Integrated models of patient-centred multi-disciplinary care have been shown to reduce pain and improve function and quality of life among individuals with OA.

Osteoarthritis (OA) stands as one of the most prevalent musculoskeletal disorders worldwide, affecting millions of individuals and posing a significant burden on patients' quality of life.^1,2 

PREVALENCE AND BURDEN OF OSTEOARTHRITIS 

Characterised by progressive degeneration of joint cartilage and underlying bone changes, osteoarthritis is a leading cause of disability among the elderly. However, it also affects individuals across all age groups, with risk factors including aging, obesity, joint injury, and genetic predisposition.^1,2,3,4 According to the World Health Organization (WHO), OA affects around 10% of men and 18% of women aged over 60 globally, making it a significant public health concern.^1,2,4 

THE ROLE OF JOINT SUPPLEMENTS 

Joint supplements have emerged as an integral component of OA management, offering symptomatic relief, modifying disease progression, and improving joint function. Among these supplements, Avocado Soybean Unsaponifiables (ASU) and Boswellia have garnered considerable attention due to their promising clinical evidence. 

Avocado Soybean Unsaponifiables (ASU): A natural vegetable extract derived from avocado and soybean oils, ASU has demonstrated anti-inflammatory, chondroprotective, anabolic, and anticatabolic properties. Clinical studies have shown that ASUs reduce pain and stiffness while improving joint function. Moreover, ASUs are a natural, slow-acting agent that do not merely address acute pain but actively prevent progression of OA symptoms.⁵ 

Boswellia: Extracted from the resin of the Boswellia serrata tree, Boswellia has been traditionally used in Ayurvedic medicine for its anti-inflammatory properties. Clinical research supports its efficacy in reducing pain and improving joint function in OA patients.⁶ Furthermore, Boswellia has shown synergistic effects when combined with other joint supplements, enhancing overall therapeutic outcomes.⁷ 

IMPORTANCE OF RECOMMENDING JOINT SUPPLEMENTS 

Promoting patient-centred care and optimising treatment outcomes in OA management is important.² Recommending joint supplements is crucial for several reasons: 

• Early intervention: Osteoarthritis is a progressive disease with irreversible joint damage.^1,2 Recommending joint supplements at the onset of symptoms or diagnosis can potentially halt disease progression, preserve joint integrity, and mitigate long-term disability.^5,6,7 

• Symptomatic relief: Joint supplements offer symptomatic relief by alleviating pain, reducing inflammation, and improving joint mobility, thereby enhancing patients' quality of life and functional capacity.^5,6,7 

• Complementary to conventional therapy: Joint supplements complement conventional pharmacological and non-pharmacological therapies, providing a holistic approach to OA management.⁸ Their favourable safety profiles and minimal adverse effects make them suitable for long-term use, either as monotherapy or adjunctive therapy.^5,6,7 

• Patient empowerment: Recommending joint supplements empowers patients to actively participate in their treatment journey, fostering self-management skills and adherence to therapy. Educating patients about the benefits of joint supplements instils confidence and encourages proactive health-seeking behaviours. 

By recommending joint supplements early, pharmacists contribute to optimising patient outcomes, alleviating symptom burden, and improving overall quality of life in individuals living with osteoarthritis. 

REFERENCES 

1. Allen KD, Thoma LM, Golightly YM. Epidemiology of osteoarthritis. Osteoarthritis Cartilage. 2022 Feb;30(2):184-195. doi: 10.1016/j.joca.2021.04.020. Epub 2021 Sep 14. PMID: 34534661; PMCID: PMC10735233. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735233/  
2. Osteoarthritis Research Society International. Osteoarthritis: A Serious Disease. Submitted to the U.S. Food and Drug Administration 1 December 2016. Available from: https://oarsi.org/sites/oarsi/files/library/2018/pdf/oarsi_white_paper_oa_serious_disease121416_1.pdf 
3. Mayo Clinic. Osteoarthritis. Available from: https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925?p=1 
4. Steinmetz J, Culbreth G, Vos T, et al. GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Rheumatology. 21 August 2023. doi: 10.1016/S2665-9913(23)00163-7. Available from: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00163-7/fulltext 
5. Christiansen BA, Bhatti S, Goudarzi R, Emami S. Management of Osteoarthritis with Avocado/Soybean Unsaponifiables. CARTILAGE. 2015;6(1):30-44. doi:10.1177/1947603514554992. Available from: https://journals.sagepub.com/doi/full/10.1177/1947603514554992 
6. Lindler BN, Long KE, Taylor NA, Lei W. Use of Herbal Medications for Treatment of Osteoarthritis and Rheumatoid Arthritis. Medicines (Basel). 2020 Oct 28;7(11):67. doi: 10.3390/medicines7110067. PMID: 33126603; PMCID: PMC7693010. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693010/ 
7. Sethi V, Garg M, Herve M, Mobasheri A. Potential complementary and/or synergistic effects of curcumin and boswellic acids for management of osteoarthritis. Ther Adv Musculoskelet Dis. 2022 Sep 22;14:1759720X221124545. doi: 10.1177/1759720X221124545. PMID: 36171802; PMCID: PMC9511324. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9511324/ 
8. Arthritis Foundation. Popular Supplements for Arthritis: What You Need to Know. Available from: https://www.arthritis.org/health-wellness/treatment/complementary-therapies/supplements-and-vitamins/vitamins-supplements-arthritis