Osteoarthritis: How to Manage Naturally

What is Osteoarthritis?

Normal Knee (1), Osteoarthritis of Knee (2)

Osteoarthritis (OA) is the most common form of joint disease, affecting millions of people around the world.  OA results from biochemical degeneration of articular cartilage in synovial joints. Cartilage is a firm, rubbery tissue that provides cushion for the bones of joints, and allows the bones to glide over one another.  If the cartilage breaks down, the cushion disappears and the bones eventually rub against each other. When this happens, bone spurs and Eggers Cysts may form, and the ligaments and muscles around the joint become stiffer and weaker.

The characteristic signs and symptoms of OA include stiffness, pain and decreased range of motion.  OA is notorious for "morning stiffness" that typically lasts about 30 minutes and improves with gentle motion that "warms up the joint".  Pain may increase throughout the day as activity increases, and may be relieved again by rest.  A cracking, grating, or rubbing sensation may also be noticed during joint motion.  Weight-bearing joints are most commonly affecting, such as the cervical and lumbrosacral spine, and the knees, hips, and feet, although it may also involve other joints.  OA comes in two distinct varieties.  The first is mostly the result of aging, and is known as primary, or idiopathic osteoarthritis. The second is known as secondary osteoarthritis. and is the consequence of obesity, repetitive joint use, congenital or developmental defects, trauma,  or endocrine or metabolic disorders.

Although the cause of OA is occasionally unknown, there are a number of risk factors that may precede its development.  Please see the following link for details regarding causes, incidence, and risk factors: PubMed Health

All Is Not Lost:
Until present, OA was thought to be an irreversible and progressive degenerative disease.  Recent studies, however, have demonstrated evidence that challenges our previous understanding of the natural history and pathogenesis of this condition.  Specifically, we now know that the cartilage in the joints of patients with OA is highly active metabolically and that damaged cartilage can be repaired.  Furthermore, while some individuals have managed to stop the progression of their disease, others have even reversed it.  This is a very exciting prospect.

How Is This Possible?

Several studies have been conducted to investigate the "natural course" of osteoarthritis.  That is, the natural course of the disease if no medical intervention is given.  One such study documented significant clinical improvement in a population of people with advanced osteoarthritis of the hip over a ten year period, with no medical intervention.   X-rays confirmed recovery of the joint space in 14 of 31 hips, and the authors reported their results as reflecting the natural course of the disease. 

In addition, data collected from the earliest onset of osteoarthritis to the most advanced stages has suggested that cellular and tissue response of the body is aimed at repairing the damaged joint structure.  Based on such research, experts have stated that the process leading to osteoarthritis appears to be stoppable and sometimes reversible.  As a result, enhancing the repair process of various connective tissue cells appears to be the major goal of therapy.  Unfortunately, the medications currently being used to treat osteoarthritis may actually inhibit the repair process. 


Treatments Causing More Harm Than Good:
The current conventional medical treatment for osteoarthritis routinely includes the use of non-steroidal anti-inflammatories (NSAIDs), acetaminophen (Tylenol) and narcotics.  Acetaminophen and narcotics are recommended to reduce the pain of osteoarthritis. Although acetaminophen has been shown to be effective for the pain of mild to moderate osteoarthritis, it has no anti-inflammatory effect and can cause liver damage at high doses. Narcotics, such as codeine, are often prescribed for more severe arthritis pain. Although narcotics are very effective at relieving pain, like acetaminophen, they do not reduce inflammation. Furthermore, they frequently cause nausea, constipation, drowsiness, and dependence.

The non-prescription drugs of choice for the treatment of osteoarthritis appear to be non-steroidal anti-inflammatories (NSAIDs), which reduce both pain and inflammation.  Over-the-counter NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin.  Although NSAIDs are generally very good at reducing pain and inflammation, they can cause a number of side effects, many of them life-threatening.  Some examples include cardiovascular problems, bleeding problems, stomach upset, ringing in the ears, and liver and kidney damage.  Furthermore, older people are at the highest risk of complications, and this is the population most commonly afflicted with osteoarthritis. 


The Untold Truth: 
The irony of NSAIDs use is that they may actually accelerate the rate of cartilage destruction and inhibit cartilage repair.  This is a side effect of NSAIDs that is not often mentioned. Research studies have shown that NSAIDs use can accelerate osteoarthritis by increasing joint destruction, yet medical doctors continue to recommend them as first-line treatment of this condition. Since osteoarthritis is caused by a break down of cartilage, it would seem logical to avoid giving osteoarthritis patients drugs that would accelerate this process.  As a result, many alternative health professionals are now advocating against the use of NSAIDs in the treatment of osteoarthritis.

