Dietrs for the joints: myths and reality

Dietrs for the joints: myths and reality

Content:

Part 1: Anatomy and joint physiology — the basis of understanding

1. The structure of the typical synovial joint:

   • Joint surfaces of the bones: evenness, congruence, adaptation.
   • Articular cartilage: hyaline cartilage, role of chondrocytes, matrix (type II collagen, proteoglycans), depreciation function, lack of vessels and nerves.
   • Synovial membrane: the production of synovial fluid, nutrition of cartilage, waste removal.
   • Synovial fluid: viscosity, hyaluronic acid, role in lubrication and nutrition.
   • Joint capsule: fibrous shell, strength, stabilization.
   • Blues: extracurricular and intra -articular, collagen, elastin, stabilization and restriction of movement.
   • Meniski (in the knee joint): fibrous cartilage, depreciation, stabilization, load distribution.
   • Muscles and tendons: dynamic stabilization, ensuring movement.
   • Burses: Filled with liquid bags, reduction of friction between tissues.

2. Joint functions:

   • Ensuring mobility and flexibility of the skeleton.
   • Depreciation and load distribution.
   • Stabilization bodies.
   • Participation in coordination of movements.

3. The mechanisms of the normal functioning of the articular cartilage:

   • Power supply through synovial fluid: diffusion of nutrients.
   • Mechanical stimulation of chondrocytes: synthesis and matrix update.
   • The balance between the synthesis and degradation of the cartilage: the role of matrix metalloproteinase (MMP) and MMP inhibitors (TIMP).
   • The role of hyaluronic acid in maintaining the viscosity of the synovial fluid and reducing friction.

4. Joint aging processes:

   • Reducing the synthesis of collagen and proteoglycans.
   • Reducing the number of chondrocytes.
   • Deterioration of the cartilage of cartilage.
   • Reducing the viscosity of synovial fluid.
   • The development of microtrauma and inflammation.
   • Weakening of ligaments and muscles.

5. Risk factors for the development of joint diseases:

   • Age: natural aging of the joints.
   • Genetic predisposition: hereditary weakness of cartilage or ligaments.
   • Injuries: damage to cartilage, ligaments, meniscus.
   • Excess weight: increased load on the joints.
   • Incorrect posture and flat feet: uneven load distribution.
   • Excessive physical activity: damage to cartilage and ligaments.
   • Sedentary lifestyle: deterioration in cartilage.
   • Autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus.
   • Infections: septic arthritis.
   • Metabolic disorders: gout.

Part 2: The most common joint diseases

1. Osteoarthrosis (OA):

   • Determination: degenerative joint disease, characterized by the destruction of cartilage.
   • Pathogenesis: violation of the balance between the synthesis and degradation of cartilage, inflammation, bone remodeling.
   • Symptoms: pain, stiffness, limitation of mobility, crunch in the joint.
   • Diagnostics: radiography, MRI, clinical inspection.
   • Treatment: non -drug methods (weight loss, physiotherapy, exercises), drug methods (analgesics, NSAIDs, chondroprotectors, intra -articular injections), surgical treatment (endoprosthetics).

2. Rheumatoid arthritis (RA):

   • Determination: Autoimmune disease that affects the joints.
   • Pathogenesis: The immune system attacks the synovial shell, causing inflammation and destruction of the joint.
   • Symptoms: pain, stiffness, swelling, redness of the joints, symmetrical damage to the joints, general weakness, fever.
   • Diagnostics: blood test (rheumatoid factor, antibodies to the cyclic citrollinized peptide (ACCP)), radiography, MRI, clinical inspection.
   • Treatment: drug methods (basic anti-inflammatory drugs (BPVP), genetically engineering biological drugs (GIBP), glucocorticosteroids), physiotherapy, surgical treatment.

3. Gout:

   • Determination: a disease caused by the accumulation of uric acid crystals in the joints.
   • Pathogenesis: violation of uric acid metabolism, deposition of crystals in the joints, inflammation.
   • Symptoms: acute pain, redness, swelling of the joint, usually the thumb of the foot.
   • Diagnosis: blood test (uric acid level), synovial test analysis (detection of uric acid crystals), radiography, clinical examination.
   • Treatment: drug methods (NSAIDs, Colchicin, drugs that reduce uric acid levels), diet, plentiful drink.

4. Bursit:

   • Definition: inflammation of the brush.
   • Pathogenesis: injury, overload, infection.
   • Symptoms: pain, swelling, restriction of movement in the area of ​​Bource.
   • Diagnostics: clinical inspection, ultrasound, MRI.
   • Treatment: peace, ice, NSAIDs, injections of corticosteroids, antibiotics (for infection), physiotherapy.

