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Called the "wear and tear" arthritis, Osteoarthritis is the most common form of arthritis. Nearly all vertebrates suffer from OA, including porpoises and whales, and those long-extinct giants, the dinosaurs. It is a chronic disease in which the cartilage breaks down. Cartilage is a slippery tissue that covers the ends of bones in a joint, allowing the bones to glide over one another. It also absorbs energy from the shock of physical movement. When cartilage in a joint deteriorates, Osteoarthritis (OA) occurs.
Incidence; Causes & Development
Some facts:- It affects over 20 million Americans.
- It is 8 times more common than rheumatoid arthritis.
- Almost everyone over the age of 75 is affected in at least one joint.
- Before age 45, more men have it; after age 45, it is more common in women.
- OA is responsible for more than 7 million visits to the physician each year.
There are two categories of OA, primary and secondary. Primary OA appears without any apparent cause, usually as a result of aging. Secondary OA occurs in joints that have sustained injuries, or experienced infections or fractures. The pain of OA is often caused by ligament relaxation around the joint. Obesity can also cause secondary OA due to the added pressure on weight-bearing joints. Secondary OA can also occur as the result of another type of arthritis, such as rheumatoid.
In cases of OA, old cartilage breakdown exceeds new cartilage synthesis and may be associated with loose ligaments. Maintaining the integrity of the synovial joints is fundamental to osteoarthritis prevention.
Signs & Symptoms
As the cartilage in a joint deteriorates, the bones begin to rub together, causing pain, swelling, and loss of motion of the joint. The joint may begin to lose shape. Small bone spurs called osteophytes may grow on the edges of the joint. Inflammation may or may not be present. The pain may come and go. These symptoms almost always begin gradually, taking years until the pain is severe enough to be reported to a doctor. OA is commonly found in the joints of the fingers, feet, knees, hips and spine, and is rarely found in joints of the wrist, elbows, shoulders or jaw.
Diagnosis & Tests
Although it is usually not difficult to diagnose OA, no single test can pinpoint the disease. Most doctors use a combination of patient history, physical examination and X-rays to diagnose the disease and rule out other causes for the symptoms.
Treatment & Prevention
Treatment of OA should focus on managing pain while improving joint function by strengthening the joint and encouraging cartilage growth. This can be done in several ways.
People in occupations or activities requiring repetitive and stressful movement should find ways to reduce joint trauma. Adjusting the work area, substituting tasks or changing exercise activities to produce less stress on joints can help reduce further 'wear and tear'.
Corticosteroids are typically injected into affected joints rather than taken orally to relieve the pain, but repeated injections may further weaken loose ligaments and prevent healing which requires an inflammatory like response.
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Signs, symptoms & indicators of Osteoarthritis:
Conditions that suggest Osteoarthritis: | | | | | Hormones |  Estrogens Low | In studies of older women, a lower risk of osteoarthritis was found in women who had used oral estrogens for hormone replacement therapy. The researchers suspect that low estrogen levels could increase risk for the disease, but further studies are needed. |
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Musculo-Skeletal |
 Heberden's Nodes| | The symptoms of osteoarthritis usually begin slowly and may be mild at first. The pain is usually worse after a lot of activity or during movement after long periods of inactivity. You may feel discomfort in the joint before or during a change in the weather. You may also have swelling and loss of flexibility in the joint. Over time, the cartilage that serves as a cushion between the bones may completely wear away, causing the bones to rub against each other. This can cause the bone ends to thicken and form bony growths or spurs. In the fingers these bony lumps are called Bouchard's or Heberden's nodes. |
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Symptoms - Skeletal |
Osteoarthritis (confirmed) |
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Risk factors for Osteoarthritis:
Osteoarthritis suggests the following may be present:
Recommendations and treatments for Osteoarthritis: | | | | | Amino Acid / Protein |  L-Phenylalanine| | D-phenylalanine (DPA) has been used to treat the chronic pain of osteoarthritis with both positive and negative results. |
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Animal-based |
 Glucosamine / Chondroitin Sulfate| | Clinical studies, comparing glucosamine (in sulfate or hydro-chloride form) with both placebo and standard arthritis drugs (including Ibuprofen), showed that glucosamine outperformed both in reducing long-term pain, joint tenderness and swelling, accelerating recovery, reversing cartilage damage, and helping to restore joint function, range of motion, and walking speed. Glucosamine is a component of hyaluronic acid which has been used by injection to successfully reduce knee pain.
