Laurie's Blogs.

 

03
Jul 2021

How Much? Part 2 of Joint Supplementation for Osteoarthritis

Laurie Edge-Hughes, BScPT, MAnimSt, CAFCI, CCRT

 

Last week’s blog, Prescribing Prevention for Osteoarthritis, https://www.fourleg.com/Blog?b=519 looked at the potential for nutraceuticals to prevent osteoarthritis.  In this blog, we’re going to dive into dosing.  Because, we all know that if we say to a client, “You should look into joint supplements.”  The next question will be, “What do you recommend, and how much should I give?”  Let’s see what can be found in the literature to enable us to give an evidence-based answer.

 

First off, what are we trying to do with the supplement?  Reduce pain?  Slow the progression of osteoarthritis (OA)?  Reverse the OA?  Those are important questions, and can lead to a multi-modal approach.  

 

Let’s look at glucosamine…

 

Research in regards to whether glucosamine is useful in dogs with osteoarthritis is conflicting.

 

McCarthy et al used a dose that was somewhere between 100mg/kg (44.4mg/lb) to 150mg/kg (66.9mg/lb).  Dogs treated with this Glucosamine/Chondroitin combination showed statistically significant improvements in scores for pain, weight-bearing and severity of the condition by day 70 of the study.1

 

Moreau et al found no improvement in ground reaction forces specific to the arthritic joint with the use of nutraceuticals at day 30 and 60.2   However, their study evaluated a Glucosamine/Chondroitin supplement dosed somewhere between 33mg/kg (15mg/lb) to 75mg/kg (33.5mg/lb).  Furthermore, after a month this dose was further decreased.  Could this be a reason for the negative result?

 

What about hyaluronic acid & hydrolysed collagen?

 

One study used a product called Hyaloral (Pharmadiet, Spain).3 The supplement contained 20 mg of hyaluronic acid, 2.2 g of enzymatically hydrolysed collagen, 312.5 mg of crystallized glucosamine, 200 mg of chondroitin sulphate, and 100 mg of gamma oryzanol per tablet. Dosage was based on body weight (dose: ½ tablet/day for each 10 kg of body weight, 1 tablet/day for each 20 kg of weight, 1.5 tablets/day for each 30 kg of weight, and 2 tablets/day for each 40 kg of weight).  Note, these doses for the glucosamine are very low compared to typical glucosamine products, since the main active ingredient is the hyaluronic acid and the collagen.  The study concluded that oral treatment with Hyaloral may have a potential cumulative action that provides protection against dysplasia and significantly improves symptoms of elbow dysplasia.

 

AVOCADO–SOYBEAN UNSAPONIFIABLES

 

Avocado–soybean unsaponifiables (ASU) are plant extracts derived from unsaponifiable residues of avocado and soya bean oils, commonly mixed at a ratio of one-third to two-thirds, respectively.4   Few studies have evaluated the in vivo efficacy of ASU in dogs.  Boileau et al performed a study on dogs with a surgically induced model of OA (transected cruciate ligament) where they prophylactically administered ASU. The size and the severity of the macroscopic cartilage lesions, as well as the scores of histological parameters, were decreased in dogs treated with 10 mg/kg per day of ASU.5  

 

Curcumin?

 

Curcumin is the major component of turmeric, a yellow spice derived from the roots of the plant Curcuma longa. Curcumin is a polyphenol and it has long been used in traditional Chinese and Ayurvedic medicine. In vitro, anticatabolic, anti-apoptotic and anti-inflammatory effects of curcumin have been largely described, on different cell culture models. It was shown that curcumin decreased NO, PGE2, IL6, IL-8, COX-2, iNOS, MMP-3 and MMP-9 synthesis through the inhibition of NF-jB translocation and TNF-a signaling pathways in chondrocytes.4   A major concern met with natural curcumin is the absence of information concerning its bioavailability in dog.

 

In diving into Pubmed, I was unable to find clinical research studies able to show measurable improvement in OA parameters tested with curcumin / curcumin-added dietary protocols.

 

Lastly, how about polyunsaturated fatty acids (PUFAs)?

