Sugar Soak for basal thumb arthritis to reduce pain

 October 2023

Soaking your hands in a water/dextrose solution reduces reduces and at times stops the pain of basal thumb arthritis.  Here is my story.  I am 69 years old. 

Four years ago, I was diagnosed with Basal Thumb arthritis in both hands.  I tried cortisone injections and exercises/stretching and neither helped.  The exercises increased my pain.  When I went to the OT she mentioned one of her patients was getting sugar injections.  My husband is a chemist and he looked into what is known about sugar for basil thumb arthritis.  He found dextrose (a.k.a. glucose) is absorbed through the skin and is used by the body to make galactose that is required for joint lubrication. I have been soaking my hands in for 2 ½ years which has reduced my pain substantially and most of the time I am in no pain.

When I first started, I soaked my hands for 10 minutes each day.  Now I soak a few times a week depending on what activities I have done or how my hands are feeling.  For activities which I know will increase the pain I soak before and after.  Gardening and birding (holding binoculars) can increase my pain.  I have had to adjust my gardening but not my bird watching. I also wear the push meta grip hand braces for these activities which I learned about from this group. 

When I was 1^st diagnosed I didn’t realize I was in constant pain until they numbed my hand for the cortisone injection.  I had my worse hand done 1^st and on the way home my ‘better’ hand hurt. I didn’t realize I was in constant pain.    

I started the soaks 2 ½ years ago.  I soaked both hands daily.  In about 4 weeks I saw consistent improvement in pain reduction.  I have also modified my activities, got some adaptive kitchen tools and as I mentioned above I wear push meta grip for activities which can increase my pain. 

Mix 130 grams or 7/8 of a cup of dextrose in 5 cups of water. 

You can use a scale to weigh 130 grams or use a dry measure measuring cup for 7/8 cup.

You want the solution to be around body temperature (98 to 100 degrees).  When I make the solution, I heat the water before adding the sugar.  When I reuse the solution, I put around ¾ of cup of the solution in microwave and heat on high for about 1 ½ minutes.  The solution will keep at room temperature for a few days.  When it starts to smell or gets really cloudy make a new batch.    

Make sure to wash your hands before and after your soaks.  I got a skin rash during the 2^nd month.  I have not gotten a rash since I started washing my hands after I soak.    

  

Here is a link for ordering the dextrose by Nutricost.  .Order Dextrose

Here is  a write up my husband who is a chemist on the research he did explaining why this works.

Decreasing Pain and Joint Space Narrowing with D-Glucose Soaks

A Tale of Two Sugars – D-Glucose (a.k.a. Dextrose) and D-Galactose

by Dennis N Crouse 

My wife has been diagnosed by x-ray with osteoarthritis in both of her first carpometacarpal (CMC) joints of her left and right hands. This joint is at the base of thumb and is also called the trapeziometacarpal (TMC) joint.  Carpometacarpal osteoarthritis (CMC OA or TMC OA)) of the thumb is painful and occurs when the cushioning cartilage of the joint surfaces wears away (at arrow in figure 1) and/or the metacarpal bone becomes offset from the joint as seen by x-ray:

When joint space narrowing occurs, the cartilage no longer keeps the bones a normal distance apart. This can be painful as the bones can put too much pressure on each other. Joint space narrowing is seen in osteoarthritis (OA) or rheumatoid arthritis (RA). A proposed solution is to both lower the pain and widen joint space by promoting the increase of proteoglycans, such as aggrecan required for cartilage restoration and lubricin for joint and tendon sheath lubrication. This may be possible with periodically (i.e., every few days) soaking of the hands in 10% D-glucose for 10 minutes. The dextrose is converted to D-galactose by the body and they diffuse into the synovial fluid that surrounds the joint. Both D-glucose and D-galactose are biosynthesized to aggrecan and lubricin that keep the joint lubricated.

Articular cartilage is the smooth, white tissue that covers the ends of bones where they come together to form joints. Healthy articular cartilage in our joints makes it easier to move as it allows the bones to glide over each other with very little friction. Articular cartilage contains up to 10% proteoglycan by weight, most of which is aggrecan. Aggrecan consists of  many galactose-containing chondroitin and keratan sulfate glycosaminoglycan chains in a bottlebrush structure. Aggrecan’s loss is an early sign of OA or RA.