5. Tendinitis and Tendinosis:

   • Definition: nasal (tendonitis) or degenerative changes (tendinosis) tendons.
   • Pathogenesis: overload, trauma, repeated movements.
   • Symptoms: pain, traffic restriction in the tendon.
   • Diagnostics: clinical inspection, ultrasound, MRI.
   • Treatment: peace, ice, NSAIDs, physiotherapy, corticosteroid injections, surgical treatment.

Part 3: Review of popular dietary supplements for joints and their composition

1. Glucosamine:

   • Chemical structure: aminosahar, component of glycosaminoglycans (GAG), which are part of the cartilage.
   • The mechanism of action (alleged): stimulation of the synthesis of the Gag and collagen, inhibiting enzymes that destroy cartilage, anti -inflammatory effect.
   • Release Forms: Sulfate Glucosamina, Glucosamine Hydrochloride, N-Achetilukozamin.
   • Recommended doses.
   • Side effects: nausea, diarrhea, constipation, allergic reactions.
   • Interactions with drugs.
   • Clinical studies: effectiveness for osteoarthritis, conflicting results. Review of major studies (Gait, Legs). Analysis of research methodology and interpretation of results.
   • Myths and reality: evidence of effectiveness, comparison with placebo, the impact on the progression of osteoarthrosis.

2. Chondroitin:

   • Chemical structure: sulfate GAG, component of the cartilage matrix.
   • The mechanism of action (alleged): keeping water in cartilage, stimulation of the synthesis of the Gag and collagen, inhibiting enzymes that destroy cartilage, anti -inflammatory effects.
   • Forms of release: chondroitin sulfate.
   • Recommended doses.
   • Side effects: nausea, diarrhea, constipation, allergic reactions.
   • Interactions with drugs.
   • Clinical studies: effectiveness for osteoarthritis, conflicting results. Review of major studies (Gait, Sekoia). Analysis of research methodology and interpretation of results.
   • Myths and reality: evidence of effectiveness, comparison with placebo, the impact on the progression of osteoarthrosis.

3. Glucosamine and chondroitin in combinations:

   • Substantiation of combined use: synergistic effect.
   • Clinical studies: the effectiveness of combination for osteoarthritis, conflicting results. Review of major studies (Gait). Analysis of research methodology and interpretation of results.
   • Myths and reality: evidence of the effectiveness of the combination, comparison with monotherapy, the impact on the progression of osteoarthrosis.

4. Hyaluronic acid (Civil Code):

   • Chemical structure: GAG, the main component of the synovial fluid.
   • The mechanism of action (alleged): improvement of the viscosity of the synovial fluid, decrease in friction in the joint, anti -inflammatory effect, stimulation of the synthesis of the GAG.
   • Forms of release: oral capsules, intra -articular injections.
   • Recommended doses (orally).
   • Side effects (orally): nausea, diarrhea, constipation, allergic reactions.
   • Interactions with drugs.
   • Clinical studies: effectiveness for osteoarthritis, conflicting results. Analysis of oral -form research.
   • Myths and reality: evidence of the effectiveness of the oral form, comparison with the placebo, the mechanism of action after the oral administration.

5. MSM (methyl sulfonylmetatan):

   • Chemical structure: organic sulfur -containing compound.
   • The mechanism of action (alleged): anti -inflammatory action, antioxidant action, participation in the synthesis of collagen.
   • Recommended doses.
   • Side effects: nausea, diarrhea, constipation.
   • Interactions with drugs.
   • Clinical studies: effectiveness for osteoarthritis, limited data.
   • Myths and reality: evidence of effectiveness, mechanism of action.

6. Collagen:

   • Chemical structure: protein, main component of cartilage, bones, ligaments, tendons.
   • Types of collagen: type I collagen (bones, tendons, ligaments), type II collagen (cartilage).
   • The mechanism of action (alleged): Providing building blocks for the synthesis of your own collagen, anti -inflammatory effect.
   • Forms of release: hydrolyzed collagen (peptides of collagen), non-reinvented type II collagen (UC-II).
   • Recommended doses.
   • Side effects: nausea, diarrhea, constipation.
   • Interactions with drugs.
   • Clinical studies: effectiveness for osteoarthritis, conflicting results. Analysis of studies of various types of collagen.
   • Myths and reality: evidence of effectiveness, mechanism of action, differences between the types of collagen.

7. Boswelia (Boswellia Serrata):

   • Chemical composition: Bosvevel acids.
   • The mechanism of action (alleged): inhibiting the enzyme 5-lipoxygenase, a decrease in inflammation.
   • Recommended doses.
   • Side effects: nausea, diarrhea.
   • Interactions with drugs.
   • Clinical studies: effectiveness for osteoarthritis, limited data.
   • Myths and reality: evidence of effectiveness, mechanism of action.

