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Osteoarthritis |
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Also Listed As: |
Arthritis,
Osteo- |
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Osteoarthritis (OA) is the most common form of arthritis, especially among
older people. It is a joint disease caused by the breakdown of
cartilage—the firm, rubbery tissue that cushions bones
at joints. Healthy cartilage allows bones to glide over one another and
cartilage absorbs energy from the shock of physical movement. In OA cartilage
breaks down and wears away. As a result, the bones rub together, causing pain,
swelling, and stiffness. OA may also limit the range of motion in affected
joints. Most often, OA develops in the hands, knees, hips, and spine. The
disease affects men and women nearly equally. More than 20 million people in the
United States have OA. Symptoms tend to appear when individuals are in their 50s
and 60s. |
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Signs and Symptoms |
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Signs and symptoms of OA may include the following: - Joint pain (often a deep, aching pain) that is worsened by movement
and improved with rest (in more severe cases, a person may experience constant
pain)
- Stiffness in the morning or after being inactive for more than 15
minutes
- Joint swelling
- Joints that are warm to the touch
- Crunching or crackling noise when the joint moves
(crepitation)
- Limited range of motion
- Muscle weakness
- Abnormal growth of bony knobs near joints causing deformities (such as
Heberden's nodes, in which bumps appear on the outermost finger
joints)
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Causes |
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OA is also often called degenerative joint disease because this condition
involves the destruction of cartilage, which normally protects the joint.
Although there are
risk factors that may predispose a
person to developing OA, it is usually not entirely clear what initiates the
damage and loss of cartilage. Once the cartilage becomes somewhat damaged,
however, it is more likely for further injury to ensue from repetitive use or
another injury. Less commonly, OA is due to a fracture, mechanical abnormalities
(such as unequal lower limb lengths), other bone and joint disease (such as
gout), or an underlying metabolic or hormonal disorder. |
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Risk Factors |
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Risk factors for OA include: - Increasing age
- Genetic predisposition
- Obesity
- Injury to the joint
- History of inflammatory joint disease
- Metabolic or hormonal disorders (such as hemochromatosis and
acromegaly)
- Bone and joint disorders present at birth
- Repetitive stressful joint use (such as with certain occupations like
baseball, ballet dancing and construction work)
- Deposits of crystals in joints, such as happens with gout
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Diagnosis |
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Because no single test can diagnose OA, most healthcare practitioners use a
combination of the following methods to diagnose the disease and rule out the
possibility of other causes of arthritis: - Medical history—the doctor assesses symptoms
by asking when they started and how they changed over time, including which
joints are currently involved and have been affected previously. He or she will
also ask about other medical conditions that may be contributing to current
joint symptoms, and whether any factors (such as a fall or injury) could have
caused these symptoms. The doctor will also determine whether the you are taking
might interact with drugs that he or she is considering prescribing.
- Physical exam—each of the affected joints is
examined for redness and swelling, crepitations (a crackling noise that may be
heard and sensation felt when bone is rubbing on bone due to lack of cartilage),
the presence of fluid in the joint, and the strength and range of motion of the
joint.
- X-rays—can detect cartilage loss (which is
indicated by narrowing of the joint space on x-ray) and bone damage such as bone
spurs or erosions.
- Blood tests—are performed to look for general
signs of inflammation, to help eliminate the possibility of other types of
arthritis such as rheumatoid or Lyme's disease, and to check for possible
markers of OA such as hyaluronic acid, a substance that normally provides
lubrication for joints but breaks down in the case of OA.
- Joint aspiration - if fluid is present, it
can be withdrawn from the joint for evaluation using a needle and syringe;
normally with OA, there is not an adequate amount of fluid in the joint space to
aspirate; therefore, evaluation of fluid may reveal another cause of arthritis
such as gout or an infection.
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Preventive Care |
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The following measures may reduce the risk of developing OA: - Protecting an injured joint from further damage
- Exercising
- Losing weight
- Avoiding excessive repetitive
motions
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Treatment Approach |
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The goals of OA treatment are to relieve symptoms, maintain mobility, and
minimize disability. A combination of conventional treatment and complementary
and alternative medicine (CAM) may be most effective. It is possible, if not preferable, to treat OA without the use of
medications. Pain-killers and anti-inflammatory
medications should not be used as the
primary treatment for OA—they should be used only in
addition to other forms of treatment.
