Introduction
Osteoarthritis (OA) is a widespread degenerative-inflammatory disease of synovial joints that develops as a result of cellular stress and maladaptive regeneration processes, leading to loss of function and the need for total arthroplasty of the affected joints.
The relevance of the problem of OA is emphasized by the widespread prevalence of this disease among the population of the Russian Federation and the steady increase in the number of patients. Thus, during the period from 1997 to 2021, the increase in the overall incidence of OA was 260% [1]. The problem of effective conservative treatment of OA remains no less important. Current approaches, which include the use of drugs with delayed structure-modifying effects, non-steroidal anti-inflammatory drugs, intra-articular corticosteroids and sodium hyaluronate, are largely palliative. OA affects all joint structures, including subchondral bone, articular cartilage, muscles and ligaments. This important feature requires multimodal approaches to therapy, which must provide adequate therapeutic effects on all tissues involved in the development and progression of the disease. In this regard, in recent years the possibility of using vitamin D preparations (colecalciferol) in complex therapy of OA has been actively discussed. The relevance of this discussion is supported by the multifaceted osteoprotective and pleiotropic effects of colecalciferol and its active metabolites [2]. On the other hand, the significant deficiency of vitamin D in the population of the Russian Federation, which increases with age, seems important. Thus, in young people, the serum concentration of colecalciferol averages 31.7 pg/ml; in elderly and senile age, this figure decreases to 24.9 and 20.7 pg/ml, respectively [3].
Target
This work is a critical analysis of the results of studies on the effectiveness and safety of vitamin D in the treatment of OA.
Vitamins for arthritis to restore the joint
But what to do if measures to stop pathological processes in the joint were not taken in time, and the cartilage has already begun to deteriorate? Are there vitamins for arthritis and arthrosis that can start the regeneration process and speed it up? It turns out yes. And here nature comes to the rescue. But first things first.
The peculiarity of cartilage tissue is that the number of cells involved in its renewal and restoration (chondrocytes) is negligible. For example, in the joints of the intervertebral discs there are only 1% of the volume of the total cartilage. The use of non-hormonal anti-inflammatory drugs (the gold standard for the treatment of arthritis and arthrosis) further reduces this indicator. It has been proven that drugs in this group, used to relieve pain, swelling and redness, suppress the division of cartilage building cells and reduce the production of the main components of its matrix - proteoglycans, glycosaminoglycans and hyaluronic acid.
A powerful stimulator of cartilage tissue growth is the growth hormone somatotropin. Through the liver, it influences chondrocytes, encouraging them to actively divide and restore cartilage. But the level of somatotropic hormone drops sharply with age: after 18–25 years, by 50% every 7 years.
Dandelion has a similar effect on joints. Yes, yes, the same weed that we have been unsuccessfully fighting for hundreds of years, trying to eradicate it from our garden plots. The plant contains substances that, like somatotropin, act on the liver and stimulate the production of compounds in the main chemical laboratory that encourage chondrocytes to actively divide and restore cartilage. These are taraxacin and taraxacerin. In addition, dandelion contains other substances that have a beneficial effect on the condition of joint tissue.
- Nicotinic acid (vitamin PP or B3). Promotes the production of your own growth hormone.
- Inulin. Normalizes intestinal function, thereby improving the absorption of magnesium, calcium, zinc and copper - minerals necessary for the complete restoration of cartilage tissue.
- Amino sugar. They stimulate the production of intra-articular fluid - a substance that nourishes cartilage cells, and maintain its optimal volume. They are raw materials for the production of collagen. Half of the intercellular substance of cartilage consists of the latter.
- Rubber. This is a natural elastomer. There is an assumption that its penetration into the intra-articular fluid helps to increase its elasticity.
- Arnidiol. Has an anti-inflammatory effect on the affected joint.
- Essential oils. They have analgesic properties.
