Typical symptoms of osteoarthritis are episodes of pain and stiffness, which occur at intervals of months or sometimes years. Inflammation can also be present, although redness and warmth are not commonly seen with osteoarthritis. When they are, it’s the result of cartilage fragments that infiltrate the joint. Unlike rheumatoid arthritis, which is an inflammatory disease that invades other parts of the body, osteoarthritis is not systemic. Therefore, symptoms like malaise, fever and fatigue generally do not occur.
Since the first symptoms of osteoarthritis usually begin to appear during the same time that signs of aging are also starting to occur, the signs often are not recognized as being associated with the early stages of osteoarthritis.
Medical experts long believed that osteoarthritis was simply and entirely an inevitable result of the aging process.
It is certainly true that the disease is seen most often in middle-aged and older people, rarely appearing before the age of forty. However, a few years ago scientific evidence was established that there is a genetic defect that contributes to the occurrence of osteoarthritis in the hands. The presence of the gene results in a weakening of the protein whose job it is to strengthen the cartilage that cushions the joints. Also, trauma from an injury, such as a blow to a joint that occurs during an athletic injury, can result in the formation of osteoarthritis in that joint many years later. There is also evidence that years of a repeated motion, such as sewing or weaving, can result in osteoarthritis in the fingers.
Some researchers believe that various chemical reactions of the body that control the metabolism of cartilage in the joint can operate improperly and harm the cartilage, which could result eventually in osteoarthritis. Some day, it may be possible for persons from families with osteoarthritis to be tested for the defective gene. They might be able to delay or even prevent the onset of osteoarthritis by avoiding activities that irritate joints.
Typically, osteoarthritis occurs in only three locations: the fingers, the spine and the weight-bearing joints, namely the hips, knees or feet. Unlike rheumatoid arthritis, which frequently attacks many joints, most people will have the symptoms of osteoarthritis in just one place. However, it is possible for osteoarthritis to attack two or even all three locations, at the same time or at different times.
Even when osteoarthritis is limited to a single location, the affected joint can cause serious disruption to the smooth workings of the entire body. Muscles that are located away from the joint may begin to tighten in order to avoid pain or to protect the afflicted joint, while unaffected joints may begin working overtime to make up for any deficiencies. When knee cartilage has been seriously depleted, the entire lower leg may eventually be deformed.
Among all arthritis patients, about 25 percent have serious arthritic problems with their hands and wrists. Osteoarthritis of the hand increases with age, so that by age seventy-five, fully 85 percent of the population have some evidence of the condition. The gnarled appearance of arthritic fingers is caused by the bony knobs that enlarge the finger joints. These knobs, called nodes or nodules, usually appear spontaneously but can be caused by injury.
Nearly 90 percent of cases of nodal osteoarthritis, as it is often called, afflict women over the age of forty-five. It is believed to be a hereditary condition. Nodes most often begin prominently in just one finger but can involve all of the finger to some degree. While there can be tenderness, stiffness and pain with nodes, there is little chance of any real disability. There are certain activities, such as turning handles or opening jars, that may become clumsy or slightly painful, however.
Spinal osteoarthritis, especially when it affects the neck and lumbar spine, is fairly common, although not always to the extent of causing any clinical symptoms. Osteoarthritis can develop in the joints that connect the upper part of the spine as well as in the joints of the spine itself. The bony outgrowths, or osteophytes, can be detected by X ray but usually don’t change a person’s appearance. Many researchers believe that lifestyle habits, including prolonged sitting, cigarette smoking, consumption of alcohol, and weight gain, contribute to the onset of spinal osteoarthritis. However, for the most part the primary cause is not known.
The knees, hips and feet are where osteoarthritis strikes with the most damaging results because they support the weight of the entire body. These weight-bearing joints are most susceptible to osteoarthritis after either long-term exposure to heavy-lifting occupations, such as mining, or the aggravation of an injury in a contact sport like football. Not surprisingly, then, osteoarthritis in the knees, hips, and feet occurs more frequently in men than in women.
