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Osteoarthritis

Osteoarthritis

Description

Osteoarthritis, or degenerative joint disease, is the most common form of arthritis, seen primarily but not exclusively in the elderly. The weight-bearing joints are the ones principally affected by the degenerative changes associated with osteoarthritis. Specifically, there is much cartilage destruction followed by hardening and the formation of large bone spurs (calcified osteophytes) in the joint margins. Pain, deformity, and limitation of motion in the joint results. Inflammation is usually minimal.

Surveys indicate over 40 million Americans have osteoarthritis, including 85% of persons over the age of 70. Under the age of 45, osteoarthritis is much more common in men; after age 45 it is ten times more common in women than men.

Treatment involves achieving normal body weight, thereby reducing unnecessary strain on the joint. The first drug generally employed is aspirin. It is often quite effective in relieving both the pain and inflammation. It is also relatively inexpensive. Since the therapeutic dose required however is relatively high (2 to 4 grams per day), toxicity often occurs. Tinnitus (ringing in the ears) and gastric irritation are early manifestations of toxicity.

Other NSAID (nonsteroidal anti-inflammatory drugs) are often used as well, especially when aspirin is ineffective or is intolerable. These drugs are also associated with side effects including gastrointestinal upset, headaches and dizziness, and are therefore recommended for only short periods of time.

One side effect of aspirin and other NSAIDs often not mentioned is their inhibition of cartilage synthesis. Since osteoarthritis is caused by a degeneration of cartilage it appears while these drugs are fairly effective in suppressing the symptoms, they actually worsen the condition by inhibiting cartilage formation. This has been upheld in retrospective clinical studies which have shown that NSAID use is associated with acceleration of osteoarthritis and increased joint destruction.

Various physical therapy modalities (exercise, heat, cold, diathermy, etc.) are often very beneficial in improving joint mobility and reducing pain. Surgery to remove loose pieces of cartilage and bone or to put in an artificial joint is reserved for those individuals with severe disease.



Causes

Primary Factors
Degenerative changes in the joint
Damage to the cartilage
Aging

It is believed that the cumulative effects of decades of use of the joints will lead to degenerative changes by stressing the integrity of the collagen matrix of the cartilage. Damage to the cartilage results in the release of enzymes that destroy collagen componenets. With aging, there is a decreased ability to restore and synthesize collagen structures. Aspirin and other Non Steroid Anti Inflammatory Drugs (NSAIDs) may suppress the pain but they compound the destruction of joint structure and inhibit the ability to repair them.

Predisposing factors
Congenital abnormalities in joint structure/function (i.e. hypermobility and abnormally shaped joint surfaces)
Trauma (i.e. obesity, fractures along joint surfaces, surgery)
Crystal deposition
Presence of abnormal cartilage
Previous inflammatory diseases of the joint (i.e. rheumatoid arthritis, gout, septic arthritis)

Osteoarthritis is divided into two categories, primary and secondary. In primary osteoarthritis, the degenerative "wear-and-tear" process occurs after the fifth and sixth decades with no predisposing abnormality apparent. Secondary osteoarthritis is associated with some predisposing factor responsible for the degenerative changes.









Signs & Symptoms

Early Symptoms
Morning joint stiffness

Later Symptoms
Pain on motion of the involved joint (made worse by prolonged activity and relieved by rest)

There is usually no signs of inflammation. The specific clinical picture varies with the joint involved. Disease of the hands leads to pain, swelling, and instability. Osteoarthritis of the hip causes local pain and a limp. Spinal osteoarthritis is very common and may result in compression of nerves and blood vessels, causing pain and vascular insufficiency.





Nutritional Supplements

Structure & Function:
        Joint Support &
        Bone Support


---------------------------------
General Supplements
---------------------------------

Adult
Boron*
Chondroitin sulfate*
Copper 1 mg./day
D-phenylalanine*
Fish oils*
Glucosamine sulfate*
Methionine250 mg. 4 times/day
Niacinamide500 mg. 4 times/day
Vitamin A 10,000 I.U./day
Vitamin B-6 50 mg./day
Vitamin C 1,000 mg./day
Vitamin E 600 I.U./day
Zinc 45 mg./day



* Please refer to the respective topic for specific nutrient amounts.

Discussion:-

Fish oils have been gaining popularity (10 ml daily).

