Straight answers to common joint soreness questions

Sources

1. A meta-analysis of 20 dietary supplements across 69 randomised trials in hand, hip or knee osteoarthritis found that seven (collagen hydrolysate, passion fruit peel extract, Curcuma longa extract, Boswellia serrata extract, curcumin, pycnogenol and L-carnitine) showed large short-term effects on pain, and six more (undenatured type II collagen, avocado soybean unsaponifiables, methylsulfonylmethane, diacerein, glucosamine, chondroitin) showed statistically significant but clinically unclear effects. At MEDIUM term only green-lipped mussel extract and undenatured type II collagen retained clinically important effects, and NO supplement had a clinically important effect on pain at long term.

   Liu X, Machado GC, Eyles JP, Ravi V, Hunter DJ — Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis.. British Journal of Sports Medicine, 2018. DOI: 10.1136/bjsports-2016-097333.

2. Within the VITAL trial - 25,871 US adults randomised in a 2-by-2 factorial design to vitamin D and/or marine omega-3 fatty acids - a subgroup of 1,398 participants with pre-existing chronic knee pain (mean age 67.7, 66% women, mean WOMAC pain 37 of 100) was followed for a mean of 5.3 years. WOMAC pain did not differ between active vitamin D and its placebo, or between active omega-3 and its placebo, at any time point, and the time-by-treatment interactions were not significant. Function and stiffness gave the same answer.

   MacFarlane LA, Cook NR, Kim E, et al. — The Effects of Vitamin D and Marine Omega-3 Fatty Acid Supplementation on Chronic Knee Pain in Older US Adults: Results From a Randomized Trial.. Arthritis & Rheumatology, 2020. DOI: 10.1002/art.41416.

3. In a randomised, double-blind, placebo-controlled trial, 136 patients with hand osteoarthritis or psoriatic arthritis who still had moderate pain on existing therapy received synthetic cannabidiol 20-30 mg daily or placebo for 12 weeks. The between-group difference in pain intensity at 12 weeks was 0.23 mm on a 0-100 mm scale (95% CI -9.41 to 9.90; p=0.96). There were no significant effects on sleep quality, depression, anxiety or pain catastrophizing either.

   Vela J, Dreyer L, Petersen KK, Arendt-Nielsen L, Duch KS, Kristensen S — Cannabidiol treatment in hand osteoarthritis and psoriatic arthritis: a randomized, double-blind, placebo-controlled trial.. Pain, 2022. DOI: 10.1097/j.pain.0000000000002466.

4. OARSI's 2019 guideline is the only major osteoarthritis guideline that grades treatments separately for people with disease in MULTIPLE joints. Its Core Treatments for polyarticular OA are arthritis education and structured land-based exercise. Critically, intra-articular corticosteroid and intra-articular hyaluronic acid were Level 1B/2 options for knee OA only and were NOT recommended for hip or polyarticular OA; oral NSAIDs were not recommended at all for people with cardiovascular comorbidity or frailty; and paracetamol/acetaminophen was conditionally not recommended.

   Bannuru RR, Osani MC, Vaysbrot EE, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.. Osteoarthritis and Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

5. In a structured review of 14 studies covering 6,242 patients with an acutely painful swollen joint (653 with confirmed septic arthritis), no single symptom rules the diagnosis in or out: joint pain was present in 85%, a history of joint swelling in 78%, and fever in only 57%. The most powerful bedside data came from aspirating the joint - the summary likelihood ratio rose with the synovial fluid white cell count, from 0.32 below 25,000/microL to 2.9 at 25,000 or more, 7.7 above 50,000 and 28.0 above 100,000.

   Margaretten ME, Kohlwes J, Moore D, Bent S — Does this adult patient have septic arthritis?. JAMA, 2007. DOI: 10.1001/jama.297.13.1478.

6. The FTC's Health Products Compliance Guidance sets out the standard every health claim in advertising must meet. Advertising must be truthful and not misleading, and before an ad runs the advertiser must hold adequate substantiation for every objective claim it conveys expressly or by implication. As a general rule, claims about the health benefits or safety of foods, dietary supplements, drugs and other health-related products require substantiation in the form of 'competent and reliable scientific evidence'. The guidance explicitly covers websites, social media, influencer marketing, press interviews, seminars, and claims made indirectly through healthcare practitioners.

   Federal Trade Commission, Bureau of Consumer Protection — Health Products Compliance Guidance. FTC Business Guidance, 2022.

7. A systematic review of 25 observational studies (15 rated high quality) found moderate evidence that overweight is associated with developing osteoarthritis of the HAND - a joint that carries none of the body's weight - with an approximate risk ratio of 1.9. That association is the standard argument that body weight acts on joints systemically, not only mechanically.

   Yusuf E, Nelissen RG, Ioan-Facsinay A, et al. — Association between weight or body mass index and hand osteoarthritis: a systematic review.. Annals of the Rheumatic Diseases, 2010. DOI: 10.1136/ard.2008.106930.