Osteoarthritis: Nutrition and lifestyle intervention

Abstract

Osteoarthritis (OA) is a chronic and common musculoskeletal disease that affects a significant portion of the population, particularly with age. It is characterized by cartilage degeneration and new bone formation at joint margins, leading to pain and stiffness. Although OA was once considered a passive process of joint wear and tear, it has now been recognized as a metabolically active process. Several factors can contribute to OA, including age, sex, ethnicity, genetic profile, hormonal status, bone mineral density, and lifestyle factors, such as obesity, joint injuries and deformities, sports participation, muscle weakness, and occupational factors. Currently, there is no known cure for OA. OA management focuses on reducing pain and maintaining or improving joint functions. Pharmacological and nonpharmacological treatments are available for OA. Nonpharmacological treatments include exercise, patient education, telephone support, and weight reduction, all of which are safe and effective interventions. However, dietary and lifestyle interventions have received insufficient attention. Therefore, this review aims to highlight the importance of nutritional and lifestyle interventions in the management of OA, particularly knee osteoarthritis.

References

1. Jones A, Doherty M. ABC of Rheumatology: Osteoarthritis, Br. Copper. J., 310(6977): 457–460,1995.
2. Mathers, C. D., Vos, E. T., Stevenson, C. E. and Begg, S. J., The Australian Burden of Disease Study: Measurement of health loss due to diseases, injuries, and risk factors, Med. J. Aust., 172: 592–596, 2000.
3. Australian Bureau of Statistics, National Health Survey, AGPS, Canberra, 2000.
4. World Health Organization. 1997.
5. Hogue, J.H. and Mersfelder, T.L., Pathophysiology and first-line treatment of osteoarthritis, Ann.Pharmacotherapy, 36(4): 679–686, 2002.
6. Birchfield, P.C. Osteoarthritis Review. Geriatr. Nurs., 22(3): 124–130, 2001.
7. Manek, N.J. and Lane, N.E., Osteoarthritis: current concepts in diagnosis and treatment, Am Fam Physician, 61(6):1795–1804, 2000.
8. Felson, D.T. and Zhang, Y., An update on the epidemiology of knee and hip osteoarthritis with a view for prevention, Arthritis Rheum., 41(8):1343–1355, 1988.
9. Felson, D.T.; Lawrence, R.C.; Dieppe, P.A.; Hirsch, R.; Helmick, C.G.; Jordan, J.M.; et al. Osteoarthritis: a new observation. Part 1: Disease and its risk factors Ann. Intern. Med., 133(8): 635-646, 2000.
10. Manninen, P., Riihimaki, H., Heliovaara, M., Makela, P., Overweight, sex and knee osteoarthritis, Int. J. Obesity, 20: 595–597, 1996.
11. Felson, D.T., Zhang, Y., Hannan, M.T., Naimark, A., Weissman, B., Aliabadi, P., and Levy, D., Risk factors for incident radiographic osteoarthritis of the knee in the elderly: the Framingham Study, Arthritis Rheum., 40(4): 728–733, 1997.
12. Spector T.D., Hart, D.J. and Doyle, D.V., Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: influence of obesity, Ann. Rheumatism. Dis., 53: 565–568,1994.
13. Sandmark H., Hogstedt C., Lewald S., et al.: Osteoarthritis of the knee in men and women in association with overweight, smoking, and hormone therapy. Ann. Rheumatism. Dis., 58(3): 151–155, 1999.
14. Dougados, M., Gueguen, A., Nguyen, M., Thiesce, A., Listrat, V., Jacob, L., Nakache, J.P., Gabriel, K.R., Lequesne, M., and Amor, B., Longitudinal radiological evaluation of osteoarthritis of the knee, J. Rheumatol., 19: 378-383, 1992.
15. Schouten J.S., van den Ouweland F.A., Valkenburg H.A.: A 12-year follow-up study in the general population on prognostic factors of cartilage loss in knee osteoarthritis. Ann. Rheumatism. Dis., 51: 932-937, 1992.
16. Saville, P.D. and Dickson, J., Age and weight in osteoarthritis of the hip, Arthritis Rheum., 11: 635–644, 1968.
17. Tepper S., Hochberg M.C.. Factors associated with hip osteoarthritis: Data from the First National Health and Nutrition Examination Survey (NHANES-1). Am. J. Epidemiol., 137: 1081-1088, 1993.