Although the hip joint cannot be readily felt, being located about four inches within the groin, advanced osteoarthritis of the hip can be a severely disabling condition. In fact, before the development of joint replacement surgery, a diseased hip meant life in a wheelchair or on crutches. Today, more than one hundred fifteen thousand hips are replaced in the U.S. every year, with nearly 95 percent of these patients experiencing good to excellent results.
Fortunately, while the hip joints of virtually all older persons show signs of wear, the majority do not develop serious osteoarthritis. The initial pain of very mild osteoarthritis can be significant, however, leading patients to incorrectly suspect a far worse condition. When there is advanced osteoarthritis of the hip, developing over many years, a patient is usually dealing with constant pain, a decrease in function, and often an intolerance for anti-inflammatory drugs. This is the point at which surgical replacement of the joint becomes a serious consideration.
The knee is undoubtedly the most complicated joint in the body, both in its design and function. It can fold upon itself, rotate, and lock into place. Despite its flexibility, however, the knee is a vulnerable area because it has little inherent stability and must rely on the ligaments and muscles that surround it. So, whenever those ligaments or muscles are injured, the knee becomes even more unstable and vulnerable.
As in other joints, it is not known just what triggers osteoarthritis of the knee. Factors that are considered most likely include poor alignment, such as being bowlegged or knock-kneed, damaged ligaments or traumatic injuries that took place many years before. A knee injury that is not correctly treated at the time the joint was injured becomes a nagging condition that, in time, eventually becomes a serious case of osteoarthritis.
In the past twenty years, there has been considerable advancement in surgical procedures that can alleviate afflicted knees. For example, the use of a surgical instrument, the arthroscope, enables surgeons to more readily examine the interior of the knee and make small repairs. Also important is the development of techniques for the partial and total replacement of the knee surfaces for severely damaged knee joints.
Traditional Treatments
Although there is no cure yet for osteoarthritis, much progress has been made in its treatment, with a variety of effective methods that are widely used to reduce pain and to limit the disabling effects of the disease. Indeed, since there is such a large segment of the population that is coping with osteoarthritis and because there is a strong desire among all patients to find relief from its painful symptoms, the variety of available options is enormous, contributing to a great deal of confusion among osteoarthritis patients, who are liable to try almost any remedy in the hope of finding an effective solution. Many of these treatments are harmless at best while others that might be the most appropriate are not widely known.
Official recommendations for the treatment of osteoarthritis had never been issued until 1995, when the American College of Rheumatology released the first-ever guidelines for the medical management of two forms of osteoarthritis; those affecting the knee and the hip. The suggestions include the use of simple analgesics for relief of pain; regular exercise programs; weight reduction if overweight and the use of assisting devices such as elastic shoe laces, levers to turn faucets, and extended shoe horns.
It is important to stay up-to-date about treatment with information from reputable sources such as the Arthritis Foundation and the American College of Rheumatology, along with the recommendations of your physician. Osteoarthritis is an individual and long-term challenge for each patient, and is best approached with a treatment plan that is individual in its design, reflecting the needs and concerns of the individual. Since you will need to follow a treatment plan for the rest of your life, you must be comfortable with it and be ready to make adjustments to keep it fresh and effective.
Acetaminophens Over-the-counter analgesics that are called acetaminophens, such as Tylenol, act like aspirin in decreasing pain and lowering fever. However, an important advantage of an acetaminophen is that it does not irritate the stomach. The American College of Rheumatology considers acetaminophens to be the first choice for pain relief, far more desirable for treating the pain associated with osteoarthritis than nonsteroidal anti-inflammatory drugs (NSAIDs), which for many years have been a popular choice (see below). Since the pain from osteoarthritis, unlike rheumatoid arthritis, has very little to do with inflammation, NSAIDs are not really appropriate, especially since there are side effects associated with its continued use. The recommended dosage of acetaminophen is 4,000 mg daily. It is possible for some side effects to emerge after prolonged usage, however.
