17. MUSCULOSKELETAL HEALTH Flashcards
What is the definition of arthritis?
Joint inflammation with pain, encompassing over 100 conditions affecting joints.
What are the common types of arthritis?
- Osteoarthritis
- Rheumatoid arthritis
- Gout
- Fibromyalgia
- Ankylosing spondylitis
- Psoriatic arthritis
What is osteoarthritis?
Degenerative arthritis of the articular cartilage, typically affecting weight-bearing joints.
What are the signs and symptoms of osteoarthritis?
- Joint pain
- Joint stiffness
- Joint swelling
- Deformity
- Crepitus
- Heberden’s nodes
What is the extracellular matrix (ECM)?
A non-cellular component of connective tissue.
What is the role of chondrocytes in cartilage?
They synthesize ECM components and proteolytic enzymes responsible for breakdown.
What is the pathophysiology of osteoarthritis?
- Proteolytic breakdown of cartilage matrix
- Release of pro-inflammatory mediators
- Loss of cartilage integrity
- Erosion of cartilage leading to bone exposure
What are the common causes/risk factors for osteoarthritis?
- Increasing age
- Previous joint trauma
- Overweight/obesity
- T2DM
- Genetics
- Drivers of chronic inflammation
- Nutritional deficiencies
What are the key x-ray findings for osteoarthritis?
- Joint-space narrowing
- Osteophytes
- Subchondral sclerosis
True or False: There is a strong correlation between x-ray severity and pain in osteoarthritis.
False
What is the main conventional medication used for osteoarthritis?
NSAIDs
What are the functions of glucosamine sulphate?
- Stimulates proteoglycan synthesis
- Inhibits cartilage degrading enzymes
- Provides sulphate ions for chondroitin sulphate synthesis
Fill in the blank: Chondroitin sulphate increases the amount of _______ in joints.
hyaluronic acid
What is the role of vitamin C in osteoarthritis management?
Required for chondrocyte protein synthesis and reduces impact of ROS.
What is methylsulfonyl-methane (MSM) used for?
Has anti-inflammatory effects and stimulates proteoglycan synthesis.
What is the significance of vitamin D in osteoarthritis?
Prevents articular cartilage erosion and regulates collagen II turnover.
What natural herbs are considered for osteoarthritis management?
- Turmeric
- Boswellia
- Devil’s Claw
- Ginger
What is rheumatoid arthritis (RA)?
A chronic inflammatory autoimmune disease characterized by synovial joint inflammation.
What are the signs and symptoms of rheumatoid arthritis?
- Symmetrical polyarthritis
- Hand deformities
- Subcutaneous nodules
What is the role of RANKL in rheumatoid arthritis?
Regulates osteoclast activity.
What is citrullination?
Conversion of arginine to citrulline, which is recognized as foreign by the immune system.
What genetic factors are associated with rheumatoid arthritis?
- HLA-DRB1 alleles
- PTPN22 SNP
Which bacteria is linked to rheumatoid arthritis due to its role in citrullination?
Porphyromonas gingivalis
What are common blood test findings in rheumatoid arthritis?
- Raised inflammatory markers (ESR/CRP)
- Rheumatoid factor
- Anti-citrullinated protein antibodies
What is the conventional treatment for rheumatoid arthritis?
DMARDs (e.g., methotrexate)
What are the blood test findings indicative of Rheumatoid Arthritis?
Raised inflammatory markers (ESR / CRP), Rheumatoid factor (RF) in 70% of cases, Anti-citrullinated protein antibodies (ACPAs) can be present up to 10 years before symptoms.
RF is an IgM antibody that targets the constant region of IgG antibodies.
What are common conventional treatments for Rheumatoid Arthritis?
DMARDs (e.g., methotrexate), NSAIDs, corticosteroids, biologics (e.g., infliximab).
Treatment response is highly variable and often includes side effects.
What dietary changes are recommended in the natural approach to manage Rheumatoid Arthritis?