18. Van Sasse, J.L., Vandenbroucke, J.P., van Romunde, K.J., and Valkenburg, H.A., Osteoarthritis, and obesity in the general population: a relationship in need of explanation, J. Rheumatol., 15: 1152–1158, 1988.
19. Creamer, P. and Hochberg, M.C., Osteoarthritis, Lancet, 16: 350(9076): 503–508, 1997.
20. Kee C.C. Osteoarthritis: A manageable scourge for aging. Nurs. Clin. N. Am., 35(1): 199–208, 2000.
21. Nevitt, M.C., Lane, N.E., Scott, J.C., Hochberg, M.C., Pressman, A.R., Genant, H.K., and Cummings, S.R. Radiographic osteoarthritis of the hip and bone mineral density. Osteoporosis study Fractures Research Group, Arthritis Rheum., 38:907-916, 1995.
22. Hannan, M.T., Anderson, J.J., Zhang, Y., Levy, D., and Felson, D.T., Bone mineral density and knee osteoarthritis in elderly men and women: the Framingham study, Arthritis Rheum., 36: 1671–1680, 1993.
23. Sowers, M., Lachance, L., Jamadar, D., Hochberg, M.C., Hollis, B., Crutchfield, M., and Jannausch, M.L., Association of bone mineral density and markers of bone turnover with osteoarthritis hand and knee in pre-and perimenopausal women, Arthritis Rheum., 42: 483–489, 1999.
24. Zhang, Y., Hannan, M.T., Chaisson, C.E., McAlindon, T.E., Evans, S.R., Aliabadi, P., Levy, D., and Felson, D.T., Bone mineral density and the risk of incidental and progressive radiographic osteoarthritis of the knee in women: the Framingham study, J. Rheumatol., 27: 1032–1037, 2000.
25. Sowers M. Epidemiology of osteoarthritis risk factors: Systemic factors. Curr. Opin. rheumatol., 13(5): 447–451, 2001.
26. Nevitt, M.C., Cummings, S.R., Lane, N.E., Hochberg, M.C., Scott, J.C., Pressman, A.R., Genant, H.K. and Cauley, J.A., Association of estrogen replacement therapy with risk of osteoarthritis hip in older white women, Arch. Intern. Med., 156: 2073-2080, 1996.
27. Hannan, M.T., Felson, D.T., Anderson, J.J., Naimark, A., and Kennel, W.B., Estrogen use and radiographic osteoarthritis of the knee in women: the Framingham Osteoarthritis Study, Arthritis Rheum.,33: 525-532, 1990.
28. Samanta, A., Jones, A., Regan, M., Wilson, S., Doherty, M. Is osteoarthritis in women affected by hormonal changes or smoking? Bro. J. Rheumatol., 32: 366-370, 1993.
29. Spector, T. D., Nandra, D., Hart, D. J., and Doyle, D. V. Is hormone replacement therapy protective against osteoarthritis of the hands and knees in women?: the Ching Ford study. Ann. Rheumatism. Dis., 56: 432–434, 1997.
30. Vingard E., Alfredsson, L. and Malchau, H., Lifestyle factors and osteoarthritis of the hip: a case-reference study body mass index, smoking, and hormone therapy in 503 Swedish women. Acta. Arthop. Scand., 68: 216-220, 1997.
31. Oliveria, S.A., Felson, D.T., Klein, R.A., Reed, J.I., and Walker, A.M., Estrogen replacement therapy and development of osteoarthritis, Epidemiology, 7: 415–419, 1996.
32. Maetzel A, Makela M., Hawker G., Bombardier C., Osteoarthritis of the hip and knee and mechanical occupational exposure: A systematic review of the evidence. J. Rheumatol., 24: 1599–1607, 1997.
33. Coggon, D., Croft, P., Kellingray, S., Barrett, D., McLaren, M. and Cooper, C., Occupational Physical activities and osteoarthritis of the knee, Arthritis Rheum., 43: 1443–1449, 2000.
34. Jensen, L.K., Mikkelsen, S., Loft, I.P., Eenberg, W., Bergmann, I., and Logager, V., Radiographic osteoarthritis of the knee in floor men and carpenters. Scand. J. Work environment. Health, 26: 257–262, 2000.
35. Sandmark H., Hogstedt C., Vingard E., Primary osteoarthritis of the knee in men and women as a result of a lifetime of physical strain from work. J. Work environment. Health, 26: 20–25, 2000.
