Nurturing Our Body's Foundation: The Importance of Joint Support in Humans

Your joints are the pillars that support your body's movement, taking care of them is vital for overall well-being.

Overview	Science	Reasons	Joint Constituents
Joint supplement and Health	Recommendations

Overview

Human bodies are a complex system, and one integral aspect of this intricate system is our joints. Joints or articulations are the junctions that connect bones, or bone and cartilage together to form connection and perform a wide range of activities including movement ^[1,2]. As we age, our bodies undergo various changes, and one of the most common concerns is joint health. With time, wear and tears, injuries and/or certain medical conditions, our joints can become a source of discomfort and pain. Pain and stiffness, and injuries in joints result in reduced mobility, which can significantly impact our daily lives^[3,4]. This is where joint support supplements may come into play, potentially offering a lifeline to maintain and improve joint health.

Understanding Joints Health

Before diving into joint support supplements, it's essential to understand a few important details about joints. Joints play a pivotal role in our everyday lives, allowing us to walk, run, bend, stretch, and perform a plethora of activities. They exist in various forms. Structurally there are three types of joints based on whether they are connected by fibrous connective tissue (fibrous joints), joined by cartilage (cartilaginous joints), or have articulating surfaces within a lubricated joint cavity (synovial joints). Based on the degree of movement, joints are functionally classified as immovable, slightly moveable and freely immovable. Each type of joint performs a specific function, and they are all equally vital. Synovial joints being the most common joints in humans and allow for free movement between bones. Most common free movement joints are hinge joints (e.g., knee), ball-and-socket joints (e.g., hip), and pivot joints (e.g., neck)^[5].

Likely Reasons for Joint Pain

Over time, joints can face inflammatory conditions like arthritis or osteoarthritis^[6,7]. These conditions can lead to pain, stiffness, and reduced mobility^[8]. Overall, multiple factors contribute to an individual's likelihood of experiencing joint pain.

One of the most significant factors contributing to joint pain is age. Due to  natural wear and tear cartilage that cushions the ends of our bones can deteriorate over time, leading to the most common form of arthritis-osteoarthritis, that affects millions of people worldwide^[9]. Osteoarthritis primarily targets older individuals, making age a significant risk factor for joint pain. Previous joint injuries aggravate pain in the joints further in old age^[10]. Studies have shown that females are more susceptible to joint pain compared to male^[11]. Excess weight, particularly in the lower body also increases the risk further^[12]. Occupation and lifestyle can also contribute to joint pain, especially in jobs involving repetitive motions or high-impact sports.

Functions of Supplements in Joints

Proper rehabilitation and preventive measures are vital for those with a history of joint injuries. To address these problems, joint support supplements have gained popularity as a natural, non-invasive approach to promote joint health.

Glucosamine

Glucosamine is naturally synthesized in our body, and it plays an important role in joints, joint fluids, cartilage, tendons, and ligaments^[13]. Some of the key roles it plays in the overall health of joints and bones are:

1. Cartilage formation: Glucosamine is a crucial component of cartilage, and it helps in the formation and repair of cartilage, which is essential for joint flexibility and mobility^[14,15].
2. Chondroitin sulfate production: In our body glucosamine is used to synthesize chondroitin sulfate, another component of cartilage. Chondroitin helps to maintain the elasticity and shock-absorbing properties of cartilage^[16,17].
3. Joint lubrication: Glucosamine can aid in the regeneration of synovial fluid, which lubricates the joints. The lubrication from synovial fluid is crucial for reducing friction between joint surfaces and preventing joint pain and stiffness^[18,19].
4. Osteoarthritis: Glucosamine supplements are often used to manage osteoarthritis, a degenerative joint disease. Research has shown that glucosamine can alleviate joint pain, reduce joint stiffness, and slow the progression of the condition^[20,21].
5. Anti-Inflammatory properties: Some studies have suggested that glucosamine may have anti-inflammatory properties. Inflammation is a common factor in joint conditions like osteoarthritis, and reducing inflammation can contribute to better joint health^[22,23].
6. Joint and bone health: glucosamine indirectly supports overall bone health. Healthy bones with healthy joints are essential for maintaining mobility and flexibility, which, in turn, can help prevent bone loss and maintain bone density.

Chondroitin

Chondroitin sulfate is a natural biomacromolecule in humans which is also a major component of  cartilage, ligaments, tendons and bones^[24]. Chondroitin sulfate in conjunction with glucosamine supports joint function^[25,26].