Topical analgesics The use of topical analgesics such as methyl salicylate or capsaicin cream, applied directly to the affected joint, can be also be an effective way of relieving pain without the side effects of NSAIDs.
Aspirin A widely used pain reliever for osteoarthritis is aspirin, probably because it is a proven remedy already familiar to most households. Caution is needed in using aspirin because excessive amounts can irritate the stomach and cause ringing in the ears, heartburn, nausea and even vomiting, diarrhea or gastrointestinal bleeding. The usual dosage is two tablets of 325 mg each, four times a day. There are many varieties of aspirin, including buffered, film-coated, enteric-coated and time-release, so you may want to try different versions to see if one offers a superior result.
Nonsteroidal anti-inflammatory drugs (NSAIDs) Very popular in the treatment of arthritis are nonsteroidal anti-inflammatory drugs (NSAIDS), especially for rheumatoid arthritis, because NSAIDs not only relieve pain but also reduce inflammation. However, there are possible side effects, including upset stomach, heartburn, nausea, diarrhea, rash, weight gain, headache, drowsiness, dizziness, increased bleeding when cut, ear ringing, stomach ulcers, gastritis, bleeding ulcers, kidney problems and blood problems. There are over-the-counter NSAIDs known as ibuprofen, including Advil, Motrin and Nuprin, as well as more than a dozen types of NSAIDs that are available by prescription. An NSAID is not the most appropriate pain reliever for osteoarthritis since inflammation is a very limited element associated with the condition.
Heat therapy An effective way of relieving the pain of osteoarthritis is through heat therapy, which relaxes the muscles around the affected joint, increases the blood flow and lessens the stiffness. Moist heat seems to work better than dry heat and can be gotten simply by taking a relaxing hot bath or, for a more localized treatment, applying a hot-water bottle. A whirlpool bath is both soothing and stimulating for many people. Also good for treating localized areas is a moist hot pack. One method of preparing a hot pack is to heat a wet towel in the microwave for two or three minutes at medium heat. At the drugstore there are also hot packs available that when activated will last for about one half hour. When using any hot compresses, be sure to protect your skin from burning by placing a cloth or towel over the area before applying the pack.
There are also special treatments in which different forms of energy are converted to deep, penetrating heat. Diathermy and ultrasound are commonly utilized methods of deep, penetrating heat. In diathermy treatments, short-wave radiation is transformed into deep heat. This method should not be used by patients who have metallic implants because the radiation tends to concentrate in metal. Before treatment, one must take care to remove all metallic jewelry and any clothing with metal fasteners. Ultrasound therapy utilizes high-energy sound waves, which convert to heat and can be delivered to the deeper joint areas. Along with improving joint movement, ultrasound treatment also warms injured tissue, relieves muscle tension and increases blood circulation.
Cold treatments When there is intense pain, cold treatments are used to relieve inflamed joints. Since cold also acts as a local anesthetic, it can decrease muscle spasms and soothe muscle aches that come from holding muscles tightly to avoid pain. It is important that ice not be placed directly on the skin because that can cause frostbite or tissue damage. Wrapping ice cubes or even a bag of frozen vegetables in a towel are methods of creating simple ice packs. There are also instant, disposable cold packs that are chemically activated and last for about twenty minutes as well as reusable gel packs that are first frozen in the freezer before using. Don’t apply cold packs for more than twenty minutes at a time because frostbite can occur after longer periods of time. It’s all right for the area to become reddish and a little bit numb, but should it become white or blue, remove the cold pack immediately.
Weight control An important aspect of an osteoarthritis treatment plan is weight control. The more excess weight that a person carries, the more stress and pressure are placed on the joint, which adds stress on the cartilage and increases pain and any swelling. Studies have shown that overweight persons with osteoarthritis may be able to reduce the level of painful symptoms by losing weight, while those without the disease are able to reduce the risk for developing it.
