Nutrition And Arthritis

, by Rayman, Margaret; Callaghan, Alison

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ISBN: 9781405124188 | 1405124180
Cover: Paperback
Copyright: 10/13/2006

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Arthritis affects millions of people throughout the world and while its treatment is usually medical or surgical, there exists an increasingly large body of evidence concerning the positive effects of nutrition on the condition.There are over two hundred forms of rheumatoid disease, with conditions varying in prevalence. In this important title the authors have focussed on osteoarthritis (OA) and rheumatoid arthritis (RA), the most common arthritic diseases with the largest body of dietary data. Including coverage of disease incidence and prevalence, pathology, aetiology and measures of disease assessment and dietary risk factors, Nutrition and Arthritis is a clear, concise and user-friendly book gathering the latest research to bring the reader state-of-the-art information on:Micronutrients (e.g. vitamins C, D and selenium), food supplements and their potential to ameliorate arthritis Polyunsaturated fatty acids, with particular attention paid to n-3 fatty acids Glucosamine and chondroitin The value of exclusion, vegetarian, vegan and other dietary approachesNutritionists and dietitians, including those working in the health services, rheumatologists, orthopaedic surgeons, general practitioners, osteopaths and commercial organisations involved in the formulation of dietary supplements will find this book an important and practical reference source. Libraries in medical schools and universities and research establishments where nutrition, dietetics and food science are studied and taught will find it a valuable addition to their shelves.

Acknowledgements

xiii

Abbreviations

xiv

Introduction

(10)

The range of rheumatic diseases

(1)

Rheumatoid arthritis (RA): description

(1)

Osteoarthritis (OA): description

(1)

Incidence and prevalence

(2)

Mortality

(1)

Morbidity

(1)

Economic cost of arthritis

(1)

The aim of this book

(3)

Classification, pathology and measures of disease assessment

(29)

Classification of OA

(1)

Classification of RA

(2)

Pathology of OA

(6)

General features of OA

(1)

Structure of cartilage

(1)

Pathogenesis of OA

(1)

Cartilage degradation

(2)

Nitric oxide synthesis damages chondrocytes

(1)

Sulphation pattern of GAGs in articular cartilage

(1)

Bone changes

(1)

Inflammation

(1)

Angiogenesis

(1)

Oxidative stress

(1)

Pathology of RA

(12)

General features of RA

(1)

Immunopathogenesis and production of inflammatory mediators

(1)

Autoantibodies: rheumatoid factor

(1)

Glycosylation patterns of immunoglobulins and complement activation

(1)

Dietary lectins, gut translocation and the shared epitope

(1)

Abnormal gut microflora

(1)

Reactive oxygen and nitrogen species involved in damage to the rheumatoid joint

(1)

Phagocytosis

(1)

Hypoxia reperfusion injury and joint pH

(1)

Involvement of nitric oxide and peroxynitrite

(1)

Consequences of the production of reactive oxygen and nitrogen species in the RA joint

(1)

Lipid abnormalities and cardiovascular risk in RA

(1)

C-Reactive Protein (CRP)

(1)

Dyslipidaemia

(1)

Endothelial dysfunction

(1)

Oxidised LDL in the joint and the formation of fatty streaks

(1)

Adhesion molecules

(1)

Haemostatic changes

(1)

Elevated homocysteine and low vitamin B6 status

(1)

Elevated homocysteine and impaired sulphur metabolism

(2)

Insulin resistance

(1)

Angiogenesis

(1)

Osteoporosis

(1)

Assessment of severity of RA and OA

(9)

Outcome measures for RA

(1)

Patient's global assessment

(1)

Pain

(1)

Disability

(1)

Swollen and tender joint counts

(1)

Acute phase reactants

(1)

RA quality of life index

(1)

Radiological assessment

(1)

Some outcome measures for OA

(1)

Patient global assessment

(1)

Pain score

(1)

New joint score

(1)

Severity score

(1)

Disability

(1)

Radiological assessment

(5)

Aetiology and risk factors for osteoarthritis and rheumatoid arthritis

(21)

Introduction

(1)

Genetic risk factors

(2)

Age

(2)

Gender

(1)

Biomechanical factors as risk factors for OA

(1)

Occupation, sport and physical activity

(1)

Joint trauma and surgery

(1)

Load distribution and malalignment

(1)

Muscle weakness

(1)

Obesity

(2)

Smoking

(1)

Dietary factors

(3)

Olive oil

(1)

Fish and n-3 polyunsaturated fatty acid (PUFA)

