Osteoarthritis is a metabolic disease. It is not just a degenerative joint condition.
This small distinction might seem trivial, but it is far from it. Instead, this change in classification will revolutionize the way that we look and treat Osteoarthritis.
Recent scientific breakthroughs have finally identified the missing piece of the arthritis puzzle. Like an unfinished jigsaw puzzle, Osteoarthritis has long been associated with words like: joint pain, inflammation and cell damage. Individually, these symptoms make sense but they were never linked together. However, a link has been established with this re-classification from degenerative joint condition to metabolic disease. This new distinction acts as the final piece of the puzzle that provides a complete picture of Osteoarthritis.
Joints with OA display two major side effects : chronic inflammation and apoptosis (cell death). However, neither side effect is efficiently attacked with current treatment options. Toll-Like-Receptor 4 (TLR4) is a molecule that is one of the largest drivers of inflammation in arthritic joints. Being able to stop or suppress the TLR4 damage will have a dramatic effect on improving joint function. Furthermore, OA increases the rate of cell death in joints and an anti-oxidant that slows down this process could reduce or stop joint degradation at its source. Until recently, trying to find a treatment that can simultaneously target TLR4 and also slow down the degradation of a joint has never been achieved. However, Wogonin has been found to treat both.
A breakthrough in Osteoarthritis research
Osteoarthritis (OA) has always been known as a ‘wear-and-tear’ or ‘degenerative joint’ disease. Our understanding of the condition has centered on the belief that factors like obesity, joint injury, and age were the sole driving forces behind it. A promising scientific breakthrough has altered this way of thinking.
Studies have now shown that OA is more than just a ‘wear-and-tear’ disease. The Osteoarthritis Research Society International (OARSI) has classified OA as a metabolic disease linked to metabolic processes like diabetes, metabolic syndrome, heart disease, high blood pressure, Alzheimer’s and obesity.
Meta-inflammation caused by some of these factors results in stress and inflammation of the cells. This stress triggers a vicious cycle that leads to cell dysfunction which itself can eventually result in joint damage .
The most prominent symptoms of Osteoarthritis are pain and stiffness, and there is a complex web of molecules that increase the inflammatory process. One of these molecules is known as ‘Toll-like receptor-4’ (TLR4). It is one of the biggest culprits of inflammation . So stopping (or suppressing) the actions of TLR4 will stop the inflammation from osteoarthritis.
Studies are being carried out on many different fronts to further our understanding of the link between OA and metabolic processes and to take a closer look at the molecules behind the inflammatory pathway. This means by targeting the cellular level, like TLR4, could be the most promising path. These types of breakthroughs are changing the way we view Osteoarthritis and are helping to craft a better understanding of it.
The treatment of OA
In 2016 the Osteoarthritis Research Society International (OARSI) released a document that read in part: ‘Presently there are NO drugs approved that can prevent, stop, or even restrain progression of OA. Moreover, the available medications that promise to mitigate the pain of OA have a number of risk/benefit considerations.’
But since then, a lot has changed.
Traditionally, Osteoarthritis has been treated with over-the-counter (OTC) anti-inflammatory drugs like Ibuprofen, Aspirin or Acetaminophen. While these drugs have a role to play in the management of OA symptoms, unfortunately, a systemic approach with these drugs and other anti-inflammatory agents can have serious adverse side effects. For example, long-term use of Ibuprofen can lead to severe problems with the liver and kidneys or even an erosion of the stomach lining (known as gastritis). This last symptom can result in internal bleeding .
Other available drugs on the market run into different problems.
Treatments such as menthol, camphor, wintergreen or capsaicin work by stimulating nerves in the applied area but the result is a temporary cessation of pain that keeps coming back. Other technologies like Lidocaine and skin patches only mask the symptoms of OA.
The general management of Osteoarthritis has revolved around suppressing its symptoms and keeping the pain at bay. But this has meant dealing with medications that provide temporary pain relief at the cost of unwanted side effects. Without addressing the root cause of the pain, the chronic inflammation of OA is lessened but never gone.
Wogonin is a new supplement that is being used in the revolution against OA. It is a natural compound found in the root of the Skullcap Baicalensis plant and is thought to be a safe and highly effective natural anti-inflammatory .
Skullcap Baicalensis has been used for centuries as a Chinese herbal medicine. Over the past 10 years scientists have been studying Wogonin to understand how it reacts with an arthritic joint. Wogonin could be a potential therapeutic agent for diseases such as Osteoarthritis and unlike other over-thecounter products; Wogonin is one of the first treatments of its kind to target the TRL4 receptor to reduce inflammation at its source.