36. Lau, E.C., Cooper, C., Lam, D., Chan, V.N., Tsang, K.K., Sham, A., Factors associated with hip and knee osteoarthritis in Hong Kong Chinese: obesity, joint injury, and occupation activities, Am. J. Epidemiol., 152: 855-862, 2000.
37. Yoshimura, N., Sasaki, S., Iwasaki, K., Danjoh, S., Kinoshita, H., Yasuda, T., Tamaki, T., Hashimoto, T., Kellingray, S., Croft, P., Coggon, D., Cooper, C. Occupational lifting is associated with hip osteoarthritis: A Japanese case-control study. Rheumatol., 27: 434–440, 2000.
38. Sowers M.F., Lachance L., Vitamins, arthritis: the role of vitamins A, C, D, and E, Rheum. Dis. Clin. N. Am., 25: 315-332, 1999.
39. 39. McAlindon, T.E., Jacques, P., Zhang, Y., Hannan, M.T., Aliabadi, P., Weissman. B., Rush, D., Levy, D. and Felson, D.T. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum., 39(4): 648–56, 1996.
40. McAlindon, T.E., Felson, D.T., Zhang, Y., Hannan, M.T., Aliabadi, P., Weissman, B., Rush, D., Wilson, P.W., and Jacques, P., Relationship of dietary intake and serum vitamin D levels to progression osteoarthritis of the knee among participants in the Framingham Study, Ann. Intern. Med., 125(5): 353–359, 1996.
41. Lane, N. E., Gore, L. R., Cummings, S. R., Hochberg, M. C., Scott, J. C., Williams, E. N., and Nevitt, M. C. Serum vitamin D levels and incident changes in radiographic coxarthrosis: a longitudinal study. Study of Osteoporotic Fractures Research Group, Arthritis Rheum 42(5):854–860, 1999.
42. Bischoff, H., Stahelin, H., Dick, W., Akos, R., Knecht, M., Salis, C., Nebiker, M., Theiler, R., Pfeifer, M., Begerow, B., Lew, R., and Conzelmann, M., Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial, J. Bone Miner. Res., 18: 343-351, 2003.
43. Machtey, I. and Ouaknine, L., Tocopherol in Osteoarthritis: A controlled pilot study, J. Am. Geriatrician. Soc., 26(7):328-330, 1978.
44. Felson, D. T. and Lawrence, R. C., Hochberg, M. C., McAlindon, T., Dieppe, P.A., Minor, M.A., Blair, S.N., Berman, B.M., Fries, J.F., Weinberger, M., Lorig, K.R., Jacobs, J.J., Goldberg, V., Osteoarthritis: New Insights, Part 2: Treatment Approaches, Ann. Intern. Med., 133: 726-737, 2000.
45. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines, Recommendations for the medical management of osteoarthritis of the hip and knee, 2000 update, Arthritis Rheum, 43:1905–1915, 2000.
46. Puett, D. W. and Griffin, M. R. Published studies on non-medical and non-invasive therapies for hip and knee osteoarthritis Med., 121: 133-140, 1994.
47. American Geriatrics Society Panel on Exercise and Osteoarthritis, Exercise Prescription for the Elderly adults with osteoarthritis pain: Consensus practice recommendations, J. Am. Geriatrician. Soc., 49(6): 808-823, 2001.
48. Slemenda, C., Brandt, K.D., Heilman, D.K., Mazzuca, S., Braunstein, E.M., Katz, B.P., and Wolinsky, F.D., Quadriceps weakness and osteoarthritis of the knee, Ann. Intern. Med., 127(2): 97-104, 1997.
49. Van Baar, M.E., Assendelft, W.J., Dekker, J., Oostendorp, R.A., Bijlsma, J.W. Effectiveness of exercise therapy in patients with hip or knee osteoarthritis: systematic review of randomized clinical trials. A systematic review of a randomized clinical trial. Arthritis Rheum, 42:1361–1369, 1999.
50. Chamberlain M.A., Care G., Harfield B., Physiotherapy in osteoarthritis of the knee: a controlled trial of hospital versus home exercises. Int. Rehabilitated. Med., 4(2): 101-106, 1982.
51. Minor, M.A., Hewett, J.E., Webel, R.R., Anderson, S.K. and Kay, D.R., Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis, Arthritis Rheum., 32: 1396–1405, 1989.
52. Jan M.H., Lai J: Effects of physiotherapy on osteoarthritis knees in women. Formos. Copper. Assoc., 90(10): 1008–1013, 1991.
