The pain lozenge

Category Archives: Arthritis

Notes on joint pain.

Arthritis and Joint Pain Offer – Try Banjo for 2 months – Free

Do you have joint pain? Arthritis? If so, please consider taking advantage of our “sample survey” offer – you’ll receive a free, two month supply of Banjo in return for your feedback via three short surveys. (No cost – no gimmicks – we just want your honest feedback.) Banjo is an herbal lozenge that relieves…

Banjo for Ehlers-Danlos Pain and Fatigue

I’m looking for a few people (US residents only – sorry,) who might like to assist with a little Banjo ‘market research’. Free product in exchange for your assistance – just provide feedback via surveys. Banjo has proven effective at providing relief from pain and fatigue for some with Ehlers-Danlos syndrome. I would like to…

Osteoarthritis is not caused primarily by wear and tear

Osteoarthritis is a chronic, progressive disease characterized by inflammation in and around the joint space. Inflammation eventually results in damage to joint structures, especially the cartilage covering the end of each bone at the joint space.

Because osteoarthritis commonly makes its appearance late in life, it has often been called “wear and tear” arthritis. That term, however, is generally misleading. An actual tear or other damage to a joint component will increase the likelihood of later developing osteoarthritis and will speed the progression of osteoarthritis. But in the absence of such physical damage, moderate exercise is beneficial to the joint, as it reduces inflammation. If osteoarthritis was simply the result of normal use (e.g. “wear and tear”) then additional wear and tear would not be expected to have a beneficial effect.

Osteoarthritis: Socioeconomic impact basics

27 million Americans have osteoarthritis (OA). Direct medical costs resulting from OA total $185 billion a year in the U.S. insurers pay $149.4 billion patients pay $36.1 billion out-of-pocket Avg. woman: $1,400 a year Avg. man: $700 a year Osteoarthritis affects: 25-30% of persons aged 45-64 years 60% of persons older than 65 years Over…

Can a person have both EDS and fibromyalgia?

Recently heard about a geneticist who, several years after having first diagnosed a patient with Ehlers-Danlos syndrome, was then asked by that patient about a more recent diagnosis of fibromyalgia.

“Oh, fibromyalgia is just a symptom of EDS,” the geneticist is said to have replied.

So the question is, in the case of a patient with EDS, is it possible to make the distinct diagnosis of fibromyalgia?

Severe fatigue afflicts 75% of those with Ehlers-Danlos Syndrome

Fatigue, it seems, is a near constant companion of pain, which has led many to conclude that pain is the cause of fatigue.

It’s true of course that pain is ‘fatiguing’ – but it seems something else might be at work. Perhaps both pain and fatigue result from a form of mild, chronic inflammation.

It’s noteworthy that lupus patients, for example, often report that while pain abates during a remission, in many cases fatigue does not…

Raw, vegan diet for fibromyalgia, rheumatoid arthritis

Raw Vegetables Reduce Inflammation

In a nutshell ;-) those suffering with fibromyalgia or rheumatoid arthritis experienced a substantial improvement in their conditions when they switched to a raw, vegan diet. Specifically, they experienced a decrease in pain and stiffness and self-perception of their health was improved.

The problem, of course, is that this diet represents a substantial and some would say extreme departure from our ‘normal’ diet. A vegan diet includes no animal products whatsoever – no milk, eggs, butter. The “living food” diet studied here included only raw foods – no cooking whatsoever.

The obvious reality is that very few people will ever attempt such an extreme dietary modification, and fewer still will adhere to it. Nonetheless, it is one option, and might result in general improvement in conditions related to inflammation other than those specifically studied.

As an alternative, one might want to add more fruits and vegetables to the diet, especially fresh, raw fruits and vegetables. Supplements might be considered as well.

Chronic pain in Ehlers-Danlos syndrome

Ehlers-Danlos syndrome is actually a group of inherited connective tissue disorders believed to be caused by a genetic defect in collagen metabolism. Collagen is a critical component of various tissues throughout the body. It comprises an essential part of joints, ligaments, blood vessels, internal organs, skin and the inter-cellular matrix.

Up to ten different types of Ehlers-Danlos have been reported, each in theory associated with a unique defect in collagen metabolism. However, in 1997 a new classification system was introduced which defined six basic types of Ehlers-Danlos syndrome. The three most common (but still rare types) are the hypermobility type (formerly type 3), classical type (formerly types 1 and 2) and the vascular type (formerly type 4.) Even within a particular type, individual variability can be extreme, with symptom manifestation ranging from mild to severe.

Most patients are diagnosed based on clinical criteria, though precise diagnosis can sometimes be confirmed by genetic testing. The fact that patients with Ehlers-Danlos often have quite different symptoms…

Prevalence of joint pain in the United States

Number of Americans estimated to be living with arthritis or chronic joint pain:

1985 – 35 million

1990 – 37.9 million

1998 – nearly 43 million

2005 – 66 million: 42.7 million have doctor-diagnosed arthritis and 23.2 million people have chronic joint pain from another cause or that has not been diagnosed by a doctor.

