Osteoarthritis

Osteoarthritis is characterized by degenerative joint changes that cause pain tenderness and limited range of motion The most common form of arthritis it most frequently affects the hands feet knees shoulders hips and spine. Osteoarthritis affects men and women almost equally.

Signs and Symptoms

• Morning stiffness or stiffness after inactivity for less than 15 minutes
• Joint pain worsened by movement and improved with rest
• Soft-tissue swelling
• Bony crepitus (crackling noise with movement)
• Bone deformities (for example on fingers)
• Limited range of motion
• Subluxation (incomplete or partial dislocation of a joint)

What Causes It?

Primary osteoarthritis appears to be caused by overuse of a joint (for example seen in baseball pitchers ballet dancers dock workers) which leads to a destruction of the cartilage. Fractures and other abnormalities may also lead to osteoarthritis. There may be a genetic predisposition to osteoarthritis. Secondary osteoarthritis is associated with an underlying medical condition.

What to Expect at Your Provider's Office

Your health care provider will give you a thorough physical examination to determine the extent of your disability. Your provider will help you manage pain and avoid joint deformation and disability.

Treatment Options

Treatment Plan

Osteoarthritis cannot be cured but can be treated to reduce symptoms. The goals of treatment are to reduce pain minimize disability and maintain range of motion and mobility.

Drug Therapies

Prescription

• Nonsteroidal anti-inflammatory drugs—help reduce inflammation and pain; various side effects including gastric problems (peptic ulcer)
• Tramadol—a weak opiate for pain
• Glucocorticoids—for symptom relief; injected into the joint cannot be taken orally
• Capsaicin cream—reduces pain by temporarily desensitizing nerve endings

Over the Counter

• Aspirin—helps reduce inflammation and pain
• Acetaminophen (Tylenol)—helps reduce pain
• Ibuprofen—helps reduce inflammation and pain

Complementary and Alternative Therapies

Alternative therapies can help improve joint function and decrease inflammation. Exercise that combines muscle strengthening and aerobic conditioning can help improve joint stability and function.

Nutrition

• Reduce proinflammatory foods such as refined foods sugar saturated fats (meat and dairy products) and omega-6 fatty acids (such as evening primrose or flaxseed oil).
• Omega-3 fatty acids reduce inflammation. Increase intake of cold-water fish nuts and seeds or supplement with essential fatty acids (such as fish oil 1 000 to 1 500 mg twice a day).
• Increase intake of whole grains vegetables and legumes.
• Vitamin C (1 000 mg three to four times a day) to support cartilage.
• Vitamin E (400 to 800 IU a day) inhibits breakdown of cartilage.
• Vitamin A (5 000 IU a day) or beta-carotene (50 000 IU a day) zinc (20 to 30 mg a day) and selenium (200 mcg a day) are antioxidants that protect cartilage and reduce damage secondary to inflammation.
• Boron (3 mg a day) helps slow joint degeneration.
• Essential fatty acids (1 000 to 1 500 mg twice a day) reduce inflammation.
• Glucosamine sulfate (500 mg three times a day) has in at least some studies been shown to be more effective than ibuprofen at relieving pain as well as being better tolerated than ibuprofen or other NSAIDs.
• S-adenosylmethionine or SAM (1 200 mg a day for 21 days tapering to 200 mg a day). SAM stimulates production of cartilage and is a mild analgesic and anti-inflammatory agent. Do not take if you are manic-depressive.
• Niacinamide (500 to 1 000 mg three times a day) increases joint mobility and reduces pain.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Hawthorn (Crataegus oxyacantha) and bilberry (Vaccinium myrtillus) are high in flavonoids especially anthocyanidins and proanthocyanidins which enhance the integrity of connective tissue. Take 100 to 200 mg dried extract two to three times per day.
• Devil's claw (Harpagophytum procumbens) yucca (Yucca bacata) turmeric (Curcuma longa) black cohosh (Cimicifuga racemosa) ginger root (Zingiber officinalis) and meadowsweet (Filependula ulmaria) may be combined in equal parts as tea (1 cup three times per day) or tincture (30 to 60 drops three times per day) to reduce inflammation and relieve pain.

Homeopathy

Some of the most common remedies used for osteoarthritis are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• Arnica montana for arthritis with sore stiff joints
• Bryonia alba for arthritic pain that is worse with movement and cold
• Pulsatilla for wandering arthritis that is worse with heat and on initiating movement but is relieved by continued movement
• Rhus toxicodendron for arthritis that is worse on waking in the morning in damp and cold weather and with exertion

Acupuncture

Acupuncture can relieve pain and reduce inflammation.

Special Considerations

• Manic-depressive people should not take SAM because its antidepressant activity may lead to a manic episode.
• High doses of nicotinamide have been associated with liver damage and glucose intolerance. Since osteoarthritis appears to be made worse by obesity you should lose weight.
• Many pregnant women are normally too young to have primary osteoarthritis; however if you have an underlying condition associated with osteoarthritis (secondary osteoarthritis) consult your health care provider concerning the safety of the usual medications.

Supporting Research

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.

Kelly WN. Textbook of Internal Medicine. 3rd ed. Philadelphia Pa: Lippincott-Raven; 1997:1121–1124.

Koopman WJ. Arthritis and Allied Conditions: A Textbook of Rheumatology. 13th ed. Baltimore Md:Williams & Wilkins; 1997:1985–2006.

Lockie A Geddes N. The Complete Guide to Homeopathy. New York NY: DK Publishing 1995:154–155.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993:38 74 314 326.

Murray MT. Encyclopedia of Nutritional Supplements. Rocklin Calif: Prima Publishing; 1996:336–342 365–373 475

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin Calif: Prima Health; 1998:695–705.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.