Lifestyle approaches, including exercise,
and many alternative medical therapies are becoming more popular and are
considered safe and effective for the treatment OA. Several natural remedies are
at least as effective as conventional medication for symptom relief, and may
diminish the progression of the disease. Various surveys conducted in 1997 found
that anywhere from 26% to 100% of patients with rheumatologic disorders (painful
conditions of the muscles, tendons, joints, and bones) had tried some form of
complementary and alternative medicine. Some of the most promising complementary approaches for treating OA include
the following: - Reducing physical stress on the joint (such as by losing weight or
improving posture)
- Lifestyle changes (particularly
exercise)
- Supplements including
S-adenosylmethionine (SAMe), glucosamine and/or chondroitin, and
antioxidants
- Herbs with anti-inflammatory properties,
including devil's claw, willow bark, and capsaicin (cream)
- Acupuncture
- Chiropractic
- Physical therapy and magnet
therapy
- Yoga
- Tai
chi
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Lifestyle |
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Exercise Exercise to strengthen, stretch, and relax muscles around affected joints is
almost always included in a treatment plan for OA. Several studies support the
value of exercise for people with OA. One recent study, for example, found that
people with OA of the knee who participated in a home exercise program
experienced a 23% reduction in pain compared with only 6% reduction in people
who did not exercise. Other studies also suggest that in addition to reduction
of pain and disability, exercise improves strength, range of motion, balance and
coordination, endurance, and posture. |
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Medications |
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The following medications may be used in addition to lifestyle approaches
(such as exercise) and alternative therapies (such as herbs and supplements) to
treat OA: - Acetaminophen—reduces pain; the American
Geriatrics Society recommends trying this medication first to alleviate pain.
- Aspirin and other nonsteroidal anti-inflammatory drugs
(NSAIDs)—reduce pain and swelling. These include
numerous over-the-counter drugs, such as ibuprofen, ketoprofen, and naproxen
sodium, as well as prescription medications, such as diclofenac, diflunisal,
etodolac, fenoprofen, indomethacin, nabumetone, oxaprozin piroxicam, sulindac,
salsalate, and tolmetin as well as stronger versions of the OTC drugs. Studies
indicate that NSAIDs used for extended periods may cause stomach ulcers and
other gastrointestinal problems. Some evidence even suggests that NSAIDs may
accelerate the progression of OA because they appear to inhibit cartilage
repair. Further studies are needed about this controversial issue.
- Cyclooxygenase 2 (COX-2) inhibitors (such as celecoxib and
rofecoxib)—reduce pain and are less likely to cause the
gastrointestinal side effects that sometimes accompany NSAIDs
- Tramadol—for pain that does not improve with
other medications
- Hyaluronic acid—may restore lubrication to
the joints. The medication is injected into affected joints once per week for 3
to 5 weeks and the effects may last up to one year. After each injection,
weight-bearing activity should be avoided for about 48 hours.
- Glucocorticoids—injected in or around
affected joints to relieve symptoms; no more than two to three injections should
be administered in one year.
- Misoprostol or omeprazole—taken together with
an NSAID may reduce ulcers and gastrointestinal bleeding associated with NSAID
use
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Surgery and Other Procedures |
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Surgery is usually only considered as a last resort for OA. Surgical options
include: - Arthroscopic debridement and lavage (using a lighted instrument to
examine the interior of a joint, remove dead tissue, and wash the joint) may
reduce symptoms
- Osteotomy (removal of all or part of the bone; loose fragments that
may be causing symptoms are removed at the same time) may alleviate pain and
inflammation in people with moderately advanced knee or hip OA.
- Arthrodesis (fusion of joints) may be considered for the spine and
small joints of the wrist, hand, and foot to reduce pain. Fusion of the bone,
however, eliminates movement of that joint.
- Arthroplasty (joint replacement) is used for people with severe and
advanced OA who have not improved from any other treatments. This procedure
works best for older people because artificial joints typically last only 20
years.