 

Polyunsaturated fatty acids (PUFAs) are classified as omega-3, omega-6 or omega-9.    The main dietary PUFAs are omega-3 [such as linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)] and omega-6 (such as linoleic acid and arachidonic acid). Omega-3 is mainly present in fish oils, flaxseeds and walnuts, whereas omega-6 is found in safflower, corn, soya bean and sunflower oils as well as in meat fat. Omega-3 and omega-6 can then be metabolized by COXs and lipoxygenases (LOXs) into distinct eicosanoids. The omega-6 derived eicosanoids tend to be proinflammatory, whereas the omega-3-derived eicosanoids tend to be anti-inflammatory.4   

Of studies that recorded an improvement in clinical measures of function and/or reduction of NSAID use, the following dosages of Fish Oil were used:

•Fish Oil: 90 mg EPA+DHA/kg daily6

•Fish Oil: 110.25 mg ± 5.75 (SD) omega-3 fatty acids (predominantly EPA and DHA)7

 

Perna Canaliculus is a lipid extract from New Zealand green lipped mussels (GLM). It is rich in omega-3 PUFAs, vitamins, amino acids and minerals.4 Of the studies that looked specifically at Green lipped Mussel formulations:

•20–49 mg/kg daily, depending on the body weight of the dog, for 10 days, and then, half of the loading dose for the rest of the study8

•375 mg daily (dogs 5–15 kg); 625 mg daily (dogs 16–20 kg); 750 mg daily (dogs 21–25 kg); 1000 mg daily (dogs 26–45 kg); 1125 mg daily (dogs 46+ kg)9

 

What else? 


Well, this is a blog about supplements, but naturally, many of our modalities can target joint cartilage and pain pathways (i.e. Laser therapy, shockwave, PEMF).  Exercise can help as well, as can joint mobilizations.  All in all, the information above gives you a good place from which to start a dialogue

 

I hope this helps you to be the best rehab professional you can be!



Until next time, CHEERS!  

 

References:

 

  1. McCarthy G, O'Donovan J, Jones B, McAllister H, Seed M, Mooney C. Randomised double-blind, positive-controlled trial to assess the efficacy of glucosamine/chondroitin sulfate for the treatment of dogs with osteoarthritis. Vet J. 2007 Jul;174(1):54-61. 
  2. Moreau M, Dupuis J, Bonneau NH, Desnoyers M. Clinical evaluation of a nutraceutical, carprofen and meloxicam for the treatment of dogs with osteoarthritis. Vet Rec. 2003 Mar 15;152(11):323-9. 
  3. Martí-Angulo S, García-López N, Díaz-Ramos A. Efficacy of an oral hyaluronate and collagen supplement as a preventive treatment of elbow dysplasia. J Vet Sci. 2014 Dec;15(4):569-74. 
  4. Comblain F, Serisier S, Barthelemy N, Balligand M, Henrotin Y. Review of dietary supplements for the management of osteoarthritis in dogs in studies from 2004 to 2014. J Vet Pharmacol Ther. 2016 Feb;39(1):1-15. 
  5. Boileau, C., Martel-Pelletier, J., Caron, J., Msika, P., Guillou, G.B., Baudouin, C. & Pelletier, J.P. (2009) Protective effects of total fraction of avocado/soybean unsaponifiables on the structural changes in experimental dog osteoarthritis: inhibition of nitric oxide synthase and matrix metalloproteinase-13. Arthritis Research and Therapy, 11, R41.
  6. Hansen, R.A., Harris, M.A., Pluhar, G.E., Motta, T., Brevard, S., Ogilvie, G.K., Fettman, M.J. & Allen, K.G. (2008) Fish oil decreases matrix metalloproteinases in knee synovia of dogs with inflammatory joint disease. Journal of Nutritional Biochemistry, 19, 101–108.
  7. Hielm-Bjorkman, A., Roine, J., Elo, K., Lappalainen, A., Junnila, J. & Laitinen-Vapaavuori, O. (2012) An un-commissioned randomized, placebo-controlled double-blind study to test the effect of deep sea fish oil as a pain reliever for dogs suffering from canine OA. BMC Veterinary Research, 8, 157.
  8. Hielm-Bjorkman, A., Tulamo, R.M., Salonen, H. & Raekallio, M. (2009) Evaluating complementary therapies for canine osteoarthritis Part I: green-lipped mussel (Perna canaliculus). Evidence-Based Complementary and Alternative Medicine, 6, 365–373.
  9. Pollard, B., Guilford, W.G., Ankenbauer-Perkins, K.L. & Hedderley, D. (2006) Clinical efficacy and tolerance of an extract of green-lipped mussel (Perna canaliculus) in dogs presumptively diagnosed with degenerative joint disease. New Zealand Veterinary Journal, 54, 114–118.

 

 



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