(1)

Meat

(1)

Fruit and vegetables

(1)

Antioxidants

(1)

Vitamin C

(1)

β-Cryptoxanthin

(1)

Vitamin D

(1)

Beverage consumption

(2)

Coffee and tea

(1)

Alcohol

(1)

Hormones, OA and RA

(1)

Medical risk factors for RA

(5)

Infection and micro-organisms

(1)

Blood transfusions

(1)

Haemochromatosis

(4)

Current management of osteoarthritis and rheumatoid arthritis

(17)

Overview of current treatment

(1)

Medication

(7)

Analgesia

(1)

Non-steroidal anti-inflammatory drugs (NSAIDs)

(2)

Disease-modifying antirheumatic drugs (DMARDs)

(3)

Biological agents

(1)

Glucocorticoids

(1)

Side effects of arthritis medication likely to affect nutritional status

(1)

Surgical management

(3)

Preventative

(2)

Preservative

(1)

Corrective

(1)

Salvage

(1)

Physiotherapy and occupational therapy management

(2)

Physiotherapy

(2)

Occupational therapy

(1)

Acupuncture

(4)

Nutritional status and adequacy of the diet in rheumatoid arthritis and osteoarthritis

(10)

Introduction

(1)

Body mass index (BMI)

(3)

Low BMI and rheumatoid cachexia

(2)

High BMI

(1)

Malnutrition and malnutrition screening

(1)

Macronutrient intake

(1)

Micronutrient intake and deficiency in RA

(3)

Drug-nutrient interactions

(1)

Importance of individual assessment

(2)

Popular dietary approaches

(4)

Introduction

(1)

Well known popular diets

(2)

Food avoidance

(1)

Supplements

(2)

Exclusion, vegetarian, vegan and other dietary approaches in rheumatoid arthritis

(20)

Introduction

(1)

Exclusion diets

(3)

Vegan and vegetarian diets

(2)

The Mediterranean diet

(1)

Elemental diets

(2)

Summary of dietary findings

100

(1)

Possible mechanisms by which exclusion, elemental, vegan and vegetarian diets may exert their effects on RA

101

(7)

Food allergy or intolerance

102

(1)

Alteration of gastrointestinal permeability

103

(1)

Effect of lectins

103

(2)

Alteration to gut flora: pre- and probiotic dietary components

105

(2)

Weight reduction and associated immunosuppression

107

(1)

Placebo effect

108

(1)

Risks of undertaking dietary modifications

108

(4)

Role of micronutrients in the amelioration of rheumatoid arthritis and osteoarthritis

112

(34)

Introduction

112

(1)

Antioxidants in the body

112

(1)

Vitamins A, C and E and β-carotene and their role in RA and OA

113

(4)

Description and functions of vitamins A, C and E and β-carotene

113

(1)

Studies of vitamins A, C and E and β-carotene in RA and OA

114

(2)

Conclusions and recommendations from these studies

116

(1)

Selenium in RA and OA

117

(7)

Functions of selenium relevant to RA and OA

117

(2)

Selenium status in OA and RA patients

119

(1)

Prospective and intervention studies with selenium

120

(2)

Recommendations for selenium intake

122

(2)

Copper, zinc and RA and OA

124

(2)

Functions of copper and zinc relevant to RA and OA

124

(1)

Copper and zinc status in OA and RA patients

124

(1)

Intervention studies with copper and zinc

125

(1)

Recommendations for intake of copper and zinc in RA and OA

126

(1)

Iron in RA and OA

126

(3)

Functions of iron relevant to RA and OA

126

(1)

Iron status in OA and RA patients

127

(2)

Effect of resolution of anaemia on RA symptoms and quality of life

129

(1)

Recommendations for iron intake

129

(1)

Vitamin D in OA and RA

129

(8)

Role of vitamin D in relation to OA and RA

129

(1)

Studies looking at the relationship between vitamin D and arthritis

130

(1)

Vitamin D intake and status

131

(3)

Recommendations for vitamin D intake

134

(3)

Boron and arthritis

137

(1)

Magnesium and arthritis

138

(1)

Potassium and arthritis

138

(1)

Recommendations for achieving optimal micronutrient status in OA and RA

138

(8)

Polyunsaturated fatty acids in the treatment of arthritis

146

(38)

Essential fatty acids and their nomenclature

146

(1)

Role of fatty acids: relevance to arthritis

146

(1)

Metabolism of polyunsaturated fatty acids

147

(2)

