Osteoarthritis (OA) is the most common form of arthritis. 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.
Signs and symptoms of OA may include the following:
Most of the time, the cause of OA is unknown. It is primarily a disease due to aging. However, metabolic, genetic, chemical, and mechanical factors can play a role in its development.
Risk factors for OA include:
There is no single test to diagnose OA, so most doctors use a combination of methods to diagnose the disease and rule out the possibility other causes. A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness. An x-ray of affected joints will show loss of the joint space and, in advanced cases, wearing down of the ends of the bone and bone spurs.
The following measures may reduce the risk of developing OA:
The goals of treatment are to relieve pain, maintain or improve joint mobility, increase the strength of the joints, and minimize the disabling affects of the disease. The specific treatment depends upon the affected joints. A combination of conventional treatment and complementary and alternative medicine (CAM) may be most effective. 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 help keep the disease from getting worse. Americans spend more on natural remedies for OA than for any other medical condition. Some of the most promising complementary approaches for treating OA include:
Exercise to strengthen, stretch, and relax muscles around affected joints is almost always included in a treatment plan for OA. Several clinical studies support the value of exercise for people with OA. Clinical studies also suggest that in addition to reduction of pain and disability, exercise improves strength, range of motion, balance and coordination, endurance, and posture.
The most common type of medication used to treat osteoarthritis are nonsteroidal, anti-inflammatory drugs (NSAIDs). They are common pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen (Motrin, Advil, Nuprin), and naproxen (Aleve, Naprosyn, Anaprox). Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding. In April 2005, the U.S. Food and Drug Administration (FDA) asked drug manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk for stomach bleeding.
Other medications used to treat OA include:
Surgery and Other Procedures
Surgery to replace or repair damaged joints may be needed in severe, debilitating cases. Surgical options include:
Nutrition and Dietary Supplements
Following these nutritional tips may help reduce symptoms:
You can address nutritional deficiencies with the following supplements:
Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1-2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer).
Capsaicin (Capsicum frutescens) Cream
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 clinical 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 - 7 days after applying the capsaicin cream to the skin.
Several controlled clinical 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 clinical studies have shown that people with OA experience better pain relief and improvement in function from acupuncture than from NSAIDs such as aspiroxicam.
Although there is no evidence that chiropractic care can reverse the joint degeneration that causes OA, some clinical studies indicate that spinal manipulation may:
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.
Physical therapy can be useful to improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating OA.
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:
Exposure to electromagnetic fields has boosted 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, users can apply magnets in 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).
Clinical studies using either type of magnet therapy for arthritis are limited, and the few that exist have used poor methods, making 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 - 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:
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 clinical 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:
TENS is a technique used by many physical therapists. When the nerve stimulation of TENS is applied to acupuncture points, it is called electroacupuncture.
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. Physical therapists use these mechanical aids most frequently to treat arthritic hands, wrists, knees, ankles, and feet. Orthoses should be custom-fitted by a physical or occupational therapist.
Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following treatments to alleviate respiratory symptoms (such as those experienced from cystic fibrosis) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
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:
Other Common Homeopathic Remedies for OA Include:
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.
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.
This ancient form of classical conditioning practiced in China for centuries has been reported in clinical studies to produce a number of benefits, including the following:
In a clinical trial of subjects with OA of the knee or hip (ranging in age from 49 - 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:
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 take substances for pain and other symptoms only under the supervision of their obstetrician.
Prognosis and Complications
Complications of OA include:
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.
Arthritis - osteo; Degenerative joint disease; Osteoarthrosis
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