Arthritis is a common healthcare problem; although it can strike at any age, it is more common among older individuals. According to the Centers for Disease Control and Prevention (CDC), nearly 50 million people in the U.S. report having some form of arthritis that has been diagnosed by a doctor. Some arthritis sufferers take calcium and Vitamin D supplements with the hope that they will relieve symptoms; however, a new study led by Harbor-UCLA Medical Center hematologist Rowan Chiebowski, MD, PhD found that taking the supplements had no more benefit than a placebo. The results of the study were published online on August 19 in the Journal of the Academy of Nutrition and Dietetics. Although the study found no benefit from calcium and Vitamin D supplements, lifestyle choices, medication, and alternative medicine can relieve symptoms.
The researchers note that low Vitamin D intake and levels have been associated with increased joint symptoms in some studies; however, the findings are mixed and evidence from randomized trials is sparse. Therefore, they conducted a study to evaluate the influence of supplemental calcium and Vitamin D on joint symptoms in the Women’s Health Initiative randomized, placebo-controlled, clinical trial.
The investigators reviewed data from the Women’s Health Initiative randomized clinical trial in which 36,282 postmenopausal women were randomized to receive calcium carbonate (1,000 mg as elemental calcium) with Vitamin D-3 (400 IU) daily or a placebo were examined. The researchers studied a subgroup of 1,911 women (6%). The two groups had similar rates of joint pain and joint swelling. They also had similar rates of smoking, physical activity, body mass index, and other factors. Information on joint pain and joint swelling was collected by questionnaire before entry into the study and two years later. The data was subjected to statistical analysis to compare the occurrence and severity of joint symptoms across randomization groups.
The researchers found that at baseline, total calcium and Vitamin D intakes from diet and supplements were similar in the two randomization groups. In addition, both joint pain (reported by 73%) and joint swelling (reported by 34%) were commonly reported and comparable in the supplement and placebo groups. Two years after randomization, no statistically significant differences between supplement and placebo groups were seen for joint pain frequency (supplement group: 74.6%; placebo group: 75.1%) or joint swelling frequency (supplement group: 34.6%; placebo group: 32.4%) or in severity scores for either outcome. Subgroup analyses suggested study participants also using nonprotocol calcium supplements at study entry may have less joint pain with supplement group randomization.
The authors concluded that joint symptoms are relatively common in postmenopausal women. However, daily supplementation with 1,000 mg calcium carbonate and 400 IU Vitamin D-3 in a randomized, placebo-controlled clinical trial setting did not reduce the self-reported frequency or severity of joint symptoms.
The question becomes: If calcium and Vitamin D supplements do not benefit arthritis sufferers, what does?
Poor lifestyle choices such as lack of exercise, obesity, and smoking can increase arthritis and its symptoms:
Weight loss. If you are overweight or obese, losing weight will reduce the stress on your weight-bearing joints. This may increase your mobility and reduce the need for future joint injury.
- Exercise. Regular exercise can help keep your joints flexible. Swimming or water aerobics is often a good choice because the buoyancy of the water reduces stress on weight-bearing joints.
- Heat and cold. Heating pads or ice packs may help relieve arthritis pain.
- Assistive devices. Using canes, walkers, raised toilet seats and other assistive devices can help protect your joints and improve your ability to perform daily tasks.
The medications used to treat arthritis vary depending on the type of arthritis. Commonly used arthritis medications include:
- Analgesics. These medications alleviate pain but have no effect on inflammation. Examples include acetaminophen (Tylenol and other brands), tramadol (i.e., Ultram and Ryzolt) and narcotics containing oxycodone (i.e., Percocet, Oxycontin) or hydrocodone (i.e., Vicodin, Lortab). These drugs are effective pain killers; however, they highly addictive, have side-effects, and are subject to abuse.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both pain and inflammation. Over-the-counter products include aspirin, ibuprofen (i.e., Advil, Motrin) and naproxen (Aleve). Some types of NSAIDs are available only by prescription. Oral NSAIDs can cause stomach irritation, and some may increase your risk of heart attack or stroke. Some NSAIDs are also available as creams or gels, which can be rubbed on joints.
- Counterirritants. Some varieties of creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these preparations on the skin over an aching joint may interfere with the transmission of pain signals from the joint itself.
- Disease-modifying antirheumatic drugs (DMARDs). Often used to treat rheumatoid arthritis, DMARDs slow or stop the immune system from attacking the joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).
- Biologics. Typically used in combination with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules that are involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).
- Corticosteroids. These drugs (e.g., prednisone and cortisone) reduces inflammation and suppresses the immune system. Corticosteroids can be taken orally or be injected directly into a painful joint.
Physical therapy can benefit some types of arthritis. Exercises can improve range of motion and strengthen the muscles surrounding joints. In some cases, splints or braces may be helpful.
If the arthritis is sever and conservative measures, such as weight loss and medication do not help, surgery may be considered. One must be aware that all surgical procedures have risks of complications, including death. Knee or hip replacement surgeries are major procedures with significant risk. Over time, artificial joints can fail:
Joint replacement. This procedure removes your damaged joint and replaces it with an artificial one. Joints most commonly replaced are hips and knees.
Joint fusion. This procedure is more often used for smaller joints, such as those in the wrist, ankle and fingers. It removes the ends of the two bones in the joint and then joins those ends together until they heal into one rigid unit.
A number of arthritis sufferers turn to alternative remedies for arthritis; however, the medical literature contains limited evidence to support the use of many of these products. The most promising alternative remedies for arthritis include:
Yoga or tai chi. The slow, stretching movements associated with yoga and tai chi may help improve joint flexibility and range of motion in individuals with some types of arthritis.
- Acupuncture. This therapy uses fine needles inserted at specific points on the skin to reduce many types of pain, including that caused by some types of arthritis.
- Transcutaneous electrical nerve stimulation (TENS). Using a small device that produces mild electrical pulses, TENS therapy stimulates nerves near the aching joint and may interfere with the transmission of pain signals to the brain.
- Glucosamine. Study results have been mixed; however, the current verdict is that, just like Vitamin D and calcium, glucosamine works no better than a placebo.