53. Kovar, P.A., Allegrante, J.P., MacKenzie, C.R., Peterson, M.G., Gutin, B., and Charlson, M.E., Supervised fitness walking in patients with knee osteoarthritis, Ann. Intern. Med., 116: 529–534, 1992.
54. Borjesson, M., Robertson, E., Weidenhielm, L., Mattsson, E., Olsson, E. Physiotherapy in knee osteoarthritis: effect on pain and walking, Physiother. Res. Intern., 1: 89–97, 1996.
55. Schilke, J.M., Johnson, G.O., Housh, T.J., and O’Dell, J.R., Effects of muscle strength training on the functional status of patients with osteoarthritis of the knee joint, Nurs. Res., 45: 68-72, 1996.
56. Ettinger, W.H., Jr., Burns, R., Messier, S.P., Applegate, W., Rejeski, W.J., Morgan, T., Shumaker, S., Berry, M.J., O’Toole, M., Monu, J., and Craven, T., A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis: Fitness Arthritis and Seniors Trial (FAST), JAMA 277:25–31, 1997.
57. Bautch, J.C., Malone, D.G., and Vailas, A.C., Effects of exercise on knee osteoarthritis: a pilot study of biological markers, Arthritis Care Res., 10: 48–55, 1997.
58. Van Baar, M.E., Dekker, J., Oostendorp, R.A., Bijl, D., Voorn, T.B., Lemmens, J.A., Bijlsma, J.W., Efficacy of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial, J. Rheumatol., 25: 2432–2439, 1998.
59. Rogind H., Bibow-Nielsen B., Jensen B., Moller H.C., Frimodt-Moller H., Bliddal H. Effects of a physical training program on patients with knee osteoarthritis. Arch. Phys. Copper. Rehab., 79(11): 1421–1427, 1998.
60. Mangione, K.K., McCully, K., Gloviak, A., Lefebvre, I., Hofmann, M., Craik, R., The effects of high- and low-intensity cycle ergometry in older adults with knee osteoarthritis, J. Gerontol., 54: M184–M190, 1999.
61. Maurer, B.T., Stern, A.G., Kinossian, B., Cook, K.D., Schumacher, H.R. Jr., Osteoarthritis of the knee: isokinetic quadriceps exercise versus educational intervention, Arch. Phys. Copper. Hospital., 80(10): 1293–1299, 1999.
62. O’Reilly, S.C., Muir, K.R. and Doherty, M. Effectiveness of home exercise on pain and disability of osteoarthritis of the knee: A randomized controlled trial. Ann. Rheumatism. Dis., 58: 15-19, 1999.
63. Deyle, G. D. and Henderson, N. E., Matekel, R. L., Ryder, M. G., Garber, M. B., and Allison, S. C., Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled court, Ann. Intern. Med., 132: 173-181, 2000.
64. Petrella, R. J., Bartha, C. Home exercise therapy for elderly patients with knee osteoarthritis: a randomized clinical trial. J. Rheumatol., 27: 2215–2221, 2000.
65. McCarberg B.H., Herr K.A. Osteoarthritis. Management of pain and improvement in patient function. Geriatrics, 56(10): 14–7, 20–2, 2001.
66. Lorig, K., Lubeck, D., Kraines, R.G., Selesnick, M., and Holman, H.R., Outcomes of self-help education of patients with arthritis, Arthritis Rheum., 28: 680–685, 1985.
67. Lorig, K. and Holman, H.R., Long-term results of the arthritis self-management study: effects strengthening efforts, Soc. Sci. Med., 29(2): 221-224, 1989.
68. Weinberger, M., Tierney, W.M., Booher, P. and Katz, B.P., Can be providing information to patients with osteoarthritis to improve functional status - a randomized controlled trial, Arthritis Rheum., 32: 1577–1583, 1989.
69. Calfas, K.J., Kaplan, R.M., and Ingram, R.E., One-year evaluation of a cognitive-behavioral intervention for osteoarthritis, Arthritis Care Res., 5: 202–209, 1992.
70. Lorig, K.R., Mazonson, P.D. and Holman, H.R., Evidence suggesting that health education for self-management in patients with chronic arthritis has lasting health benefits while reducing health care costs, Arthritis Rheum., 36: 439-446, 1993.
71. Mazzuca, S.A., Brandt, K.D., Katz, B.P., Chambers, M., Byrd, D., and Hanna, M., Effects of self-care on the health status of inner-city patients with knee osteoarthritis, Arthritis Rheum., 40: 1466–1474, 1997.