Wogonin and joint inflammation
The story of joint pain and inflammation is a common one. Joints that experience chronic inflammation will eventually lead to a reduction in joint function, movement and mobility. This is in part due to death of cartilage cells at the joint. Cell death, also known as apoptosis is part of a normal physiological process. The cells naturally go through a cycle of birth, growth and death but in OA, cartilage cells are lost at a faster rate than they are being created. The loss of cells due to cell death leads to the characteristic features of OA including loss of cartilage and abnormal tissue remodeling .
As time goes on and the cell death continues unopposed, there is further deterioration of the joint to the point where a joint replacement ends up being the final solution for millions of people. Current medications have not been able to stop this breakdown of the joint or to halt its progression.
However, if the inflammation can be controlled at its source before the process of cell death begins, there is hope that this cycle may be interrupted or even slowed down. This is where Wogonin becomes a game-changer.
Wogonin disrupts the workings of the molecule TLR4, which is involved in this inflammatory process. As a major player in the inflammation pathway, using Wogonin to help stop the actions of TLR4 should see a reduction in the pain and stiffness caused by inflammation.
However, managing inflammation is only one hurdle of OA. Wogonin also works as an anti-oxidant. Anti-oxidants function as the body’s clean-up service. They remove free-radicals which are toxic byproducts of oxygen metabolism. Free radicals can damage sensitive parts of a cell such as proteins, DNA, and cell membranes. Wogonin behaves like an anti-oxidant and a study carried out in 2017 found that Wogonin could also act as a chondroprotective agent and an anti-inflammatory .
Unlike other over-the-counter pills that have undesirable side effects or topical applications that temporarily mask symptoms, Wogonin can play a big role in helping manage OA.
Not unsurprisingly, the joint pain of Osteoarthritis can push those with the condition towards a sedentary lifestyle. OA can be a debilitating disease that stops people from performing even the most basic tasks. This promotes further weight gain and exacerbates the factors that worsen OA. The benefits of Wogonin are two-fold: a reduction in joint pain and inflammation and the ability to help OA sufferers maintain a much more active lifestyle.
Osteoarthritis is no longer seen as just a simple ‘wear-and-tear’ disease. The Osteoarthritis Research Society International (OARSI), a leading authority in Osteoarthritis research recently classified Osteoarthritis as a ‘serious disease.’ The consideration of osteoarthritis as a serious disease by the Food & Drug Administration (FDA) would allow greater speed in the approval process of a drug that “treats a serious condition and generally provides a meaningful advantage over other available therapies.”
Because OA affects more than 240 million people worldwide and because its prevalence continues to rise, finding new ways to treat this growing problem is a goal that many researchers are working on. Wogonin, which suppresses TLR4 (a prominent molecule in joint inflammation) is a promising new supplement on the horizon. As an anti-oxidant and anti-inflammatory, it is thought to slow down cell death and may also reduce the progression of OA.
Wogonin might well revolutionize the management of OA.
1) American Academy of Orthopaedic Surgeons (AAOS). Projected volume of primary and revision total joint replacement in the U.S. 2030 to 2060. March 2018 http://aaos-annualmeeting-presskit.org/2018/research-news/sloan_tjr/
2)Wang, X., Hunter, D., Xu, J., & Ding, C. (2015). Metabolic triggered inflammation in osteoarthritis. Osteoarthritis and Cartilage, 23(1), 22-30. https://www.sciencedirect.com/science/article/pii/S1063458414012801
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4) Osteoarthritis: A Serious Disease, Submitted to the U.S. Food and Drug Administration December 1, 2016. https://www.oarsi.org/sites/default/files/docs/2016/oarsi_white_paper_oa_serious_disease_121416_1.p df
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The term arthritis has become a catch-all phrase with a variety of meanings. Most people have come to think of arthritis as a single disease but there are actually more than 100 different types of arthritis and arthritis-related conditions that affect people of all ages, sexes, and races .
Osteoarthritis is the most common form of arthritis. It is an inflammation of the joints that can lead to pain, stiffness, and tenderness.
Although osteoarthritis is the number one cause of disability among adults in the United States , it has not always garnered the same amount of attention that more prominent medical conditions have received.
In recent years, however, this trend has started to shift. There has been a resurgence of research and scientific interest within the osteoarthritis field with new and exciting developments being made in both pain management and treatments as well as working toward a possible cure.
As our understanding of osteoarthritis increases, so too will the number of treatment options that will become available to the estimated 30 million Americans who are currently living with this condition.
What is osteoarthritis?
As we get older, our joints experience natural wear and tear. Couple that with lifestyle factors, this damage can becomes excessive, and the cartilage that supports our bones and joints starts to weaken and disintegrate. This results in joint pain that causes tenderness, stiffness, and difficulty moving.
The problem of osteoarthritis begins in the bones. Thick-padded surfaces naturally cushion our bones at their ends which prevents them from rubbing against one another. This cushion is known as cartilage, and in osteoarthritis when the cartilage starts to wear away and disappear, it leaves the ends of the bones exposed. This lets the bones slide against one another which causes friction that leads to pain, swelling, and stiffness.
