Osteoarthritis
Adam Rinde, ND
Naturopathic Physician
Sound Integrative Health
7/11/08 @ Natures Pantry
Key Points
Pain relief is available in a non-pill form!
Joint replacement can be prevented You can take charge of your pain
Osteoarthritis: Description
Osteoarthritis: a disease effecting any joint with associated alteration of cartilage
Also known as: Degenerative Joint
Disease Osteoarthrosis Hypertrophic
Osteoarthritis
.
Osteoarthritis
Osteoarthritis
Primary Osteoarthritis: Associated with
gradual aging-related destruction of cartilage in joint-space.
Secondary Osteoarthritis Usually secondary to
trauma/overuse, repetitive strain, and subsequent faulty repair and regeneration of cartilage.
Epidemiology of OA
The #1 joint-causing disorder that begins asymptomatically in the 20’s and 30’s and becomes extremely common by the age of 70.
By the age of 40 most people have some change in weight bearing joints, although relatively few have symptoms.
OA affects almost all vertebrates
Osteoarthritis: Epidemiology occurs in whales,
dolphins, and porpoises. Does not occur in Bats
which hang upside down.
This finding suggest that it is an ancient Paleozoic mechanism of repair and remodeling rather than a disease in the usual sense.
Osteoarthritis: how does it happen A Cartilage trauma
combined with Faulty repair Faulty
regeneration Faulty remodeling Leading to
• Deformed cartilage
• friction• Loss of function
OA Symptoms
Gradual onset usually involving one or a few joints
Pain is the earliest symptom and is usually worsened with exercise and relieved by rest
Morning stiffness follows inactivity but lasts <15-30 minutes and lessens with movement
As OA progresses joint motion diminishes, tenderness and crepitus sensations appear and flexion contractures may occur.
Pathologic changes can cause joint enlargement
OA symptoms OA of the cervical and lumbar vertebrae
• can lead to myelopathy or radiculopathy Hip OA is
• Characterized by gradually increasing rigidity and loss of range of motion.
• Pain may be felt in the inguinal (groin) area or referred to the knee
Knee OA• Cartilage is lost in the medial aspect in 70% of the cases• The ligaments become lax and the joint less stable with local
pain arising from the ligaments and tendons• Tenderness on palpation and pain on passive motion are
relatively late signs Hands
• the base of the thumb, where the thumb and wrist come together (the trapezio-metacarpal, or basilar, joint)
• at the end joint closest to the finger tip (the distal interphalangeal or DIP joint)
• at the middle joint of a finger (the proximal interphalangeal or PIP joint)It also often develops in the wrist.
Osteoarthritis: Diagnosis
Diagnosis is confirmed by x‑rays. Report may
describe degree of joint space narrowing
Subchondral Sclerosis
Presence of osteophytes
Periodic X-rays useful in tracking progress of therapies.
Treatment Options for Osteoarthritis
Therapeutic Goals
Preserve Quality of Life by reducing disability
Reduce Pain and Inflammation Prevent/Arrest cartilage degeneration (joint
space narrowing) Utilize conservative therapies for long-term
management Reduce reliance on NSAID Or Opiods Prevent need for higher invasive therapies
OA Treatment Strategy
Reduce aggravating factors promoting destruction of joint cartilage
Restore and maintain healthy joint biomechanics
Reduce pain and modulate chronic inflammatory state.
Stimulate healthy cartilage regeneration and repair
OA Treatment: Ergonomics Consider home devices
such as grab bars in the tub enclosure, raised toilet seats
Avoid soft deep chairs and recliners from which arising is difficult
Avoid pillows under the knees as this encourages contractures
Sit in straight chairs without slumping
OA Treatment :Ergonomics
Sleep in a firm bed with a bed board Use a car seat designed for comfort
OA treatment: Exercise
Exercise/Physical therapy: Daily stretching important Local application of moist
heat especially before exercise s
Perform postural exercise Resistance Training
• Quadriceps strengthening important (for Hip and Knee)
Try not to immobilize (stay active)
Rest every 4-6 hours in the daytime to allow rehydraton of cartilage and balance with exercise and use
OA treatment: Exercise
Cardiovascular Exercise to promote weight reduction/weight management At least 5 days per week
of 30 minutes at 70% of your maximum Heart Rate
Choose low impact forms of exercise
• Walking, Golf, bicycle, elliptical, swimming,
• cross country skiing nordic-track
• Water jogging
Manual Therapy
• Muscle Release Therapy• Active Isolated Stretching• Neuromuscular Reeducation
Therapeutic Exercise
• Re-conditioning compensated muscle groups• Building a strong foundation of joint support• Reducing excess force on joints
Acupuncture
May promote healing
May provide pain relief and improved joint function
Diet:Low-inflammatory
Omega-3-rich diet Wild-caught salmon COD
Organic Vegetables and Fruit 5-7 servings are fruits and
vegetables a day Kiwi, Papaya, Pineapple
Limited Chicken and Cow Intake
Avoid Food Sensitivities (especially Nightshades)
Fiber rich (at least 30 g/day) Low processed foods Low simple sugars No Transfats
Neutraceuticals for OA
Glucosamine and Chondrotoin Sulfate
Niacinamide May raise liver
enzymes Vitamin D (check
levels through your Dr.)
Polyunsaturated Fatty Acids (PUFAS) Fish Oil
Contains omega-3 essential fatty acids
Choose mercury free
Marine Lipid Extract Perna canniliculus Green lipped mussels Another form of PUFA’s
Always discuss Fish Oil supplementation with your Dr. as Fish Oil may interact with Blood Thinners.
Supplementation: Cartilage protective/stimulatory? Avocado Soybean Unsulfoniables
(ASU)• A phytosterol that has been studied reduce
pain and inflammation in OA.• It may protect further cartilage damage.
Anti-inflammatory Proteolytic enzymes
Bromelain Papain Rutin
Peptizym
OA treatments;Botanical Medicine Anti-inflammatory
herbs Devils Claw Willow Bark Ginger Turmeric
Note: some of these may interact with anti-coagulants, check with physician
Antioxidant Supplementation
Usually can be obtained through a quality daily multivitamin Vitamin C Vitamin A Vitamin K Vitamin E Selenium Zinc
Reduce InflammationIntraarticular Injections
Prolotherapy• growth factors or
growth factor stimulator injections
Viscosupplemention Hylagen (injectable
synthetic hyularonic acid)
• FDA approved for knee injection
• Show effective for Knees (not yet for hips)
Corticosteroid Injections
Drug interventions
Simple Analgesic Acetaminophen (Tylenol) OTC pain relievers
• Can prolong the halflife of warfafin NSAID
Cox-2 Inhibitors (Celebrex)• Know the warnings (ie. Cardiovascular/Gastroinestinal)• Be assessed for risk of GI bleeding before taking • Know the risks of taking long term• Know when they are beneficial and when they are not.• Try and use for the shortest amount of time possible at
the lowest effective dose. Tramadol
Synthetic Central Acting Opoid Used for severe pain
Surgery
Knee Arthroplasty Replacement
usually has road-life of 10-12 years
Hip Arthroplasty Usually last 20
years
OA resources
Arthritis Foundation-Local Chapter National Institute for Arthritis,Skin, and
Musculoskelatal Disorders. Health Clubs (International Health and
Racquet Club) Vitalchoices.com Pioneer Grocery
Adam Rinde, ND
Contact Information Appointments: 425-889-5894 Email:[email protected] Sound Integrative Health
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