Exercise An essential part of ongoing therapy for osteoarthritis is an exercise program, because inactivity can result in muscles becoming weaker and joints stiffening. Weak muscles are not able to support joints as well, while coordination and posture may also deteriorate. Not all exercise is appropriate for patients with osteoarthritis, however. Weight-bearing or high-impact activities such as running or basketball are likely to aggravate the condition. Ideal exercises include swimming, walking, stationary bicycling and cross-country skiing. Floor exercises are appropriate for arthritis in the back.
Quite possibly the single most pleasurable and beneficial activity for arthritis sufferers is exercise in a warm swimming pool. The buoyancy of the water reduces stress on the joints and makes exercise easier. Thanks to buoyancy, a person in a pool weighs only about 10 percent of normal “land” weight. Additionally, a warm swimming pool decreases pain and feels good. So-called aqua exercises will help to reduce pain and stiffness, increase muscle strength and improve flexibility and stamina. These aqua exercises consist of various waving, walking and bending motions performed in waist-high water, and they progress to patterns of aqua dance.
A special program of aquatic exercises is conducted by the Arthritis Foundation at various YMCAs and YWCAs throughout the United States. Any local chapter of the Arthritis Foundation can provide details about area programs. The foundation also sells a videotape that demonstrates a number of different pool exercises.
No matter what kind of exercise or activity you undertake, if you feel pain for two hours afterwards, you’ve done too much. It would then make sense to divide the activity into segments and reduce the intensity of the activity. The best time to exercise is when you feel the best—when the pain medication is most effective or after a hot bath. Always start slowly to avoid fatigue and muscle pain. After exercising vigorously, rest your joints until you feel completely recovered.
Corticosteroids Prescription drugs called corticosteroids, which are modified forms of hormones made in the adrenal gland, are effective in reducing pain and inflammation. While steroids are not prescribed in oral form for osteoarthritis, they may occasionally be injected into an acutely inflamed weight-bearing joint such as the hip, knee or ankle. Most common among the twenty steroid drugs is prednisone. Since this drug actually may accelerate joint disease, a doctor will limit the number of injections to no more than two or three times a year, and usually only at times of extreme pain.
Occupational therapy Techniques of occupational therapy can help to prevent loss of function and improve a person’s ability to perform daily tasks when faced with limitations from osteoarthritis. Preserving energy and protecting joints are the key principles utilized to minimize fatigue, reduce stress on joints, reduce pain and increase performance. Patients are trained in alternate methods and the use of adaptive equipment for performing daily self-care and tasks at work, home and leisure.
A key premise in planning and managing activities is to alternate those that require substantial energy with those that are less strenuous. This technique will help to preserve energy and also to protect joints. Depending on the condition of a joint, a splint may be recommended to improve function, prevent contracture or shortening, provide stability and lessen pain.
It is a good idea to develop the habit of refraining from positions that promote misalignment or deformity of the joints. For example, when in the kitchen, stir with the thumb on top of the spoon as though holding an ice pick and make the circular motion with the shoulder instead of the hand. Refrain from leaning on your hands if you’re standing against a railing. Try to avoid unnecessary wringing motions simply by letting washcloths dry or by using an electric rather than a handheld can opener. Always use the largest joint and strongest muscle available. Therefore, try to open doors with the power from the upper arm or even hip rather than from the fingers. When getting up from a sitting position, try to use the whole body to rise, avoiding pressure on the hip and knee joints. This involves sliding forward as far as possible, then leaning forward and swinging up, pushing off with forearms or palms.
There is an array of special devices known as assistive equipment that can offer help to those with osteoarthritis. Examples include elastic shoe laces, levers to turn faucets, handles that are built up to be thicker to be easier to hold forcefully. Also, a raised toilet seat, an extended shoehorn, tub grab bars and a shower seat offer protection for people with hip and knee problems.
Surgery After all conservative treatments have failed to alleviate the pain and stop the advancement of osteoarthritis, a decision may be made to replace joints through surgery. By that time, the joint is virtually destroyed and the patient is usually suffering from severe pain. For many osteoarthritis patients, joint replacement is a wondrous cure that rescues them from being crippled or wheelchair-bound by the disease. Still, the decision to have joint replacement is considered to be an elective one since such surgery is not essential to preserve a patient’s life.