8. Kurkuma (Curcuma longa):

   • Chemical composition: curcumin.
   • The mechanism of action (alleged): anti -inflammatory action, antioxidant effect.
   • Recommended doses.
   • Side effects: nausea, diarrhea.
   • Interactions with drugs.
   • Clinical studies: effectiveness for osteoarthritis, limited data. Problems with the bioavailability of curcumin and methods for solving them (piperin, liposomes).
   • Myths and reality: evidence of effectiveness, mechanism of action, bioavailability.

9. Omega-3 fatty acids:

   • Types of omega-3: EPA (eicopascentenoic acid), dha (nonsenseic acid).
   • The mechanism of action (alleged): anti -inflammatory action.
   • Recommended doses.
   • Side effects: fish belching, diarrhea, blood thinning.
   • Interactions with drugs (anticoagulants).
   • Clinical studies: effectiveness for rheumatoid arthritis, limited data for osteoarthritis.
   • Myths and reality: evidence of effectiveness, mechanism of action.

10. Vitamin D:

    • The role in the health of bones and joints: regulation of the metabolism of calcium and phosphorus, maintaining muscle strength.
    • Recommended doses.
    • Side effects: hypercalcemia.
    • Interactions with drugs.
    • Clinical studies: the relationship between vitamin D deficiency and the risk of osteoarthrosis, the role in the prevention of falls and fractures.
    • Myths and reality: evidence of effectiveness, mechanism of action.

11. Avocado and soy oil inequipped compounds (ASU):

    • The mechanism of action (alleged): anti -inflammatory action, stimulation of collagen synthesis, inhibition of enzymes that destroy cartilage.
    • Recommended doses.
    • Side effects.
    • Interactions with drugs.
    • Clinical studies: effectiveness for osteoarthritis, limited data.
    • Myths and reality: evidence of effectiveness, mechanism of action.

Part 4: Evaluation of the effectiveness and safety of dietary supplements

1. Clinical research methodology:

   • Randomized controlled studies (RCTs): Gold Standard.
   • Double blind placebo-controlled research: elimination of subjectivity.
   • Meta-analyzes and systematic reviews: combining data of several studies.
   • Study quality assessment: GRADE criteria, COCHRANE RISK of BIAS TOOL.

2. Problems with the quality of dietary supplements:

   • Lack of production standardization.
   • The inconsistency of the composition declared on the label.
   • The presence of impurities and pollutants.
   • The risk of falsification.
   • Lack of control by state bodies in some countries.

3. Risk and benefit assessment:

   • Assessment of individual factors: age, health status, the presence of related diseases, drugs taken.
   • Consultation with a doctor: discussion of potential risks and benefits, receiving individual recommendations.
   • Side effects monitoring: attentive observation of your condition, timely seeking a doctor in case of undesirable reactions.

4. The importance of an integrated approach:

   • Bad as an addition to the main treatment.
   • The importance of non -drug methods: weight loss, physiotherapy, exercises, proper nutrition.
   • The need to see a doctor for the diagnosis and treatment of joint diseases.

5. Recommendations for the choice of dietary supplements:

   • The choice of products of famous and reliable manufacturers.
   • Checking the availability of quality certificates (GMP, NSF).
   • Reading reviews and reviews.
   • Appeal to the doctor or pharmacist to receive recommendations.

Part 5: Alternative and additional methods of treating joint diseases

1. Non -drug methods:

   • Weight loss: reduction of the load on the joints.
   • Physiotherapy: Improving mobility and muscle strength.
   • Media physical education (exercise therapy): muscle strengthening, joint stabilization, improvement of coordination.
   • Orthes and bandages: joint stabilization, pain reduction.
   • Cane or crutches: unloading of the joints.
   • Heat and cold: reduction of pain and inflammation.
   • Massage: Improving blood circulation, muscle relaxation.
   • Acupuncture: stimulation of biologically active points, pain reduction.

2. Medication methods (traditional medicine):

   • Analgesics: anesthesia.
   • NSAIDs (non -steroidal anti -inflammatory drugs): a decrease in pain and inflammation.
   • Corticosteroids: strong anti -inflammatory action.
   • Intra -articular injections of hyaluronic acid: improvement in the viscosity of synovial fluid.
   • Intra -articular injections of corticosteroids: reduction of inflammation.
   • BPVP (basic anti -inflammatory drugs): for the treatment of rheumatoid arthritis.
   • GibPP (genetically engineering biological drugs): for the treatment of rheumatoid arthritis.

3. Surgical treatment:

   • Arthroscopy: the minimum invasive operation for the diagnosis and treatment of joint damage.
   • Actoprosthetics of the joint: replacing the damaged joint artificial.