72. Superio-Cabuslay, E., Ward, M.M., and Lorig, K.R., A patient education intervention for osteoarthritis and rheumatoid arthritis: a meta-analytic comparison with nonsteroidal anti-inflammatory drug therapy, Arthritis Care Res., 9: 292–301, 1996.
73. March L.M., Stenmark J. Non-pharmacological approaches to arthritis treatment. Med. J. Aust.,175: S102–107, 2001.
74. Weinberger, M., Hiner, S.L., Tierney, W.M., Improving functional status in arthritis: effect social support, Soc. Sci. Med., 23: 899-904, 1986.
75. Rene, J., Weinberger, M., Mazzuca, S.A., Brandt, K.D. and Katz, B.P., Reduction of joint pain in of knee osteoarthritis patients who received monthly phone calls from lay staff and whose treatment regimens remained stable, Arthritis Rheum., 35: 511–515, 1992.
76. Weinberger, M., Tierney, W.M., Cowper, P.A., Katz, B.P., and Booher, P.A., Cost-effectiveness increased telephone contact for patients with osteoarthritis: a randomized controlled trial, Arthritis Rheum., 36: 243-246, 1993.
77. Maisiak, R., Austin, J., and Heck, L., Health outcomes of two telephone interventions in patients with rheumatoid arthritis or osteoarthritis, Arthritis Rheum, 39(8):1391–1399, 1996.
78. Cronan, T.A., Groessl, E. and Kaplan, R.M., Effects of social support and educational interventions on health care costs. Arthritis Care Res., 10(2):99–110, 1997.
79. Toda, Y., Toda, T., Takemura, S., Wada, T., Morimoto, T., and Ogawa, R., Change in body fat but and not body weight or metabolic correlates of obesity is related to symptomatic relief in obese patients for knee osteoarthritis after a weight control program. J. Rheumatol., 25(11): 2181–2186, 1998.
80. Messier, S. P., Loeser, R. F., Mitchell, M. N., Valle, G., Morgan, T. P., Rejeski, W. J., Ettinger, W. H. Exercise and weight loss in older adults with obesity and knee osteoarthritis: A preliminary study Soc., 48(9):1062–1072, 2000.
81. Williams, R.A. and Foul Sham, B.M., Weight reduction in osteoarthritis using phentermine, Practitioner, 225: 231-232, 1981.
82. Keating, E., Faris, P., Ritter, M., Kane, J. Use of lateral heel and foot wedges in the treatment of medical osteoarthritis of the knee, Ortho pad. Rev., 22: 921-924, 1993.
83. Berman B.M., Swyers J.P., Ezzo J.. Evidence for acupuncture as a treatment for rheumatic conditions. Rheum. Dis. Clin. N. Am., 26(1): 103–15, 2000.
84. Ernst E. Acupuncture as a symptomatic treatment of osteoarthritis: a systematic review. Scand. J. Rheum., 26(6): 444–447, 1997.
85. Gaw, A.C., Chang, L.W., and Shaw, L.C., Efficacy of acupuncture for osteoarthritis pain: a controlled, double-blind study, N. Engl. J. Med., 293: 375-378, 1975.
86. Thomas, M., Eriksson, S.V., and Lundeberg, T., A comparative study of diazepam and acupuncture in patients with osteoarthritis pain: a placebo-controlled study Am. J. Chin. Med., 19: 95-100, 1991.
87. Christensen, B.V., Iuhl, I.U., Vilbek, H., Bulow, H.H., Dreijer, NC. and Rasmussen, H.F., Acupuncture treatment of severe osteoarthritis of the knee: A long-term study. Acta Anaesthesiol. Scand., 36: 519–525,
88. Takeda, W. and Wessel, J., Acupuncture for the treatment of knee osteoarthritis pain, Arthritis Care Res., 7: 118-122, 1994.
89. Berman B.M., Lao L., Greene M., Anderson R.W., Wong R.H., Langenberg P., Hochberg M.C.. Effectiveness of traditional Chinese acupuncture in the treatment of symptomatic osteoarthritis of the knee A pilot study, Osteoarthritis Cartilage, 3(2):139–142, 1995.
90. Berman, B.M., Singh, B.B., Lao, L., Langenberg, P., Li, H., Hadhazy, V., Bareta, J., and Hochberg, M.C., A randomized trial of acupuncture as adjunctive therapy in osteoarthritis of the knee, Rheumatology (Oxford), 38: 346–354, 1999.
