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:drrinde@soundintegrative.com Sound Integrative Health