Three years of treatment with glucosamine sulfate (1500mg per day) prevented joint space narrowing and reduced pain in two randomized, double-blind, placebo-controlled trials with a total of 414 women, including 319 of postmenopausal age.
[North American Menopause Society 12th Annual Meeting, Oct. 4-6, 2001, New Orleans, LA.]
Along with glucosamine, chondroitin sulfate has become a widely used dietary supplement for treatment of osteoarthritis. Due to the popularity of the glucosamine-chondroitin supplement and the lack of reliable information about its usefulness in treating osteoarthritis [McAlindon TE et al (2000); Glucosamine and Chondroitin for Treatment of Osteoarthritis: A Systematic Quality Assessment and Meta-analysis; JAMA 283: pp.1469-1475.] the National Institutes of Health funded a study to test the effects of chondroitin and glucosamine on osteoarthritis of the knee.
This multicenter, placebo-controlled, double-blind, six month long trial found that glucosamine plus chondroitin had no statistically significant effect on symptoms of osteoarthritis.[Clegg DO et al (2006); Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis; New Engl J Med 354 (8): pp.795-808.]
The control group of patients who took celecoxib (a commonly used osteoarthritis drug) did have a statistically significant improvement in their symptoms. These results indicate that glucosamine and chondroitin do not effectively relieve osteoarthiritic pain. Although the study found no overall effect for the supplements, a secondary analysis of a subgroup of patients suggested that the supplements taken together helped people with more severe pain. |
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Botanical |
 Ginger Root| | A concentrated extract of 2 ginger species (255mg bid) over a period of 6 weeks reduced pain in a double-blind, placebo-controlled study of 261patients with moderate to severe pain from osteoarthritis of the knee. Acetaminophen was allowed to be used if the pain was not controlled sufficiently. [Arthritis Rheum 2001;44(11): pp.2531-2538] |
Cayenne Pepper| | Topically for pain control only. |
Boswellia |
Diet |
Weight Loss| | Overweight people can lessen the shock to their joints by losing weight. Knees, for example, sustain an impact three to five times the body weight when descending stairs. Therefore a loss of five pounds can eliminate at least 15 pounds of stressful impact on the joint. The greater the weight loss, the greater the benefit. |
Nightshade Family Food Avoidance| | Elimination of nightshade family foods does not help all people with arthritis, but people who respond are usually helped a great deal. |
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Drug |
NSAIDs| | NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are commonly used to treat osteoarthritis. Available over the counter or by prescription, they fight inflammation or swelling and relieve pain. Acetaminophen such as Tylenol can also be very effective in treating the pain. Research has shown that in many patients acetaminophen relieves pain as effectively as NSAIDs. These pain killers will only help control the symptoms, and if used at all should only be used for pain control while more effective therapies are at work. The newer COX2 inhibitors will have fewer side effects, but still do not restore normal function. Topical pain-relieving creams, rubs and sprays can be applied directly to the skin. There are many brands available over the counter. |
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Habits |
Aerobic Exercise| | Research shows that a good treatment for Osteoarthritis is exercise. It can improve mood and outlook, decrease pain, increase joint flexibility, improve the heart and blood flow, maintain or decrease weight, and promote general well being. The amount and form of exercise will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done. |
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Hormone |
Natural Progesterone |
Mineral |
MSM (Methyl Sulfonyl Methane)| | Research at the UCLA School of Medicine found an 82% reduction in pain after 6 weeks of MSM use in a double-blind study on degenerative arthritis. The study lasted 4 months and involved 16 patients on about 2gm MSM per day; 10 patients on MSM and 6 on placebo. After only 6 weeks, those patients using the MSM experienced better than 80% control of their pain, while those on the placebo experienced 18% improvement. [Federation of American Societies for Experimental Biology, 69th Annual Meeting, Apr. 21-26, 1985, p.692] |
Boron| | Dr. Newnham, PhD, DO, ND has demonstrated clear demographic evidence for the usefulness of boron in treating or preventing both rheumatoid arthritis and osteoarthritis. The prevalence of arthritis seems to follow inversely the availability of boron in the soil. [Australian & New Zealand Association for Advancement of Science. 1979]
