Arthritis is a general term for a group of conditions that cause pain, stiffness, and swelling in the joints. The most common form of arthritis is osteoarthritis, sometimes called “wear and tear” arthritis. Most people with arthritis have osteoarthritis— in fact, some 21 million American adults suffer from it.
People with arthritis often face serious reductions in their quality of life. The pain, stiffness, and inflammation make it hard to stay active, but inactivity can lead to a downward spiral of worsening health. When activity levels drop, depression, obesity, diabetes, heart disease, and problems with work and relationships often develop. And inactivity actually makes sore joints even worse, which just accelerates the downward spiral. For most people, life just isn’t as enjoyable with arthritis.
New Treatment Options
The good news is the high prevalence of arthritis has led to increased awareness and increased research efforts. The most exciting part about the new treatment options that are now becoming available is they don’t just relieve pain. They actually improve function while also being very safe. Unlike anti-inflammatories such as naproxen (Aleve), for example, treatments such as glucosamine and hyaluronic acid don’t cause gastric bleeding or ulcers, and they don’t raise your risk of a heart attack, stroke, or kidney disease.
In the 1990s, hyaluronic acid (HA) became available as a treatment for knee osteoarthritis. For people with severe knee arthritis, injecting HA into the joint often provides relief. Injectable HA is a prescription product that has to be administered by a physician. Most patients need a series of three to five weekly injections. Injectable hyaluronic acid is well-established as a safe therapy for osteoarthritis. In fact, it’s part of the American College of Rheumatology guidelines for treating osteoarthritis of the knee. Injectable HA works reasonably well. After receiving the series of injections, over half of all patients have improvements in pain and function that can last for up to a year. Because injectable HA provides long-lasting relief, osteoarthritis patients can often avoid the dangers associated with over-thecounter or prescription anti-inflammatory drugs.
Injectable HA has some significant drawbacks, however. Receiving an injection directly into the joint isn’t something to take lightly. It’s an invasive procedure that involves pain and a small chance of introducing an infection in the joint. It’s expensive—the series of injections can run to $1,500 and may not be covered by health insurance. It’s also inconvenient to keep going to the doctor for several weeks in a row to receive the full series of injection—or repeat injections, if necessary.
In the past couple of years, oral forms of hyaluronic acid have become available. Oral HA is a nonprescription product that’s sold as a dietary supplement. The benefits of an oral formulation compared to injections are obvious: lower cost, no pain, lower risk, and improved convenience. The positive results for patients have vaulted this product into the limelight.
To appreciate what a breakthrough oral HA is, it helps to understand the crucial role of HA in joint health. In your body, HA is a naturally occurring family of extremely large molecules that are contained in many tissues, not just the joints. HA is one of the components that give our tissues flexibility. Your eyeballs, for instance, are “squishy” mainly because of their high HA content. The same goes for the cartilage in your joints.
Joint cartilage (what doctors call articular cartilage) is a glistening, smooth, translucent, whitish-colored living tissue found on the ends of your bones. Joint cartilage caps the ends of the bones in the 230 different joints found in the human body. When it’s healthy, cartilage is extremely smooth. It provides a low-friction environment for easy movement and also acts as a shock absorber to protect your bones and keep them from fracturing with activity.
Hyaluronic acid is essential for healthy cartilage. It’s the chemical backbone that holds together the molecules, such as chondroitin sulfate, that make up the cartilage and give joint cartilage its special properties. HA is what makes joint cartilage the smoothest and most friction-free substance in nature. Nothing man-made can approach the performance of this remarkable tissue.
In any joint, the whole structure of bone, cartilage, ligaments, and tendons is surrounded, held together, and protected by a watertight, fibrous joint capsule. Specialized cells called synoviocytes line the interior portion of the joint capsule. They produce the synovial fluid—a thick, clear substance that looks and feels like raw egg white. Synovial fluid fills the space within the joint. It lubricates the articular cartilage, much as grease lubricates the ball joints of your car. Synovial fluid also increases the effectiveness of shock absorption in the joint, much as hydraulic shock absorbers smooth out the ride of your car. Because joints don’t have a blood supply of their own, the synovial fluid also carries nutrients into the joint and carries waste products out.
