Cibo e artrosi UOS Dr U Massafra Reumatologia Osp San pietro Fbf Roma - SIGR

Cibo e artrosi

  Dr U Massafra
      UOS
  Reumatologia
  Osp San pietro
    Fbf Roma

CIBO

Fast food

tradizionale

salutista

ARTROSI

Intern Med J. 2016 Feb;46(2):229-36. What's new in osteoarthritis
pathogenesis? Jones G.

    “osteoarthritis should be regarded as an umbrella term for a
    number of pathophysiological processes leading to pain
    and/or cartilage loss.

    If these are inside the joint (such as bone marrow lesions,
    cartilage defects or meniscal tear) then they can be considered
    osteoarthritis,

    Those outside the joint (such as obesity, weak muscles and
    vitamin D deficiency) could be considered the osteoarthritis
    syndrome “

T. Funck-Brentano, M. Cohen-Solal. Cytokine & Growth Factor Reviews 22 (2011)

T. Funck-Brentano, M. Cohen-Solal. Cytokine & Growth Factor Reviews 22 (2011)

Proc Natl Acad Sci U S A. 2014 May 13;111(19):6940-5. Bhumiratana S et Al

Il-4 IL-10 Il-13   Il-6 IL-15 Il-17 IL-18 Il-1 β

CIBO   ARTROSI

156 articoli
                                                                               27 selezionati

                                                                               17 inclusi

                                                                               8 US
                                                                               2 India
                                                                               1 UK Canada Australia
                                                                               Malesia Tailandia Turchia

WHO defined CAM as health practices that involved diverse approaches to incorporate understand and
beliefs related to medicines of plant or animal origin, and other traditional or spiritual approaches to
manage illness

 Alternative medical System : omeopatia medicina cinese tradizionale

 Mind Body Intervantion           : tecniche che aumentano capacità mentali e fisiche

 Biologically based therapy : suppl. dietetici, prodotti a base di erbe o cartil di squalo

 Manipulative and Body based method: movimentazione di parti corporee

 Energy theraphy : uso di energie verso il corpo

                                               Journal of Clinical and Diagnostic Research. 2016 Feb, Vol-10(2):

8 US

232 pts                                          National Health Survey 2002
2\3 sperimentato CAM (44% massaggi)              106.000 pts
24% responders                                   75% sperimentato CAM (biologiche)
Utilizzatori + frequenti: OA pts
NON condivisione con medico curante
                                                        1121 OA pts
480 pts                                                 33% sperimentato CAM (90%
28% sperimentato CAM (90% chiropratica)                 chiropratica e massaggi)
26% users di provenienza rurale 29% urbana
Motivo utilizzo: non risposta dalla terapia
convenzionale                                              Popolazione afro-americana in US
                                                           95% sperimentato CAM (integratori
Popolazione ispanica e non ispanica in US                  di erbe)
90% sperimentato CAM (31.2% integratori di                 Maschi in prevalenza
glucosamina\condroitina)
Motivo utilizzo: aiuto alla terapia convenzionale

                                            Journal of Clinical and Diagnostic Research. 2016 Feb, Vol-10(2):

Deficit nutrizionali   Errori nutrizionali

Deficit nutrizionali e artrosi

    139 patients 71.4 years( 48–88 )

    24% prevalence of vitamin D deficiency in group of
    elderly patients with advanced OA

    mean preoperative KSS significantly lower in
    the vitamin D deficient group than in the vitamin D
    sufficient group (31.5 vs 37.1, p=0.047)

    mean postoperative KSS at 6 months lower in the
    vitamin D deficient group (74.6 vs 80.4)
    difference not statistically significant (p=0.075).

Deficit nutrizionali e artrosi
  Ann Rheum Dis. 2014 Apr;73(4):697-703.
  Moderate vitamin D deficiency is associated with changes in knee and hip pain in older adults: a 5-year
  longitudinal study. Laslett LL, Quinn S, Burgess JR, Parameswaran V, Winzenberg TM, Jones G Ding C

 Longitudinal population-based cohort study
 769 randomly selected older adults mean 62 years; 50% M

 Serum 25-hydroxyvitamin D (25-OHD) assessed at baseline
 pain assessed at baseline, 2.6 and/or 5 years by WOMAC.
 Linear regression with adjustment for age, sex, body mass index and season,
 further adjusted for radiographic OA, BMLs, chondral defects and muscle strength.

 Mean total knee WOMAC score was 3.2 (range 0-39).
 4.2% had moderate vitamin D deficiency at baseline (25-OHD 12.5-25 nmol/l).

 25-OHD

Deficit nutrizionali e artrosi
  Rheumatology (Oxford).2014 Oct;53(10):1778-82. doi: 10.1093/rheumatology/keu178. Epub 2014 May 9.
  Serum 25-hydroxyvitamin D and the risk of knee and hip osteoarthritis leading to hospitalization: a cohort
  study of 5274 Finns.
  Konstari S, Kaila-Kangas L, Jääskeläinen T, Heliövaara M, Rissanen H, Marniemi J, Knekt P, Arokoski J,
  Karppinen J

 5274 from National Health Examination Survey
 no knee or hip OA at baseline. Data from National Health Care Register.

 Follow-up of 10 years (50 134 person-years),

 127 subjects developed incident, physician-diagnosed OA in the knee and 45 in the hip joint.

 Covariates, including age, sex, education, BMI, work load, leisure time physical activity, smoking
 history, knee or hip complaint during the past month and previous injuries, gathered at baseline.

