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DOI: 10.1055/s-2007-963401
© Georg Thieme Verlag KG Stuttgart · New York
Ernährungsmedizinische Aspekte der Arthrose: Pathophysiologie und Studien
Aspects of Osteoarthritis from the Point of View of Nutritional Medicine: Pathophysiology and TrialsPublication History
Publication Date:
04 September 2007 (online)
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Zusammenfassung
Die Arthrose ist eine multifaktorielle Erkrankung, auf die genetische, statische, physikalische, biochemische sowie nutritive Faktoren Einfluss haben. Die Pathophysiologie der Arthrose zeigt den großen Stellenwert entzündlicher Prozesse für den Knorpelabbau. Hier können Nährstoffe mit bekannter Wirkung auf den Entzündungsprozess eingreifen, wie Omega-3-Fettsäuren, Antioxidantien und Phytotherapeutika. Nutritiv sind Stoffe von Bedeutung, deren Verfügbarkeit, infolge einer unzureichenden Biosynthese oder Verfügbarkeit in der Nahrung, limitiert ist. Mögliche Wirkstoffe sind Glucosamin, Chondroitin, Vitamine und Mineralien. Da die Entwicklung einer Arthrose im Allgemeinen langsam abläuft und die Ursachen vielfältig sind, ist der Einfluss eines Nährstoffes schwer nachzuweisen. Dies spiegelt sich in der uneinheitlichen Bewertung der vorliegenden Studien wider. Hochrangige, GCP-konforme klinische Studien mit Nährstoffen sind aus finanziellen und technischen Gründen kaum durchführbar. Häufig wird deshalb der Nachweis einer Wirksamkeit durch Surrogatparameter belegt. Für die Antioxidantien wurde die Problematik dieser Messgrößen in jüngster Zeit offenbar. In diesem Review wird die Datenlage aus der verfügbaren Literatur zu den wichtigsten nutritiven Faktoren für die Entstehung der Arthrose geschildert.
Abstract
Osteoarthritis is a multifactorial disease, with relevant influences of genetic, static, physical, biochemical and nutrical factors. The pathophysiology of osteoarthritis reveals the eminent relevance of inflammatory processes for the destruction of cartilage. These processes are targets for omega-3 fatty acids, antioxidants and phytochemicals. Nutritional relevance is elicited by compounds with limited availability, either because of insufficient biosynthesis or deficient dietary supply. Of potential relevance are chondroitin, glucosamines, vitamins and minerals. Since, in most cases, the development of osteoarthritis is slow and causes are variable, the effect of one nutrient on this process is hard to prove. This is reflected by the ambiguous ranking of the available studies. High ranking, GCP-conform clinical studies with nutrients are rare, because of technical and financial reasons. Frequently, surrogate parameters are used for the proof of efficacy. The bias of this approach has lately become evident for antioxidants. This review presents data from the literature relating to nutritional factors with relevance for the development of osteoarthritis.
Schlüsselwörter
Arthrose - Ernährung - Antioxidanzien - Glucosamin - Nahrungsergänzungsmittel
Key words
osteoarthritis - nutrition - antioxidants - glucosamines - nutraceuticals
Literatur
- 1 Ameye L G, Chee W S. Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence. Arthritis Res Ther. 2006; 8 (4) R127
- 2 Appelboom T, Schuermans J, Verbruggen G. et al . Symptoms modifying effect of avocado/soybean unsaponifiables (ASU) in knee osteoarthritis. A double blind, prospective, placebo-controlled study. Scand J Rheumatol. 2001; 30 (4) 242-247
- 3 Arita M, Bianchini F, Aliberti J. et al . Stereochemical assignment, antiinflammatory properties, and receptor for the omega-3 lipid mediator resolvin E 1. J Exp Med. 2005; 201 (5) 713-722
- 4 Bjelakovic G, Nikolova D, Gluud L L. et al . Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA. 2007; 297 (8) 842-857
- 5 Blotman F, Maheu E, Wulwik A. et al . Efficacy and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip. A prospective, multicenter, three-month, randomized, double-blind, placebo-controlled trial. Rev Rhum Engl Ed. 1997; 64 (12) 825-834
- 6 Brien S, Lewith G, Walker A. et al . Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evid Based Complement Alternat Med. 2004; 1 (3) 251-257
