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Osteoarthritis: What is it? Do any alternative therapies exist to treat it?

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Wednesday, December 15, 2010

Osteoarthritis: What is it? Do any alternative therapies exist to treat it?

There are three main forms of Arthritis: Rheumatoid arthritis is a chronic inflammation disorder that usually affects the small joints in hands and feet, Gout which is a build up of uric acid in the small joints (usually in feet) and is preventable and reversible, and Osteoarthritis (OA) is the most common, which is a degenerative joint disease that occurs when the cartilage between bones wears down, the bones rub and cause significant pain. It is caused by the normal wear and tear of the body and repetitive motions, the aging process, obesity and extra stress on the joints, heredity, and muscle weakness.   There is no cure but there are plenty of ways to live a healthy active life with it, and many treatments both modern and alternative medical treatments.

Where does it most likely occur?
Hands
Hips
Knees
Neck
Lower back

What are the symptoms?
They are gradual and develop over time, so they may be difficult to notice at first.
Pain: after using the joint
Tenderness: When you put light pressure on the joint
Stiffness: When you first wake up in the morning or after long periods of inactivity
Loss of Flexibility: you may notice that you don't have full range of motion, or are unable to move your joints the way that you could.
Grating sensation: You may hear or feel a grating sensation when you use the joint, you can sometimes feel the bone grating on bone
Bone spurs: sometimes extra bits of bone will form around and in the joint and make it feel/appear misshapen.

What are some Risk Factors?
Age: Older than 40 years old is when the signs of OA usually start to occur.
Sex: Women are more likely to develop OA than men
Bone Deformities/Injuries: Sometimes people are born with malformed joints at birth or have had joint injuries due to sports, etc., and those joints are more likely to have OA.
Obesity: Being overweight puts more stress on the joints and increases your risk of OA.
Occupation: As repetitive motions can cause the cartilage to wear down, any job with repetitive motions.  For example, Nurses have a high rate of OA in their hand joints from using their hands to manipulate IV tubing and doing other fine motor movements with their hands.
Genetics: Having Gout or Rheumatoid Arthritis (RA) increases your risk of developing OA.

Complications?
The main complication is that it is a degenerative disease that doesn't stop, and it can be very painful for people and make it difficult to get through your day, so it can make your life harder.  You don't realize how much you use your joints and how easy life is when they don't cause you any pain!  So, learning to live with the disease is the main complication.

How am I diagnosed?
Usually you are diagnosed by your reported joint pain to your HCP, then through the use of X-Ray and MRI (Magnetic Resonance Imaging).  Your HCP may draw some fluid out of the joint to test that the pain isn't due to infection.

What are some medical treatments?
Medications: Acetaminophen (Tylenol) can help with moderate pain but you need to limit intake if you drink alcohol, Ibuprofen (Advil/Motrin) Naproxen (Aleve) will help with moderate pain and diminish and swelling that might occur but you need to be careful to eat when you take ti to prevent ulcers and also you cannot take these medications if you have a history of bleeding ulcers or renal disfunction.  Tramadol (Ultram) is a prescription analgesic that takes care of moderate to severe pain but should only be used short-term to prevent wide effects of constipation and nausea. Other stronger prescription pan medications (oxycodone) can be used but there is the risk of addiction and side effects of drowsiness and inability to drive or perform other daily tasks.  Finally, for extreme pain, your HCP may opt to administer cortisone shots directly into the joint and the pain is most often completely relieved for up to 6 weeks BUT too many injections can caused added joint destruction so they may only be administered when absolutely necessary.

Therapy: The use of physical therapy can aid in keeping functionality and range of motion of the joint. Some orthotics/shoe inserts can decrease stress on your joints and help to relieve pain. As well, group therapy with other people that have OA can discuss ways that they live with their disease and support each other.

Surgical/Invasive procedures: Viscospplementation is when substances similar to the fluids that are normally in your joints (which comes from rooster combs) is put into your joint and adds cushioning to the joint and can diminish pain, currently only approved for OA of the knee but is being studied in other joints.  Joint replacement therapy is when the damaged portions of your joint are removed and a plastic and metal prothesis is put back in its place that lasts up to 20 years and you can have basically ANY joint replaced (even in small hand joints) but there is a small risk of bleeding and infection along with the surgery.  Another surgical procedure is called bone realigning, and it is when you cannot get a joint replacement, part of the bone is removed to allow for decreased pressure on the joint (usually performed for knee OA).  And bone fusion can also be done surgically which increases stability and decreases the pain, so an ankle that becomes fused will have no pain with full weight bearing, but you will no longer have your full range of motion.

Alternative Therapies:
Acupuncture can assist in decreasing your pain by inserting needles directly into certain pressure points (please read my acupuncture blog from last week).
Ginger can assist in decreasing OA pain, and can be ingested candied, cooked, as tea BUT it can interact with blood thinning medications, so you need to discuss with your HCP.
Glucosamine and Chondroitin have mixed studies (please see my earlier blog) but some people report feeling better with their use.  Just be aware that they can also interact with blood thinners.
Avocado-soybean unsaponifiables (ASUs) are newly being studied but have shown that the oils from both when taken together decrease the degeneration of the cartilage and can assist in cartilage repair in hips and knees.  I really have high hopes that this will be a great treatment for people with OA!!
Tai Chi/Yoga help with OA because of the easy moving and stretching and as people learn to breathe and feel their bodies it aides in de-stressing and studies have found that people report a decrease in OA pain.  It allows for range of motion without heavy stress on the joints.

How do I live with OA?
You need to keep your joints warm and moving, the pain occurs mostly in the morning or when you don't use your joints a lot, but if you have swelling and perform repetitive motions, try to rest your joint to decrease the swelling and try not to do repetitive motions (as much as possible- I know, easier said than done!) Light exercise that has low impact, such as tai chi, yoga, and swimming can help with joint pain because it decreases the stress on the joints but allows you to keep them moving.  If you re overweight, try to lose weight as it will significantly decrease the stress on primarily your hip and knee joints. Also, some over the counter pain relief creams gels can really help, such as icy hot, etc.  One cream that I am a huge advocate of is called Sombra cream and it is amazing at relieving joint pain, I sometimes slap some on my knees before going for a long run, if they are sore, and they feel great (I'm trying to find research on Sombra...I may have to do my own to show how great it is!!)  And, if your joint pain is really severe and makes it difficult to go through the day, you can go see an occupational therapist (with referral from your HCP) and you can get assistive devices to help you get through your day (such as grabbers, stability devices, walking aides, etc.)

OA can be difficult to live with but there are numerous ways to live with it, and even adding yoga to your exercise routine might help to prevent it (studies are still being done).  As well, I really have high hopes that the ASUs that will help to stave off cartilage degeneration and prevent the pain of OA, and I will update you all with the research as it comes out.  I hope that some of these treatments, whichever way you choose to go with your OA works for you, and if there are any treatments/alternative therapies that I am missing I would love to hear them!!

Yours in Good Health
B

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