Chula Medicine Determines “Cytokines” as Indicator of “Degenerative Joints” Giving Hopes for Better Disease Mitigation

Chula Medicine announced the discovery of “cytokines” in the body’s immune system that can determine the severity of osteoarthritis in elderly adults, hoping to facilitate the planning of follow-up and treatment of the disease, and reduction of its severity, while also recommending vitamin D and vitamin E supplements, body weight control, and proper exercise.

Older adults and osteoarthritis seem to be two peas in a pod. As they age, many older adults begin to walk more slowly, and have a more difficult time going up and getting down the stairs with joint popping and crackling, or sometimes joint pain, be it the knees, the hips, or finger joints. The disease, although not life-threatening, undermines their happiness and quality of life.

“Osteoarthritis is a major public health problem in Thailand and around the world, affecting the quality of life of older people. The longer Thai people live today, the more they will have this disease. It is incurable, but if we can predict its severity, we will be able to find a way to lessen its impact,” Professor Sittisak Honsawek, M.D., Department of Biochemistry, Faculty of Medicine, Chulalongkorn University elaborated on the inception of the research project “Cytokines and Biochemistry Substances as Indicator and Target of Osteoarthritis Treatment” which received an Excellent Research Award by Chula personnel in health science 2021.

For more than 10 years in research, Professor Dr. Sittisak and his team have been arduously working on this study to understand the causes of osteoarthritis, its mechanisms, and its severity indicators to determine ways of monitoring, preventing, and mitigating the disease, which will improve the patient’s quality of life.

Cytokines and osteoarthritis

According to Professor Dr. Sittisak, the study of osteoarthritis mechanisms show that some cytokines contribute to bringing about the disease and contribute to its progression.

“Cytokines are a group of proteins secreted by inflamed cells within the joints. Cytokines and some biochemicals encourage cartilage cells to secrete substances that aid cartilage formation and breakdown. The presence of unbalanced cytokines induces faster degeneration of cartilage, causing more degeneration of the joints.”

This discovered knowledge can be used to develop a monitoring process of patients to predict if their case of osteoarthritis would become acute in the future, as well as find ways to reduce or inhibit the cytokines responsible for osteoarthritis.

Currently, cytokine levels are only measured after the patients have undergone arthroplasty.

“After surgery, we will measure cytokine levels that help indicate whether there may be complications from inflammation. If the levels are very high, it indicates that there may be a postoperative infection. Therefore, antibiotics are needed until cytokine levels drop to normal,” said Professor Dr. Sittisak.

Getting to Know osteoarthritis and its risk factors

The major cause of osteoarthritis is the degeneration of articular cartilage with age, which can occur in people aged 40 and over, and is evident in people aged 60 and over — the greater the age, the more likelihood of osteoarthritis.  According to recent statistics, more than 50 percent of people aged 70 and over have osteoarthritis.

“All the joints in the body are made up of two bones: the hard bone and the cartilage. As people age, cartilage production deteriorates, resulting in the loss of cartilage function. The body then stimulates cartilage cells to produce cytokines, causing inflammation of the tissues around the joints, ligaments, and muscles,” Professor Dr. Sittisak explained the mechanism of osteoarthritis in older adults, which occurs in various joints in the body, but the most common is the knee joints, followed by the hip joints and the knuckles.

Apart from the age factor, women are 2 – 3 times more likely to suffer from osteoarthritis than men because of the reduction in hormone production during menopause, thus affecting the quality of cartilage. Moreover, another risk factor is excessive body weight which contributes to more severe osteoarthritis.

Symptoms and severity levels of osteoarthritis

The degree of severity of osteoarthritis varies depending on the duration of the disease. At first, joint pain occurs when walking, standing, or going up and down the stairs. Then, the joints begin to make noise. You need to take a rest after walking for a while. The symptoms will improve when you stop putting pressure on the joints.

If osteoarthritis becomes more acute, the patients will experience pain, swelling in the joints, inflammation, or inability to bend or fully extend the joints. In severe cases, the joints will become bent and disfigured, causing knee flexion, and finger flexion.  X-rays will show bone spurs piercing the tissue in the knee joints, causing inflammation and pain.

“This disease is not fatal, but it makes it impossible to live a normal life. Quality of life has been deteriorating in patients who have had this disease for a long time. Muscle weakness may be caused by inactivity, and 50 percent of osteoarthritis patients have a chance of having bilateral osteoarthritis.”