 Serum 25(OH)D concentrations were determined from baseline serum

 After adjustment for age and gender, serum 25(OH)D showed statistically significant associations
 with known risk factors for OA except injuries.

 In the fully adjusted model, low serum 25(OH)D concentration did not predict increased
 incidence of knee and hip OA

60,000 IU per day for 10 days
followed by 60,000 IU once a month
for 12 months

JAMA 2016 Mar 8;315(10):1005-13. doi: 10.1001/jama.2016.1961.
Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain Among Patients With
Symptomatic Knee Osteoarthritis: A Randomized Clinical Trial.
Jin X, Jones G, Cicuttini F, Wluka A, Zhu Z, Han W, Antony B, Wang X, Winzenberg T, Blizzard L, Ding C.

multicenter randomized, double-blind, placebo-controlled
413 enrolled participants (63.2 ; 50% F) 340 (82.3%) completed the study.

50000 UI Vit D vs placebo

level of 25-hydroxyvitamin D increased more in the vitamin D group (40.6 nmol/L) than in the
placebo group (6.7 nmol/L) (P < .001) over 2 years.

No significant differences in annual change of tibial cartilage volume or WOMAC pain score.

No significant differences in change of tibiofemoral cartilage defects or change in tibiofemoral
bone marrow lesions.

AE (≥ 1 per patient) in 56 vitamin D group and in 37 placebo group (P = .04).

Deficit nutrizionali e artrosi
                                 1626 chinese pts
                                 KL 2
                                 OARSI atlas

                                  PLoS ONE 2015 10(5): e0127666

Buon profilo lipo-proteico   cattivo profilo lipo-proteico

Errori nutrizionali e artrosi

Mice were fed high-fat diets rich in various fatty acids (FAs) including saturated FAs (SFAs), ω-6
polyunsaturated FAs (PUFAs), and ω-3 PUFAs.

OA was induced by destabilizing the medial meniscus. Wound healing was evaluated using an
ear punch.

OA, synovitis and wound healing were determined histologically, while bone changes were
measured using microCT.

Activity levels and serum cytokines were measured at various time-points. Multivariate models
were performed to elucidate the associations of dietary, metabolic, and mechanical factors with
OA and wound healing.

Our results indicate that dietary FA content is a primary regulator of OA
severity and wound regeneration with obesity, supporting the need for
further studies of dietary FA supplements as a potential therapeutic
approach for OA

overall prevalence of
BML was 17 %

(grade 1: 10.7 %,
grade 2: 4.3 %,
grade 3: 1.8 %)

1,001 knee OA, 993 hip OA and 933 control

 Increasing beer consumption was associated with an increasing risk of OA (P
 for trend ≤0.001).
 Compared to those who did not consume beer, aORs for people who
 consumed 20 or more servings of beer were 1.93 (95% CI 1.26 to 2.94)
 and 2.15 (95% CI 1.45 to 3.19) for knee OA and hip OA, respectively

 increasing levels of wine consumption were associated with decreased
 likelihood of knee OA (P for trend

Clin Rheumatol. 2016 Jan 19.
Associations between dietary antioxidants intake and radiographic knee osteoarthritis.
Li H, Zeng C, Wei J Yang T, Gao SG, Li YS, Lei GH

cross-sectional associations between dietary antioxidants (carotenoid, vitamin C, E, and selenium)
intake and radiographic knee osteoarthritis (OA).

4685 pts.

Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire.
Radiographic knee OA was defined as Kellgren-Lawrence (K-L) grade 2 in at least one leg.

A multivariable logistic analysis model to test the relationship between dietary antioxidants
(carotenoid, vitamin C, E, and selenium) intake and radiographic knee OA with adjustment of a
number of potential confounding factors.

A significant positive association between dietary vitamin C intake (P value for trend was 0.04 in
multivariable adjusted analysis) and radiographic knee OA was observed.

The relative OR of RX knee OA were increased by 0.39 times in the third quintile (OR 1.39, 95 % CI
1.11-1.73), 0.42 times in the fourth quintile (OR 1.42, 95 % CI 1.13-1.79), and 0.33 times in the fifth
quintile (OR 1.33, 95 % CI 1.03-1.71).

RX knee OA was not significantly associated with dietary carotenoid, vitamin E, and selenium.

Missbach et al. (2015), PeerJ, 1337

OA e cibo: relazioni?
Cibo come fonte di terapie farmacologiche per l’artrosi

                                         P&T® • June 2014 • Vol. 39 No. 6

Cibo come terapia per l’artrosi

                                  Il-6 IL-15 Il-17 IL-18 Il-1 β
       Il-4 IL-10 Il-13

Curcuma

Cibo come terapia per l’artrosi

Avocado-soybean unsaponifiables

Avocado-soybean unsaponifiables

Boswellia serrata

49 randomised controlled studies (33 interventions, 5980 participants) were
included.

17 studies of confirmatory design (sample and effect sizes pre-specified) were
mostly at moderate risk of bias.

The remaining 32 studies of exploratory design were at higher risk of bias.

Vit D : effetti controversi

               Magnesio: possibili effetti protettivi

 Grassi saturi: effetto accellerante OA

                  Vino: effetto protettivo?
                        birra accellerante

  Vit C: possibile effetto accellerante?

                                   Glutine: ????

Boswellia\ ASU\ curcuma: antiossidanti