2009 – 70 million

Ehlers-danlos syndrome, diffuse pain and chronic fatigue

Ehlers-danlos syndrome (EDS) is an inherited disorder of connective tissue. More specifically, EDS involves a defect in collagen production. It is reported that over 75% of those with EDS suffer with extreme, chronic fatigue. How does a defect in collagen production lead to chronic fatigue? Those with EDS, especially the hypermobility type (type 3), also…

NF-kapaB activation in joint leads to cartilage destruction

Cartilage destruction is a hallmark feature of osteoarthritis. It is associated with elevated production of basic fibroblast growth factor (bFGF) and matrix metalloproteinase-13 (MMP-13). In addition, it is reported in the study briefly summarized below that the ability of cartilage to heal is severely limited in the presence of bFGF.

MMP-13 was found to be elevated in large part due to over-activation of NF-kB. This may in part account for the observation that cartilage healing is severely limited when joints are inflammed, but may progress rapidly once joint inflammation is relieved.

Ginger extract reduces inflammation in arthritis

Ginger root extract was found to reduce inflammation in this study of cartilage cells in a pig model of arthritis.

Nitric oxide (NO) and prostaglandin-E2 (PGE2) were both reduced within 24 hours after application of ginger root extract. Both are key pro-inflammatory agents thought to be important in the pain and inflammation of arthritis.

It is suggested that ginger root extract may play an important role in the future treatment of arthritis.

Ginger an effective anti-inflammatory agent in arthritis

Ginger shown to reduce COX2 and tumor necrosis factor-alpha (TNF-alpha) – probably via inhibition of NF-kB.

Arthritis is characterized by joint inflammation that causes pain and results in cartilage destruction.

TNF-alpha plays a key role in the course and progression of arthritis. It is both a product and an activator of NF-kB. It is probably by means of this NF-kB activating effect that it leads to an increase in other pro-inflammatory cytokines as well as destructive enzymes – all of which means that TNF-alpha plays a central role in arthritis.

In the study summarized below, ginger was found to decrease the level of TNF-alpha while also reducing the level of pro-inflammatory cytokines and destructive enzymes.

A decrease in the level of activated NF-kB was also observed, which is the most likely mechanism by which ginger exerts its beneficial effects in arthritis.

Synergy of multiple NF-kappaB inhibitors

Turmeric (curcumin) and resveratrol found to act synergistically in the treatment of arthritis.

This is an essential publication because it demonstrates that by combining different natural inhibitors of NF-kB, a greater anti-inflammatory effect may be achieved than is possible with either agent alone. The study further suggests that this might be especially true when the different agents act to inhibit NF-kB through different mechanisms.

By implication, the observed synergy will not be limited to the specific combination studied (curcumin + resveratrol.)

Banjo combines a number of different natural NF-kB inhibitors, each of which may act through a slightly different mechanism in the inhibition of NF-kB. While many of the individual agents might provide some benefit, Banjo is expected to provide a substantially greater benefit than any single agent. That possibility is confirmed by the study briefly summarized below.

Moderate exercise reduces joint pain

NF-kB is the master switch controlling response to exercise.

This is really quite interesting. Somehow, moderate exercise – through the transmission of physical forces in your joints – leads to the inhibition of NF-kB. The result is a decrease in inflammation.

However, if instead of being subject to the mechanical stress of moderate exercise, your joints are instead subject to a higher magnitude of physical forces – those physical forces transmitted to the joint (e.g. knee) activate NF-kB.

NF-kB is truly the Master switch of inflammation. It’s even mediating inflammation or anti-inflammation effects in response to physical forces on the knee.

Subchondral bone inflammation in osteoarthritis

Active inflammatory processes were found to be ongoing in the subchondral bone (the bone underneath the collagen) of those with osteoarthritis.

The suggestion is offered that this ‘deeper’ inflammation may be responsible for some substantial portion of cartilage damage witnessed in osteoarthritis.

Genetics in osteoarthritis

In general, genetics play a weak role in the development of osteoarthritis.

The strongest genetic association is with FRZB – also known as “frizzled-related-protein-3″ – which is associated with hip osteoarthritis in women. Why might that be?

FRZB is an antagonist to (counter balances) the effects of the WNT pathway.

When there is a slight mutation at the gene coding for FRZB, the FRZB that the body produces is slightly defective – it does not do quite so good a job at inhibiting or counter-balancing WNT. Therefore, whatever WNT does – when FRZB is defective, WNT will do more of it. Got that?

What does WNT do? One thing it does is activate NF-kB.

So defective FRZB => more WNT activity => more NF-kB activity => hip osteoarthritis in women.

I have no idea why the hip – or why women.