Joint replacement surgery, a procedure that can restore function to almost any joint in the body, was pioneered in the late 1960s. Today, more than two million Americans have artificial joints. These devices are usually made of various metals and polyethylene, a plastic-like material. Often the implants are custom-designed for a patient by computer. An artificial joint consists of two parts. One part is a metal shaft that has a ball on the tip, which is wedged into a bone. The other part is a cup-shaped metal socket that has a plastic lining; this part fits into the adjacent bone. The ball then fits into the socket and swivels, allowing generous freedom of movement.
A decision to have joint replacement surgery is usually made when the pain of advanced osteoarthritis is so severe that it’s hard to sleep at night or when normal activities have become greatly limited during the day. Your doctor will offer an opinion about undergoing the surgery based on the extent of the pain and disability, the condition of the bones and the strength of ligaments supporting the joint, as well as your overall health, including weight and physical condition and your own attitude towards the surgery. Although joint replacement is performed upwards of three hundred thousand times a year in the U.S., and with a high rate of success, there are risks associated with this surgery. Infection can occur, although it happens in only about one half a percent of cases. It is also possible that the artificial joint can become loose or dislocated.
Other surgical procedures such as osteotomy and arthrodesis, that were traditionally used to correct joints damaged by osteoarthritis, are not commonly utilized today because of the successful development of joint replacement.
Osteotomy is a procedure during which a wedge of bone is either removed or added, resulting in a realignment of a joint by shifting the weight bearing from one part of the joint to another. Arthrodesis is a method of eliminating pain and achieving stability by fusing two or more bones in a joint; it is used mostly for wrists. This procedure is a debilitating one, since a fused joint will lose its function.
Surgery on a much smaller scale is possible through use of the arthroscope, a small fiber-optic instrument that is commonly used in both diagnostic procedures and surgery. The arthroscope can be used to remove the so-called osteoarthritic debris, consisting of floating pieces of cartilage and bone fragments from the cavity of the joint.
Alternative Treatments
The utilization of alternative therapies to cope with a chronic condition like osteoarthritis is widespread because the chance to obtain relief from pain without troublesome side effects is very appealing. Since the philosophy of natural remedies is one that places the nexus of managing pain within the province of the body itself, more and more arthritis patients have been turning to alternative treatments.
At the same time, the pain and disability of a long-term condition like osteoarthritis can lead people to such despair that they are susceptible to deceptive practices and unscrupulous sales pitches for nonexistent magical cures. More than two billion dollars are spent on unproven arthritis remedies every year by older Americans, according to the Arthritis Foundation. Many of those remedies not only are simply useless but are also dangerous and ought to be avoided. Typically, these are remedies that promise outright cures, immediate results or the capability to treat multiple disorders. Often these remedies are sold through mail order; a post office address is provided; and benefits are proclaimed through the testimonials of “cured” individuals.
However, this should not discourage you from considering the many natural treatments. They have been widely demonstrated to be effective and safe, although they have never been put to the scientific scrutiny that allopathic remedies routinely undergo. However, the Office of Alternative Medicine, created by the National Institutes of Health in 1992, has been conducting clinical trials on a number of alternative treatments which eventually may be helpful to people in their evaluation of possible treatments. Meanwhile, learning as much as possible about viable therapies and discussing the possibilities with your doctor are important procedures to undertake as a safeguard in avoiding harmful choices.
Acupressure Pain can be soothed and mobility increased through acupressure treatments directed at the pressure points that correspond to specific joint locations. The best technique, which can be learned and self-administered, uses consistent, light pressure. Benefits of acupressure include reduction of pain and lessening of muscle tension, both of which result in an overall feeling of relaxation.
For joint pain that is located anywhere on the body, press both of the St 36 points, which are located several inches below each kneecap, in the indentation at the front of the shinbone. Pressing these points for about one minute three times a day will help to relieve pain.