Osteoarthritis and HA
Where does HA fit into joint health? It’s the principal functional component of synovial fluid. HA is what makes synovial fluid thick and viscous—and it’s these properties that are vital to normal joint function. But when osteoarthritis strikes, the hyaluronic acid in the joint is affected. Here’s how it happens: The joint cartilage on the ends of the bones slowly erodes, the bone underlying the cartilage changes (leading to bone spurs and pain), and the synovial fluid in the joint changes in character. Specifically, the amount of HA in the joint drops. In severe osteoarthritis, the level of hyaluronic acid in the joint fluid may decrease by 75 percent or more. Because HA serves as a shock absorber and lubricator, it’s no wonder that a big decrease in such an important molecule results in adverse consequences. When HA levels in the knee drop, for instance, the result is a creaking or grinding sensation, pain, and often a condition called “movie-goers knee.” It may sound funny, but movie-goers knee is no joke. It’s a real medical condition that occurs after someone with knee osteoarthritis sits with the knee bent at a sharp angle for a prolonged period of time—such as sitting through a feature movie or driving a car for a couple of hours. Upon arising, a sudden, sharp, stabbing pain occurs in the knee. The pain usually goes away after walking a few steps, as the remaining fluid in the knee coats the surfaces of the cartilage and cuts down on the friction.
The prevailing theory of how HA works is that the molecules attach to binding sites on cells within the joints. Once the attachment is made, it triggers a complex cascade of events within the cells. One of the things that seems to happen is the HA molecules inhibit some of the enzymes that help break down the cartilage matrix in the joint. HA also seems to inhibit some of the natural chemicals, such as interleukin-1b and prostaglandin E2, that create inflammation in an arthritic joint. The anti-inflammatory mechanism of HA isn’t fully understood, but we do know it’s quite different from that of anti-inflammatory drugs. HA molecules also appear to disrupt some of the nerve impulses that transmit pain signals from the joint to the brain. Importantly, HA molecules can stimulate the cells that line the joint capsule and trigger them to manufacture even more hyaluronic acid—something highly desirable in osteoarthritic joints.
When there’s not enough HA in a joint, all the things it does to maintain pain-free normal function don’t happen as well— that’s where supplemental HA comes in.
Choosing the Best HA Supplement
As researchers learn more about the HA pathways in the joints, they continue to discover new ways in which HA helps relieve pain and improve function in patients with osteoarthritis. One of the things they’ve learned is oral HA supplements can be very effective—but only if they’re a high-quality product that closely mimics the body’s own HA.
Today the oral forms of hyaluronic acid sold as dietary supplements come from three general categories: low-purity animal extractions mixed with large quantities of (relatively inactive) collagen; fermentation from bacteria; or concentrated extraction from avian cartilage. The original pharmaceutical forms of injected hyaluronic acid were all derived from the avian cartilage, so it makes sense this is also the optimal form for dietary supplements. Low-purity animal extractions mixed with collagen are undesirable because of two reasons. To get an adequate quantity of hyaluronic acid from these supplements, you’d have to take them in very large amounts. Also, it’s questionable whether the biologic activity of this source of hyaluronic acid compares with the others.
Hyaluronic acid derived from bacterial fermentation may also be less functional and it doesn’t have some of the natural active components found in the concentrated extractions from avian cartilage. Perhaps this helps explain the results of an internal study comparing the effectiveness of fermented HA to a concentrated extract from avian cartilage. When a culture of living synovial cells was exposed to the avian extract, the cells were stimulated to produce twice as much HA as when they were exposed to the bacterial HA—even though the concentrations of each product was the same (200 mcg/ml ).
It’s also important to note that concentrated avian extracts have been used in most of the important worldwide research that has been done on HA. The concentrated extractions have been utilized extensively in the clinic and in large human studies (some of long duration) sponsored by the pharmaceutical industry.
Hyal-Joint® Oral Hyaluronic Acid Supplements
Hyal-Joint oral hyaluronic acid supplements appear to be the best available product. This product is a concentrated HA extraction from avian cartilage and also contains other naturally active components such as vital glycosaminoglycans. Hyal- Joint has been studied in a number of laboratory experiments, animal studies, and in a human clinical study. Even more research is underway. The studies suggest that Hyal-Joint raises HA levels in the joints and, just as important, also stimulates the body to produce more of its own natural HA. In the first human study, the participants took only 80 mg of Hyal-Joint a day, an amount that fits into a small capsule or tablet. This daily dosage delivers approximately 48 to 54 mg HA, 4 to 12 mg other glycosaminoglycans, and 16 to 24 mg collagen. A clinical trial is underway now using a smaller dose of just 40 mg, and some supplement manufacturers are considering adding 20 mg of Hyal-Joint to existing joint health formulations containing other active components such as glucosamine and chondroitin sulfate.