Like glucosamine, chondroitin also helps keeps cartilage healthy, helps in joint lubrication, has anti-Inflammatory properties which are beneficial in osteoarthritis management^[17]. Chondroitin sulfate (CS) inhibits rheumatic disease-related enzymes in synovial fluid. In this way, it stops destruction of cartilage and stimulates processes and synthesis of macromolecules involved in the formation of new cartilage. It also stimulates hyaluronic acid production which improves viscosity of synovial fluid^[27,28].

Hyaluronic Acid

Hyaluronic acid (HA) is a naturally occurring gel-like substance found in various parts of the body,  most importantly, in the synovial fluid^[29]. It has viscoelastic property, due to which it acts as a shock absorber and lubricant for our joints, helping to reduce friction and maintain smooth, pain-free movement^[30,31,32].

MSM (Methylsulfonylmethane)

Methylsulfonylmethane, commonly known as MSM, occurs naturally in humans, animals, and in green plants, fruits, and vegetables^[33]. Studies have shown that MSM, alone or in combination with glucosamine and chondroitin, may help reduce joint pain and improve function in individuals with osteoarthritis. It's believed to reduce inflammation and support collagen production, which is vital for healthy joints^{[34,35,36,37]}.

Calcium and Vitamin D

Calcium and vitamin D play important roles in maintaining joint health, and their relationship is closely linked^[38]. Calcium is a primary mineral crucial for maintaining bone strength and density, supporting joint structure, and providing a stable foundation for ligaments and tendons^[39]. Vitamin D helps regulate calcium levels in the blood by facilitating the absorption of calcium from the intestines^[40,41]. Inadequate calcium intake can lead to weakened bones, making them more susceptible to fractures and osteoporosis^[42,43]. Without sufficient vitamin D, even if you have an adequate dietary intake of calcium, the body cannot absorb and utilize calcium effectively, leading to calcium deficiency and an increased risk of bone and joint problems^[38,44,45].

Collagen

Collagen, the most abundant protein in the human body and joints rely on collagen to stay strong and pain-free^[46,47]. Collagen provides the structural foundation for tendons, ligaments, and cartilage, the key components of joints^[48]. Collagen's lubricating and cushioning properties can ease the friction in joints, making movements smoother and more comfortable^[49]. For those suffering from conditions like osteoarthritis, especially elderly people, collagen may offer relief by protecting and repairing the cartilage^[50,51,52].

Omega-3 Fatty Acids

The three primary omega-3 fatty acids EPA (eicosapentaenoic acid), DHA (docosahexaenoic acid), and ALA (alpha-linolenic acid) are essential fats found in certain foods like fish and fish oil, flax seed, soybean, walnuts and obtained through diets^[53]. These essential fats are known for their numerous health benefits including joint health^[54,55]. They have anti-inflammatory properties and were specifically found helpful to reduce joint pain and stiffness in people with rheumatoid arthritis^[56,57].

Significance of Joint Support Supplements

Glucosamine, hyaluronic acid, and chondroitin sulfate are important basic components of joint supplements. As a joint support supplement, they can help reduce inflammation and alleviate joint pain. A meta-analysis suggests that chondroitin provides a moderate benefit for pain and has a large effect on function in knee OA^[58]. It was found that chondroitin-glucosamine is effective and safe in the symptomatic and functional improvement of patients with temporomandibular disorders^[26].

Joint supplements promote improved joint mobility by supporting the health of the cartilage, synovial fluid, and surrounding tissues^[59]. This enables individuals to maintain their range of motion and engage in daily activities without discomfort. Cartilage is the cushioning tissue that protects our joints. Over time, it can break down, leading to conditions like osteoarthritis^[60].

Joint support supplements can help slow down this deterioration and, in some cases, stimulate the body's natural cartilage repair processes^[61,62]. Synovial fluid lubricates joints, reducing friction and facilitating smooth movement. Supplements containing hyaluronic acid can enhance the production of synovial fluid, ensuring that your joints move effortlessly^[19,63,64].

Recommendations

Remember, your joints are the pillars that support your body's movement, so taking care of them is a vital part of your overall well-being. Joint support supplements offer an accessible and natural solution for maintaining and improving joint health. With the increasing emphasis on an active lifestyle, these supplements have gained significant importance in recent times. By prioritizing joint health and incorporating joint support supplements into daily routine, people can potentially alleviate pain, improve mobility, and enjoy an active, pain-free life. Joint supplements are not only for those who already experience joint problems. They can also be used proactively to prevent joint issues and maintain long-term joint health. This is particularly relevant for individuals who engage in high-impact sports or have a family history of joint conditions. However, it's essential to consult with a healthcare professional before starting any supplement regimen, as they can provide personalized advice and recommendations based on your specific needs and medical history.