However, as anyone suffering from this disease knows, osteoarthritis can be very painful. The question therefore becomes, what can one do to eliminate pain and inflammation without the use of NSAIDs?

Alternative Methods of Pain Management:

• Glucosamine: Glucosamine is perhaps one of the best-known and well-researched supplements available for the treatment of osteoarthritis.  Proteoglycans are a large group of molecules found in articular cartilage.  They create the material that gives joints their strength and resilience. Glucosamine is necessary for the production of proteoglycans and is synthesized in the body from glucose.  In vitro studies have shown that glucosamine can stimulate the creation of proteoglycans, inhibit their degradation, and rebuild damaged cartilage.  Furthermore, numerous double-blind studies have shown glucosamine sulfate to be as effective as or even more effective than NSAIDs in relieving pain and inflammation related to osteoarthritis.   The pain relieving effects of glucosamine appear to be due to its ability to regenerate cartilage and are thus most profound after at least 4 weeks of continuous use.  Most studies have demonstrated glucosamine sulfate to be superior to glucosamine hydrochloride, although further research is needed.  

• Platelet-Rich Plasma Therapy (PRP): PRP is a progressive non-surgical treatment involving the injection of platelet-rich plasma into the affected area to stimulate and enhance healing.  It has been used in many fields, including maxillofascial, oral, and plastic surgery, and is showing very promising results in the treatment of musculoskeletal conditions.  When platelets are activated, they release healing proteins called growth factors.  There are many types of growth factors, each with its own responsibilities, and cumulatively, these growth factors accelerate tissue and wound healing.  PRP can be seen as a cocktail of many growth factors that, when used together, stimulate repair and regeneration.  There have been numerous studies illustrating its effectiveness in the treatment of osteoarthritis, including significant reductions in pain and increased mobility.  Orthohealing Center, Knee Surgery, Sports Traumatology, Arthroscopy, The Prolotherapy Institute, Arthritis Today  

• Prolotherapy and Prolozone: Like PRP, prolotherapy and prolozone are injection therapies. Prolotherapy heals via inflammation and prolozone heals via the anti-inflammatory and oxygenating-properties of ozone gas and a variety of nutrients. Both of these therapies are less expensive and less invasive than PRP and are an excellent starting point for osteoarthritis. I have seen significant clinical improvement with many of our patients whose only western medical option is joint replacement.

• Niacinamide: Research has shown marked improvement in OA with the regular use of niacinamide. Some experts have gone so far as to say it is as effective as glucosamine, and suggest using the two together to achieve optimal results.  Caution must be used when supplementing with this nutrient. Please see a qualified health practitioner before starting.  PubMed

• S-Adenosylmethione (SAMe): SAMe has been reported to have pain relieving and anti-inflammatory effects.  In fact, numerous research studies have demonstrated SAMe to be as effective in the treatment of OA as NSAIDs (including ibuprofen, naproxen, indomethacin, celcoxib, and piroxicam) without the unwanted side-effects.

• Vitamin C: Vitamin C is an essential vitamin for the synthesis of collagen and proteoglycans.  Clinical trials have demonstrated significant improvement in OA symptoms with the supplementation of vitamin C. 

• Elimination of Food Allergy/Sensitivity:  Some experts have declared a significant improvement in symptoms of OA in 20-30% of patients after the identification and avoidance of allergenic foods.  Avoidance of nightshade foods (potato, tomato, bell pepper, eggplant, tobacco) has also been shown to improve OA symptoms in certain people.  

• Weight Loss and Exercise:  In patients who are overweight or obese, even a small reduction in weight has been shown to create significant improvement in OA symptoms.

• Herbal Medicine: Certain herbs such as Boswellia serrate, Curcuma longa, Harpagophytum procumbens, Arnica montana, Capsicum spp, and others have also been used historically for the management of arthritis.  

• Homeopathy: There are a number of homeopathic remedies for the treatment of arthritis.  Please see a qualified homeopathy or naturopath to determine which remedy, or combination there of, is right for you.  

Reference Links:

• A Natural Treatment of Osteoarthritis
• Annals of the Rheumatic Diseases
• Nonsteroidal Anti-inflammatory Drugs and Articular Cartilage
• NSAIDs and COX-2 Inhibitors Impede Tendon, Bone and Cartilage Repair
• NSAIDs- The Unintended Consequences
• The Mayo Clinic
  
• Two More Reasons to Not Treat Athletic Pain with NSAIDs