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Nutrition and Dietary Supplements |
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Glucosamine and Chondroitin Glucosamine and chondroitin are compounds that occur naturally in human
cartilage. For use in supplements, they are derived from bovine and calf
cartilage. They have been widely used in Europe for more than a decade and have
also recently gained popularity in the United States. Both compounds have been
shown to inhibit inflammation in laboratory experiments. To evaluate the
long-term effectiveness and possible toxic effects of these substances, the
National Center for Complementary and Alternative Medicine (NCCAM) of the
National Institutes of Health (NIH) has funded a large clinical trial comparing
glucosamine, chondroitin, and a combination of the two agents, to placebo. The
study is projected to be complete by March 2005. Several reviews of clinical trials examining either glucosamine or
chondroitin for OA concluded that these agents showed a number of benefits. Glucosamine is administered orally or by injection into
a joint or muscle. In its most commonly used form, glucosamine sulfate, it has
been shown to: - Decrease pain more effectively than placebo or NSAIDs (particularly
ibuprofen)
- Take longer to begin working than ibuprofen but alleviate pain for a
longer period of time
- Have significantly fewer adverse effects than ibufrofen
- Significantly improve pain and range of motion compared to both
placebo and the NSAID piroxicam
- Have longer-lasting improvement of symptoms compared to piroxicam
Although encouraging, these studies did not examine the long-term safety and
effectiveness of this supplement. In one long-term study in which 212 patients
with OA received either glucosamine sulfate or placebo for 3 years, those in the
glucosamine group experienced a 25% improvement in symptoms as well as
diminished narrowing of the joint space, suggesting that the supplement slowed
the progression of the disease. Participants in the glucosamine group reported
no more adverse effects than those in the placebo group. Some experts believe that another form of glucosamine known as glucosamine
hydrochloride may be absorbed more readily by the body than glucosamine sulfate.
Since most research to date has been conducted on glucosamine sulfate, this is
the form generally recommended for OA. Chondroitin is also administered orally or by injection into a
joint or muscle. It has been found to produce the following results in several
well-designed clinical trials: - Reduce the need for NSAIDs and other pain relievers
- Alleviate pain (sometimes more effectively than conventional
medications; this effect even lasts up to 3 months after chondroitin
supplementation is discontinued)
- Increase mobility
- Decrease swelling
- Reduce amount of fluid in the joint
- Enhance walking pace
- Slow the progression of the disease
Although glucosamine and chondroitin have been studied separately,
accumulating evidence suggests that taking both supplements together may be a
safe and effective treatment for OA. As mentioned earlier, a large NIH-funded
study comparing glucosamine, chondroitin, and a combination of the two agents to
placebo is currently underway. The study is expected to be completed by March
2005. Medical experts caution that glucosamine and chondroitin supplements sold
over the counter in the United States are not regulated by the U.S. Food and
Drug Administration, meaning that there is no standardization nor any guarantee
that a product contains what is listed on the label. S-adenosylmethionine (SAMe) Laboratory and animal studies suggest that SAMe may reduce pain and
inflammation, but researchers are not clear how this works. Clinical trials with
humans (although generally small in size and of short duration) have also shown
favorable results for SAMe when used to relieve OA symptoms. In several short-term studies (ranging from 4 to 12 weeks), SAMe supplements
(1200 mg/day) compared favorably to NSAIDs in adults with knee, hip, or spine
osteoarthritis in the following ways: - Diminished morning stiffness
- Decreased pain
- Reduced swelling
- Improved range of motion
- Increased walking pace
In an extensive review of studies conducted with SAMe (collectively
representing over 20,000 people), including trials of longer duration (namely, 2
years), the supplement was associated with the following
benefits: - Improved symptoms
- Few side effects
- No negative influences on cartilage production (unlike
NSAIDs)
- Reduced risk for relapse
Vitamin D Vitamin D is essential to bone and cartilage health. Studies evaluating
vitamin D use for OA have found the following: - Vitamin D prevents breakdown of cartilage
- Lower intake of vitamin D may be linked to greater risk of hip OA in
older women and OA-related joint changes (visible on X-rays) in both men and
women
Antioxidants Antioxidants appear to significantly ease oxidative stress and inflammation