References

1. Betts JG, Young KA, Wise JA, Johnson E, Poe B, Kruse DH, DeSaix P et al (2020). Anatomy & physiology 2e. Retrieved on 10/24/2023.  https://openstax.org/details/books/anatomy-and-physiology-2e
2. Buckwalter JA, Mankin HJ (199a). Articular cartilage: part I. J Bone Joint Sur, 79:600.
3. Ahmed MS, Matsumura B, Cristian A (2005) Age-related changes in muscles and joints. Phy Med Rehab Clin, 16:19-39.
4. Ostojic SM, Arsic M, Prodanovic S, Vukovic J, Zlatanovic M, (2007) Glucosamine administration in athletes: effects on recovery of acute knee injury. Res Sports Med, 15:113-24.
5. Harcus J (2022) Bones and Joints-E-Book: A Guide for Students. Elsevier Health Sciences.
6. Malaviya AN (2006) Clinical approach to patients with joint disease: importance of distinguishing inflammatory from non‐inflammatory conditions. APLAR J Rheumatol, 9:11-17.
7. Kuettner KE, Cole AA (2005) Cartilage degeneration in different human joints. Osteoarthritis Cartilage, 13:93-103.
8. Buckwalter JA, Mankin HJ (1997b) Articular cartilage: part I and II. J Bone Joint Surgery, 79:612.
9. Nelson AE (2018) Osteoarthritis year in review 2017: clinical. Osteoarthritis Cartilage, 26:319-325.
10. Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP (2015) Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage, 23:507-515.
11. Kim JR, Kim HA (2020) Molecular mechanisms of sex-related differences in arthritis and associated pain. Int J Mol Sci, 21:7938.
12. Tukker A, Visscher TLS, Picavet HSJ (2009) Overweight and health problems of the lower extremities: osteoarthritis, pain and disability. Public Health Nutri, 12:359-368.
13. Barclay TS, Tsourounis C, McCart GM (1998) Glucosamine. Annals of Pharmacotherapy, 32:574-579.
14. Bassleer C, Rovati L, Franchimont P (1998) Stimulation of proteoglycan production by glucosamine sulfate in chondrocytes isolated from human osteoarthritic articular cartilage in vitro. Osteoarthritis Cartilage, 6:427-434.
15. James CB, Uhl TL, (2001) A review of articular cartilage pathology and the use of glucosamine sulfate. J Athl Train, 36:413-9.
16. Silbert JE, Sugumaran G (2002). Biosynthesis of chondroitin/dermatan sulfate. IUBMB life, 54:177-186.
17. Miller KL, Clegg DO (2011). Glucosamine and chondroitin sulfate. Rheumatic Disease Clinics, 37:103-118.
18. Conrad BP (2001) The effects of glucosamine and chondroitin on the viscosity of synovial fluid in patients with osteoarthritis (Doctoral dissertation, University of Florida).
19. McCarty MF (1998) Enhanced synovial production of hyaluronic acid may explain rapid clinical response to high-dose glucosamine in osteoarthritis. Medical hypotheses, 50:507-510.
20. Anderson JW, Nicolosi RJ, Borzelleca JF (2005) Glucosamine effects in humans: a review of effects on glucose metabolism, side effects, safety considerations and efficacy. Food ChemToxicol, 43: 187-201.
21. Thakral R, Debnath UK, Dent C (2007) Role of glucosamine in osteoarthritis. Current Orthopaedics, 21:386-389.
22. Shin JA, Hwang JS, Kim SY, Oh SK, Nam G, Han IO (2013) A novel glucosamine derivative exerts anti-inflammatory actions via inhibition of nuclear factor-kappaB. Neuroscience Letters, 550:162-167.
23. Kantor ED, Lampe JW, Navarro SL, Song X, Milne GL, White E (2014) Associations between glucosamine and chondroitin supplement use and biomarkers of systemic inflammation. J Altern Complement Med, 20: 479-485.
24. Volpi N (2019) Chondroitin sulfate safety and quality. Molecules, 24:1447.
25. Singh JA, Noorbaloochi S, MacDonald R, Maxwell LJ (2015) Chondroitin for osteoarthritis. Cochrane Database Systematic Rev, 1: CD005614.