Nitric oxide and NF-kappaB in osteoarthritis

The role of NO as either beneficial or detrimental in the arthritic joint has long been debated. NO appears to act in a very complex manner. However, the fact that it inhibits NF-kB and therefore serves an anti-inflammatoey roles suggests that NO inhibition may have detrimental effects in osteoarthritis.

CNS regulation of peripheral inflammation

CNS regulation of peripheral inflammation, implications in fibromyalgia?

The central nervous system (CNS = brain and spinal cord) can regulate peripheral inflammation, but the pathways and mechanisms by which it does so remain unclear.

The study summarized below investigates the possibility that the neurotransmitter acetylcholine (ACh) exerts an anti-inflammatory effect via binding to a specific receptor found primarily on the synovial lining of rheumatoid arthritis and osteoarthritis joints.

That possibility is confirmed by observations of reduced pro-inflammatory cytokine activity as a result of such binding.

While the authors suggest that the receptor identified in rheumatoid arthritis and osteoarthritis joints might be a potential target for drug development, I am curious if a similar mechanism might explain the connection between observed neurotransmitter abnormalities seen in fibromyalgia and the persistence of peripheral inflammation.

NF-kappaB controls harmful bone resorption in osteoarthritis

Excess activation of NF-kB leads to osteoclast over-activation and increased bone destruction in arthritis.

Healthy bone metabolism requires a balance between osteoclasts (break down and re-absorb bone) and osteoblasts (make new bone.)

Osteoclasts – the bone destroying cells – are over-active in many disease conditions that include bone destruction (such as osteoarthritis.)

In the study summarized below, it was found that excess NF-kB activation led to osteoclast over-activity.

The authors note that the NF-kB inhibitor parthenolide (a major active component in the herb feverfew) has shown a beneficial therapeutic effect in reducing inflammation induced bone destruction in a mouse model.

It is noted that NF-kB over-activation and associated osteoclast over-activity is also seen in Paget’s disease of bone, and periodontitis.

How fat cells can worsen arthritis

Osteoarthritis has been called “wear and tear” arthritis. But that’s somewhat misleading. Osteoarthritis results not from years of use, but from years of chronic, low grade inflammation.

Yes, mechanical stress (the pounding your knee joint takes every time you walk or run) does cause mild inflammation. But that inflammation would normally resolve quickly and entirely. When it doesn’t – when your body can’t entirely turn off the inflammation – chronic inflammation results.

Chronic, mild inflammation eventually progresses to chronic severe inflammation. Osteoarthritis results when that inflammation begins causing pain.

One reason your body might have trouble turning off the inflammation is “leptin.”

Enbrel may act to reduce inflammation through inhibition of NF-kappaB

Etanercept (Enbrel) inhibits NF-kB when used in the treatment of psoriatic arthritis. The immune system is extremely complex and includes many feedback loops (positive and negative) as well as much ‘cross talk’ between its various components. The relationship between NF-kB and TNF is defined (in part) by a positive feedback loop.

Glucosamine and chondroitin show a modest effect on pain and inflammation in osteoarthritis

Americans spend approximately $1 billion each year on various forms of glucosamine supplements, primarily for the treatment of osteoarthritis. Is that money well spent, or wasted?

Turmeric reduces pain and joint damage in rheumatoid arthritis

In rheumatoid arthritis the synovium becomes thickened and develops finger-like projections extending out into the joint space. This thickening process is called “hyperplasia,”and typically leads to pannus formation. Pannus means “flap” – and the pannus in rhuematoid arthritis contributes to the joint destruction characteristic of that disease.

Joint Pain and NF-kappaB

When treated with the NF-kB inhibitor early in the course of knee inflammation, or before it begins, the result is “total prevention” of the “hyperexcitability” of the neurons – taken to be an indication of pain signaling.

Gooseberry, a natural NF-kB inhibitor, may be useful for rheumatoid arthritis

Osteoclasts (OCs) are involved in several pathologies associated with bone loss, including rheumatoid arthritis, osteoporosis, bone metastasis of myeloma, osteosarcoma, and breast cancer.

In this review we determined the effects of natural compounds, including extracts from medicinal plants, on differentiation and survival of human primary osteoclasts.

NF-kappaB inhibition for rheumatoid arthritis and osteoporosis

Postmenopausal osteoporosis and rheumatoid joint destruction result from increased osteoclast formation and bone resorption that is under the control of NF-kB.

Puree of seahorse for arthritis

You don’t really need to grind up a seahorse to get relief from arthritis pain. Though it might be one way, it’s probably not the best way and definitely not the easiest way. NF-kB inhibitors are all around us.

Dandelion and turmeric in arthritis

Bone undergoes continuous remodeling through bone formation and resorption, and maintaining the balance for skeletal rigidity. Bone resorption and loss are generally attributed to osteoclasts. Osteoclast activity is inhibited by turmeric and dandelion, probably by means of NF-kB.