Most notably, in several trials, glucosamine sulfate has out-performed various NSAIDs.

Methionine

Methionine, administered as S-adenosyl-methionine, was shown to be superior to ibuprofen (Motrin) in the treatment of osteoarthritis in a double-blind clinical trial. The positive effect in this trial upheld previous clinical studies. Methionine is a sulfur-containing amino acid which is very important in cartilagenous structures.


Niacinimide

Dr. William Kaufman has reported very good clinical results in the treatment of hundreds of patients with rheumatoid and osteoarthritis using high dose niacinamide (i.e., 900 to 4,000 mg. in divided doses daily). Niacinimide at this high dose can result in significant side effects (glucose intolerance, liver damage) and should therefore be instituted under strict medical supervision.



Vitamin E

A clinical trial using 600 I.U. of vitamin E in patients with osteoarthritis demonstrated significant benefit from the vitamin E. The benefit was thought to be due to vitamin E's antioxidant and membrane stabilizing actions.

Vitamins A, B-6, and E; Zinc and Copper

These nutrients are required for the synthesis of collagen and maintenance of cartilage structures. A deficiency of any one of these would allow accelerated joint degeneration.


Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.




Nutrient Depletion

Arthritis medications may rob your body of important nutrients, including:

Vitamin C NSAID drug therapy (including aspirin) can cause urinary excretion of vitamin C. This important vitamin is essential for maintaining connective tissue and synthesizing collagen, a protein and primary constituent of connective tissue. It also plays a role in the body's healing process by enhancing the immune system and aiding in the prevention of infections. Low levels of vitamin C are common in sufferers of rheumatoid arthritis (RA).

Calcium Corticosteroids can reduce dietary calcium, vital for nerve, muscle, and bone functioning. Reduced levels can increase the risk of osteoporosis. Low levels of calcium might cause aching joints, muscle cramps, extremity numbness, and is a common deficiency in R-A sufferers.

Vitamin E This antioxidant is essential in protecting the body's cellular membranes and aiding in the body's healing process.

Zinc Low serum levels of zinc are common in people taking corticosteroid medication and in those suffering from RA. This key mineral in the body is a constituent in the enzyme synthesis of collagen.

Arthritis medications may also affect the levels of Vitamin D, Folic Acid, & Selenium.

References:

Mahan, K. & Escott-Stump, S: Krause's Food, Nutrition and Diet Therapy. Saunders, 1996.

Walji, Hasnain. 1994. Arthritis & Rheumatism - Orthodox & Complementary Approaches Hodder Headline Plc. London.

Drug Interactions

Drugs are the primary allopathic therapy to control the pain and inflammation associated with osteoarthritis and, more especially, Rheumatoid Arthritis.

Most of the drugs diminish the production of prostaglandins, produced by the inflammatory process. [Vitamin E is a natural prostaglandin inhibitor.]

Today, the first line of attack comprises NSAIDs (Nonsteroidal anti-inflammatory drugs) including salicylates. More exotic drugs may also be resorted to in desperation: antimalarial agents, gold salts, penicillamine, steroids and immunosuppressive agents.

Side effects frequently include nutritional status.

Nutritional Considerations:

Aspirin, for example, increases urinary excretion of vitamin C. Decreased vitamin status with respect to vitamin C as well as folate have been noted. There may also be extensive bleeding both with salicylates and other NSAIDs. An associated condition is anemia.

Methotrexate and Sulfasalazine (both used as NSAIDs) are associated with the greatest losses of folate and these drugs should be accompanied with daily supplements of folate.

Naproxen is a prescription drug classified as a nonsteroidial anti-inflammatory agent (NSAID). It is used to relieve pain (especially joint pain), dysmenorrhea, stiffness, and inflammation from arthritis and gout as well as osteoarthritis.

Naproxen also reduces the concentration of prostaglandins in tissue.

Corticosteroids are the most potent drugs but are mostly reserved for the worst cases as the side-effects are so severe. Nutritionally, they can produce a negative nitrogen balance, so that protein is lost and muscle tissues waste away. There is also reduced calcium absorption, so that bones become soft and weak.

Penicillamine (like gold salts) may both cause proteinuria but with penicillamine there may also be depletion of minerals: zinc, copper and iron.

A low sodium diet is recommended.

Use caution with gastrointestinal irritants, like potassium supplements.