Based on work done at Oxford in the Agriculture Faculty it is believed that at the cellular level mineral metabolism is similar in both plants and man. If this can be relied on, then boron is a membrane catalyst which allows various ions to pass through the cell membrane, particularly phosphates to support synthesis of ATP. This will give energy for efficient repair. It is obvious that in osteo arthritis the cartilage is worn out; if it is because it lacks the necessary energy for cell division, that would explain the action of boron. [Boron and Membrane Function in Plants. Metals and Micronutrients: Uptake and Utilization by Plants. Academic Press; 1983: Ch. 6]
Boron influences calcium and magnesium metabolism, possibly through the parathyroid gland. It does alleviate and seems to cure arthritis either by acting against whatever organism may cause rheumatoid diseases and/or as a membrane catalyst that permits repair of damaged cartilage and collagen. |
Copper |
Nutrient |
TMG (Tri-methyl-glycine)| | TMG, administered as S-adenosyl-methionine (SAMe), 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 is consistent with several other clinical studies. |
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Oriental Medicine |
Acupuncture| | Some people have found pain relief using acupuncture. Preliminary research shows that acupuncture may be a useful part of an osteoarthritis treatment plan. |
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Physical Medicine |
Rest| | Treatment plans recommended by some doctors include regularly scheduled rest. Others, however, stress the importance of continued mobility during the recovery phase, if tolerated. |
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Surgery/Invasive |
Prolotherapy| | Prolotherapy is the best and often only treatment when ligaments are weakened and cartilage damaged. As good as some of the other treatments are for pain, nothing seems to come close to the effectiveness of Prolotherapy. Prolotherapy is the only treatment that can stimulate the regrowth of the injured tissue. |
Hyaluronic Acid| | The use of hyaluronic acid (HA) in osteoarthritis has been found to be effective in terms of relieving pain due to osteoarthritis (OA) of the knee and may potentially be a structure-modifying drug. Results of a study of 100 patients with OA of the knee who were treated with five weekly injections of intra-articular HA demonstrated significant improvement in terms of pain on walking at week five, which persisted for six months in two-thirds of patients. [Rheumatology 1999; 38: pp.602-607]
These treatments, called viscosupplementation, are administered as a course of injections into the knee joint and are believed to supplement the viscosity of the joint fluid, thereby lubricating the joint, cushioning the joint, and producing an analgesic effect. It has also been suggested that hyaluronan has positive biochemical effects on cartilage cells. However, some placebo controlled studies have cast doubt on the efficacy of hyaluronan injections, and hyaluronan is recommended primarily as a last alternative to surgery. |
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Vitamins |
Vitamin B5 (Pantothenic Acid)| | Low pantothenic acid levels are implicated in the development of human osteoarthritis and rheumatoid arthritis, as whole blood pantothenic acid levels have been reported to be lower in rheumatoid arthritis patients compared with normal controls. In addition, disease activity was inversely correlated with pantothenic acid levels. |
Vitamin Niacinamide| | Results may be seen in 3-4 weeks with a plateau of improvement reached at 12 weeks. The dose may be lowered at this time but if discontinued, the symptoms will come back. Intake of 500mg 3-6 times daily has commonly been recommended. Sustained release forms require less frequent dosing. [Inflamm Res 1996;45: pp.330-4] |
Vitamin E| | A clinical trial using 600 IU of vitamin E in patients with osteoarthritis demonstrated significant benefit. The benefit was thought to be due to vitamin E's antioxidant and membrane stabilizing actions. Later studies have shown that vitamin E has an ability to inhibit the enzymatic breakdown of cartilage as well as to stimulate cartilage synthesis. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Adenosine Triphosphate (ATP)
A compound consisting of the nucleotide adenosine attached through its ribose group to three phosphoric acid molecules. It serves to store energy in muscles which is released when it is hydrolyzed to adenosine diphosphate.
Analgesic
Agent which relieves pain without causing loss of consciousness.
Anti-inflammatory (Antiinflammatory)
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Antioxidant (Antioxidants)
A chemical compound that slows or prevents oxygen from reacting with other compounds. Some antioxidants have been shown to have cancer-protecting potential because they neutralize free radicals. Examples include vitamins C and E, beta carotene, the minerals selenium and germanium, superoxide dismutase (SOD), coenzyme Q10, catalase, and some amino acids.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
BID
Twice per day.
