In the past 5 years joint health supplements for human arthritis sufferers have received much attention in magazine articles, TV, newspapers, and human medical journals. The general informed public wants more than just relief from pain ...they are looking for restored function. There may not be any cures for degenerative joint disease with these supplements, but joint supplementation will improve function, enhance cartilage regeneration, and decrease inflammation when used regularly. They may also prevent or inhibit the disease process in a joint until the animal is much older.

The general acceptance of these products is growing because they work and have little or no side-effects. Current research and clinical trials demonstrate their effectiveness, and they will soon be part of the standard protocol recommended for the treatment of osteoarthritis by physicians and veterinarians.
What supplements work best? How do you combine them? What is the proper dosage? How long should you wait before you can expect to see results? What is actually happening to the diseased joint when you "feed it" these substances? Can you do harm?

I can answer these questions from my clinical experience of the past 30 years, researching the research, learning and studying herbology, nutrition, Chinese Medicine, acupuncture, trigger point therapy, massage, hydrotherapy, pain management, biochemistry and pharmacology. It is my "quest" or mission in life to help animals live a quality life without pain, and improve their longevity. Supplementation with appropriate substances is one way to achieve these goals.

The list of supplements I find very helpful in managing osteoarthritis and DJD in animals are: Glucosamines, MSM, Manganese, Selenium, Omega-3 EFA, Vitamins E & C, and chondroitin sulfates. Some lesser known constituents are the chondroitins from Perna mussel and sea cucumber. In use in Chinese medicine for 100's of years are the nourishing or "tonic"herbs, Angelica sinensis, Rehmannia glutinosa, and Polygonum multiflouri. What these substances provide is nutrition to the bones, cartilage matrix, and articular surfaces helping them to regenerate and heal more efficiently.

Let us review what supplements are in current favor and have shown benefits in the treatment of osteoarthritis and other forms of degenerative joint disease such as hip and elbow dysplasia, hock and stifle problems and spondylosis.

Glucosamines
Glucosamine is a natural substance which is the "building block" of glycosaminoglycans (GAGS) and glycoproteins in the ground substance of the articular cartilage. In vitro studies adding glucosamine sulfate to human chondrocytes have resulted in increased proteoglycan synthesis. The principal source of the carbon atoms of the glycosaminoglycan chains of the cartilage proteoglycans, such as the chondroitin sulfate chains, is from glucose. Glutamine is also important as the donor of the nitrogen group, and a key enzyme is glutamine:fructose-6-phosphate aminotransferase. It also incorporates sulfur into joint cartilage.

Repair of the cartilage matrix which is destroyed in arthritis needs the synthesis of glycosaminoglycans to produce proteoglycans before collagen deposition can occur7,2. These mucopolysaccharides, stimulate the repair of damaged cartilage by encouraging the anabolic metabolism of cartilage cells and by inhibiting the catabolic processes found in osteoarthritis. Long chain glycosaminoglycans have inhibitory processes against enzymes which result in degenerative joint disease. Glucosamine sulfate is not an analgesic but seems to relieve pain.

A recently published The Lancet study of over 3 years by Yves Reginster in Belgium showed radiographic evidence that glucosamine restored cartilage and joint space as opposed to the placebo group. Best results are seen after 4 weeks of supplementation. Glucosamine sulfate was used in 1500mg doses per day.
Glucosamine supplementation has produced a 95% response rate in human patients compared to 72% in patients taking nonsteroidal anti-inflammatory drugs. Daily doses of glucosamine salts at 1500 mg are standard. Glucosamine sulfate has been the drug of choice for treatment of osteoarthritis in Portugal, Spain and Italy since the early 1980s.

Many animal products contain glucosamine HCl. Research is divided on which is better. One should keep in mind that glucosamine must be converted to glucosamine sulfate to be used in GAG production. Hence, glucosamine sulfate is more efficacious since it avoids the sulfation step.

Side-effects? A small percentage of dogs will experience gastrointestinal irritation until they get used to the supplements and will exhibit signs of loose stools or diarrhea. In such animals, the dosage needs to be adjusted downwards or divided and administered in decreased amounts 2-3 times daily until the animals' system adapts to the supplement.

The possibility that glucosamine products could cause insulin resistance in diabetics is very remote and would require dosages of 7-10 X recommended dosages. In humans, dosages of up to 5 grams had no effect on blood sugar or insulin sensitivity.