Acupuncture The technique of acupuncture is thought to reduce pain by releasing natural painkillers called endorphins and enkephalins which act like morphine to deaden pain. Practitioners of acupuncture believe that arthritis is the result of a blockage at the joint by the body’s vital force or essence. An acupuncturist will determine a specific course of treatment for you after asking a series of questions about your particular symptoms and overall state of health.
Despite its growing popularity, however, many doctors and scientists believe that there is no physiological basis for the success of acupuncture and that it is successful only through a placebo effect.
Aromatherapy Massaging aromatic oils into sore joints is a soothing treatment for lessening the aches of osteoarthritis. One common mixture consists of six drops each of rosemary and chamomile essentials added to four ounces of a carrier oil such as sesame, almond or avocado. Also soothing is the addition of ten drops each of rosemary and chamomile to a warm bath.
Ayurveda An ancient system of healing based on five thousand years of folk wisdom from India, ayurveda works from the basic principle that the human body is a moving stream of submolecular particles that can be arranged and rearranged at will. Disease is seen as a state in which the particles are out of the order in which they normally flow. To loosen stiff joints and relieve pain, the suggested ayurveda remedy is to gently rub sesame oil on the affected areas, followed by a hot shower about twenty or thirty minutes later. Additionally, it is considered therapeutic to add spicy herbs such as cayenne, cinnamon and dried ginger to foods.
Biofeedback The techniques of biofeedback can be harnessed to combat the painful symptoms of osteoarthritis. Using biofeedback techniques, a person is able to control certain body functions, such as decreasing the heart rate or altering brain rhythms. By using the same techniques to concentrate on relaxing muscle groups and eliminating muscle tension you can reduce pain. It does, however, take some time and practice to learn biofeedback techniques before being able to utilize them successfully.
Flotation tanks Relief from chronic pain, especially stiff and achy joints, can be found through the use of flotation tanks. Today’s tanks are not the earlier coffinlike structures that were called sensory-deprivation or isolation tanks. The new models are user-friendly, some with such features as a Jacuzzi, an intercom and a video screen.
When you float in a tank, you are drifting in a warm, buoyant liquid inside a light-free, soundproof chamber. Scientists have found that a person floating free of light, sound and touch can achieve a profound relaxation that triggers the same positive physical and mental effects as those that occur during meditation, which can linger long after the float is over.
As an aid in pain management, flotation tanks offer several benefits. First, buoyancy reduces pressure on the body and eases pain. More importantly, floating has been found to trigger the production of endorphins, the body’s natural painkillers. Finally, a big advantage of flotation is that it serves as a natural form of biofeedback. Patients are able to concentrate on their breathing, heart rate and muscle tension, by learning how to deeply relax and alter bodily functions at will.
Flower therapy The premise of flower therapy rests on the belief that flowers and essences stimulate the brain to release neurochemicals that can alter emotions such as fear, anger and anxiety. The result of these neurochemicals is believed to be a strengthening of the body’s innate ability to heal itself. These flower essences are sold in a highly concentrated form, usually taken in one-fourth of a glass of water. Osteoarthritis is viewed by essence therapists as a condition in which the entire system has become somewhat acidic, a condition that is thought by many practitioners to be the result of hidden, unexpressed anger. A combination of the essences of holly and grapevine are identified as being able to remedy the condition.
Food therapy The reliance on food as an aid to treating osteoarthritis is a subject of much controversy. There is no conclusive scientific evidence that certain foods can play a pivotal role in battling osteoarthritis. Since the symptoms of arthritis can suddenly emerge and just as suddenly disappear without any outside intervention, a remission of symptoms that is coincidental with a certain regimen can lead to unfounded claims. Thus, there have been some extreme recommendations such as that sufferers consume only white meat, eat dried rattlesnake meat or consume frequent doses of vinegar and honey.
