OSTEOARTHRITIS
Osteoarthritis is degeneration of the joints in the body. Although trauma to a joint is often the initial cause, most joints afflicted with OA (osteoarthritis) have not been injured. The actual cause of the degeneration is not known. This has resulted in calling this type of arthritis “wear and tear” arthritis.
The major weight bearing joints (spine, hips, knees, ankle) and the hands are most commonly affected. Joint damage tends to progress as the person ages. However, studies have shown reversal of the x-ray changes of OA in the hips so it is possible to improve. Standard therapy includes using medication, modifying use of a joint, physical therapy, injections into the joint, assistive devices and surgery.
Many people use over-the-counter pain medications such as acetaminophen (Tylenol), aspirin, ibuprofen, and naproxen. Unfortunately, chronic use of these medications can cause ulcers of the stomach lining, kidney damage and liver damage (acetaminophen). Prescription arthritis medications also have similar problems. A new class of arthritis drugs called COX inhibitors is not likely to cause ulcers but since they are new on the market, all the complications that they cause may not have yet become apparent. They are very expensive as well.
Alternative therapies have a fairly good chance of being of some benefit. Diet may have a contribution to the joint inflammation, especially the saturated fats in animal foods (meat, dairy). Reducing saturated fat intake and increasing intake of omega-3 fish oils or omega-6 oils (evening primrose oil, borage oil) have considerable research and clinical evidence of lowering inflammation in the body. German studies show that 6 mg of boron supplement daily improves symptoms of OA.
Vitamin C and E both show evidence of being beneficial in OA. Adequate calcium and magnesium intake help support bone and joint health. Vitamin A, B-6, zinc and copper are necessary for cartilage synthesis so supplements may be helpful if you are deficient. A relatively new supplement SAM-e (S-adenosylmethionine) is also needed for cartilage synthesis. Clinical trials show reduced pain when taken at 400 mg three times daily.
Glucsoamine sulfate has been extensively studied and gives pain relief comparable to the standard medications. In addition, it is very safe and may promote regrowth of degenerated cartilage tissue. The usual dose is 500 mg three times daily. Onset of benefit is slow so allow at least 2 months of use before giving up. Diabetics may find it can elevate their blood sugar although this is mostly a theoretical risk at this time. Chondroitin sulfate is often added to glucosamine products but studies show that it is poorly absorbed from the intestines due to its large molecular size. Cetyl myristoleate is a fatty acid that has recently arrived on the scene. It appears to be safe and anecdotal reports show many people getting a marked improvement. It can be taken orally or applied to the skin over the affected area.
Herbs have a long tradition of treating OA but clinical studies are few. Herbs used include devil’s claw, yucca, Boswellia serrata, ground ivy, watercress, blackcurrant, feverfew, Thuja, nettle, bilberry and vervain. Boswellia has a clinical study showing good relief of symptoms at a dose of 400 mg three times daily (standardized extract containing 37-65% boswellic acid). Consult an herbalist or other practitioner with experience in herbal use.
Topical application of menthol-based creams may help by counter-irritation of the skin. Capsaicin is a chemical in chile peppers that can be rubbed into the skin. It has been shown to deplete Substance P, a neurotransmitter involved in transmitting pain messages from the body to the brain.
Traditional Chinese Medicine (TCM) is an ancient healing tradition that takes a holistic view of the person. Depending on the overall assessment of the person’s health, a practitioner may give complex mixtures of herbs in an effort to promote rebalancing of the person’s energy and health. Acupuncture is a branch of TCM that has some good preliminary research showing relief of OA symptoms by insertion of fine needles into acupuncture points.
Magnet therapy is another treatment that may be very effective in some people. The mechanism of action is unknown but likely involves the influence of the magnetic field on the electromagnetic field of the cells in the body. Preliminary research shows definite benefit over placebo treatment.
Aromatherapy with essential oils has a long tradition of use. Applying the oils to the joints and/or breathing the volatile fumes can be helpful in reducing pain. Consult a knowledgeable practitioner about use.
Homeopathy is effective for some people but an experienced practitioner is needed to get best results. It is considered quite safe. Energetic therapies such as Qi Gong, Reiki, Therapeutic Touch, pranic healing and spiritual healing have all been used. Continued research is beginning to show that the subtle energy field being worked with arises out of the quantum field discovered by physicists. Such healing can be powerful and effective and a few preliminary studies show benefit in treating OA. This brief review shows that many possible ways exist to treat this very common condition.
Daniel Blodgett MD