Dosage? It takes several weeks before a symptomatic relief can be obtained.1 Clients need to be instructed to supplement 4-6 weeks before expecting clinical results. Dosages range from 5-10 mg per one lb of body weight in dogs and cats.

Chondroitins

The exact mechanism of action of chondroitin sulfate in osteoarthritis is not completely clear, but based upon experimental data, there are clearly three mechanisms that could be involved: 1) chondroitin sulfate does have anti-inflammatory properties; 2) it "upregulates" the synthesis of hyaluronate and cartilage proteoglycans; and 3 ) it inhibits some proteolytic enzymes such as collagenase, elastase and proteoglycanase and decreases the levels of reactive oxygen species. Regarding the various mechanisms involved in the development of osteoarthritis, chondroitin sulfate acts as a cellular and metabolic regulator that prevents most of the deleterious processes associated with the progression of the disease.

Oral chondroitin sulfate is an effective symptomatic treatment for knee, hip and finger OA in humans, and it alleviates both pain and functional limitation 2 to 3 months after initiation of therapy. At the initiation of the treatment, it can be combined with drugs such as aspirin if necessary. The use of nonsteroidal anti-inflammatory drugs in conjunction with chondroitin sulfate is generally not necessary according to one study10. Chondroitin is a major glycosaminoglycan present in articular cartilage, which blocks enzymes that may potentially destroy the cartilage.

What dosage and what form to use? Although the most common source of chondroitin is bovine or chicken cartilage, only10-25% of this will be absorbed. More readily absorbable forms of condroitins are present in the green lipped Perna mussel and the sea cucumber although these are generally more expensive to use. Using similar dosages of bovine or chicken sources, the Perna mussel and the sea cucumber seems to work quicker in the clinical cases I have seen. More research needs to be performed in this area. Low molecular weight (LMW) chondroitins as found in specially processed products (Cosequin) and those present in natural substances such as sea cucumber and perna mussel show better aborption rates in some studies.

In one rat study, it was found that a polysaccharide (glycogen) extracted from the Perna canaliculus and given i.v. demonstrated a dose dependent anti-inflammatory effect in rats with carrageenan- induced foot pad edema. Mobilization of neutrophils to the site of an inflammatory stimulus was also significantly reduced. If the glycogen extract was treated with KOH or proteinase K the anti-inflammatory activity was lost. This suggests that the anti- inflammatory activity resides within a protein moiety associated with the glycogen.

Minerals Manganese, Sulfur (MSM), Selenium

Sulfur is found mainly in muscles, skin, bones, nails and hair. It is an essential component of various compounds in the body including hormones, enzymes, antibodies, antioxidants, and is essential in the synthesis of collagen. Methionine is a sulfur-containing amino acid and is important in the maintenance of cartilage, especially proteoglycans and glycosaminoglycans. MSM (methyl-sulfonyl-methane) is an organic sulfur that is a naturally occurring substance in the living body. MSM and its related compounds - DMSO and dimethlysulfide- are the source of nearly all of the sulfur in humans, plants, and animals. MSM is essentially DMSO with an extra oxygen molecule, and as such isn't lipid-soluable like DMSO.

Robert Herschler was one of the pioneer investigators of DMSO and MSM, and first promoted these products to veterinarians primarily for use in horses. But is was Stanley Jacobs in the Department of Surgery at the Oregon Health Sciences University who began to do initial clinical investigation with MSM, after DMSO demonstrated some clinical problems, ie, skin irritation and foul odors.

MSM is considered very safe, and besides supplying the body with an easily absorbed sulfur molecules has anti-inflammatory and analgesic properties. Studies have shown that MSM helps improve joint flexibility and elasticity of connective tissues, reduces stiffness and swelling, improves circulation, reduces pain associated with arthritis, reduces scar tissue and breaks up calcium deposits that may be associated with arthritis with long term use. Because it "boosts" the absorption and availability of such substances as vitamin C, calcium and glucosamine, it can be found in combination formulas in human and animal joint products.

