduce the need for analgesic medications. Low-impact exercises such as walking and swimming are preferred. The activity should be initiated gradually and increased as joint function improves. Warm compresses, coldpacks, massage therapy, electrotherapy, and ultrasound are techniques used in treatment of both human and canine OA patients. Nutrition: Fish oil as a source of omega-3 fatty acids has been shown to reduce inflammation and pain in mammals. Certain omega-3 fatty acids have been shown to reduce the expression and activity of proteoglycandegrading enzymes, thereby having the potential to stop the progression of osteoarthritis (Fig.4). Damaged chondrocytes produce inflammatory cytokines that contribute to the progression of OA through catabolic
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using nutrition to ease the pain of osteoarthritis - HillsVet

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