Musculoskeletal

• This lecture explores musculoskeletal health.
• Key topics include arthritis, osteoarthritis, rheumatoid arthritis, gout, fibromyalgia, back pain, ankylosing spondylitis, and osteoporosis.

Arthritis

• Arthritis is joint inflammation accompanied by pain.
• The term originates from Greek, combining "arthro-" (joint) and "-itis" (inflammation).
• Arthritis encompasses over 100 conditions that affect joints.
• Common types of arthritis include osteoarthritis, rheumatoid arthritis, gout, ankylosing spondylitis, and psoriatic arthritis.
• Osteoarthritis involves the degeneration of articular cartilage.
• Rheumatoid arthritis is an autoimmune disease affecting synovial joints.
• Gout results from uric acid crystal deposition in joints.
• Ankylosing spondylitis is an autoimmune disease impacting the spine.
• Psoriatic arthritis is linked to psoriasis as an autoimmune joint disease.

Osteoarthritis

• Osteoarthritis (OA) is a degenerative arthritis primarily affecting weight-bearing joints.
• OA typically seen after age 45.
• Signs and symptoms include gradual onset of joint pain, often unilateral, worsened by activity and relieved by rest.
• Joint stiffness and swelling also occur.
• Deformity due to osteophytes is also a symptom.
• Crepitus may be felt within the joint.
• Heberden's nodes are swellings at the distal interphalangeal joints.

Articular Cartilage Composition

• Articular cartilage is composed of an extracellular matrix of water, collagen, proteoglycans and chondocytes.
• Normal turnover of matrix components is facilitated by chondrocytes.
• Chondorocytes synthesize ECM components and proteolytic enzymes.
• Proteoglycans are created by glycosaminoglycan (GAG) chains such as chondroitin sulphate, which are bound to hyaluronic acid.
• This provides osmotic property is crucial to resisting compressive forces.

Pathophysiology of Osteoarthritis

• The process starts with the proteolytic breakdown of the cartilage matrix caused by matrix metalloproteases (MMP).
• MMPs such as collagenase degrade ECM, releasing fragments into synovial fluid and setting off pro-inflammatory mediators.
• Pro-inflammatory mediators include IL-1ẞ and TNF-α.
• The amount of proteoglycans drops, resulting in the cartilage softening.
• Cartilage thins and loses elasticity.
• Joint surface integrity is further compromised.
• Fibrillations (vertical clefts) develop along articular cartilage.
• Over time, the loss of cartilage leads to loss of joint space.
• Damaged cartilage erosion progresses.
• Erosion until underlying bone becomes exposed.
• Subchondral bone responds with vascular invasion and increased cellularity.
• Bone thickening ("eburnation") and osteophyte (bone spur) formation occurs.

Osteoarthritis Risk Factors

• Increasing age results in loss of chondrocyte function with erosion of chondrocyte telomere length and mitochondrial dysfunction due to oxidative damage.
• This is also associated with "inflammaging".
• A previous joint trauma is another risk factor with associated joint inflammation, as well as cartilage degradation.
• Being overweight or obese has a direct effect of mechanical load on the joints, contributing to OA risk.
• Type 2 diabetes mellitus (T2DM) indirectly affects cartilage by reducing the structural components of cartilage.
• Insulin stimulates chondrocytes to synthesise proteoglycans are needed for this component.
• Genetics plays apart in increased OA risk.
• Drivers of chronic inflammation trigger OA.
• Chronic inflammation are caused by metabolic endotoxemia.
• Other joint diseases will cause OA, like gout or rheumatoid arthritis (RA).
• Nutritional deficiencies in vitamin D will cause OA degradation and bone loss.

Osteoarthritis and Radiography

• Radiography is able to find the joint-space narrowing, osteophytes, and subchondral sclerosis that are all related to OA.
• A lack of correlation between the severity shown by a radiograph and the level pain.
• Joints can appear normal on x-rays with minimal joint space narrowing, with the amount of pain someone experiences.

Conventional Medications

• Main treatment is NSAIDs.
• NSAIDs suppress symptoms for short relief.
• NSAIDs inhibit collagen matrix synthesis and accelerate cartilage breakdown.
• Rate of degeneration is worsened by NSAIDs.

Natural Management

• CNM Naturopathic Diet to promote hydration is used.
• Dietary needs to be a focus on anti-inflammatory to support synovial joints.
• Identify and address the source of the symptoms.
• Need to manage insulin sensitivity.
• Address dysbiosis.
• Address the cause of intestinal pemeability.
• Change dietary fats and incorporate necessary oils.
• Switch out arachidonic acid to eicosapentaenoic acid.