Over time, the joints lose their strength and stop functioning correctly. The result is pain and discomfort which millions of people with osteoarthritis regularly experience.
What joints does osteoarthritis affect?
Osteoarthritis can affect any joint in the body, but it commonly targets the hands, knees, hips, and spine . It rarely affects the elbow, wrist, and ankles. Osteoarthritis is a chronic condition that tends to gradually worsen over time but there might be some steps you can take to help improve your joint pain and function.
What causes osteoarthritis?
Over the last few years, our understanding of osteoarthritis and the causes behind it has evolved. A growing body of research has shown that osteoarthritis is far from being a simple mechanical “wear and tear” disease like first thought, but is much more complex.
The Osteoarthritis Research Society International (OARSI) recently classified osteoarthritis as a “metabolic disease” due to new studies highlighting a link between metabolic components and the development of osteoarthritis.
Put simply, it is thought that meta-inflammation caused by factors like obesity and metabolic surplus (excess energy or nutrients), can result in stress and inflammation of the cells. This stress triggers a vicious cycle that leads to cell dysfunction which itself can eventually result in joint damage [4b].
Other conditions such as being overweight, having high lipid levels, a Vitamin-D deficiency or an impaired glucose tolerance level, have also been linked to meta-inflammation and joint damage [4b].
Who is at risk for developing Osteoarthritis?
There are several risk factors that can increase a person’s chances of developing osteoarthritis. Most people with osteoarthritis have one or more of these factors. These include [5,6, 6b]:
• Excess weight – Excess weight puts additional stress on the joints. Because they are forced to carry more weight than they can manage, this wears down the joints and can lead to arthritis.
• Age – The risk of developing many types of arthritis — including osteoarthritis and rheumatoid arthritis increases with age.
• Sex – Women are more likely than men to develop osteoarthritis, but it’s not clear why.
• Previous joint injury – any traumatic injury to the joints can weaken them and lead to the development of arthritis. People who have injured a joint in the past (i.e. traumatic injury or accident) are more likely to eventually develop arthritis in that particular joint.
• Work factors – Jobs in which people carry out repetitive movements or do a great deal of heavy lifting, can cause stress in the joints and/or an injury, which can lead to arthritis.
– Osteoarthritis of the knee has been linked to certain occupations that require frequent squatting and kneeling, including cotton processing, dock work, shipyard work, and carpentry.
– Osteoarthritis of the hip has been linked to farm work, construction work, and other activities that require heavy lifting, prolonged standing, or walking several miles each day.
The primary symptoms of arthritis are joint pain, tenderness, and stiffness:
Pain – This is the primary symptom for most osteoarthritis sufferers. Pain is centered around the joint and is usually made worse during or after movement. In some cases, the pain may be severe enough to prevent you from carrying out your normal day-to-day activities
Tenderness – Tenderness is another common symptom that is experienced by many osteoarthritis sufferers. The joint may feel tender when you apply light pressure to it and may be accompanied by redness and swelling. You may find that ice packs, heating pads or pain creams applied directly to the joint may help.
Stiffness – Joint stiffness is most noticeable when you wake up in the morning or after a period of inactivity. It usually gets better as the day goes on or with light movement.
Unfortunately, stiffness of the joint usually gets worse with time as the disease progresses. To combat joint stiffness think about starting up moderate exercise.
Loss of flexibility – With osteoarthritis you may not be able to move your joint through its full range of motion. This means your range of movement is limited and moving your joint left, right or rotating it around may be extremely painful.
Grating sensation – sufferers sometimes hear or feel a grating sensation when using the joint.
Instability of the joint – Giving way or buckling is a common symptom in knee osteoarthritis.
The diagnosis of osteoarthritis is a relatively straightforward one for your doctor to make. During the physical exam, your doctor will check your joints for swelling, redness, and warmth. He or she will also want to see how well you can move your joints or if you have reduced range of motion. Depending on the type of arthritis suspected (i.e. rheumatoid arthritis, gouty arthritis), your doctor may also suggest some additional tests like a blood test to look for certain proteins in the blood or a joint fluid sample (aspiration of the joint).
Imaging tests such as Xrays or an MRI are also used to confirm the diagnosis of osteoarthritis.
There is no single treatment for osteoarthritis. However, there are steps you can take to help deal with its symptoms. In general, the management of arthritis is directed towards reducing symptoms and slowing down any further deterioration of the joint. Here are some of the more well-known treatment options:
First line medications — Once diagnosed with osteoarthritis, there are some medications that your doctor might initially suggest. The majority of these drugs are used to manage the pain of arthritis and includes things like acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular glucocorticoids (joint injections that reduced pain, swelling, and inflammation)
Lifestyle changes – Just as important as medications (if not more so) are lifestyle changes that can be made, such as starting an exercise program, physiotherapy, weight loss or diet modifications . Sometimes these changes are suggested before the medications because of the positive effect they can have on reducing joint pain.