MSM (Methyl sulfonyl Methane)

Is a derivative of DMSO and organic form of sulfur that can be readily absorbed and utilized by the body. Sulfur is necessary for making collagen and is an important nutrient needed by the body for healthy connective tissue and joint function. MSM also acts as an analgesic and anti-inflammatory agent. In a double blind study of MSM'' impact on degenerative arthritis, it was found that, on average, there was an improvement in pain reductions by 82%. Since MSM can restore flexibility and permeability to cell walls, fluids pass more easily through tissue. Harmful substances, such as lactic acid and toxins are allowed to flow out, while nutrients are permitted to flow in. This prevents pressure build up in cells which otherwise would lead to inflammation.

An arthritis study conducted with humans and dogs concluded that MSM alone is excellent for pain relief. Moreover, when MSM is taken in conjunction with glucosamine, MSM not only relieves pain but can also help to repair worn or damaged cartilage in joints, ligament and tendons.

Although more investigation needs to be done, the dosages of MSM I have used in small animals has been: 5-20mg/lb/bdwt.

Manganese is an essential cofactor in the synthesis of glycosaminoglycans, by facilitating the process of transglycosylation and the synthesis of proteoglycans of the organic matrix of bone.

Selenium supplementation may down-regulate cytokine signaling, and with fish oil (omega-3) intake may reduce synovial interleukin-1 production, which may benefit osteoarthritis. This mineral is an anti-oxidant and works with Vitamins C & E to synthesize more of the antioxidant glutathione in the liver.

Vitamins

In human studies, Vitamin E at 600 units/day has shown benefit, possibly due to its membrane-stabilizing effect; this could also be due to its ability to inhibit the activities of the lysosomal enzymes and to stimulate increased deposition of proteoglycan. There is data suggesting vitamin E might be helpful to modulate the inflammatory phases of OA, mostly by decreasing the production of oxygen-free radicals.

Bone collagen synthesis also requires ascorbic acid. Vitamin C may be of benefit by stimulating collagen synthesis which counteracts the breakdown and forms the development of autoantibodies and/ or by stimulating glucocorticoid synthesis and secretion which depresses antigen-antibody complexes. Because of it's antioxidant properties, and synergistic effects when used with Vitamin E and Selenium, Vitamin C helps to protect joints from free radical damage.

How about SAMe?
S-adenosylmethionine is synthesized from methionine and in human trials has shown to be effective in treating symptoms associated with osteoarthritis through a mechanism similar to nonsteroidal anti-inflammatory medications.

S-adenosylmethionine (SAMe) upregulates the proteoglycan synthesis of chondrocytes, possibly by its functioning as a signal of sulfur availability. Interleukin-1 may reduce SAMe in chondrocytes and supplementation of SAMe may help reduce this deficit.

Recently, controversy was stirred-up over the correct effective dosage of SAMe for humans suffering with arthritis. Recent studies recommended 6 times the previous dose ( from 200mg to 1200mg bid ) and will cause consumers to pay 6 times the cost for an effective response. Therefore, this product is really not cost-effective for long term use in pets for this problem.

Plant flavones

Ipriflavone (7-isopropoxy-isoflavone) is one of the flavonoid compounds found in some plants, particularly alfalfa. This substance has been shown to prevent bone calcium loss induced by a mild calcium-restricted, vitamin D-deficient diet in rats. Ipriflavone has also been shown to be effective in immobilization- induced osteopenia.

Antioxidants

In a double blind study, the saponin extract of Yucca showed a positive therapeutic benefit. Cherries, Hawthorn berries and blueberries are rich sources of anthocyanidins and proanthocyanidins. These compounds are beneficial in enhancing collagen matrix integrity and structure.

Omega-3

One study in vitro, showed that incorporation of omega-3 fatty acids into articular cartilage chondrocyte membranes results in a dose-dependent reduction in: 1. the expression and activity of proteoglycan degrading enzymes and 2. the expression of inflammation-inducible cytokines and cyclooxygenase-2 (COX-2), but not the constitutively expressed COX-1. Omega-3 fatty acid supplementation can specifically affect regulatory mechanisms involved in chondrocyte gene transcription. Omega-3 fatty acid supplementation can affect molecular mechanisms that regulate the expression of catabolic factors involved in articular cartilage degradation.

Supplementing a pets' diet through omega-3 food sources as deep water fish..sardines, cod, ahi, menhaden or, plant oils such as flax and borage oils can be beneficial to controlling inflammation and repairing diseased joints .