91. Ezzo, J., Hadhazy, V., Birch, S., Lao, L., Kaplan, G., Hochberg, M.C., and Berman, B., Acupuncture for osteoarthritis of the knee: a systematic review, Arthritis Rheum., 44(4): 819–825, 2001.
92. Pendleton, A., Arden, N., Dougados, M., Doherty, M., Bannwarth, B., Bijlsma, J.W., et al, EULAR recommendations for Treatment of osteoarthritis of the knee: report of a working group of the Standing Committee on International Clinical Trials, including therapeutic trials (ESCISIT). Ann. Rheumatism. Dis., 59: 936-944, 2000.
93. Eccles, M., Freemantle, N. and Mason, J., Northern England, developing evidence-based guidelines project: A summary guideline for non-steroidal anti-inflammatory drugs versus basic analgesia in treating the pain of degenerative arthritis, Br. Copper. J., 317(7157): 526-30, 1998.
94. Wolfe, F., Zhao, S., and Lane, N., Preference of nonsteroidal anti-inflammatory drugs over acetaminophen in patients with rheumatic disease: a survey of 1,799 patients with osteoarthritis, Rheumatoid arthritis, and fibromyalgia, Arthritis Rheum., 43(2): 378–385, 2000.
95. Haq, I., Murphy, E., and Dacre, J., Osteoarthritis, Postgrad. Copper. J., 79: 377-383, 2003.
96. Garcia Rodriguez, L.A., and Hernandez-Diaz, S., Risk of upper gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs, glucocorticoids, acetaminophen, and combinations of these agents, Arthritis Res., 3(2): 98–101, 2001.
97. Gotzsche, P.C. Nonsteroidal anti-inflammatory drugs. Br. Copper. J., 15: 320(7241): 1058-1061, 2000.
98. Watson M.C., Brookes S.T., Kirwan J.R., Faulkner A, Non-aspirin non-steroidal anti-inflammatory drugs for the treatment of osteoarthritis of the knee. Cochrane Musculoskeletal Group, Cochrane Database System. Rev., Issue 3, 2002.
99. Towheed, T., Shea, B., Wells, G. and Hochberg, M., Analgesia and non-aspirin non-steroidal anti-inflammatory drugs for osteoarthritis of the hip, Cochrane Musculoskeletal Group, Cochrane Database Syst. Rev., Issue 3, 2002.
100. Hochberg M.C. What a difference a year makes: Reflections on AČR recommendations for the medical management of osteoarthritis? Curr. Rheumatol. Rep., 3(6): 473–478, 2001.
101. The Deal, C.L., Schnitzer, T.J., Lipstein, E., Seibold, J.R., Stevens, R.M., Levy, M.D., Albert, D., and Renold, F., Treatment of arthritis with topical capsaicin: a double-blind study, Clin. Ther., 13(3): 383-395, 1991.
102. Silverstein, F.E., Faich, G., Goldstein, J.L., Simon, L.S., Pincus, T., Whelton, A., et al, Gastrointestinal toxicity with celecoxib vs. nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Celecoxib Long-term Arthritis Safety Study, JAMA 284(10):1247–1255, 2000.
103. B. Bombardier, L. Laine, A. Reicin, D. Shapiro, R. Burgos-Vargas, B. and Davis, R. Day, M. B. Ferraz, C. J. Hawkey, M. C. Hochberg, T. K., Kvien, T. J. Schnitzer and VIGOR Study Group. Comparison of upper gastrointestinal toxicity between rofecoxib and naproxen in patients with rheumatoid arthritis. Study group VIGOR, N. Engl. J. Med., 343(21): 1520-1528, 2000.
104. Savage R. Cyclo-oxygenase-2 inhibitors: when should they be used in the elderly? Aging drugs,22(3): 185–200, 2005.
105. Hawker, G., Wright, J., Coyte, P., Paul, J., Dittus, R., Croxford, R., Katz, B., Bombardier, C., Heck, D. and Freund, D., Health-related quality of life after knee replacement, J. Bone Joint Surg., 80(2):163–173, 1998.
106. Dieppe, P., Basler, H.D., Chard, J., Croft, P., Dixon, J., Hurley, M., Lohmander, S., and Raspe, H., Knee replacement surgery for osteoarthritis: effectiveness, practice options, indications and possible determinants of utilization, Rheumatology, 38(1): 73–83, 1999.
107. Chang, R.W., Pellisier, J.M., and Hazen, G.B., Cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip, JAMA, 275(11):858-865, 1996.
