Treatment of osteoarthritis consists of a combination of various therapeutic modalities (see also Ref. 2).
Treatment for osteoarthritis
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weight normalization : excessive weight accelerates it
stay as active as possible : prevents joint stiffness
proper foot wear, canes etc. : offloading prevents deterioration
rearrange daily living routines : help with shopping and physical chores helps to reduce load on joints
non-steroidal anti-inflammatories : use only for flare-ups; regular use endangers kidney function
physiotherapy treatments : used for acute flare-ups
wax baths, hot tub etc. : heat has anti-inflammatory effects and improves circulation
topicals: heat rub, capsaicin : helps reduce the pain perception
intra-articular hyaluronic acid injection : helps to replenish lubricant in joint, but is expensive
intra-articular corticosteroid injection : limited to three injections per joint, otherwise leads to cartilage atrophy
alternative arthritis treatment: omega-3-fatty acid capsules (7 to 8 capsules per day of the high strength formulation) as well as 2 -3 capsules of chicken cartilage type II per day (fikzol is a good brand name, available at a health food store, or UC-II)
arthroscopy : useful for debridement or removal of loose bodies
radioisotope synovectomy : helps some patients with chronic synovitis of large joints
joint replacement : for end-stage osteoarthritis
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Watching body weight and using insoles
Notably, the initial measures are simple steps such as watching the body weight, improving body mechanics by changing footwear with insoles and supportive shoes or by adding a cane to stabilize the gait. The COX-2 inhibitory drug (brand name: Celebrex) was thought to be useful as it is easier on the stomach. Keep an eye on side-effects of the COX-2 inhibitory medications as one of these drugs (VIOXX) was pulled from the market in October of 2004. Certainly, in 2014 a study showed that strokes were more frequent in the COX-2 inhibitory drug group.
The VIOXX link above explains this story in detail. However, it is important to realize that like the regular anti-inflammatories (brand names: Naprosyn, Voltaren etc.) the kidneys eliminate them as well. This means that they are toxic to the kidneys when used long-term. That is to say that this “nephropathy”, as physicians call it, is a serious complication and occurs easier in older patients. It is because of this danger that patients should use these medications only intermittently rather than continuously.
Physiotherapy treatments
Along with these measures doctors recommend physiotherapy treatment. Many patients find that heat is useful and makes it easier for them to move their affected joints. Such modalities as wax baths or soaking in a hot tub can improve the pain and help improve the ROM for a number of days.
Heat rubs and capsaicin work in a similar fashion as heat. Injections into the knee are something that the physician will on occasion suggest and do. Corticosteroids have anti-inflammatory effects and often last 6 to 9 months. The doctor may administer hyaluronic acid (brand name: Synvisc) as a set of three injections 1 or two weeks apart. The effect, if it works, will last several months up to a year and can then be repeated again. Glucosamine sulfate has been a folk remedy for the past 15 to 20 years and has been well researched.
Glucosamine sulfate
Many studies showed glucosamine sulfate to be almost as powerful as the traditional anti-inflammatory medication, but without the stomach irritating side-effects. Unfortunately these studies were not always well controlled and recently a well controlled study regarding glucosamine and arthritis could not find any significant effect over the placebo effect. There will likely be newer agents developed in future and it might be possible to, for instance, match an injectable agent to what’s missing in the affected joint fluid, based on joint fluid analysis. Research in this area has been slow in the past, but one of the products that has come out of it is Synvisc. Perhaps there may be more effective similar medications in future with continued research. An alternative over-the-counter method is the use of supplemental collagen available at your health food store.
Arthroscopy
It is important to realize that more invasive procedures like arthroscopy can buy time of about 5 years through shaving off of irregularities of the joint surface, removal of foreign bodies and osteophytes. Unfortunately the process repeats itself: the joint surface sheds bits and pieces of the degenerative arthritic surface into the joint space along with broken off osteophytes.
Foreign bodies in the arthritic joint
The movement of the joints grind this material down to become “foreign bodies” in the physician’s lingo. Indeed, the truth is that this material is not “foreign” at all, but is material, which should not be in the joint space. By the fact that it is there, causes it to become sand-like material. This only helps to deteriorate the diseased joint surface. By all means, when the orthopedic surgeon removes the material and flushes it out with saline solution, the patient feels often remarkably better. However, to put it differently, 5 years later a total joint replacement or fusion surgery is often necessary.
Treatment of Osteoarthritis (Total Knee Replacement)
Total joint replacement
It is important to realize that before the physician considers a total joint replacement, he might consider a radioisotope injection. Yttrium-90 has been used for this purpose and is used by injection into the affected joint. It may work by treating the chronic inflammation of the synovial membrane and modifying the aggressive immune cells that lead to further deterioration of the osteoarthritis. In any event, this type of treatment is usually reserved for the rheumatologist in collaboration with a radiation therapist.