It is very difficult to preserve all of the listed compounds in full when harvesting a plant and processing it. Some of them are destroyed under the influence of sunlight, others - under the influence of high temperatures. However, science does not stand still. Technologies have already appeared that make it possible to preserve the active substances of plants as much as possible. Thus, in Russia, based on the root of the medicinal dandelion, the drug Dandelion P using cryogenic technology for processing plant raw materials. This is a tablet form of the plant, which allows you to take advantage of its healing power without wasting time and effort.
Attention! You can already purchase this drug in online stores and pharmacies.
Joint pain and dysfunction
A large meta-analysis including 19 randomized controlled trials (RCTs) with 3436 patients with chronic pain syndrome showed an analgesic effect of long-term vitamin D supplementation (≥4 weeks), with a significant reduction (mean 0.7, 95% confidence level). interval [CI]: -1.26, -0.14) pain, compared with placebo [4]. According to data performed by Gao et al. (2017) meta-analysis of 4 RCTs (1136 patients with gonarthrosis), the use of vitamin D in a daily dose of over 2000 IU leads to a significant reduction in pain and functional dysfunction of the knee joints [5]. Both studies highlight good tolerability and a low incidence of adverse reactions comparable to placebo. On the other hand, the question arises about the optimal dosage of colecalciferol. Studies have shown the effectiveness of vitamin D in achieving target serum concentrations regardless of dosage, but higher doses of the drug had an effect on pain and functional deficits.
There is strong evidence for the effectiveness of long-term vitamin D supplementation in OA. In particular, it has been shown that a decrease in pain is observed after 12 months. treatment [6]. Thus, there is sufficient reason to believe that long-term use of high doses of vitamin D can have a pronounced symptomatic effect and be useful in the complex therapy of OA.
Types of arthritis and arthrosis
The choice of vitamins for arthritis of the joints, as well as for arthrosis, may be determined by the type of disease. The term “arthritis” is used for various joint pathologies of inflammatory nature. Highlight:
- infectious arthritis caused by direct penetration of infection into the joint;
- rheumatoid arthritis, provoked by disturbances in the functioning of the immune system, its excessive activity;
- gout associated with the deposition of uric acid in the joints;
- reactive arthritis, which is a reaction of the immune system to a previous infectious disease.
The word “arthrosis” can also hide several degenerative pathologies of the joint. Depending on the affected area, there are:
- gonarthrosis – arthrosis of the knee joint;
- coxarthrosis – arthrosis of the hip joint;
- uncovertebral arthrosis – arthrosis of the cervical vertebrae;
- vertebral arthrosis – arthrosis of the spine;
- patellofemoral arthrosis – damage to the cartilaginous part of the patella and femoral bone.
It is clear that vitamins for rheumatoid arthritis and infectious arthritis will differ depending on their composition, mechanism of action and the tasks that their intake will solve.
Muscular dystrophy
In OA, a sarcopenic phenotype of muscular dystrophy is formed, which is directly related to the radiological stage [5, 7]. It is obvious that the loss of muscle tissue mass is caused by the low mobility of patients with OA. Muscular dystrophy is caused by dysfunction of actin and myosin, activation of proteolytic enzymes, apoptosis of myocytes, and diffuse proliferation of connective tissue [7]. A study of muscle tissue biopsies in patients with late stages of OA showed a strong association of low levels of vitamin D with a high rate of degradation of muscle ubiquitin-proteasomes, a key participant in sarcopenia [6, 7].
Heidari B. et al. (2016) convincingly showed that replenishment of vitamin D deficiency in patients with stage IV OA leads to a significant increase in the strength of the quadriceps femoris muscle and is combined with a significant reduction in the level of pain and functional deficit [8]. Similar results were obtained with the colecalciferol metabolite alfacalcidol, which inhibits proinflammatory cytokines (IL-1, IL-6, tumor necrosis factor-α [TNF-α]) of tissue macrophages, thereby providing an increase in muscle strength [9]. Since muscle dysfunction plays an important role in the pathophysiology of osteoarthritis, the use of colecalciferol and its active metabolites may be beneficial in terms of maintaining muscle mass and strength.