108. Fortin, P.R., Clarke, A.E., Joseph, L., Liang, M.H., Tanzer, M., Ferland, D., Phillips, C., Partridge, A.J., Belisle, P., Fossel, A.H., Mahomed, N., Sledge, C.B., and Katz, J.N., Outcomes of total hip and knee replacement: preoperative functional status predicts six-month postoperative outcomes, Arthritis Rheum., 42(8): 1722–1728, 1999.
109. McAlindon, T. and Felson, D. T. Nutrition: risk factors for osteoarthritis, Ann. Rheumatism. Dis., 56: 397-402, 1997.
110. Volker, D.H., Katz, T., Shui, L., Quaggiotto, P., Garg, M., and Major, G. Nutrition in inflammatory disease: Evidence for the practice, Asia Pac. J. Clin. Nutr., 24: 49, 2002.
111. Curtis, C., Rees, S., Cramp, J., Flannery, C., Hughes, C., Little, C., Williams, R., Wilson, C., Dent, C., Harwood, J. and Caterson, B., Effects of n-3 fatty acids on cartilage metabolism, Proc. Nutr. soc., 61: 381-389, 2002.
112. Miles E.A., Calder P.C.: Modulation of immune function by dietary fatty acids. Why. Nutr. Soc. 57: 277-300, 1998.
113. National Research Council Committee on Diet and Health, Diet and Health: Implications for Reduction Chronic Disease Risk, 2nd ed., Washington, D.C., 1989.
114. Simopoulos, A.P. Omega-3 fatty acids on health, disease, growth, and development. Am. J. Clin. Nutr., 54, 438-463, 1991.
115. Garg, M., Sebokova, E., Wierzbicki, A., Thomson, A., and Clandinin, M., Differential effects of dietary linoleic acid and alpha-linolenic acid on lipid metabolism in rat tissues, Lipids, 23: 847-852, 1988.
116. Hwang, D., Essential fatty acids and the immune response, FASEB, 3: 2052–2061, 1989.
117. Whelan, J. Antagonistic effects of dietary arachidonic acid and n-3 polyunsaturated fatty acids. J. Nutr., 126: 1086S–1091S, 1996.
118. Long, L., Soeken, K. and Ernst, E., Herbal medicines for the treatment of osteoarthritis: a systematic review, Rheumatology, 40(7): 779–793, 2001.
119. Zhang, W.Y. and Li Wan Po, A. Efficacy of topically applied capsaicin: a meta-analysis, Eur. J. Clin. Pharmacol., 46: 517-522, 1994.
120. Altman R.D., Aven A, et al.: Capsaicin cream 0.025% as monotherapy for osteoarthritis: A double-blind study. Arthritis Rheum., 23 (Suppl.): 25–33, 1994
121. Blotman, F., Maheu, E., Wulwik, A., Caspard, H. and Lopez, A., Efficacy, and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip: a perspective, A multicenter, three-month, randomized, double-blind, placebo-controlled trial, Rev. Rheumatism. English Ed. 64: 825-834, 1997.
122. Maheu, E., Mazieres, B., Valat, J.P., Loyau, G., Le Loet, X., Bourgeois, P., Grouin, J.M., and Rosenberg, S., Symptomatic efficacy of avocado/soy unsaponifiables in the treatment of osteoarthritis knee and hip: a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial with a six-month treatment period and a two-month follow-up showing a sustained effect, Arthritis Rheum., 41: 81-91, 1998.
123. Mills S.Y., Jacoby R.K., Chacksfield M., Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Br. J. Rheumatol., 35: 874-878, 1996.
124. Schmid B., Ludtke R., Selbmann H.K., et al.: Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: a randomized placebo-controlled, double-blind clinical trial, Phytother. Res., 15(4): 344–350, 2001.
125. Randall, C., Randall, H., Dobbs, F., Hutton, C., and Sanders, H., A randomized controlled trial of nettle sting for treating pain in the base of the thumb, J.R. Soc. Med., 93: 305-309, 2000.
126. Kulkarni, R. R., Patki, P. S., Jog, V. P., Glandage, S. G., Patwardhan, B. Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled crossover study, J. Ethnopharmacol., 33: 91–95, 1991.
127. Bliddal, H., Rosetzsky, A., Schlichting, P., Weidner, M.S., Andersen, L.A., Ibfelt, H.H., Christensen, K., Jensen, O.N., and Balslev, J., A randomized, placebo-controlled, crossover study of ginger extracts and ibuprofen in osteoarthritis, Osteoarthritis Cartilage, 8: 9–12, 2000.