Focus on reducing inflammation: no refined sugar, trans fats, dairy, limited red meat; high omega-3; abundant antioxidants (rainbow diet).
RA sufferers typically have low serum levels of antioxidants.
What is the autoimmune protocol (AIP) in relation to Rheumatoid Arthritis?
A dietary approach to support immune health, often gluten-free to reduce intestinal permeability.
Gluten is a key food source of molecular mimicry.
What role does Vitamin D play in managing Rheumatoid Arthritis?
A potent inhibitor of Th17 pathogenicity and promotes Treg differentiation; shown to lower RANKL levels.
Vitamin D levels should be tested and optimized.
What is the function of Omega-3 in the context of Rheumatoid Arthritis?
Has anti-inflammatory effects, reduces Th17 cells and IL-17 levels, inhibits PGE2, NFκB, TNF-α, and Interleukin-6.
Recommended dosage is 1 g+ of actual EPA.
What are the benefits of GLA (Gamma-Linolenic Acid) in Rheumatoid Arthritis treatment?
Shown to reduce pain, stiffness, and swelling in RA by being converted to DGLA, which forms anti-inflammatory PGE1.
Recommended dosage is 1–2 g daily of borage oil.
What is the role of Resveratrol in managing inflammation in Rheumatoid Arthritis?
Reduces Th17 cells; downregulates NF-KB and COX-2.
Recommended dosage is 200 mg/day.
How does Quercetin contribute to inflammation management in Rheumatoid Arthritis?
Inhibits NF-kβ and COX-2, as well as various inflammatory cytokines like IL-17 and TNF-α.
Recommended dosage is 1.5–3 g/day.
What are the common symptoms of Gout?
Monoarticular arthritis, pain, swelling, redness, heat, shiny skin, inability to use the joint during symptomatic episodes.
Most commonly affects the 1st metatarsophalangeal joint (big toe).
What is hyperuricaemia and its role in Gout?
Raised serum uric acid; it is a key risk factor for gout and a prerequisite for MSU crystal formation.
Uric acid is the final breakdown product of purine metabolism.
What are common causes of uric acid overproduction leading to Gout?
Dietary purines (meat, seafood), high cell turnover disorders, chemotherapy, fructose consumption.
Fructose can increase ATP degradation to AMP, a uric acid precursor.
What are the risk factors for underexcretion of uric acid in Gout?
Medication side effects, renal insufficiency, alcohol consumption, genetics, obesity, dehydration.
Diuretics and low-dose aspirin can increase urate renal retention.
What is the gold standard for diagnosing Gout?
Synovial joint microscopy showing urate crystals.
Presence of hyperuricaemia alone does not equate to a diagnosis.
What dietary recommendations are made for managing Gout?
Avoid alcohol, fructose-containing beverages, pro-inflammatory foods; follow a low purine diet.
Minimum of 2L of water daily is recommended to dilute urine.
What is the role of Quercetin in managing hyperuricaemia and Gout?
Inhibits xanthine oxidase and promotes activity of urate excretion transporters; has anti-inflammatory activity.
Recommended dosage is 200-400 mg x 3 daily.
What is the function of EPA in the context of Gout treatment?
Inhibits urate transporter 1 (URAT1), increasing renal urate excretion; has anti-inflammatory effects.
Recommended dosage is 3 g daily.
What are the benefits of tart cherry extract for Gout?
Inhibits COX-1, COX-2, NFκB, and IL-1β; reduces uric acid levels through XO inhibition or increased renal clearance.
Recommended dosage is up to 3000 mg/day.
What nutrient is shown to inhibit XO with high affinity for the binding site for the enzyme’s cofactor?
High dietary folate
Folate is involved in various biochemical processes including DNA synthesis and repair.
What is the daily extract dosage of tart cherry recommended?
Up to 3000 mg / day extract
Tart cherry is known for its anti-inflammatory properties.
Which polyphenols in tart cherry are credited with its health benefits?
Anthocyanins
Anthocyanins are known for their antioxidant effects.
What are the key actions of tart cherry?