Still, there are a number of recommendations regarding the role of diet in the treatment of arthritis that have gained broad acceptance. Generally, these recommendations focus on good nutrition and the avoidance of foods that are thought likely to trigger symptoms. Some studies have shown that a vegetarian diet is very beneficial in reducing and sometimes eliminating arthritis pain. A diet that is low in fat and sugar is thought to be beneficial because an excess of fat and sugar inhibits the body’s ability to accept vital minerals such as calcium, magnesium, phosphorus and manganese, which are vital to healthy bones. Also important are dark green vegetables, rich in chlorophyll, because the center molecule of chlorophyll is magnesium. Magnesium helps to remove impurities from the bloodstream.
There has been much written about the need for people with arthritis to avoid the so-called nightshade vegetables—green peppers, eggplant, tomatoes, white potatoes. This is based on the belief that they contain a toxin called sotanine that can interfere with enzymes in the muscles and cause pain. While there is no scientific evidence in support of this, avoiding the “nightshades” has brought positive results for some people.
Herbal therapy There are a number of herbs that are believed to be beneficial in easing the discomfort of osteoarthritis. These include alfalfa leaves, black cohosh, celery seed, chaparral leaves, valerian root and yucca extract. Herbal teas that are commonly recommended include brigham tea, comfrey tea, devil’s claw tea, and parsley tea.
Homeopathy A course of homeopathic therapy is devised after a homeopathist has reviewed all of the emotional and physical aspects of an individual. It’s quite possible that two people with the same illness can have the same symptoms but will be given different remedies. To gain optimum results from using homeopathy as a treatment for osteoarthritis, a patient should consult with a homeopath for optimum results.
A commonly recommended homeopathic treatment for achy muscles of arthritis that worsen with cold and in the morning is 30 c of cimicifuga. Also two very popular remedies in treating painful joints are arnica and rhus toxicodendron.
Massage A soothing massage can help to ease the pain of osteoarthritis, but it must be done gently. Put a little vegetable oil or massage oil on the fingertips so that the fingers will move easily over the skin. Don’t massage the affected joint directly but rather work around it, staying just above and below the area with your fingertips. Make small, gentle circles around the joint for about three or four minutes each day.
Nutritional therapy The role of nutrition has been embraced by many as an effective method for the treatment of osteoarthritis. In addition to the specific foods listed above, a number of vitamins have been identified as being useful in the treatment of osteoarthritis.
Niacin, also known as vitamin B3, is used to help reduce joint pain and improve mobility. Niacin does occurs in its pure form in foods, but only in small or moderate amounts. The best sources include liver, poultry, fish and peanuts. As a supplement, a common dosage is in the range of 500 mg twice a day up to 1,000 mg three times a day.
Vitamin B12, known to help boost the energy level and activity of the nervous system, has been useful in treating symptoms of osteoarthritis. However, it is difficult to acquire B12 through a regular diet, although such foods as meats, oily fish and milk products contain it. One study of arthritis patients showed that taking a combination of vitamin B12 and vitamin B1 resulted in greater effectiveness of NSAID painkilling drugs. Thus, it is possible that the dosage of painkilling drugs could be reduced by taking a combination of B12 and B1. A recommended dosage is 100 mg of B1 daily and 1,000 mcg of B12.
Dietary supplements recommended by nutritionists include: primrose or salmon oil capsules, two capsules, twice a day; superoxide dismutase; calcium plus magnesium, 2,000 mg daily; coenzyme Q10, 60 mg daily; garlic tablets, two capsules three times daily; kelp, eight tablets daily; multi-
enzymes, with meals; niacin plus vitamin B6, 100 mg, three times daily; vitamin B complex with B3, B6, PABA (para-aminohemzoic acid) and B5, 100 mg, three times daily; vitamin B12 and folic acid, lozenges daily; vitamin C plus bioflavonoids, 3,000 to 10,000 mg daily in divided doses.
