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We believe in a natural approach to understanding and treating Degenerative Joint Disease

Osteoarthritis is the most common form of arthritis, especially among older people. Osteoarthritis 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.

Symptoms of Osteoarthritis

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 joint

Causes of Osteoarthritis

Osteoarthritis 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 Osteoarthritis, 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, Osteoarthritis 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.

Risk Factors of Osteoarthritis

Risk factors for Osteoarthritis 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

Diagnosing Osteoarthritis

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.

Preventive Care

The following measures may reduce the risk of developing OA:

• Protecting an injured joint from further damage
• Exercising
• Losing weight
• Avoiding excessive repetitive motions

Our approach to treating Osteoarthritis

Our goal in treating Osteoarthritis is to relieve symptoms, maintain mobility, and minimize disability. we use a combination of Chiropractic manipulation, therapy and supplementation with natural products. It is possible, and 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 when absolutely necessary, in addition to other forms of treatment. Lifestyle approaches, including exercise, and many alternative 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:

• Chiropractic manipulation of affected joints.
• 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
• Physical therapy and magnet therapy
• Yoga
• Tai chi

Lifestyle changes

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.

Dietary Supplements and Natural treatment

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 under way. 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 cold water fatty fish (such as salmon, mackerel, and herring), flaxseed, rapeseed (canola), 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 anecdotal 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

Herbal Remedies

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.

Acupuncture

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.

Pregnancy and Osteoarthritis

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 Doctor.

Prognosis and Complications

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.