Inflammation
Systemic and tissue inflammation plays a significant role in the development and progression of OA. It is known that changes in the phenotype of chondrocytes in OA are associated with the activation of intracellular signaling pathways, transcription factors and the expression of pro-inflammatory cytokines (IL-1, IL-6, TNF-α, etc.), which ultimately leads to degradation of the intercellular matrix of articular cartilage [2 ]. Askari A. et al. (2016) in a comparative study that included 131 patients with OA and 262 volunteers, found that low vitamin D levels are associated with high serum concentrations of IL-17A [10].
The synovial membrane, whose macrophages and lymphocytes are capable of expressing high concentrations of inflammatory mediators, is of key importance in maintaining inflammation. in vitro studies
It was shown that the addition of the active metabolite of vitamin D to the culture of synoviocytes leads to a significant decrease in the expression of IL-6, interferon-γ, fibroblast growth factor and vascular endothelium, comparable to the effect of dexamethasone. At the same time, delayed persistence of the anti-inflammatory effect of the active metabolite of vitamin D was noted [11]. The active metabolite of colecalciferol is alfacalcidol at a dose of 0.5 mcg for 3 months. increased the CD4+/CD8+ lymphocyte ratio and decreased the IL-6/IL-10 ratio, indicating the systemic effect of this drug on cellular and humoral immunity [12].
The data presented convincingly show that low levels of vitamin D are directly related to the activation of humoral factors of innate immunity in patients with OA, and replenishment of colecalciferol deficiency leads to a decrease in the intensity of synovial inflammation.
Satisfy your vitamin hunger
Many factors play a role in maintaining healthy bones, joints and ligaments, including adequate intake of vitamins. But, alas, even a balanced diet often does not meet the need for them 100%. In this situation, a proven vitamin and mineral complex will come to the rescue as an additive to the daily diet. Prevention and treatment of many diseases of the musculoskeletal system often cannot be done without them. By the way, such products are actively used by athletes, because with many types of physical activity, bones, joints and ligaments work to the limit and need support.
Honda drink, 10 sachets, 12.8 g each, Evalar
1 152 ₽
Dietary supplement NOT A MEDICINE
Articular cartilage
A decrease in the volume of articular cartilage is considered to be one of the key factors in the pathogenesis of OA. A decrease in mechanical properties due to changes in the biochemical landscape of cartilage due to a decrease in the concentration of glycosaminoglycans and dehydration of the intercellular matrix is associated with the level of pain and functional deficit. Factors in the progression of structural changes in joints are mechanical, oxidative, and microcrystalline stress vectors, which have a direct impact on the phenotype of chondrocytes, the state of the intercellular matrix, trophic patterns, neovascularization and innervation of cartilage [13, 14]. These factors are realized through molecular patterns of inflammation and activation of matrix metalloproteinases, which leads to degradation of articular cartilage [15, 16].
The first report of the effect of vitamin D on cartilage metabolism was made by Z. Schwartz et al. in 1989. The authors showed that colecalciferol modulates the synthesis of the extracellular matrix of articular cartilage, activates collagen synthesis and membrane ATPases of chondrocytes [17]. Subsequently, it was found that 25-dihydroxyvitamin D3 activates the synthesis of sulfated glycosaminoglycan in the extracellular matrix of cartilage, inhibits the activity of matrix metalloproteinases, apoptosis due to the transfer of calcium ions, activation of phospholipase D, and increased production of lysophosphatidic acid [18]. Intra-articular injection of vitamin D after injury to the knee joint stimulates the regeneration of articular cartilage and prevents the development of OA [19]. On the other hand, in the VIDEO study, treatment with vitamin D at a daily dose of 800 IU in patients with advanced OA was not accompanied by a significant increase in cartilage mass [20].
There is reliable data on the positive effect of colecalciferol on the biochemistry of articular cartilage, regulation of apoptosis and inflammation. It should be noted that the addition of vitamin D to complex therapy for OA should be carried out as early as possible and in the maximum tolerated doses.