Physiatry A small medical subspecialty called physiatry consists of physicians who have training in physical medicine and rehabilitation, including five years of specialty training after medical school. As rehabilitation experts, they work with other health professionals to devise and manage a treatment plan for patients who must make adjustments in their lifestyles following an illness or in the wake of a long-term, chronic ailment. For an osteoarthritis patient, a treatment plan might include heat and massage treatments, posture therapy, self-relaxation training and labor-saving ways of organizing chores. An advantage of consulting a specialist in physiatry is that the orientation is focused entirely on diagnostic and rehabilitative strategies, so you are likely to have a single, highly knowledgeable source for a multitude of practical and useful techniques.
Poultice The use of poultice can relieve the pain of stiff or swollen joints associated with osteoarthritis. One of the solutions often suggested is a solution of two cups of Epsom salts in a gallon of warm water, in which a towel is dipped and then placed on the affected joint. After fifteen or twenty minutes, the towel should be removed and castor oil gently massaged on the area.
Relaxation therapy Helpful in the management of pain from osteoarthritis is relaxation therapy. Particularly effective is a stretch-based technique. For example, weave your fingers together and raise your hands over your head, palms down. Then, straighten your elbows and rotate the palms outward until you can feel resistance. After holding the position for ten seconds, quickly release and then let your arms rest at your sides for one minute.
Thermal biofeedback A special form of biofeedback called thermal biofeedback was developed at the Menninger Clinic. It is based on the idea that stress causes a restriction of the blood flow to the hands and feet, which causes them to become colder than the rest of the body. By using thermal biofeedback, you can warm your hands, thereby eliminating the stress and achieving a state of relaxation. Warm hands lead to an increase in the blood flow and a lessening of the stress hormones, resulting in relaxation of the muscles.
Most people can learn to use thermal biofeedback in one session. You simply sit down comfortably and place a thermometer across the fingers of one hand that is resting on your leg, palm side up; your other hand is palm down. Then, touch your fingertips together so that the little finger of each hand is touching the index finger of the opposite hand. Next, roll your fingers together so that they wrap around the thermometer and then rest your hands in your lap. Focus on trying to feel the signs of any sensation in your fingers. Keep focused and soon you should feel a tingling or pulsing in the fingertips, a sign that the hands are warming. You can look occasionally at the thermometer with the intention to warm it, but don’t consciously try to raise the temperature of your hands. Let that occur naturally. The goal is to continue your focus until the finger temperature rises to ninety-seven degrees and hold it there for approximately ten minutes. After a time, you should be able to do this successfully without needing to use a thermometer.
Combined Treatments
For some people with osteoarthritis, management of the disease amounts to an occasional need to handle achy pain, stiff joints and sometimes swelling. Others, however, must face not only the management of frequent pain on a long-range basis but also the possibility of the degenerative disease eventually destroying an entire joint. Still others will fall somewhere in between.
One thing is sure, however. More and more people are living longer in the U.S., increasing the likelihood not only of their having visible symptoms of osteoarthritis, but also of there being a more severe progression of the disease. In fact, the population of people over sixty-five grew by 100 percent during the last thirty-five years, while the overall population increased just 45 percent. The most rapidly growing elderly age group is the “oldest old,” those over eighty-five which grew by 275 percent.
With osteoarthritis affecting a larger and larger percentage of the population, there will be even more attention and increased efforts devoted to the prevention and treatment of this disease. This means that virtually everyone should try to learn the basics about osteoarthritis and to keep up with treatment advancements.
Right now, for example, researchers are at work trying to develop a drug that can prevent osteoarthritis before it starts, by protecting the cartilage from deteriorating. There is also a drug under development that could stimulate the growth of new cartilage. If successful, doctors in the future could insert a temporary joint replacement that would dissolve as new cartilage forms.
With new treatment choices emerging and continued refinements of existing therapies, it’s likely that a typical program to manage osteoarthritis will consist of a combination of allopathic and alternative approaches. Since virtually every patient has a unique experience with osteoarthritis in terms of the form it takes and the therapies that are undertaken, each person needs to take full responsibility for a personalized treatment program.