caused by free radicals and may therefore slow the progression of OA. Free
radicals can be produced in the joints and have been implicated in many
degenerative changes in the aging body, including destruction of cartilage and
connective tissue. Antioxidants appear to offset the damage caused by free
radicals. Although further evidence is needed to substantiate these claims,
studies of groups of people observed over time suggest that the following
antioxidants may help to reduce the symptoms of OA: - Vitamin A and beta-carotene
- Vitamin C
- Vitamin E
In addition, more extensive research on vitamin E revealed that people with
OA experienced a significant reduction in pain after taking 600 mg of vitamin E
per day, compared with those who received placebo. Those who took 600 mg of
vitamin E three times a day experienced significantly less pain than those who
took the NSAID diclofenac. Niacinamide In one preliminary study, 72 patients with OA were randomly assigned to
receive niacinamide, a form of vitamin B3, or placebo. Participants
in the niacinamide group experienced a 30% improvement in symptoms compared to a
10% worsening of symptoms experienced by those in the placebo group. People
taking niacinamide reported the following: - Improved joint mobility
- Reduced need for anti-inflammatory medications
The study authors speculate that niacinamide may aid cartilage repair and
suggest that it may be used safely with NSAIDs to reduce inflammation. Further
research is needed to fully understand how niacinamide benefits people with OA
and to determine whether the results apply to all people with the condition. It
does appear, however, that niacinamide must be used for at least 3 weeks before
the benefits described are seen. Experts also suggest that long-term use (1 to 3
years) may slow the progression of the disease. Omega-3 Fatty Acids Omega-3 fatty acids are found in coldwater fatty fish (such as salmon,
mackerel, and herring), flaxseed, rapeseed, and walnuts. Research regarding the
use of omega-3 fatty acid supplements for inflammatory joint conditions has
focused almost entirely on rheumatoid arthritis. Based on laboratory studies,
however, many researchers suggest that diets rich in omega-3 fatty acids (and
low in omega-6 fatty acids) may benefit people with other inflammatory
disorders, such as OA. In fact, several laboratory studies of
cartilage-containing cells have found that omega-3 fatty acids decrease
inflammation and reduce the activity of enzymes that break down cartilage. Another potential source of omega-3 fatty acids is the New Zealand green
lipped mussel (Perna canaliculus), used for centuries by the Maori people
for good health. In a trial involving 38 people with OA, nearly 40% of those who
received P. canaliculus extracts experienced the
following: - Decreased joint stiffness and pain
- Increased grip strength
- Enhanced walking pace
It is also important to note, however, that 10% of participants experienced a
temporary worsening of symptoms when first taking the supplement. In addition,
it is better to use lipid extracts of P. canaliculus rather than powder
as there is less chance of an allergic reaction. P. canaliculus should be
avoided by people who are allergic to seafood. Manganese Manganese is among the substances that the body needs to build cartilage. In
a clinical trial studying glucosamine, choindroitin, and manganese, 72 people
with mild to moderate OA of the knee showed significant improvement in symptoms
after taking these supplements in combination compared to those taking placebo.
No serious side effects were reported. People with more severe forms of the
disease did not show improvement as a result of taking the combination, however.
Although earlier studies have indicated that low levels of manganese may
contribute to degenerative joint conditions and bone loss, it is not clear from
this trial what role manganese (as opposed to chondroitin and glucosamine) may
have played in the results. Interestingly, however, an estimated 37% of
Americans have low levels of manganese in their diets. Other Supplements According to anectodal reports and preliminary studies, other supplements
that may potentially alleviate the symptoms of OA include: - Bromelain
(Ananas comosus)—compared favorably to
NSAIDs for pain reduction
- Boron—population, animal, and preliminary
human studies suggest that this trace element may reduce occurrence of symptoms
of OA
- Collagen hydrolysate—may stimulate cells to
make collagen, although this theory is currently being
tested
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Herbs |
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Herbal remedies are among the most popular alternative therapies used by
individuals with arthritis. Scientific evidence suggests that the following
herbs are most effective for treating OA: - Devil's claw (Harpagophytum procumbens)
- Willow bark (Salix spp.)