Herbal Interactions:

The salicylate action of meadowsweet, European poplar or queen of the meadow, will increase the renal clearance of naproxen.

Dietary Considerations

Primary dietary therapy involves the achievement and/or maintenance of normal body weight, as excess weight means increased stress on weight bearing joints affected with osteoarthritis.

Childers, a horticulturist, popularized a diet in the treatment of osteoarthritis that eliminated foods from the Nightshade Family (of the genus Solanaceae), after finding this cured his osteoarthritis. He developed a theory that genetically susceptible individuals might develop arthriitis as well as a variety of other complaints from long-term consumption of solanum alkaloids found in tomatoes, potatoes, eggplants, peppers and tobacco. Although remaining to be proven, this diet may offer some benefit to certain individuals.





Homeopathic Remedy

1. Phosphoricum acidum

2.* Rhus Toxicodendron - 30C to 10M use chronically.

3.* Rhododendron - 6X to 15C.

4.* Elaterium - 15C especially gouty arthritis and arthritic nodules.

5. Arbutus andrachne - 3X to 15C better on larger joints.

6.* Bryonia alba tinct. - 12X to 15C especially with swelling, knees, feet.

7.** Apocynum androsaemifolium - 200X to 30C use when all joints hurt, swelling in feet, hot feet.

Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency

Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.

References

Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Herbal Approaches

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Herbs
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Blueberries
Cayenne
Cherries
Hawthorn berries
Horsetail
White willow

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Discussion:

European Mistletoe is recommended by the German Commission E for use in degenerative joint inflammation.

Anthocyanides

Cherries, hawthorn berries, blueberries and other dark red-blue berries are rich sources of anthocyanidins and proanthocyanidins. These compounds are flavonoid molecules giving them their deep red-blue color. They are remarkable in their ability to prevent collagen destruction.

Collagen

Collagen is the most abundant protein of the body and is responsible for maintaining the integrity of "ground substance" as well as tendons, ligaments and cartilage. Collagen is destroyed during inflammatory processes occurring in rheumatoid arthritis, periodontal disease, gout and other inflammatory conditions involving bones, joints, cartilage and other connective tissue.

Anthocyanidins and other flavonoids affect collagen metabolism by:

Cross-linking collagen fibers, which results in the reinforcement of the natural cross-linking of collagen that forms the so-called collagen matrix of connective tissue (ground substance, cartilage, tendon, etc.).

Preventing free-radical damage with their potent antioxidant and free-radical scavenging action.

Inhibiting enzymatic cleavage by enzymes secreted by our own white blood cells during inflammation.

Preventing the release and synthesis of compounds promoting inflammation such as histamine, serine proteases, prostaglandins and leukotrienes.

These remarkable effects on collagen structures and their potent anti-oxidant activity make flavonoid components of berries extremely useful in the treatment of osteoarthritis.





Aromatherapy - Essential Oils


Chamomile Essence,Coriander Essence,
Cypress Essence,Eucalyptus Essence,
Ginger Essence,Juniper Essence,
Lavender Essence,Lemon Essence,
Marjoram Essence,Pine Essence,
Rosemary Essence.



Abstracts

References

Bowman MA & Spangler JG: Osteoporosis in women. Prim Care, 1997 Mar, 24:1, 27-36.

Bunker VW: The role of nutrition in osteoporosis. Br J Biomed Sci, 1994 Sep, 51:3, 228-40.

Childers, N. & G. Russo. The Nightshades and Health. Horticulture Publ., Somerville, NJ.

DeMeo MT et al., Three cases of comprehensive dietary therapy and pharmacotherapy of patients with complex obesity-related diseases. Nutr Rev, 1997 Aug, 55:8, 297-302.

Ettinger WH et al., Long-term physical functioning in persons with knee osteoarthritis from NHANES. I: Effects of comorbid medical conditions. J Clin Epidemiol, 1994 Jul, 47:7, 809-15.

Gabor, M. Pharmacologic Effects of Flavonoids on Blood Vessels. Angiologica: 9; pp. 355-374, 1972.

Hathcock JN: Vitamins and minerals: efficacy and safety. Am J Clin Nutr, 1997 Aug, 66:2, 427-37.

Havesteen, B. Flavonoids, A Class of Natural Products of High Pharmacological Potency, Biochemical Pharmacology: 32; pp. 1141, 1983.