 

Lubricin (a.k.a. proteoglycan 4) is a mucinous, synovial fluid glycoprotein that enables near frictionless joint motion via both adsorption to the surface of articular cartilage and its lubricating properties in solution. Lubricin is biosynthesized by chondrocytes located at the surface of articular cartilage, and also by synovial lining cells. In total, lubricin is approximately 200nm +/- 50 nm in length and has a diameter of a few nanometers (see figure 2). The glycoprotein consists of >5% serine and >20% threonine residues, which give rise to a large number of O-glycosylations. This glycosylated mucin-like domain is thought to contain short polar (-GalNAc-Gal) and negatively charged (-GalNAc-Gal-NeuAc−) sugar groups with Gal being D-galactose. Synovial fluid of patients with OA and RA has been shown to exhibit reduced levels of lubricin when compared to healthy patients. (Kosinska)

Figure 2. Not drawn to scale as 98% of lubricin’s length is galactose containing filaments represented in blue linked by O-glycosylations to serine and threonine residues in the core of the bottlebrush.

 

Another component of articular cartilage and synovial fluid is hyaluronic acid (HA) a glycosaminoglycan that with lubricin are the fluid’s main lubricating components. (Wiki) HA is a long chain of two alternating glucose derivatives: glucuronic acid and N-acetylglucosamine.

Lower than normal levels of the following are found in the synovial fluid of those with TMC OA:

·       D-Glucose – precursor of D-galactose

·       Lubricin (a.k.a. proteoglycan 4, PRG4) - a superficial zone protein (SZP) (Kosinska)

·       Chondroitin sulfate proteoglycans (CSPGs) - protein core and chondroitin side chain

·       Hyaluronic acid (HA) – a non-sulfated glycosaminoglycan whose molecular weight is also shifted lower in OA and RA (Kosinska)

 

The MOVES study published in 2016 demonstrated that chondroitin sulfate (CH, 1,200mg/day) and glucosamine hydrochloride (GH, 1,500mg/day) augmentation (i.e., 400mg CH and 500mg GH 3 times per day orally) has been shown after 6 months to lower joint pain by 50%. (Hochberg) This conclusion is supported by a 2015 meta-analysis of recent published research indicating that both CH and GH alone can reduce joint space narrowing. (Zeng)  Glucosamine sulfate is more orally bioavailable than glucosamine hydrochloride. (Meulyzer) It has been shown that daily oral glucosamine sulfate augmentation (1,500mg/day) increases plasma and synovial fluid concentrations of glucosamine by more than 20-fold. (Persiani)

 

In addition, several injections of glucose into the synovial fluid of the TMC joint can lower pain for a year by 50% and reduce joint space narrowing by 14%. (Reeves) Increasing D-glucose in the synovial fluid surrounding the TMC joint can be done by:

 

·       Monthly injections of 10% glucose into the joint’s synovial fluid (i.e., prolotherapy)

·       Periodic soaking both hands and wrists in a warm aqueous 10% solution of D-glucose

·       Daily augmenting with D-glucose and D-galactose as lactose in whole or skim milk

 

Adults endogenously produce approximately 1 gram of D-galactose every day but this declines by 50% due to aging. One cup of whole or skim milk contains 6 grams of D-galactose and 6 grams of D-glucose both of which make up lactose. D-Galactose augmentation does not impact D-galactose endogenous production. (Bosch)

 

Prolotherapy with D-Glucose for TMC Joint Osteoarthritis

Prolotherapy with one half cc of 10% d-glucose injected into the TMC joint at 0, 2, and 4 months with assessment at 6 and 12 months showed a 42% improvement pain after finger and thumb movement. Significant reduction in joint space narrowing (14%) was observed at 12 months versus 7% joint space narrowing in the group receiving a placebo. (Reeves)

Similarly, monthly prolotherapy for 3 months with 20% d-glucose compared with a single dose of methylprednisolone at 3 months showed 3 months after the last injection that both d-glucose and methylprednisolone increased functional level, but d-glucose seemed to be more effective. (Jahan)

Note that one-half cc of a 10% d-glucose solution contains only 50mg of d-glucose. (Giri)

Soaking Therapy with D-Glucose for TMC Joint Osteoarthritis

Diffusion of one-half cc of 10% d-glucose in water could occur in 10 to 20 minutes of soaking a human hand in 10% D-glucose. For instance, a human foot exposed to water takes in 1–2 gm of water per hour or 1/6 to 1/3cc in 10 minutes. A small portion of this uptake is imbibed by the stratum corneum, the major portion seems to enter the system. The transfer has been observed for periods exceeding 50 hours. (Buettner) d-Glucose in water has been shown to passively diffuse through skin. (Kang)

Soaking the entire hand and 1 inch up the wrist in 10% D-glucose for 10 minutes daily for a week reduced the TMC joint pain. The benefits of this soaking can last for several weeks. Soaking in higher concentrations of sugar can cause skin irritation. To avoid skin irritation and hives always wash hands and wrists before and after soaking. The D-glucose (dextrose) was packed by Nutricost and purchased from Amazon.  Order Dextrose