- Stinging nettle (Urtica dioica)
- A combination of aspen (Populus tremula), ash
(Fraxinus excelsior), and goldenrod (Solidago
viraurea)
- An Ayurvedic herbal mixture containing extracts of ashwagandha
(Withania somnifera), boswellia (Boswellia serrata), and
turmeric (Curcuma longa)
- A combination of willow bark (Salix spp.), black cohosh
(Cimicifuga racemosa), sarsaparilla (Smilax spp.), guaiacum
(Guaiacum officinale) resin, and poplar bark (Populus tremuloides)
Other herbs that have shown promise in the treatment of OA include: Capsaicin (Capsicum frutescens) Capsaicin is the main component in hot chili peppers (also known as cayenne).
Applied to the surface of the skin, it is believed to deplete stores of a
substance that contributes to inflammation and pain in arthritis. Several
studies have shown that capsaicin cream provided much better pain relief than a
placebo but no improvement in joint swelling, grip strength, or function for
people with OA. Pain reduction generally begins 3 to 7 days after applying the
capsaicin cream to the skin. Avocado/Soybean extracts Laboratory studies suggest that avocado/soybean extracts stimulate the growth
of collagen (the principal protein of the skin, tendons, cartilage, and bone) in
cartilage cells. In a study of 164 people with OA of the knee or hip,
researchers found that participants who received avocado/soybean extracts for 6
months experienced the following improvements with few or no side
effects: - Reduction in pain and disability
- Increase in mobility
- Reduced need for NSAIDs
Cat's claw (Uncaria tomentosa) In astudy of 45 people with OA of the knee, those who received cat's claw
reported a significant reduction in knee pain compared to those who received
placebo. Ginger (Zingiber officinale) Ginger extract has long been used in traditional medical practices (such as
Ayurvedic and Chinese) to decrease inflammation. Although there have been a few
case reports of the benefit of ginger for OA in medical literature, one recent
trial found that the herb was no more effective than ibuprofen or placebo in
reducing symptoms of OA. Kava kava (Piper methysticum) Kava has traditionally been used as a pain reliever, but few scientific
studies have evaluated kava for this purpose. In support of this traditional
use, animal studies have also shown that kava reduces pain. Research in humans
is warranted. |
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Acupuncture |
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Several controlled trials suggest that the ancient Chinese practice of
acupuncture is an effective treatment for pain associated with OA, as well as
for other aspects of the condition, including diminished joint function and
reduced walking ability. In fact, a few studies have shown that people with OA
experience better pain relief and improvement in function from acupuncture than
from NSAIDs such as aspiroxicam. For example, a group of 29 people awaiting
surgery for OA of the knee demonstrated significant improvement in their ability
to climb stairs and in their walking pace after receiving acupuncture compared
to those who were not treated with acupuncture. The National Institutes of Health is funding a large multicenter clinical
trial due to be completed in 2001 to fully evaluate efficacy and safety of
acupuncture for OA. |
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Chiropractic |
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Although there is no evidence that chiropractic care can reverse the joint
degeneration that causes OA, some studies indicate that spinal manipulation
may: - increase range of motion
- restore normal movement of the spine
- relax the muscles
- improve joint coordination
- reduce pain
In fact, a comprehensive review of the scientific literature suggests that
chiropractic, especially when combined with glucosamine supplements and
rehabilitative stretches and exercise, is an effective supplemental treatment
for OA. Chiropractors will avoid using direct thrusts or pressure on red,
swollen joints. |
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Massage and Physical Therapy |
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Physical Therapy Manual therapy and supervised exercise may decrease or delay the need for
surgery in individuals with OA. In a trial evaluating physical therapy and
exercise in people with OA of the knee, participants who received manual therapy
to the lumbar spine, hip, ankle, and knees showed the following
improvements: - Less stiffness
- Reduced pain
- Improved functional ability
- Improved walking distance
- Less need for knee surgery one year later
Magnet Therapy Exposure to electromagnetic fields has been shown to boost the number of
cartilage-building cells and substances in laboratory experiments. One important
study found that low-energy AC and DC magnetic fields stimulated the production
of cartilage. For therapeutic purposes, magnets can be applied one of two ways:
directly to the skin surface over the bone or joint (Capacitive coupling) or via
pulsed electromagnetic fields (PEMFs) which induce an electrical current in the
target tissue without making direct contact to the body (Inductive
coupling). Studies using either type of magnet therapy for arthritis are limited, and
the few that exist have mainly used poor methods that make it difficult to draw
any definite conclusions. However, in one study of 78 people with OA of the
knee, magnet therapy (applied to the knee for 6 to 10 hours per day over a
period of one month) significantly reduced pain as compared with placebo. Balneotherapy (Hydrotherapy or spa therapy) Balneotherapy is one of the oldest forms of therapy for pain relief for
people with arthritis. The term "balneo" comes from the Latin word for bath
(balneum) and refers to bathing in thermal or mineral waters. Sulfur-containing
mud baths, for example, have been shown to relieve symptoms of arthritis.