- 7 Christensen R, Astrup A, Bliddal H. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage. 2005; 13 (1) 20-27
- 8 Cibere J, Kopec J A, Thorne A. et al . Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis. Arthritis Rheum. 2004; 51 (5) 738-745
- 9 Elmali N, Esenkaya I, Harma A. et al . Effect of resveratrol in experimental osteoarthritis in rabbits. Inflamm Res. 2005; 54 (4) 158-162
- 10 German B, Schiffrin E J, Reniero R. et al . The development of functional foods: lessons from the gut. Trends Biotechnol. 1999; 17 (12) 492-499
- 11 Gimble J M, Nuttall M E. Bone and fat: old questions, new insights. Endocrine. 2004; 23 (2 - 3) 183-188
- 12 Harris Jr. E. The bone and joint decade: a catalyst for progress. Arthritis Rheum. 2001; 44 (9) 1969-1970
- 13 Henrotin Y, Kurz B, Aigner T. Oxygen and reactive oxygen species in cartilage degradation: friends or foes?. Osteoarthritis Cartilage. 2005; 13 (8) 643-654
- 14 Kean W F, Kean R, Buchanan W W. Osteoarthritis: symptoms, signs and source of pain. Inflammopharmacology. 2004; 12 (1) 3-31
- 15 Kraus V B, Huebner J L, Stabler T. et al . Ascorbic acid increases the severity of spontaneous knee osteoarthritis in a guinea pig model. Arthritis Rheum. 2004; 50 (6) 1822-1831
- 16 Maurer H R. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001; 58 (9) 1234-1245
- 17 McAlindon T E, Biggee B A. Nutritional factors and osteoarthritis: recent developments. Curr Opin Rheumatol. 2005; 17 (5) 647-652
- 18 McAlindon T E, Jacques P, Zhang Y. et al . Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis?. Arthritis Rheum. 1996; 39 (4) 648-656
- 19 Mertz W. Food fortification in the United States. Nutr Rev. 1997; 55 (2) 44-49
- 20 Messier S P, Loeser R F, Miller G D. et al . Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum. 2004; 50 (5) 1501-1510
- 21 Michel B A, Stucki G, Frey D. et al . Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: a randomized, controlled trial. Arthritis Rheum. 2005; 52 (3) 779-786
- 22 Najm W I, Reinsch S, Hoehler F. et al . S-adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: a double-blind cross-over trial. [ISRCTN36233495]. BMC Musculoskelet Disord. 2004; 5 6
- 23 Poole A R. Biochemical/immunochemical biomarkers of osteoarthritis: utility for prediction of incident or progressive osteoarthritis. Rheum Dis Clin North Am. 2003; 29 (4) 803-818
- 24 Ramsey S D, Spencer A C, Topolski T D. et al . Use of alternative therapies by older adults with osteoarthritis. Arthritis Rheum. 2001; 45 (3) 222-227
- 25 Richette P, Bardin T. Structure-modifying agents for osteoarthritis: an update. Joint Bone Spine. 2004; 71 (1) 18-23
- 26 Spector T D, MacGregor A J. Risk factors for osteoarthritis: genetics. Osteoarthritis Cartilage. 2004; 12 (Suppl A) S39-S44
- 27 Towheed T E, Maxwell L, Anastassiades T P. et al . Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2005; a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2007, Issue 2 CD002946
- 28 Wieland H A, Michaelis M, Kirschbaum B J. et al . Osteoarthritis - An untreatable desease?. Nat Rev Drug Discov. 2005; 4 (4) 331-344
- 29 Wigler I, Grotto I, Caspi D. et al . The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis Cartilage. 2003; 11 (11) 783-789
- 30 Winther K, Apel K, Thamsborg G. A powder made from seeds and shells of a rose-hip subspecies (Rosa canina) reduces symptoms of knee and hip osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial. Scand J Rheumatol. 2005; 34 (4) 302-308
- 31 Wluka A E, Stuckey S, Brand C. et al . Supplementary vitamin E does not affect the loss of cartilage volume in knee osteoarthritis: a 2 year double blind randomized placebo controlled study. J Rheumatol. 2002; 29 (12) 2585-2591
- 32 Yudoh K, Nguyen T, Nakamura H. et al . Potential involvement of oxidative stress in cartilage senescence and development of osteoarthritis: oxidative stress induces chondrocyte telomere instability and downregulation of chondrocyte function. Arthritis Res Ther. 2005; 7 (2) R380-R391
Dr. Wolfgang W. Bolten
Innere Med., Rheumatologie, Klaus Miehlke-Klinik
Leibnizstr. 23
65191 Wiesbaden
Phone: ++ 49/6 11/57 58 11
Fax: ++ 49/6 11/57 58 88
Email: wbolten@em.uni-frankfurt.de