Patients with rheumatoid arthritis (RA) or osteoarthritis (OA) routinely need joint pain relief, and joint replacement surgery is often required for those with severe disease; however, there are no effective strategies for preventing disease progression. Tetrahydro iso-α acids (THIAAs), dietary ingredients that come from Humulus lupulus (hop) and contain a mixture of 3 major congeners, have demonstrated anti-inflammatory effects in vitro and in an animal model of RA. In addition, undenatured type 2 collagen, a dietary ingredient derived from the sternum cartilage of chickens, was shown to be effective in clinical studies of patients with RA and OA who do not have treatment-related adverse events. To further explore these findings, Robert H. Lerman, MD, PhD, former Director of Medicine and Extramural Clinical Research, Metagenics, Inc, Gig Harbor, WA, and colleagues sought to evaluate the safety and efficacy of a tablet containing 150 mg of n-enriched THIAA (nTHIAA; Metagenics, Inc) and 10 mg of a natural collagen concentrate containing 25% undenatured type 2 collagen (UC-II; InterHealth, Inc, Benicia, CA) in patients with arthritis. They found that this tablet was safe and effective in improving chronic joint pain in patients with arthritis.
This open-label case series was conducted at the Functional Medicine Research Center from February 2013 to June 2013. Eligible participants were nonsmoking adults with chronic pain from symptomatic OA or RA involving any joint or combination of joints. The 17 patients, including 12 women and 5 men aged 39 to 69 years, had joint pain, presumably caused by OA. Each participant received the tablet (containing 300 mg of nTHIAA and 20 mg of UC-II) twice daily for 12 weeks, and upon returning to the clinic at weeks 2, 4, 8, and 12, were given enough tablets to use until their next visit.
Compliance was considered to have been high; the nTHIAA and UC-II combination was well-tolerated, and no serious adverse events occurred. Significant improvements were observed in participants compared with baseline for every questionnaire measured, including the joint/muscle subscale on the Medical Symptom Questionnaire (MSQ), MSQ's total score, and the daily living subscale on the Arthritis Impact Questionnaire (AIQ). Statistically significant changes in scores occurred at weeks 4, 8, and 12 after baseline for the Visual Analog Scale for Pain questionnaire, arthritis symptoms subscale on the AIQ, and Arthritis Impact Measurement Scales 2 questionnaire. Statistically significant changes in scores occurred at weeks 8 and 12 for the physical subscale on the health and Medical outcomes Study Short-Form 36 (MOS-SF36) questionnaire, and at 12 weeks for the mental subscale on the MOS-SF36 questionnaire. At the conclusion of the study, patients reported favorable outcomes, as indicated by improvements in their scores on arthritis-related and quality-of-life questionnaires, absence of serious adverse reactions, and discontinuations or reductions in the use of analgesics.
- Lerman RH, Chang JL, Konda V, et al. Nutritional approach for relief of joint discomfort: a 12-week, open-case series and illustrative case report. Integr Med (Encinitas). 2015;14:52-61.