Osteoarthritis
Osteoarthritis (sometimes called degenerative joint disease or osteoarthrosis) is a "wear and tear" joint disease that mostly affects the cartilage that covers the ends of bones in a joint. Healthy cartilage allows bones to glide smoothly over one another and cushions the impact of joint motion. In osteoarthritis, the surface layer of cartilage wears away, allowing bones to rub together, causing pain, swelling, and loss of motion. Over time, the joint may lose its normal shape and bone spurs may develop. Bits of bone or cartilage may break off and float inside joint space, causing more pain and damage. The disease most often affects the weight-bearing joints and the joints of the hand. Osteoarthritis is one of the most frequent causes of physical disability among adults, affecting approximately 20 million people in the United States alone. Although some younger people get osteoarthritis as the result of joint injury, the disease most often occurs in older people. In fact, by age 65, more than half of the American population show evidence of osteoarthritis in at least one joint. The disease is common among both men and women, but its prevalence varies with age. Before age 45, more men have osteoarthritis, while after age 45 it is more common in women.

Contributing factors for osteoarthritis
Because osteoarthritis results from wear on joint cartilage, any factors that increase stress on joints contribute to its progression. High impact physical activity, as occurs in many athletes and other people with physically demanding occupations, can be a significant factor. Being overweight is also a major factor because of the increased pressure placed on the weight-bearing joints.

Most osteoarthritis treatment programs involve a combination of treatments tailored to the patient's lifestyle and health. Treatment programs have four general goals which are: controlling pain (through drugs and other measures), improving joint care (through rest and exercise), maintaining acceptable body weight (to diminish stress on affected joints), and achieving a healthy lifestyle. While drugs such as aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) can be effective in alleviating arthritis pain, they do nothing to address the cartilage destruction that causes the pain. In addition, many of them have harmful side effects with long-term use and some (including Naproxin, Ibuprofen, and Indomethacin) may actually inhibit cartilage repair.¹ Surgeries used in treatment of osteoarthritis include procedures to resurface bones, reposition bones, replace joints, and remove loose pieces of bone or cartilage. Currently, more than 80 percent of osteoarthritis surgery cases involve replacing the knee or hip joint.

Nutritional considerations
Nutritional considerations for osteoarthritis should focus on maintaining a healthy weight and promoting joint tissue repair. People with osteoarthritis should consume a balanced, nutritious diet. The diet should include healthy levels of vitamin C because it is required for the growth and maintenance of all collagen structures, including joint cartilage. Many osteoarthritis sufferers augment their diets with glucosamine sulfate, chondroitin sulfate, and other supplements purported to promote cartilage regeneration. Studies have shown that glucosamine sulfate can be as effective as NSAIDs in alleviating arthritis symptoms, and is significantly better tolerated. ^2-3 Most studies on glucosamine have been conducted in Europe and Asia, and few long-term studies have been done. The National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) are funding a multicenter, four-year study in the United States to determine the usefulness of glucosamine and chondroitin sulfates, alone and in combination, in the treatment of osteoarthritis.

Rheumatoid arthritis
Rheumatoid arthritis (RA) is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in joints. It has several unique features that make it different from other types of arthritis. For example, RA generally occurs in a symmetrical pattern, i.e. if one hand is affected, the other is also. The disease often affects the wrist joints and the finger joints closest to the hands. Other affected joints may include those of the neck, shoulders, elbows, hips, knees, ankles, and feet. RA may also affect other areas of the body besides the joints. People with the disease may experience fatigue, occasional fever, and malaise. The severity and duration of symptoms varies from person to person. For some people, symptoms last from a few months to a year or two and then disappear with no apparent permanent damage. Other people experience flare-ups of worsening symptoms followed by periods of remission. Still others have severe RA that is active most of the time, lasts for many years, and leads to serious joint damage and disability.

Contributing factors for rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disease in which a person's immune system attacks his or her own body tissues. It is still not known what exactly causes this to happen, but contributing factors may include genetic predisposition, environmental factors (such as infectious agents like viruses and bacteria), and hormonal factors. It appears that RA is most likely caused by an interaction of many factors which researchers are still attempting to more fully understand.

Conventional treatments
Doctors use a variety of approaches to treat rheumatoid arthritis. These are used in different combinations and at different times during the course of the disease according to the patient's individual situation. Most people with RA take medications, some of which are used only for pain relief; others to reduce inflammation; and still others to slow the disease's progression. Traditionally, doctors first prescribed aspirin or similar drugs along with rest and physical therapy, resorting to more powerful drugs only if symptoms worsened. For patients with severe, rapidly progressing RA, many doctors now prescribe early treatment with more powerful drugs in hopes of halting disease progression to reduce or prevent joint damage. Several types of surgery are used to reduce pain and improve joint function, including joint replacement, tendon reconstruction, and synovectomy (removal of inflamed joint tissue). Because inflamed joint tissue eventually grows back, synovectomy by itself is rarely performed; it is usually done as part of reconstructive surgery, especially tendon reconstruction.

Nutritional considerations
The role of nutrition in rheumatoid arthritis is still the subject of much debate. Studies have observed that deficiencies of pyridoxine, zinc, and magnesium are common in RA patients.⁴ These deficiencies might well indicate increased nutritional requirements to counteract the physiological stress of RA rather than a role for these nutrients in the cause of the disease. Some research suggests vegetarian diets may be helpful for some RA sufferers ^5-6 but these benefits have not been demonstrated in larger, long-term studies. Other studies indicate that omega-3 fatty acids found in fish oils may play a role in the prevention ⁷ and treatment ⁸ of rheumatoid arthritis. While the impact of nutritional factors on RA is still under investigation, a balanced, nutritious diet is advisable for all RA sufferers.