Boron
A mineral that may play a role in maintaining strong bones, affecting calcium and magnesium metabolism and proper membrane function.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Cartilage
Specialized fibrous connective tissue that forms the skeleton of an embryo and much of the skeleton in an infant. As the child grows, the cartilage becomes bone. In adults, cartilage is present in and around joints and makes up the primary skeletal structure in some parts of the body, such as the ears and the tip of the nose.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Collagen
The primary protein within white fibers of connective tissue and the organic substance found in tendons, ligaments, cartilage, skin, teeth and bone.
Copper
An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.
Corticosteroid (Corticosteroids)
Steroid hormone produced by the adrenal cortex.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Glucosamine
A compound manufactured from glucose used in building cartilage.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Heberden's Nodes
Bony swellings around the margins of joints, associated with degenerative changes of arthritis.
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
IU (mIU, uIU)
International Unit: An arbitrarily defined but agreed upon unit that depends on what is being measured.
mIU: 0.001 or one thousandth of an IU.
uIU: 0.000001 or one millionth of an IU.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Manganese
An essential mineral found in trace amounts in tissues of the body. Adults normally contain an average of 10 to 20mg of manganese in their bodies, most of which is contained in bone, the liver and the kidneys. Manganese is essential to several critical enzymes necessary for energy production, bone and blood formation, nerve function and protein metabolism. It is involved in the metabolism of fats and glucose, the production of cholesterol and it allows the body to use thiamine and Vitamin E. It is also involved in the building and degrading of proteins and nucleic acid, biogenic amine metabolism, which involves the transmitting of nerve impulses.
Menopause (Menopausal)
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Mineral (Minerals)
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
NSAID (NSAIDs)
Non-steroidal anti-inflammatory drug.
Osteoarthritis (Osteoarthritic)
A condition involving degeneration of cartilage and supporting joint tissue, which results in pain, swelling and reduced mobility, as the cartilage wears away and allows bone to rub against bone.
Over-The-Counter (OTC, Over The Counter)
A drug or medication that can legally be bought without a doctor's prescription being required.
Pantothenic Acid
A B-complex vitamin necessary for the normal functioning of the adrenal gland, which directly affects growth. It is also essential for the formation of fatty acids. As a coenzyme, it participates in the utilization of riboflavin and in the release of energy from carbohydrates, fats and proteins.
Parathyroid (Parathyroid Gland, Parathyroid Glands, Parathyroids)
The four parathyroid glands are embedded near the thyroid, with two attached to each thyroid lobe, on opposites sides of the throat. Hormones from the parathyroid glands help control calcium and phosphorous levels in the body. These glands oversee the breaking down of bone cells to release more of these minerals into the blood; a hormone from the thyroid has the opposite effect, and builds up the bones. Control of this system depends on blood levels of calcium ions: low levels "turn on" hormone production to break down bone tissue, so that blood levels remain stable. It is important to absorb enough dietary calcium to avoid this breakdown of bone tissue.
Placebo (Placebos)
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Postmenopause (Postmenopausal)
The postmenopausal phase of a woman's life begins when 12 full months have passed since the last menstrual period and any menopausal symptoms have become milder and/or less frequent.
Progesterone
This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (similar to a cholesterol), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman's reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites.
Prolotherapy
A single or series of injections that stimulates the body to regrow, tighten, and strengthen ligaments or tendons. It is unequaled for pain relief and restoration of normal function for any body joint where connective tissue is weak or has been damaged.
Rheumatism (Rheumatoid)
General term applied to conditions of pain, or inability to articulate, various elements of the musculoskeletal system.
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Synovium (Synovial)
The tough tissue that surrounds all of our joints, and which produces the fluid that lubricates the joint surfaces so that they move smoothly.
Topical
Most commonly 'topical application': Administration to the skin.
Tri-Methyl-Glycine (DMG, TMG)
After supplying a methyl group, TMG becomes di-methyl-glycine. DMG, a natural component of animal and plant metabolism, positively influences the immune response in laboratory animals and humans and boosts physical and mental performance.
Vitamin E
An essential fat-soluble vitamin. As an antioxidant, helps protect cell membranes, lipoproteins, fats and vitamin A from destructive oxidation. It helps protect red blood cells and is important for the proper function of nerves and muscles. For Vitamin E only, 1mg translates to 1 IU.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: May 11, 2008
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