Hoffer, A. Treatment of Arthritis by Nicotinic Acid and Nicotinamide, Canadian Medical Association Journal: 81; pp. 235-239, 1959.

Kaufman, W. The Common Form of Joint Dysfunction: Its Incidence and Treatment. E.L. Hildreth Company, Brattleboro, VT, 1949.

Keen RW et al., Association of early osteoarthritis of the knee with a Taq I polymorphism of the vitamin D receptor gene. Arthritis Rheum, 1997 Aug, 40:8, 1444-9.

Kirschmann, J.D. 1990. Nutrition Almanac: Nutrition Search. McGrew-Hill: New York.

Krause, M. V. & L. K. Mahan. Food, Nutrition, and Diet Therapy, 7th ed., pp. 677-679, W.B. Saunders, Philadelphia, PA, 1984.

Kuhnau, J. The Flavonoids. A Class of Semi-essential Food Components: Their Role in Human Nutrition, World Review Nutrition and Dietetics: 24; pp. 117-191, 1976.

Machtey, I. & L. Ouaknine. Tocopherol in Osteoarthritis: A Controlled Pilot Study, Journal of the American Geriatrics Society: 26; pp. 328-330, 1978.

Marcolongo, R., N. Giordano, B. Colombo, et.al. Double-blind Multicentre Study of the Activity of S-Adenosyl-methionine in Hip Osteoarthritis. Current Therapeutic Research: 37; pp. 82-94, 1985.

McAlindon TE et al., Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum, 1996 Apr, 39:4, 648-56.

McAlindon TE et al., Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study. Ann Intern Med, 1996 Sep 1, 125:5, 353-9.

McCarty MF: Glucosamine may retard atherogenesis by promoting endothelial production of heparan sulfate proteoglycans. Med Hypotheses, 1997 Mar, 48:3, 245-51.

Middleton, E. The Flavonoids, Trends in Pharmaceutical Science: 5; pp. 335-338, 1984.

Murray, M.T., & J.E. Pizzarno. 1991. Encyclopedia of Natural Medicine. Rocklin, Ca; Prima Publishing.

Murray, M.T. Arthritis - A natural solution. Whole Foods, 4: 76-6, 1993.

Newman, N. M. & R. S. M. Ling. Acetabular bone destruction related to non-steroidal anti-inflammatory drugs, Lancet: ii; 11-13.

Petersdorf, R., et.al. Harrison's Principles of Internal Medicine, pp. 517-524, McGraw Hill, New York, NY, 1983.

Robbins, S., R. Cotran & V. Kumar. Pathologic Basis of Disease, pp. 1356-1361, W.B. Saunders, 1984.

Roberts NB et al., Serial changes in serum vitamin K1, triglyceride, cholesterol, osteocalcin and 25-hydroxyvitamin D3 in patients after hip replacement for fractured neck of femur or osteoarthritis. Eur J Clin Invest, 1996 Jan, 26:1, 24-9.

Ryan S: Nutrition and the rheumatoid patient. (Review) Br J Nurs, 1995 Feb 9-22, 4:3, 132-6.

Seaborn, C.D. & Nielsen, F. H.: Silicon: A Nutritional Beneficence for Bones, Brains and Blood Vessels? Nutrition Today, July/August 1993;13-18.

Setnikar, I., Pacini, A., & Revel, L. Artriarthritic effects of glucosamine sulfate studies in animal models. Arzneim-Forsch, 41: 542-5, 1991.

Theiler R et al., Reduced vitamin A tolerance in a hyperlipidaemia patient with rapid destructive and hyperostotic osteoarthritis of the hip. Clin Rheumatol, 1994 Jun, 13:2, 293-8.

Uitterlinden AG et al., Vitamin D receptor genotype is associated with radiographic osteoarthritis at the knee. J Clin Invest, 1997 Jul 15, 100:2, 259-63.

Walji, Hasnain. 1994. Arthritis & Rheumatism - Orthodox & Complementary Approaches Hodder Headline Plc.London.

Walji, H. 1992. Vitamin Guide: Essential Nutrients for Healthy Living. Rockport, MA: Element, Inc.

Whitaker, J. Reversing arthritis. Health & Healing. vol 3, no 6: 1-3, 1993.

 


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