Conversion to long-chain PUFAs

147

(1)

Formation of eicosanoids from PUFA precursors

148

(1)

Inflammatory potential of eicosanoids

149

(1)

Eicosanoids in arthritis

149

(2)

Rationale for the use of specific PUFAs in the treatment of arthritis

151

(1)

Beneficial effects of GLA, DGLA and n-3 PUFAs

151

(5)

Effects on eicosanoids

151

(2)

Effects on cytokine production

153

(1)

Effects of fish oils on cytokine production depend on genotype

154

(1)

Effects on lymphocyte proliferation

155

(1)

Effects of n-3 PUFA on cartilage integrity

155

(1)

Epidemiology of n-3 PUFA and arthritis

156

(1)

Interventions with GLA and DGLA in arthritic patients

156

(1)

Interventions with fish oil in RA patients

157

(3)

Interventions with fish oil in RA patients with reduced n-6 PUFA intake

160

(1)

Limitations of human intervention studies with PUFAs

161

(1)

Recommendations for PUFA intake in inflammatory arthritis

162

(1)

Current intakes of PUFAs

162

(2)

How to achieve an anti-inflammatory intake of PUFAs

164

(10)

Oily fish

164

(2)

Fish oil supplements

166

(1)

Animal sources of n-3 PUFAs: grass-fed meat and game

167

(1)

Sources of short-chain n-3 PUFA

168

(3)

Direct long-chain n-3 PUFA sources for vegetarians or non-fish eaters

171

(2)

Practical guidelines for vegetarians

173

(1)

Reducing n-6 PUFAs in the diet

174

(1)

Collateral benefits of increasing the intake of long-chain n-3 PUFAs

175

(1)

Reduced risk of cardiovascular mortality

175

(1)

Reduced requirement for NSAIDs or other drugs

176

(1)

Safety issues

176

(3)

Contraindications for cod liver oil supplements

176

(1)

Side effects of n-3 PUFAs

176

(1)

Peroxidation issues related to increased n-3 PUFA intake

176

(1)

Effects on immunity of increased n-3 PUFA

177

(1)

Contamination with dioxins and dioxin-like PCBs

177

(1)

Fish contamination with mercury

178

(1)

Ethical issues: fish stocks

179

(1)

Conclusion

180

(4)

Glucosamine and chondroitin in osteoarthritis

184

(20)

Introduction

184

(1)

What are glucosamine and chondroitin?

185

(1)

Sources of glucosamine and chondroitin

185

(1)

Bioavailability

185

(1)

Postulated mechanism of action

186

(1)

Trials of glucosamine and chondroitin and their efficacy in OA

187

(7)

Meta-analyses of glucosamine and chondroitin trials

187

(3)

Long-term glucosamine trials

190

(2)

Combination trials including manganese

192

(1)

Glucosamine trials with negative findings

193

(1)

Possible reasons for conflicting trial results

194

(1)

Topical treatment

195

(1)

Comparison with NSAIDs

195

(1)

Safety issues

196

(1)

Adverse events

196

(1)

Contraindications

196

(1)

Caution with usage

196

(1)

Further studies

197

(1)

Preliminary results from GAIT

198

(1)

Conclusions and recommendations for glucosamine and chondroitin use

199

(2)

Supplements of glucosamine sulphate and chondroitin available

201

(3)

Other foods or supplements marketed for arthritis relief

204

(14)

Introduction

204

(1)

Green tea extracts

204

(1)

Ginger

205

(1)

New Zealand green-lipped mussel

206

(1)

Methylsulfonylmethane (MSM)

207

(3)

Non juice

210

(1)

Shark cartilage

211

(1)

Herbal remedies

211

(4)

Other supplements

215

(1)

Conclusion

215

(3)

Assessment of level of evidence for nutritional recommendations and suggestions for the future

218

(27)

Summary of nutritional factors that may affect risk of RA and OA

218

(1)

Level of evidence for nutritional recommendations in RA and OA

218

(6)

Suggestions for the future

224

(1)

Appendices

Appendix 1 How to interpret the statistical data on studies quoted in this book

225

(4)

Appendix 2 Malnutrition Universal Screening Tool ('MUST')

229

(6)

Appendix 3 Table of UK and USA dietary reference values for vitamins, minerals and trace elements

235

(2)

Appendix 4 Elimination diet for rheumatoid arthritis

237

(8)

Glossary

245

(8)

Index

253

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Nutrition And Arthritis

Summary

Author Biography

Table of Contents

Supplemental Materials