However, hydrotherapy, which can be performed under the guidance of certain
physical therapists, is occasionally used interchangeably with the word
balneotherapy. The goals of balneotherapy for arthritis include: - Improving range of joint motion
- Increasing muscle strength
- Eliminating muscle spasm
- Enhancing functional mobility
- Easing pain
Although balneotherapy is most often used for psoriatic or rheumatoid
arthritis, some medical experts believe that it may be beneficial for OA as
well. However, one large review of many trials found little evidence to support
its use. Ice Massage, Transcutaneous Nerve Stimulation (TENS), and
Electroacupuncture In a well-designed trial comparing the effectiveness of TENS,
electroacupuncture, and ice massage for the treatment of knee OA, each of these
methods were found to: - Reduce pain at rest
- Reduce stiffness
- Boost walking speed
- Increase quadriceps muscle strength
- Increase knee range of motion
TENS is a technique used by many physical therapists. When the nerve
stimulation of TENS is applied to acupuncture points, it is called
electroacupuncture. Mechanical Aids A variety of mechanical devices, called orthoses, are available for people
with OA to help support and protect joints. Made from lightweight metal leather,
elastic, foam, and plastic, orthoses allow some movement within the affected
joint and do not restrict nearby joints. For example, splints or braces help
align joints and properly distribute weight. Shock-absorbing soles in shoes can
help in daily activities and during exercise. These mechanical aids are used
most frequently to treat arthritic hands, wrists, knees, ankles, and feet.
Orthoses should be custom-fitted by a physical or occupational
therapist. |
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Homeopathy |
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Although people with OA are best treated with an individualized homeopathic
remedy chosen by a professional homeopath, several trials have found that some
common homeopathic combinations may be at least as effective as conventional
medications for OA. Potential remedies include: - A topical homeopathic gel containing comfrey (Symphytum
officinale), poison ivy (Rhus toxicodendron), and marsh-tea (Ledum
palustre)
- A combination homeopathic preparation containing R. toxicodendron.,
Arnica Montana (arnica), Solanum dulcamara (climbing nightshade),
Sanguinarra Canadensis (bloodroot), and Sulphur
- A liquid homeopathic preparation containing R. toxicodendron,
Causticum (potassium hydrate), and Lac vaccinum (cow's
milk).
Other common homeopathic remedies for OA include: - Calcarea carbonica (carbonate of lime or calcium
carbonate)
- Bryonia (wild hops)
- Graphites
- Guaiacum
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Mind/Body Medicine |
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Chronic pain and disability can make daily functioning difficult. A holistic
approach to care in these clinical circumstances may positively affect both
lifestyle and how one feels overall. Many people report that relaxation
techniques, such as guided imagery and meditation, are an important part of
comprehensive, holistic care, and help to alleviate pain and other symptoms of
OA. |
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Ayurveda |
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Yoga This ancient Indian practice is well known for its physical, psychological,
emotional, and spiritual benefits and is often recommended in the West to
relieve musculoskeletal symptoms. In one clinical trial studying OA of the hand,
the group practicing yoga showed significant decrease in pain and improved range
of motion compared to those participating in non-yoga stretching and
strengthening sessions. Certain yoga "asanas" (postures) strengthen the
quadriceps and emphasize stretching, both of which benefit people with OA of the
knee. People with arthritis should begin asanas slowly and they should be
performed only after a warm up. Yoga is best performed under the careful
guidance of a reputable instructor. Herbal Remedies Two recent trials comparing Ayurvedic herbal remedies with placebo found that
participants who consumed the Ayurvedic herbs experienced significant
improvement (with only mild side effects) compared to those in the placebo
group. An Ayurvedic combination containing the following herbs significantly
reduced pain and disability in people with OA: - Winter cherry (Withania somnifera)
- Boswellia (Boswellia serrata)
- Turmeric (Curcuma longa)