High load – high risk
“Life requires movement,” said Aristotle. Our activity largely depends on the state of the musculoskeletal system. The spine, other bones and joints, as well as tendons and ligaments experience enormous stress every day. It's no wonder that diseases of the musculoskeletal system are so common! Joint pain and decreased motor ability are among the most typical manifestations of this pathology. Arthritis, arthrosis, osteoporosis... These and other ailments of bones and joints affect millions of people.
Calcium Activator (Natural Vitamin K2), 60 capsules, Evalar
799 ₽
Dietary supplement NOT A MEDICINE
Subchondral bone
The lamina propria of the subchondral bone is important in the implementation of locomotor, biochemical and trophic functions of synovial joints. It provides a shock-absorbing function, expresses growth factors of articular cartilage, and ensures the diffusion of nutrients into the basal sections of the cartilaginous plate [21]. A number of authors emphasize the primary role of subchondral bone in the development of OA. Thus, the earliest changes in OA are observed precisely in the lamina propria of the subchondral bone, while the cartilage does not have morphological changes [22]. Remodeling of the underlying bone goes through a number of successive stages: thinning, cyst-like attachment, non-adaptive repair with the formation of a coarse fibrous calcified connective tissue (osteo-like) matrix [23]. In this case, the subchondral bone loses its fundamental functions, which has a direct negative effect on the articular cartilage. In particular, there is a strong direct relationship between changes in the underlying bone and degradation of the cartilaginous plate of the joint [24].
It is known that high doses of vitamin D activate osteocytic differentiation and functional activity of osteoblasts of the subchondral bone, which is marked by an increase in the expression of osteocalcin and prevents bone resorption [25, 26]. The Rotterdam study found that low vitamin D levels are associated with a high risk of progression of gonarthrosis, this effect was especially pronounced in individuals with initially low bone mineral density [27]. Comparable results were obtained in another large study, Framingham. Low dietary vitamin D intake and low serum vitamin D concentrations are associated with joint space narrowing and osteophyte growth (odds ratio (OR) 2.3 (95% CI 1.9 to 5.5), OR 3.1 ( 95% CI 1.3 to 7.5) respectively) [28].
Thus, colecalciferol demonstrates osteoprotective effects, which are most important in the initial stages of the disease, when non-adaptive remodeling of the subchondral bone is formed. However, at later stages, cells of the osteo-like matrix lose their reactivity to colecalciferol [29].
Efficacy and safety of different forms of vitamin D
There are two soluble forms of vitamin D on the pharmaceutical market: aqueous and oily. Until recently, active discussion about the benefits of one or another form of vitamin D was conducted from the standpoint of safety and bioavailability. Opinions have been expressed about a potentially high incidence of allergic reactions due to the presence of stabilizers and low bioavailability when treated with an aqueous solution. Experimental studies in vivo
showed that aqueous solutions of cholecalciferol undergo natural mycelization in the intestine with the formation of a surface layer of phospholipids under the influence of bile acids and dietary fats, which ensures successful absorption of the drug [30]. M. Rautureau and JC Rambaud (1981) convincingly showed that from the point of view of absorption, the most effective is an aqueous solution of vitamin D due to the effective formation of mixed micelles containing lipids and bile acid sequestrants [31]. A systematic review of 46 studies found that exposure to digestive lipases in the small intestine was able to partially inactivate an oil solution of colecalciferol [28]. In addition, the oil solution may prevent vitamin D from binding to proteins in the intestinal wall, limiting absorption [29]. This allows us to conclude that an aqueous solution of vitamin D is advantageous due to its higher bioavailability. Numerous studies have shown the safety of native colecalciferol, regardless of the form of the drug [32]. Adverse reactions in studies were observed when the daily single dosage exceeded 3000 IU [33].
In the Russian Federation, an aqueous solution of vitamin D for oral administration is registered - the drug DeTriFerol (Grotex LLC), drops for oral administration (colecalciferol 15,000 IU/ml) on a water basis. One drop of DeTriFerol contains 500 IU of native colecalciferol. To achieve the optimal dosage, patients with OA need to use 4 drops of the drug daily, and the duration of the course of treatment should be more than 12 months, which allows achieving additional chondroprotective and positive osteometabolic effects.