- Inhibit COX-1, COX-2, NFκB and IL-1β
- Reduce uric acid levels
- Reduce oxidative stress
These actions contribute to its anti-inflammatory effects.
What herb is known to reduce uric acid through inhibition of XO activity?
Celery (Apium graveolens)
Celery also has flavonoids that contribute to its health benefits.
What are the main symptoms of fibromyalgia (FM)?
- Chronic widespread pain
- Fatigue
- Sleep disturbance
- Stiffness
- Headaches
- Bowel disturbances
- Anxiety and depression
FM involves abnormal pain-processing mechanisms.
What are the American College of Rheumatology diagnostic criteria for fibromyalgia?
A WPI score of 7+ and SS score of 5+, or WPI score of 4–6 and SS score of 9+
Symptoms must last at least three months.
What are common causes or risk factors for fibromyalgia?
- Trauma (physical and emotional)
- Adversity in early life
- Disrupted cortisol levels
- Hypothyroidism
These factors can alter pain responses.
Which gut condition is highly prevalent in fibromyalgia?
SIBO (Small Intestinal Bacterial Overgrowth)
SIBO can correlate with pain intensity in FM patients.
What nutritional deficiencies may be associated with fibromyalgia?
- Vitamin D
- Vitamin B12
- Magnesium
- Gluten reactivity
These deficiencies can affect pain processing and inflammation.
What is the role of magnesium in fibromyalgia management?
Blocks NMDA receptor channels leading to anti-nociceptive and analgesic effects
Magnesium helps reduce pain sensitivity.
What is balneotherapy?
The practice of immersing a subject in mineral water
Balneotherapy is researched for its benefits in fibromyalgia.
What is one key benefit of Coenzyme Q10 in fibromyalgia?
It is a potent antioxidant and plays a key role in the electron transport chain
CoQ10 deficiency correlates with symptom severity.
Which herbal medicine is known for its anti-nociceptive effects and supports restorative sleep?
Ashwagandha (Withania somnifera)
It influences GABA and the HPAA.
What percentage of back pain is classified as non-mechanical?
A smaller percentage
Non-mechanical back pain can be due to systemic diseases.
What are the common causes of mechanical back pain?
- Muscle strains
- Facet joint issues
- Intervertebral disc problems
- Vertebral fractures
Mechanical back pain is often associated with movement.
What daily dosage of Vitamin B6 is recommended for fibromyalgia?
50–100 mg / day
Vitamin B6 is a co-factor for glutamate decarboxylase.
What is the global prevalence of lower back pain (LBP)?
About 8%
Up to 60% of adults are expected to experience LBP at some point.
What lifestyle practices can improve pain perception in fibromyalgia?
- Regular aerobic exercise
- Tai Chi
These practices should avoid high intensity.
What is a common example of systemic disease causing non-mechanical back pain?
Ankylosing spondylitis
Systemic diseases can lead to non-mechanical back pain.
Name two conditions that are considered non-mechanical back pain.
- Fibromyalgia
- Endometriosis
What dietary components are emphasized in the CNM Naturopathic Diet for reducing inflammation?
- No refined sugar
- No trans fats
- Limited red meat
- High omega-3
What diet has studies highlighted as beneficial in reducing musculoskeletal pain?
Mediterranean diet
What nutrient is shown to block NMDA-receptor channels and reduce neuropathic pain in chronic LBP?
Magnesium
Fill in the blank: Omega-3 fatty acids have shown significant improvements in LBP through inhibition of the _______ pathway.
PGE2
What is the recommended dosage of phosphatidyl-serine for chronic neuropathic LBP?
200–400 mg
True or False: Proteolytic enzymes like serrapeptase and bromelain have been shown to benefit LBP patients.
True
List three nervine herbs that can help reduce muscle tension.
- Lemon balm
- Passionflower
- Chamomile
What is the male-to-female ratio for ankylosing spondylitis?
~ 3:1
What are the extra-articular manifestations of ankylosing spondylitis?