Side effects of these herbs include nausea, dermatitis, and stomach
pain. |
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Traditional Chinese Medicine |
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Tai Chi This ancient form of classical conditioning practiced in China for centuries
has been shown to produce a number of benefits, including the following:
- Improved fitness
- Increased muscular strength
- Enhanced flexibility
- Reduced percentage of body fat
- Diminished risk of falls in the elderly
In a trial of subjects with OA of the knee or hip (ranging in age from 49 to
81), those who practiced tai chi twice a week for 3 months showed significant
improvement compared to those in the control group in the following
areas: - Overall sense of quality of life
- Diminished feelings of stress/tension
- Increased satisfaction with general health
- Decreased fatigue
- Easier self management of arthritis
symptoms
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Other Considerations |
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Pregnancy |
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Most women who become pregnant are too young to have OA. Many of the herbs
used in treatment for OA have not been tested on pregnant women and some are
known to be unsafe for women who are pregnant. For this reason, pregnant women
should only take substances for pain and other symptoms that are approved by
their obstetrician. |
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Prognosis and Complications |
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Complications of OA include: - Inability to walk due to very advanced hip or knee OA
- Gastrointestinal bleeding and decreased kidney function resulting from
long-term NSAID and aspirin use
Many people are able to control OA and prevent the condition from worsening
over time. Joint deterioration in OA tends to be slower than that of rheumatoid
arthritis, but knee OA is still the number one cause of disability in
industrialized countries such as the United States. Increased fluid in joints
and joint enlargement occur later in the course of the disease. In the most
advanced stages, OA can cause full cartilage loss. In some cases joint
replacement may become necessary. While OA can be a debilitating condition,
current treatments have shown great promise in reducing pain and improving
mobility. |
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Supporting Research |
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Acevedo E, Castaneda O, Ugaz M, et al. Tolerability profiles of rofecoxib
(Vioxx) and Arthrotec. A comparison of six weeks treatment in patients with
osteoarthritis. Scand J Rheumatol. 2001;30(1):19-24. Berman BM, Swyers JP, Ezzo J. The evidence for acupuncture as a treatment for
rheumatologic conditions. Rheum Dis Clin North Am.
2000;26(1):103-115. Bliddal H, Rosetzsky A, Schlichting P, et al. A randomized,
placebo-controlled, cross-over study of ginger extracts and ibruprofen in
osteoarthritis. Osteoarthritis Cartilage. 2000;8:9-12. Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded
Commission E Monographs. Newton, Mass: Integrative Medicine Communications;
2000. Bradley JD, Flusser D, Katz BP, et al. A randomized, double blind, placebo
controlled trial of intravenous loading with S-adenosylmethionine (SAM) followed
by oral SAM therapy in patients with knee osteoarthritis. J Rheumatol.
1994;21(5):905-911. Brandt KD. Osteoarthritis. In: Fauci AS, Braunwald E, Isselbacher KJ, et al,
eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY:
McGraw-Hill, 1998:1935-1941. Chopra A. Ayurvedic Medicine and arthritis. Rheum Dis Clin North Am.
2000;26(1):133-144. Corvol MT, Dumontier MF, Tsagris L, Lang F, Bourguignon J. Cartilage and
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Review Date: June 2001 |
Reviewed By: Participants in the review process include: Ruth Debusk, RD, PhD, Editor,
Nutrition in Complementary Care, Tallahassee, FL; Gary Guebert, DC, DACBR,
(Chiropractic section October 2001) Login Chiropractic College, Maryland
Heights, MO; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor
Integrative Medicine, Boston, MA; Joseph Lamb, MD, The Integrative Medicine
Works, Alexandria, VA; Joseph Trainor, DC, (Chiropractic section October 2001)
Integrative Therapeutics, Inc., Natick, MA; Dana Ullman, MPH, Homeopathic
Educational Services, Berkeley, CA.
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Copyright © 2004 A.D.A.M., Inc
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