4. Food and joint diseases:

   • Anti -inflammatory diet: restriction of consumption of processed products, sugar, red meat, an increase in the consumption of vegetables, fruits, fish, olive oil.
   • The role of antioxidants: cell protection from damage by free radicals.
   • The importance of maintaining a healthy weight.
   • Products useful for joints: fish, rich omega-3, vegetables and fruits rich in antioxidants, olive oil.
   • Products harmful to the joints: processed products, sugar, red meat.

5. Psychological support:

   • The influence of chronic pain on the mental state.
   • The importance of psychological support and counseling.
   • Pain control methods: relaxation, meditation, cognitive-behavioral therapy.

Part 6: Scientific research and evidence base

1. Analysis of key research on the effectiveness of dietary supplements for joints:

   • A detailed analysis of research design, methodology, results and conclusions.
   • Assessment of the statistical significance and clinical significance of the results.
   • Criticism of research: identification of weaknesses, bias, restrictions.
   • Review of meta analyzes and systematic reviews: Summarizing the data of several studies.

2. Review of authoritative organizations and their recommendations:

   • American Academy of Orthopedic Surgeons (AAOS).
   • European League against Rheumatism (EULAR).
   • National Institute of Health (NIH).
   • Other authoritative organizations.

3. Dietary supplement mechanisms: scientific explanations:

   • A detailed description of the biochemical processes underlying the alleged action of dietary supplements.
   • The role of enzymes, cytokines, inflammation mediators.
   • The impact on the synthesis and degradation of the cartilage.
   • Influence on the immune system.

4. Pharmacokinetics and bioavailability of dietary supplements:

   • How dietary supplements are absorbed, distributed, metabolized and excreted from the body.
   • The influence of various factors on bioavailability: form of release, composition, individual characteristics of the body.
   • Methods of increasing bioavailability: liposomes, piperin, micronization.

5. Future research areas:

   • Search for new dietary supplements and combinations of dietary supplements.
   • The study of the effect of dietary supplements on the progression of joint diseases.
   • A personalized approach to the treatment of joint diseases.
   • Development of more effective and safe dietary supplements.
   • The study of the role of intestinal microbiots in joint health.

Part 7: Legal and ethical aspects of the use of dietary supplements

1. Regulation of dietary supplements in Russia and other countries:

   • Differences in the legislation of different countries.
   • Requirements for registration and certification of dietary supplements.
   • Quality and safety control of dietary supplements.
   • Responsibility of manufacturers and sellers of dietary supplements.

2. Advertising of dietary supplements: ethics and truthfulness:

   • Restrictions on dietary supplements.
   • A ban on the introduction of consumers.
   • The problem of unreasonable statements about effectiveness.
   • The role of doctors and pharmacists in informing patients.

3. The problem of self -medication and responsibility:

   • Risks of self -medication of dietary supplements.
   • The importance of consulting a doctor.
   • The patient’s responsibility for his health.

4. Interaction with a doctor: how to discuss the use of dietary supplements:

   • Preparation for a conversation with a doctor.
   • Providing complete information about the dietary supplements.
   • Discussion of potential risks and benefits.
   • Obtaining individual recommendations.

5. The role of the pharmacist in counseling in dietary supplements:

   • The pharmacist as a source of information about dietary supplements.
   • Help in choosing a quality product.
   • Caution of possible side effects and interactions.

Part 8: FAQ — frequently asked questions

1. What are the most effective dietary supplements for osteoarthritis?
2. Is it safe to take glucosamine and chondroitin for a long time?
3. Can dietary supplements replace medicines for joint diseases?
4. What dietary supplements are contraindicated in kidney or liver diseases?
5. Do dietary supplements affect the results of blood tests?
6. How to choose a quality dietary supplement?
7. How to find out if dietary supplements help me?
8. Can arthritis cure dietary supplements?
9. Is it worth taking dietary supplements for the prevention of joint diseases?
10. What to do if side effects have appeared after the dietary supplement?

Part 9: Glossary Terms

• Arthritis
• Osteoarthritis
• Rheumatoid arthritis
• Gout
• Bursit
• Tendonitis
• Tendonosis
• Chondrocytes
• Colenen
• Proteoglyca
• Glucosamine
• Chondroitin
• Hyaluronic acid
• MSM
• Boswelia
• Turmeric
• Omega-3 fatty acids
• Vitamin D.
• Avocado and soybean oil inelated compounds (ASU)
• NSAID
• Bppoft
• GIBP
• Arthroscopy
• Endoprosthetics
• Placebo
• Rki
• Meta analysis
• Systematic review
• Bioavailability
• Pharmacokinetics

Part 10: List of literature (examples)

• Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006;354(8):795-808.
• Hochberg MC, Martel-Pelletier J, Monfort J, et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2016;75(1):37-44.
• McAlindon TE, LaValley MP, Gulin J, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000;283(11):1469-75.
• Towheed TE, Maxwell L, Anastassiades TP, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2005;(2):CD002946.

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