Nutrients Used to Treat

• Glucosamine sulphate:Used for GAG and assists in collagen produdction.
• Dosage of: 500mg x 3.
• Chondroitin sulphate: Keeps joints lubricated.
• Dosage of: 200-400 mg/ day.
• Methylsulfonyl-methane: Has anti-inflammatory effects to scavenge free radicals.
• Dosage of: 1 g/day, building to 3-4 g/ day.
• Vitamin C: Requires chondrocyte protein synthesis to have an anabolic effect on cartilage.
• Dosage of: 1-5000mg/ day
• Vitamin E: Will increase amount of proteoglycans, synergieses with Vitamin C.
• Dosage of: 200-400 IU/ day
• Vitamin D: Needed to prevent articular cartilage erosion.
• Dosage of: 2000-10000 IU/ day
• Tart Cherry: Is anti-inflammatory with anthocyanins and also helps to reduce pain.
• Dosage of:up to 3000mg/ day extract
• Vitamin K2: Inhibits cartilage calcification.
• Dosage of: 50-100 mcg

Anti-Inflammatory Herbs Management

• Tumeric is needed to activate cytokines.
• Dosage of:500-2000mg
• Boswellia: Inhibits MMP release to suppress inflammation.
• Dosage of: 300mg x 3 daily
• Devils Claw increases harpagosides to reduce formation of cytokines.
• Dosage of: 100 - 1000mg/ day
• Ginger: Helps reduce inflammatory joint pain.
• Dosage of: 500-1000mg

Other Management

• Hydrotherapy with contrast showers.
• Starting with heat and cold.
• Ending in cold.
• Repeating 3 to 4 times longer on spots where there is pain.
• Epsom salt baths(500g - 1kg.)-
• The four tissue salts are each one at a time for a 3 daily dose:
• Help's inflammation and pain is Ferrum phos.
• Helps reduce joint degenartaion and inflammation is Calc. phos/ Calc. fluor.
• Help's intra fluids and fluid is Nat. phos.
• Exercises, light physicality Tai Chi and Pilates help joint strenght.
• Twice daily use topical MSM and Devil's Claw.
• Cayenne, ginger and rosemary mixture help with vasodilation and blood.
• Anti-inflammatory aromatherapy like peppermint and wintergreen oils to relax muscles.

Rheumatoid Arthritis

• Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease primarily affecting synovial joints.
• RA can impact all organs and systems except for the brain.
• Signs and symptoms include symmetrical polyarthritis affecting small distal joints, mainly of the hands and feet.
• Proximate joints can also be affected.
• Hand deformities are one such symptom.
• Subcutaneous nodules are potential symptom.
• Possible complications can involve vertebral subluxation, pleursy, pulmonary fibrosis, kidney disease, Sjögren's syndrome, and carpal tunnel syndrome.

Pathophysiology of Rehumatoid Arthritis

• Key to know is RANKL = Receptor activator of nuclear factor
• APC is Antigen Presenting Cells.
• A change of arginine to citrulline.
• APCs distinguish between foreign protein sections.
• B-cells differentiate to be autoantibodies.
• Inflammation from the synovial joints to generate cytokines, TNFa and IL-1 and IL-6
• Inflammatory cytokines to fibroblast-like synoviocytes which cause cartilage degradation.

Causes and Risk Factors

• Increase genetic components with proteins tyrosine phosphatase non-receptor 2.
• Gene HLA-DRB1 can rise risks to disease in some individuals.
• Smoking can rise risk for increased expression of MMP.

Natural Approach for Rheumatoid Athritis

• Focusing of CNM Naturopathic Diet to reduce inflammation.
• Consuming anti-oxidants from an rainbow diet to fight off low serum levels.
• Avoid gluten and source of molecular mimicry.

Other Recommendations to Help

• Address the causes ex. gum infection, SIBO, oral pro-biotic and diet.
• Quit smoking and get support with immune protocols(L-lysine).
• Vitamin D is used with actual EPA and benefits RA has as anti- inflammatory.
• GLA borage helps to forms anti-inflammatory properties for joint.
• Check with Th17, for high levels to test and optimize levels of rheumatoid factors.
• A polyphenol that reduces TH17.
• Resveratrol reduces oxidative stress levels -2g / day
• Alpha lipid raise intracellular help glutathione
• EGCG helps to control COX receptors.