26. Ruiz-Romero V, Toledano-Serrabona J, Gay-Escoda C, (2022) Efficacy of the use of chondroitin sulphate and glucosamine for the treatment of temporomandibular joint dysfunction: a systematic review and meta-analysis. Cranio, 1-10.
27. David‐Raoudi M, Deschrevel B, Leclercq S, Galéra P, Boumediene K, Pujol JP (2009) Chondroitin sulfate increases hyaluronan production by human synoviocytes through differential regulation of hyaluronan synthases: role of p38 and Akt. Arthritis & Rheumatism: Official J Am College Rheumatol, 60:760-770.
28. Jerosch J (2011) Effects of glucosamine and chondroitin sulfate on cartilage metabolism in OA: outlook on other nutrient partners especially omega-3 fatty acids. Int J Rheumatol, 969012
29. Migliore A, Procopio S, (2015) Effectiveness and utility of hyaluronic acid in osteoarthritis. Clin Cases Miner Bone Metab, 12:31-3
30. Swann DA, Radin EL, Nazimiec M, Weisser PA, Curran N, Lewinnek G (1974) Role of hyaluronic acid in joint lubrication. Annals Rheumatic Diseases, 33:318.
31. Kalman DS, Heimer M, Valdeon A, Schwartz H, Sheldon E (2008) Effect of a natural extract of chicken combs with a high content of hyaluronic acid (Hyal-Joint®) on pain relief and quality of life in subjects with knee osteoarthritis: a pilot randomized double-blind placebo-controlled trial. Nutrition J, 7:1-9.
32. Chen LH, Xue JF, Zheng ZY, Shuhaidi M, Thu HE, Hussain Z (2018) Hyaluronic acid, an efficient biomacromolecule for treatment of inflammatory skin and joint diseases: A review of recent developments and critical appraisal of preclinical and clinical investigations. Int J Biol Macromol, 116:572-584.
33. Lim YZ, Hussain SM, Cicuttini FM, Wang Y (2019) Nutrients and dietary supplements for osteoarthritis. In Watson, RR and Preddy, VR. (eds.), Bioactive food as dietary interventions for arthritis and related inflammatory diseases. Academic press, New York, pp. 97-137.
34. Butawan M, van der Merwe M, Benjamin RL, Bloomer RJ (2019) Methylsulfonylmethane: anti-inflammatory actions and usage for arthritic conditions. In Watson, RR and Preddy, VR. (eds.), Bioactive food as dietary interventions for arthritis and related inflammatory diseases, Academic press, New York, pp. 553-573.
35. Gupta RC, Kalidindi SR, Doss RB, Lall R, Srivastava A, Sinha A (2021) Nutraceuticals in arthritis. In RC Gupta, R Lall, A Srivastava (eds.), Nutraceuticals, Academic Press, New York, pp. 193-214.
36. Kim LS, Axelrod LJ, Howard P, Buratovich N, Waters RF (2006) Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. Osteoarthritis Cartilage, 14:286-294.
37. Usha PR, Naidu MUR (2004) Randomised, double-blind, parallel, placebo-controlled study of oral glucosamine, Methylsulfonylmethane and their combination in osteoarthritis.  Drug Investig, 24:353–363.
38. Holick MF (2007) Vitamin D deficiency. New England J Med, 357:266-281.
39. Hall JE, Hall ME (2020) Guyton and Hall textbook of medical physiology e-Book. Elsevier Health Sciences.
40. Veldurthy V, Wei R, Oz L, Dhawan P, Jeon YH, Christakos S (2016) Vitamin D, calcium homeostasis and aging. Bone Res, 4:1-7.
41. Wimalawansa SJ, Razzaque MS, Al-Daghri NM (2018) Calcium and vitamin D in human health: Hype or real? J Steroid Biochem Mol Biol, 180:4-14.
42. Fujita T (1998) Degenerative joint disease: An example of calcium paradox. J Bone Min Metabol, 16:195-205.
43. Zhu K, Prince RL (2012) Calcium and bone. Clin Biochem, 45: 936-942.
44. Pattanaungkul S, Riggs BL, Yergey AL et al (2000) Relationship of intestinal calcium absorption to 1,25-dihydroxyvitamin D [1,25(OH)2D] levels in young versus elderly women: evidence for age-related intestinal resistance to 1,25(OH)2D action. J Clin Endocrinol Metab, 85:4023–4027.