128. McAlindon, T.E., LaValley, M.P., Gulin, J.P., and Felson, D.T., Glucosamine, and Chondroitin for treatment of osteoarthritis: a systematic quality review and meta-analysis, JAMA, 283: 1469–1475, 2000.
129. Crolle, G. and D’Este, E., Glucosamine sulfate for the treatment of osteoarthritis: a controlled clinical investigation. Curr. Copper. Res. Opin., 7(2): 104–109, 1980.
130. Drovandi, A., Bignamini, A.A. and Rovati, A.L., Therapeutic activity of oral Glucosamine sulfate in osteoarthritis: a placebo-controlled, double-blind study, Clin Ther., 3(4): 260–272, 1980.
131. Pujalte J.M., Llavore E.P., Ylscupidez F.R.: A double-blind clinical trial of oral glucosamine sulfate in the basic treatment of osteoarthritis, Curr. Copper. Res. Opin., 7(2): 110–114, 1980.
132. D’Ambrosio, E., Casa, B., Bompani, R., Scali, G. and Scali, M., Glucosamine sulfate: controlled Clinical examination of arthrosis, Pharma Therapeutic. 2(8): 504-508, 1981.
133. Vajaradul, Y., A double-blind clinical trial of intra-articular glucosamine in outpatients with gonarthrosis. Ther., 3(5): 336–343, 1981.
134. Vaz, A.L., A double-blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulfate in the treatment of osteoarthritis of the knee in outpatients, Curr. Copper. Res. Opinion, 8(3): 145–149, 1982.
135. Muller-Fassbender, H., Bach, G.L., Haase, W., Rovati, L.C., and Setnikar, I., Glucosamine sulfate compared with ibuprofen in osteoarthritis of the knee, Osteoarthritis Cartilage, 2(1): 61–69, 1994.
136. Noack, W., Fischer, M., Forster, K.K., Rovati, L.C., and Setnikar, I., Glucosamine sulfate in osteoarthritis of the knee, Osteoarthritis Cartilage, 2(1): 51–59, 1994.
137. Morreale P., Manopulo R., Galati M., Boccanera L., Saponati G., Bocchi L.. Comparison of the anti-inflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. Rheumatol., 23(8): 1385–1391, 1996.
138. Bourgeois, P., Charles, G., Dehais, J., Delcambre, B., Kuntz, J.L., and Rosenberg, S., Efficacy and tolerability of Chondroitin sulfate 1200 mg/day vs. Chondroitin sulfate 3 × 400 mg/day vs. placebo, Osteoarthritis Cartilage, 6 (Suppl. A): 25–30, 1998.
139. Conrozier, T., Anti arthrosis: efficacy and tolerability of Chondroitin sulfates, Press Med., 27(36): 1862–1865, 1998.
140. Bucsi, L. and Poor, G., Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of osteoarthritis of the knee, Osteoarthritis Cartilage, 6 (Suppl. A): 31–36, 1998.
141. Toward T.E., Anastasiades T.P., Shea B., Houpt J., Welch V., Hochberg M.C., Glucosamine therapy for the treatment of osteoarthritis, Cochrane Database Syst. Rev., Issue 2, 2002. 6409_book.FM Page 221 Saturday, September 16, 2006, 9:54 AM 222 Handbook of Nutraceuticals and Functional Foods
142. Reginster, J.Y., Deroisy, R., Rovati, L.C., Lee, R.L., Lejeune, E., Bruyere, O., Giacovelli, G., Henrotin, Y., Dacre, J.E. and Gossett, C., Long-term effects of glucosamine sulfate on the progression of osteoarthritis: a randomized, placebo-controlled clinical trial, Lancet, 357: 251–256, 2001.
143. Pennix, B., Messier, S., Rejeski, W., Williamson, J., DiBari, M., Cavazzoni, C., Applegate, W., and Pahor, M., Physical exercise and prevention of disability in activities of the daily life of elderly people with osteoarthritis, Arch. Intern. Med., 116: 2309-2316, 200
144. Foley, A., Keogh, J., Miller, M., Halbert, J., and Crotty, M., Osteoarthritis: is more attention necessary for nutritional health? Nutr. Diet., 60: 97-103, 2003.
145. R. Naqvi, "Osteoporosis an overview: Prevention and control," Biol. Sci., vol. 3, no. 1, pp. 366-375, 2023.