Other Ways to Naturally Maintain

• Eat and raise levels of Th!^ high levels mean more likely for low progression OA
• Rich with anit-inflammatory products to reduce COX in order.
• Binds with vitamin K to support dependent proteins joints is V-K.
• Helps with inflammatory cytokines to help balance and inactivate curcuminoids.
• Bwellic assists to inhibit Mmp Release.
• Reduce inflammatory joints to reduce swelling.

Important Recommendations

• Eat showerr for 1/3 of shower and 3/4 on pain .
• Tissue salts (2)pills x 3/day and each helps decrease symptoms.
• Helps inflammation providing support for Nat Phos
• Alkaline minerals are good for calc phos.
• Reduce mobility .
• Epsom salts as a bath helps muscle.
• Devil's and MSM use topically for rosemary.
• Peppermint and wintergreen for anti-inflammatory .

Case study

• Tonsillitis recurring leads to antibiotics used can induce gum swelling and mouth sores
• Positive test lead to decrease support through justification

Gout

• Gout is a formation of acute inflammation, which comes from MSU joints forming.
• The crystal inflammation lead to monosodium urate in deposition and joint.

Pathophysiology of gout

• Purine structure with DNA/RNA lead down with a breakdown.
• Interlukin 1b= Cyokine Mediating inflammation.

Risk Factors

• Increases level and disrupts activity to effect activity.
• Lead to Kidney disease and T2DM .
• Causes for uric overproduction and kidney problems.

Diagnostics

• Uric with microscopy showing presentation 6.8 MG/ DL= HYPERURICAEMLA.
• Conventional are also not practical with treatment.

Conventional Treatments/Medications

• All to reduce production is Allopurinol but needs toxicity to the body.
• Nsaids are toxic risk/ narrow side .
• Gut effects.

Natural Management

• Use the CNM approach to reducing fluids.
• Also avoid refined / minimized of alchohol products.
• Use a low purine diet that is more clean and sustainable for lower level.
• Optimize 3-6 in order.

Food and Drink

• Eat 2 L to help uric acid exit more.
• Eat intake that isn't excessive >.08g that doesn't accel to reduce proteins.
• Cold bad and warmth will help crystals as caster oil will help with wrapping to flannel to joint.

Important Key Factors

• Quercetin x0 to help transporters for activities .
• Anti - activity of targeting and reducing signaling by targeting
• Has properties to help inflammation.
• EPA has been shown and used to excretes renal rate
• Inhibition to reduce inflammation to the joints.
• Reduces oxidative stress.

More Support

• Enzymes to help enzymes with modenum that come naturally to have high levels
• Multi-mineral help deposition at rate that is shown to also help with low bodies of post men women
• 1 tsp to help mix herbs per hot for day to keep joints supported

Fibromyalgia

• Fibromyalgia (FM) = a condition of chronic widespread pain and abnormal pain-processing mechanisms.
• Symptoms lasting at least three months.

Risk Factors

• Trauma from all different factors.
• Hormones like thyroid as they inhibit synthesis in secretion of substance P.

Interstinal Dysbiosis Factors

• Pain from multiple are associated from multiple factors, the more bacteria there is for support the more reduction from pain this includes SFCAS acids , bile acids and neurotransmitters.
• All of above can affect severity within FM patients .
• Deficiency is Vitamin D for pme synthesis decrease inflammatory processes .
• B12 Enhances for support the immune function to reduce nerve system support
• Gluten sensitivity and other allergies also result.

Treatment Methods

• Support and cofactors that factor for the GAD which can cause
• Mag which is zinc/glute/ GABA / Gaba receptors
• Vitamin b levels needs to control conversions
• Low serotonin has an important part.

Treatment Methods Continued

• Detox with levels being optimized,
• Metallthionin is good with selenium .
• Enzymes to support detoxification.
• Guanthione with silymarin resveratol.
• Reduce exposure to mercury.
• Sauna and hydrotherapy (Epsom )
• Sauna 3 / X for day

• High enough exposure to break with after before / ~1 pint /20 / heavily sweating.

Fibromyaliga Natural Approach (cont.):

• Sleep support — for proper A/ rthyms for sleep
• FM
• NT synthesis and detoxification: folate, B12, B6, B2, choline, betaine( TMg),zinc
• Consider methylated B vitamins
• See nervous system lecture for insomnia recommendations

Herb support for Fibromyalgia

• Ashwandagada: to improve sleeping pattern with help from GABA
• St.Johns Wort: interacts with the body to modulate pain and function and the nervous system and MAO up.
• Devil's Claw : Inflammatory .