Finally, when bone rubs on bone and the patient cannot stand the pain any more, two surgical procedures can be offered: fusion surgery and total joint replacement. Here is what most physicians will do for the more common joints.
Surgical procedures for end-stage osteoarthritis
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cervical or lumbar spine : fusion surgery
shoulder : artificial joint replacement, done in University Center
wrist : fusion surgery
finger joints : silastic implants, if this fails fusion surgery
hip : total hip replacement when socket and hip ball are both affected; partial hip replacement when only upper femur or hip ball has to be replaced
knee : total knee replacement
ankle : fusion surgery
subtalar joint : subtalar fusion surgery toe joints : fusion surgery
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To emphasize, these surgical procedures have evolved as they were found to have the best longterm results. For instance, generally speaking, artificial wrist replacements have been done, but they failed miserably on the longterm. Surely, this does not mean that sometime in the future there might be a better solution. On the other hand, on the positive side, the new total knee replacements with porcelain joint replacements have so far a 25 to 25 year running time and seem to still last very well. Truly, it takes many years of research and follow-up studies to collect such statistics.
Longterm success rate of joint replacements
We know from comparisons that older people do much better with the longterm success rate of joint replacements, as they are more sedate and therefore less exposed to wear and tear forces. As has been noted, the worst longterm outcomes are found in athletes as they abuse their implants and loosening is a real problem. After all, when a joint has to be “re-done”, there is a much higher risk of complications like infection, lack of healing and loosening. Certainly, with any big procedure as joints replacements are, there is also a significant risk of clot formation and sudden death from an undiagnosed pulmonary embolus that broke off from one of the large veins in the surgical site. Especially, this is more likely to happen after surgery in the lower extremity.
Alternative Medicine Approach to Treatment of Osteoarthritis
Hormone disbalance
It must be remembered that there is more to the development of osteoarthritis than just the aging process. Often a number of hormones are out of balance, which leads to a dysbalance of bone and cartilage build-up versus breakdown. As matter of fact, anti-aging medicine checks this out and uses bio-identical hormones to replace what is missing. In like manner, the physician needs to individualize the treatment plan for each patient. Indeed, Dr. Thierry Hertoghe and Dr. Ron Rothenberg mentioned in several lectures at a medical conference in Las Vegas (December 2011, Ref. 9) that it is an overconsumption of refined sugar and carbohydrates that leads to excessive insulin production and subsequent hormone disbalance.
Omega-3 to omega-6 ratio
For one thing, the omega-3/omega-6 ratio is distorted, because of a relative lack of omega-3 fatty acids in the diet resulting in a premature breakdown of the hyaline cartilage in the joints. Along with the hormone replacement proper nutrition, detoxification, exercise and adequate sleep also the patient. I have summarized how “anti-aging medicine for women and men” works in a link under related topics at the end of this page.
Chicken cartilage supplement
With newer insights into the origin of osteoarthritis and rheumatoid arthritis there are new therapeutic options for patients who suffer from joint pain. The first degenerative changes of the smooth joint surface (called “hyaline cartilage”) leads to exposure of collagen to the immune system. This leads to the production of T killer cells, which attack the hyaline cartilage. Research has shown that a tolerance state of the immune system can be induced after taking undenatured chicken cartilage (either fikzol type II or UC-II) for only 90 days. The body now gets used to tolerating the chicken cartilage supplement and the joint surfaces recover from the prior degenerative changes (Ref.10).
Lack of omega-3 fatty acids keeps inflammation going
The second observation is that high omega-3-fatty acid supplementation (about 3 to 6 Grams of a high potency omega-3 molecularly distilled product) will keep the chronic inflammation of osteoarthritis at bay. Without chronic inflammation there is no arthritis, so the patient gets better or even cured. Omega-3 supplements and chicken cartilage work together with regard to controlling the chronic inflammation of osteoarthritis.
Stem cell therapy for osteoarthritis
Physicians can use stem cells for knee joint arthritis, but tit is applicable for osteoarthritis in any of the joints in the body. The physician harvests stem cells by liposuction from fatty tissue under the skin. A cell separator removes fatty tissue and mesenchymal stem cells. These latter ones are injected into the affected joints. Conventional medicine has been very slow in accepting this new simple therapy form although it is highly effective. Think about it: If you were a surgeon who gets a lot of money for total knee replacement surgeries, would you support your competition? I am not surprised that there is lobbying going on against stem cell therapy, basically as added burdens on the shoulders of patients who could be helped with less invasive procedures that preserve their own tissues. Read this link for more information on the use of stem cells to replace total knee replacements.
References
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 52.
2. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999.
3. EL Cain et al. Clin Sports Med 2001 Apr;20(2):321-342.
4. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
5. Goldman: Cecil Textbook of Medicine, 21st d.(©2000)W.B.Saunders
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
8. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
9. 19th Annual World Congress Anti-Aging and Aesthetic Medicine in Las Vegas (December 8-10, 2011)