Exercise – Exercises are great for building (and maintaining) joint strength, flexibility, and mobility. Swimming, aerobic classes, yoga and tai chi are all exercises that can help with joint mobility.
Stretching – Exercise on its own is great but combined with stretching it’s even better. One of the best times to stretch is after a workout, as part of a cool-down routine. This is when the muscles are most warm and pliable, which makes it much easier to stretch and improve flexibility.
Joint supplements and creams – The arthritis joint supplement industry is a rich field full of well-known products like Capsaicin, Glucosamine or Chondroitin.
Recent studies have also found the supplement Wagonin to provide pain relief and possibly even repair some cartilage damage. It is a natural compound found in the root of the Skullcap Baicalensis plant and is thought to be a safe and highly effective natural anti-inflammatory and antioxidant . A recent 2017 study found that Wogonin suppressed oxidative stress, inflammation and bone degradation in osteoarthritis , making it a strong contender for achievable joint relief.
In fact, the research behind Wogonin is a possible game-changer in the management of osteoarthritis symptoms. In a study published in the journal Biomolecules & Therapeutics, it was found that Wogonin suppresses some of the very molecules that are responsible for the destruction of cartilage in the joints .
Up until now, conventional scientific thinking was that the destruction of cartilage was unstoppable, but with these new findings, that thinking has changed.
Additionally, it is thought that Wogonin might be a potential new agent in the control of cartilage damage and in the future, Wogonin might one day be given via injection directly into affected joints .
In general, supplements and creams are a popular way of alleviating joint pain. At their core, they all attempt to cut down on pain, stiffness, and inflammation, but not all supplements are the same. Before choosing a supplement keep in mind that they do not all work in the same way and each has its own unique properties, quirks and possible side effects.
Alternative therapies – Although these should not be used at the expense of regular medical treatment; alternative therapies offer an additional way to help alleviate the pain of arthritis. Remember that the research behind the effectiveness of natural therapies is not always conclusive so approach all treatments with caution and be sure to speak to a healthcare provider about the impact they might have on you. With that in mind, many people have found relief using approaches such as:
It has long been felt that as a medical condition, osteoarthritis cannot be reversed or fully treated. But new research, spearheaded by the development of supplements like Wogonin, might be turning this conventional wisdom on its head.
For now, however, the symptoms of osteoarthritis – pain, stiffness and reduced joint function can be alleviated using a number of different treatments.
Most people will require a mixture of lifestyle changes, medications, supplements and sometimes additional therapies to get optimal management and control of their symptoms. However, it is worth remembering that treatments that work for one individual may not work for another so taking the time to try different techniques until you find what works for you may be an excellent approach to take.
1) Arthritis Foundation. What Is Arthritis?
2) Murphy, L., & Helmick, C. G. (2012). The impact of osteoarthritis in the United States: a population-health perspective. AJN The American Journal of Nursing, 112(3), S13-S19.
3) Centers for Disease Control and Prevention. Osteoarthritis. Page last updated: April 3, 2018
4) MayoClinic. Osteoarthritis.
4b)Wang, X., Hunter, D., Xu, J., & Ding, C. (2015). Metabolic triggered inflammation in osteoarthritis. Osteoarthritis and Cartilage, 23(1), 22-30.
5) MayoClinic. Arthritis. By Mayo Clinic Staff. January 2016
6) Cleveland Clinic. Diseases and conditions
6b) UptoDate. Patient education: Osteoarthritis symptoms and diagnosis (Beyond the Basics). Michael Doherty, MA, MD, FRCP, FHEAAbhishek Abhishek, MBBS, MD, MRCP, PhD. This topic last updated: Dec 18, 2017.
7) Centers for Disease Control and Prevention. Osteoarthritis
8) Tai, M. C., Tsang, S. Y., Chang, L. Y., & Xue, H. (2005). Therapeutic potential of wogonin: a naturally occurring flavonoid. CNS drug reviews, 11(2), 141-150.
9) Khan, N. M., Ansari, M. Y., Haynie, S., & Haqqi, T. M. (2017). Wogonin exerts anti-inflammatory effect by disrupting KEAP-1/NRF2 interactions and activating NRF2 in human OA chondrocytes. Osteoarthritis and Cartilage, 25, S82-S83.
10, 11)Park, J. S., Lee, H. J., Lee, D. Y., Jo, H. S., Jeong, J. H., Kim, D. H., … & Hwang, S. C. (2015). Chondroprotective effects of wogonin in experimental models of osteoarthritis in vitro and in vivo. Biomolecules & therapeutics, 23(5), 442.