45. Khazai N, Judd SE, Tangpricha V, (2008) Calcium and vitamin D: skeletal and extraskeletal health. Curr Rheumatol Rep., 10:110-117.
46. Shoulders MD, Raines RT (2009) Collagen structure and stability. Ann Rev Biochem, 78:929-958.
47. Viguet-Carrin S, Garnero, P, Delmas PD (2006) The role of collagen in bone strength. Osteoporosis Int, 17:319-336.
48. Benjamin M, Ralphs JR (1997) Invited Review Tendons and ligaments-an overview.  Histopathol, 12:1135-1144.
49. Park IS, Choi WH, Park DY, Park SR, Park SH, Min BH (2018) Effect of joint mimicking loading system on zonal organization into tissue-engineered cartilage. PloS one, 13:e0202834.
50. Daneault A, Prawitt J, Fabien Soulé V, Coxam V, Wittrant Y (2017) Biological effect of hydrolyzed collagen on bone metabolism. Crit Rev Food Sci Nutri, 57:1922-1937.
51. Roland WM (2000) Role of collagen hydrolysate in bone and joint disease. Seminars Arthritis Rheumatism, 30: 87-99
52. Bello AE, Oesser S (2006) Collagen hydrolysate for the treatment of osteoarthritis and other joint disorders: a review of the literature. Current Med Res Opinion, 22:2221-2232.
53. Tur JA, Bibiloni MM, Sureda A, Pons A (2012) Dietary sources of omega 3 fatty acids: public health risks and benefits. British J Nutri, 107:S23-S52.
54. MacLean CH, Mojica WA, Morton SC, Pencharz J, Hasenfeld Garland R, Tu W, et al. (2004) Effects of omega-3 fatty acids on lipids and glycemic control in type ii diabetes and the metabolic syndrome and on inflammatory bowel disease, rheumatoid arthritis, renal disease, systemic lupus erythematosus, and osteoporosis. Evidence Report/Technology Assessment no. 89. Prepared by Southern California/RAND Evidence-based Practice Center, under contract no. 290-02- 0003. Rockville, MD: Agency for Healthcare Research and Quality.
55. Kostoglou-Athanassiou I, Athanassiou L, Athanassiou P (2020) The effect of omega-3 fatty acids on rheumatoid arthritis. Mediterr J Rheumatol, 31:190-194
56. Goldberg RJ, Katz J, (2007) A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain, 129:210-23.
57. Lee YH, Bae SC, Song GG (2012) Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Arch Med Res, 43:356-62.
58. Honvo G, Bruyère O, Geerinck A, Veronese N, Reginster JY (2019) Efficacy of chondroitin sulfate in patients with knee osteoarthritis: A comprehensive meta-analysis exploring inconsistencies in randomized, placebo-controlled trials. Adv Therepy, 36:1085-1099.
59. Colletti A, Cicero AF (2021) Nutraceutical approach to chronic osteoarthritis: from molecular research to clinical evidence. Int J Mol Sci, 22:12920.
60. Martel-Pelletier J, Boileau C, Pelletier JP, Roughley PJ (2008) Cartilage in normal and osteoarthritis conditions. Best Practice Res Clinic Rheumatol, 22:351-384.
61. Fuggle NR, Cooper C, Oreffo RO, Price AJ, Kaux JF, Maheu E, ….Reginster JY (2020) Alternative and complementary therapies in osteoarthritis and cartilage repair. Aging Clinic Exp Res, 32:547-560.
62. Nieman DC, Shanely RA, Luo B, Dew D, Meaney MP, Shaw W (2013) A commercialized dietary supplement alleviates joint pain in community adults: a double-blind, placebo-controlled community trial. Nutrition J, 12:1-9.
63. Wang SJ, Wang YH, Huang LC (2021) The effect of oral low molecular weight liquid hyaluronic acid combination with glucosamine and chondroitin on knee osteoarthritis patients with mild knee pain: An 8-week randomized double-blind placebo-controlled trial. Medicine, 100: e24252.
64. Uitterlinden EJ, Koevoet JLM, Verkoelen CF, Bierma-Zeinstra SMA, Jahr H, Weinans H, ... Van Osch GJVM (2008) Glucosamine increases hyaluronic acid production in human osteoarthritic synovium explants. BMC Musculoskeletal Disorders, 9:1-7.