- Uveitis (~25%)
- Psoriasis (~10%)
- Inflammatory bowel disease (~6.5%)
What is the primary cause identified for chronic inflammation in ankylosing spondylitis?
Dysfunction of the IL-23 / Th17 signalling axis
Fill in the blank: HLA-B27 is present in over _______ of ankylosing spondylitis patients.
90%
What dietary approach has shown potential benefits for ankylosing spondylitis?
Low starch diet
What type of therapy is often recommended for back pain recovery?
Movement therapy (e.g., Pilates, yoga)
What are the signs/symptoms of osteoporosis?
- Asymptomatic until a fracture occurs
- Common fracture locations: vertebrae, hip, distal radius
What is the primary hormone involved in bone remodeling?
Parathyroid hormone (PTH)
What condition is characterized by low bone mass and increased fracture risk?
Osteoporosis
What are two significant risk factors for osteoporosis?
- Increasing age
- Female / post-menopause
True or False: Smoking has no effect on osteoporosis.
False
What type of imaging is commonly used to measure bone mineral density?
Dual energy x-ray absorptiometry (DEXA)
What are common dietary recommendations for osteoporosis management?
- Avoid dairy products
- Limit carbonated beverages
- Include anti-inflammatory foods
What is the role of vitamin D in bone health?
Facilitates intestinal calcium absorption
Fill in the blank: Chronic inflammation has been linked to _______.
Osteoporosis
What types of beverages should be limited for health?
Carbonated beverages, coffee, alcohol
Limiting these beverages can help in managing health conditions.
What are examples of anti-inflammatory foods to include in a diet?
High omega-3 foods, flax seeds, chia seeds, turmeric, ginger
These foods can help reduce inflammation in the body.
What are the benefits of green leafy vegetables?
Abundance of minerals and vitamins for bone health, e.g., calcium, magnesium, boron
They are essential for maintaining strong bones.
What should post-menopausal individuals consider including in their diet?
Phytoestrogens, e.g., organic fermented soy
These can help balance hormones in post-menopausal women.
What is the recommended protein intake for supporting bone framework?
1.0‒1.2 g / kg of body weight / day with at least 20‒25 g of high-quality protein at each main meal
Adequate protein is necessary for collagen support.
True or False: A high-protein diet decreases urinary excretion of calcium.
False
A high-protein diet increases urinary calcium excretion.
What factors should be addressed to reduce osteoporosis risk?
Stop smoking, support gastric HCl / digestion, optimise body weight, support the gut microbiome
These lifestyle changes can help manage osteoporosis risk.
What are some food sources of calcium?
Dark green leafy vegetables, sardines, sesame seeds, tahini, almonds
Calcium is crucial for bone mineralisation.
What is the recommended daily intake of calcium if supplementing?
500 mg / day
This helps ensure adequate calcium levels for bone health.
What is necessary for calcium absorption in the intestines?
Calcium must be ionised
This process depends on gastric HCl.
What effect does salt have on urinary calcium loss?
Increases urinary calcium loss by 4‒5 % for each 500 mg of sodium ingested
High salt intake can negatively impact calcium levels.
What role does Vitamin D play in bone health?
Facilitates calcium absorption and is involved in bone turnover
Low levels of Vitamin D are associated with bone loss.
What is the recommended intake of Vitamin K2?
50‒100 mcg
Supports osteocalcin production, which is important for calcium incorporation into bones.
What is magnesium’s role in bone health?
Co-factor for alkaline phosphatase and conversion of Vitamin D
Magnesium is essential for bone mineralisation.
What are some nutritive herbs beneficial for bone health?
Horsetail, Nettle
These herbs are rich in nutrients that support bone mineralisation.
What are the recommended exercises to promote bone health?
Weight-bearing exercises, e.g., walking, weight training, stair climbing, dancing, yoga, Pilates, Tai Chi, hiking
These activities promote osteoblast activity and help prevent falls.
What is the minimum recommended frequency and duration of exercise for bone health?
3 times weekly, 30 minutes per session
Regular exercise is crucial for maintaining bone density.
