Osteoarthritis is a condition of ‘wear and tear’ that leads to the degradation of a joint. As the joint breaks down, movement becomes increasingly difficult and deformity may occur. The joints involved are painful and surrounding structures such as muscles and ligaments are affected leading to increasing weakness. Inflammation occurs secondary to the joint damage. Osteoarthritis that affects the knees and hips can affect mobility and increase the risk of falls, while multiple joint involvement in the hands can reduce upper limb function.
What does Conventional Care Involve?
The pharmaceutical management of Osteoarthritis focuses on pain. However Paracetamol, Non-Steroidal Anti-Inflammatory Drugs (such as the COX-2 Inhibitors) or the Opioid drugs do not address the cause of inflammation. In fact it has been established that the use of COX-2 inhibitors may actually increase the risk of joint deterioration even whilst providing effective pain management. For this reason an integrative approach to osteoarthritis management is encouraged whereby pharmaceutical medicine is used as a ‘rescue dose’ when other interventions such as exercise and nutritional/herbal supplementation do not alleviate pain. Your doctor should best advice you as to management of your Osteoarthritis medication, both in terms of benefits and the risks and side effects that may occur with usage.
Will Exercise Help or Harm Me?
Exercise is usually of benefit in maintaining range of motion and joint strength as well as balance and coordination. The stronger the muscles about an osteoarthritic joint, the less pain is generally experienced. However, in instances where the joints are degraded to such an extent that their normal alignment is no longer present, weight bearing exercises may actually increase degradation of the joint and increase pain. It is essential if this occurs that you seek further advice on your exercise programme from a physical therapist. Exercising in water (hydrotherapy, aquatic therapy) may be a better option as less weight is carried by the joint the deeper in the water you get.
Should I Lose Weight?
Reducing weight is important when you have osteoarthritis providing that it is body fat and not muscle bulk. Therefore whilst losing weight, you must ensure a moderate protein intake and continued strengthening exercise both for the joints affected and your body in general.
May Certain Foods Worsen My Symptoms?
It has long been suggested that particular foods such as the Nightshade Group (Potato, Tomato, Capsicum, Chilli, Egg Plant) may increase Osteoarthritic pain. A wider group of foods known as Lectins that include the Nightshade Vegetables have also been implicated in food reactant arthritis (see Paleolithic/Low Lecting Eating in Specific Eating Plan Section). However, these suggestions remains based on anecdotal rather than strong evidence. If you believe a food may be associated with an increase in your symptoms (whether from the Nightshade Group or otherwise), follow the principles of a Food Elimination Regime to establish if this is the case.
What Foods Might Help?
It is assumed that foods that provide nutrients that retain joint health and reduce inflammation are of benefit in Osteoarthritis. These include: •Sulphur Rich Foods: Root Vegetables, Brassicas (Broccoli, Cauliflower, Cabbage), Nuts, Celery •Chondroitin containing Foods: Seafoods including Shellfish and Oats •Omega 3 Fish: Salmon, Tuna, Mackeral, Sardines, Herring •Anti-Inflammatory Herbs: Turmeric, Ginger, Garlic
What Nutrients/Herbs May Help Rebuild Joint Tissue?
Glucosamine and Chondroitin are two nutrients with favourable evidence of benefit in joint stabilisation, both when individually taken and when used in combination for additional gain. Controversy continues to exist due to the variable results of studies, however, some of this may be explained by factors significant to the usage of these supplements that include:
•The use of a clinically effective dosage e.g. 1500mg/day Glucosamine,> 600-800mg/ day Chondroitin •Commitment over a long enough period for effect, generally greater than 3-4 months
•Contribution of binding agents to success of treatment. Whilst Glucosamine commonly is bound to both Sulphate and Hydrochloride, it is often argued that the Sulphur provides additional value (or is actually the ingredient providing relief).
•Presence in formulations of adequate co-nutrients •Individual intolerances in sulphur sensitive users. In this case Glucosamine Hydrochloride is a more sensible joint formula. •The extent of deterioration. As these nutrients feed live cells to recreate joint matrix, severe osteoarthritis sufferers rarely gain benefits from glucosamine or chondroitin due to a lack of healthy cartilage cells.
•Associated weight gain that may occur with some powdered Glucosamine products that are bound to sugars. Review the calorie count per day carefully.
•Occasionally, users are sensitive to Glucosamine and/or Chondroitin. This should be discussed with a practitioner.
What Nutrients/Herbs May Reduce Pain and Inflammation?
The EPA component of Fish Oils may reduce the inflammation associated with Osteoarthritis. However high doses of Fish Oils must be used to gain satisfactory results in the order of 6 to 9 standard Fish Oil capsules. Concentrated and manipulated tablet or oil formulas with higher levels of EPA may be used to reduce the number of capsules required ( see Link to Fish Oils). tive when used alone. Growing evidence suggest the use of herbal anti-inflammatories may also be effective in reducing pain. Herbal anti-inflammatories that may be trialled are combinations of Turmeric (curcumin), Devil’s Claw, Willow Bark, Boswellia, Ginger, Rosemary, Hops.
You should discuss which is most appropriate with an Integrative Practitioner and review the possibility of interaction with any drug you may be taking with your Doctor, as ineffective dosages or the poor choice of herbal formulas may lead to inappropriate usage. Like Fish Oils, combined formulas with Glucosamine exist but it is important that the nutrient/herb levels of all substances are significant enough to achieve clinical results (often they are not).
Two other options that may be effective are Green Lipped Mussels or MSM. Both have gained low value evidence recently as to their effectiveness but require further investigation. May therefore be worth a trial of 3 months but cease if ineffective.
What Else May I Do For the Pain?
For general advice on understanding Pain see the appropriate section.
When Should I Consider Surgery?
The simple answer to this is when your pain is no longer manageable through conservative and pharmaceutical measures. This being said, if you are not privately insured, consider lengthy waiting lists at public hospitals.Total and partial knee replacements and total hip replacements can be very effective interventions but do come with rehabilitation periods and risk of infection. Always be prepared to discuss in detail the benefits and risks of orthopaedic surgery with your specialist. Remember, Integrative Medicine includes selecting the best available option from all forms of treatment so do not discount surgery where it may provide you with the greatest long term quality of life.