Exercise

There is no doubt on the therapeutic value of exercise and weight reduction, which should always be recommended in patients suffering from osteoarthritis. Dogs who are overweight should be encouraged to walk at least 3….10 minute walks daily.

One study of 102 patients with documented primary osteoarthritis of one or both knees showed that exercising patients decreased medication use when compared to non exercising individuals.

The key is to overload the joint just enough to trigger adaptation, but not enough to cause degradation. There is evidence, according to one researcher, that following a regimen of three 10-20 minute walks a day decreases the amount of osteoarthritis.

Hydrotherapy for Dogs?

Some clinics are using hydrotherapy in the rehabilitation of arthritic dogs and horses in their clinics. Although time consuming, veterinarians not able to offer acupuncture, massage or chiropractic, may feel more comfortable offering this type of therapy for their patients. And it works.

In 10 subjects with osteoarthritis between 60 and 85 years of age with a duration of osteoarthritis of the hip, knee and lower back of 2 to 41 years, 6 weekly sessions of flotation spa therapy resulted in improvement in all patients. Flotation spa therapy involves lying in a pool 2.4 m x 1.2 m filled with a 250 mm depth of water heated to body temperature that is so densely saturated with magnesium sulfate (Epsom Salts) that floating takes no effort.

Injectables?

Polysulfated glycosaminoglycans have heparin-like activity. They increased the activated partial thromboplastin, prothrombin, activated clotting and bleeding times. This has been shown in dog models given 5 to 25 mg/kg per day. Administration to animals with a history of hypersensitivity, in shock or with bleeding tendencies should be avoided. According to the German Department of Health, 1 sudden death occurred after injection of a particular polysulfated glycosaminoglycan formulation of 250 mg/ml. Other side effects reported in human patients include joint effusion following intra- articular administration and other allergic reactions.

There is evidence that these agents are beneficial in the prevention and treatment of experimentally induced osteoarthritis and in canine hip dysplasia. These agents appear to be more effective in prophylactics than in the treatment of advanced osteoarthritis.

Conclusions

The functional use of Joint supplements (FNI) will greatly enhance your treatments with anti-inflammatory drugs, NSAIDS, and proceedures such as acupuncture, manipulation, TENS, ultrasound, and hydrotherapy.

The other advantage to their use is safety. These products are safer than the long term use of NSAIDS used for the treatment of osteoarthritis. These products will work IF, the pet owners can administer all these "pills" to their animals in correct dosages. But clients have a hard time giving more than three pills daily, and is why I decided to create a formula with the majority of what is needed all in one pill.

Do not forget exercise, massage therapy, and the elimination of Trigger Points (TPs). It was not the scope of this lecture to discuss TP Therapy but its importance has received very little "press". If TP's are not inactivated the animals will have a limited the range of motion, and most pain reduction medications are not designed to alleviate pain in these areas.

Review of Arthritis Treatment:

1.) Antioxidants (Use Genesis Antioxidant Support)

2.) Chondroprotective agents ( Use Genesis Joint Support Plust)

3.) Dietary Changes

Reduce free radical formation:

-Lower fat (found in commercial diets), high Omega-3.
-Lower protein but easily absorbed and digestible: organ meats, fresh raw meat, eggs, cottage cheese
-High in enzymes (raw veggies & fruits)
-Chemical free

4.) Pain control

-Acupuncture
-Trigger point inactivation
-Hydrotherapy
-Herbs: Boswellia, Yucca, Tang Kwei. Meadowsweet, Cornus, Ginger, Tumeric
-Drugs: use NSAIDS sparingly = side-effects = liver damage / delayed collagen synthesis

5.) Exercise plan

-Keep these animals moving
-Swimming 20 minutes 3 times a week
-Walks 10-20 minutes 3 times daily
-Massage therapy / hydrotherapy

Back to Top

Home | About | Pet Nutrition | Herbs | Acupuncture | Consultations | Pet Care Products | Newsletter | Pet Care Resources | Contact Us

All Creatures Great & Small, Inc.
P.O. Box 159 Kapaa, Kauai, Hawaii 96746
(808)822-4229 Telephone - (808)822-5229 Fax
E-mail: drbwavevet@hawaiilink.net
©2003 Ihor Basko, DVM

Website by: Emagine