Healable though not curable

Although osteoarthritis is incurable, there are ways to improve the quality of life and reduce pain. According to Professor Dr. Sittisak, after the patient has been diagnosed through an X-ray for the abnormalities in the joints, they will undergo one of the 3 types of treatment currently available, depending on the severity of the disease, starting with no medication, medication, and surgery as a last resort.

Nonmedicinal treatment

Professor Dr. Sittisak says that 80 percent of people with osteoarthritis are overweight, so proper weight management will reduce the shock exerted on the joints and alleviate joint pain.

“To calculate excessive weight, Body Mass Index (BMI) can be used as an indicator by dividing body weight in kg by height in meters raised to the power of 2.  The figure between 18-23 is a normal range.  Another simple calculation is by subtracting your height in cm. with 100.  If your weight exceeds the result, you are overweight.”

Professor Dr. Sittisak advised the patients to regularly exercise the muscles around the joint to strengthen them, especially knee joints, by stretching their legs for 10 seconds and lowering them. Repeat for 20 sets of 20.  Joint support braces or a cane will help patients improve their gait.

Treatment with medication

for example, with pain reliever, muscle relaxant, or anti-inflammatory drugs.  Moreover, injections are also available to help patients with an early stage of osteoarthritis, i.e., hyaluronic acid, or platelet-rich plasma to alleviate joint inflammation.

“Cold compress must be administered in the first 24 hours to allay joint pain from inflammation.  Once the symptoms improved, but later exhibit persistent flare-ups, a warm compress can be used.  This will help improve blood circulation in the area and relax the muscles,” advised Professor Dr. Sittisak on pain management, while recommending acupuncture and ultrasound treatment as alternatives for joint pain treatment as well.

Surgery

this method is used in acute cases in which joint deformities or excessive pain are found to interfere with patients’ work and daily life.  There are many types of surgeries:  arthroscopy to detect bone spurs, or splints inside the joints and clean the joints up, bone deformities correction surgery, 

“The last type is arthroplasty (joint replacement surgery) which will help improve the patient’s quality of life, by giving them a chance to lead a normal life.  How long the artificial joints will last depend on care and maintenance.”

Vitamin D & E for bone enhancement

Professor Dr. Sittisak added that this research project also studies the efficiency of Vitamin D2 supplements in 200 osteoarthritis patients who received treatment at the Department of Orthopaedics, King Chulalongkorn Memorial Hospital.  Patients aged 60 and older who were found to have Vitamin D lower than 30 nanograms per milliliter were given 2 Vitamin D2 pills (Ergocalciferol 20,000 unit/pill) per week for 6 months.

Vitamin D2

helps stimulate bone construction, and the formation of minerals, calcium, magnesium, and phosphate in the bones.  Vitamin D also works with parathyroid hormone in intestinal calcium absorption, as well as promoting the kidneys’ reabsorption of calcium thereby increasing the level of blood calcium which helps strengthen the bone further.  Moreover, Vitamin D also increases the muscles’ stamina, strength, and functioning.

Professor Dr. Sittisak further stated that the research team also studied the use of Vitamin E supplements in osteoarthritis patients by having them take the vitamin E for 2 months.

Vitamin E

helps decrease antioxidants in the body.  It was found that vitamin E helps relieve joint pain and promote joint functioning.

The recommended dose of Vitamin D is 400-600 IU/day and 40-200 IU/day for Vitamin E.  The recommended dose varies according to the age and physical conditions of each individual.  Therefore, taking D and E vitamin supplements should be under the supervision of physicians or pharmacists.

Who should take Vitamin D supplements?

1. People who risk Vitamin D deficiency like the elderly and pregnant women;
2. Patients with osteoporosis and low bone mass;
3. Chronic-kidney disease patients;
4. Patients with certain intestinal diseases that cause defective intestinal Vitamin D absorption;
5. People with defective lipid digestion and absorption (because Vitamin D is fat-soluble) decrease vitamin D absorption as well.

Change your behavior to slow down joint degeneration

Professor Dr. Sittisak further advised the elderly who suffer from osteoarthritis to avoid behaviors that would exacerbate their conditions such as kneeling, sitting crossed-legged, squatting, or walking up and down the stairs often.  They should also exercise to strengthen joint muscles and do other types of exercises like swimming, walking, and light biking.

“More importantly, they should control their weight to minimize shock on the knee joints, and slow down osteoarthritis,” Professor Dr. Sittisak concluded.

People with osteoarthritis conditions can contact the Department of Orthopaedics, King Chulalongkorn Memorial Hospital, 5th Floor, Phor Por Ror Building, tel. +66-2256-5351 for doctor’s appointments during and outside of office hours (Orthopaedics Clinic), or find more information at http://ortho.md.chula.ac.th.

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