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| Osteoarthritis |
Last updated: May 12, 2008 |
Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations
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Called the "wear and tear" arthritis, Osteoarthritis (OA) 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, OA occurs.
Statistics - OA affects an estimated 20.7 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, while after age 45 it is more common in women.
- OA is responsible for more than 7 million physician visits per year.
What causes it?
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, 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.
What are the 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 act like a roller coaster, with pain spells followed by periods of relief. 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.
How is it diagnosed?
Although it is usually not difficult to diagnose OA, no single test can pinpoint the disease. Most doctors use a combination of patient history and exam, and X-rays to diagnose the disease and rule out other causes for the symptoms.
How is it treated?
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’.
Treatment plans recommended by some doctors include regularly scheduled rest. Others, however, stress the importance of continued mobility during the recovery phase, if tolerated. 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: | | | | | | Symptoms - Metabolic |  Having a slight/having a moderate/having a high fever |
Symptoms - Skeletal |
 Hip pain
 Joint pain/swelling/stiffness |
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Conditions that suggest Osteoarthritis:
Risk factors for Osteoarthritis: | | | | | | Metabolic | Problem Caused By Being Overweight | Forcing joints to carry more weight than they were designed for often results in premature failure. |
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Nutrients |
Manganese Requirement| | Bone cartilage can’t grow or repair itself adequately without manganese - an essential part of glucosamine, which is in turn a major joint building block. When glucosamine is in short supply, various forms of arthritis tend to arise, eventually leading to joint deterioration. Manganese is involved in the production of hyaluronic acid, chondroitin sulfate and other components of mucopolysaccharides, the complex sugars which form the basis of our synovial (joint) fluids and connective tissues. |
Antioxidant Requirement / Oxidative Stress |
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Osteoarthritis suggests the following may be present:
Recommendations for Osteoarthritis: | | | | | | Amino Acid / Protein |  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 (HA) 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.]
Anecdotal reports of rapid symptomatic response to high-dose glucosamine in osteoarthritis are not credibly explained by the traditional view that glucosamine promotes synthesis of cartilage proteoglycans. An alternative or additional possibility is that glucosamine stimulates synovial production of HA, which is primarily responsible for the lubricating and shock-absorbing properties of synovial fluid. Many clinical and veterinary studies have shown that intraarticular injections of high-molecular-weight HA produce rapid pain relief and improved mobility in osteoarthritis. HA has anti-inflammatory and analgesic properties, and promotes anabolic behavior in chondrocytes. The concentration and molecular weight of synovial fluid HA are decreased in osteoarthritis; by reversing this abnormality, high-dose glucosamine may provide rapid symptomatic benefit, and in the longer term aid the repair of damaged cartilage. [Med Hypotheses (1998 Jun) 50(6): pp.507-10]
Please see the link between Knee Pain and Glucosamine for a 2007 review suggesting that there was no benefit with the use of glucosamine. |
Cetyl-myristoleate| | In a small study of patients with mild to moderately severe osteoarthritis and reactive psoriatic arthritis, rapid improvement occurred in 60 hours, reaching 70-80% overall improvement by the end of 4 days. Half experienced return of mild symptoms in three to five weeks and a second course left them symptom-free, with lasting results.
In severe to crippling osteoarthritis 3 were unable to walk, and the other 11 used canes or walkers. All had pain, inflammation and marked deformity. After 20 days, all but one subject reported 90% improvement. One subject was non-responsive because of liver damage caused by sports-related steroid abuse. (Unpublished study) |
 Fish Oils| | Fish oils that contain omega-3 fatty acids have been found, in various studies, to help reduce the inflammation associated with some types of arthritis. These forms of arthritis, like rheumatoid arthritis and osteoarthritis, are characterised by inflammation. The fish oil works by reducing the number of inflammatory 'messenger' molecules made by the body's immune system.
The Arthritis Foundation recommends eating at least two fish meals a week - in particular fatty fish such as salmon, mackerel and sardines which contain the most omega-3. Alternatively, fish oil supplements are a convenient way to ensure a regular therapeutic dose. Supplements also have the added advantage of being purified of mercury, toxins and heavy metals. |
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Botanical |
Ginger Root (Zingiber officinalis)| | 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]
Researchers at Israel's Tel Aviv University enrolled 29 patients who suffered from osteoarthritis of the knees. The six men and 23 women (aged 42 to 85 years) were divided into two groups. One group received a 250mg dose of ginger extract four times each day for 12 weeks, while the other group received a placebo. The treatments were then switched for an additional 12 weeks. Overall, the "ginger extract group showed a significant superiority over the placebo group," and researchers concluded that 24 weeks of treatment with ginger extract may be optimal for the treatment of osteoarthritis of the knees. |
Rose Hip (Rosa canina)| | Using a standardized rose hip product (HybenVital) at 2,500mg bid improved severity, stiffness, and disability scores in
a well-designed study of 76 patients with hip or knee osteoarthritis. [2002 European Congress of Rheumatology, June12-15, 2002, Stockholm, Sweden] |
Cayenne Pepper (Capsicum frutescens)| | Topically for pain control only. |
Noni |
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 Food Avoidance| | Rigid omission of nightshade foods, with other minor diet adjustments, has resulted in positive to marked improvement in arthritis and general health. In general Childers reports that “We have got around 70% positive results in reducing arthritic problems if the cooperator can stay rigidly with the (elimination) diet from here on in. People truly rigid may get 94% freedom from arthritis in surveys we have made. This included many forms of arthritis, all of which seem to be affected by the nightshades.”
Researchers are quick to point out that when these people accidentally ate one of the foods or tried to go back to their former diet, their symptoms would return. The worse the initial problem, the longer it will take to see any signs of improvement. It could take several weeks or months to notice any benefits to dietary changes. [Journal of Neurological and Orthopedic Medical Surgery, 1993 article by Childers]
There may be a link between osteoarthritis and vitamin D3, which is produced by the nightshade foods. The researchers concluded that “osteoarthritis appears to be a result of long-term consumption of the nightshade foods, which naturally contain the active metabolite vitamin D3, and in excess causes crippling and early disability. |
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Drug |
Conventional Drugs / Information| | First US approval for a prescription NSAID (non-steroidal anti-inflammatory drug) treatment that can be applied directly to site of osteoarthritis pain (October 2007). Voltaren Gel is the only prescription topical medication proven to significantly reduce osteoarthritis pain in both the knees and the joints of the hands.
Voltaren Gel offers highly effective pain relief with minimal drug absorption throughout the body - shown to be 94% less than comparable oral diclofenac treatment. Voltaren Gel (diclofenac sodium topical gel) 1% has received US regulatory approval as the first topical prescription treatment that patients can apply directly to sites of pain associated with osteoarthritis. |
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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Extract |
Devil's Claw (Harpagophytum Procumbens)| | A Devil's Clas extract (60mg harpagoside per day) improved pain in a study of 85 patients with knee osteoarthritis, and 61 patients with hip osteoarthritis. [Phytomedicine 2002;9(3): pp.181-194] |
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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 |
Progesterone| | Topical progesterone has been reported to be useful in alleviating symptoms. |
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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, Ph.D., D.O., N.D. 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 with 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, it explains 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| | The use of copper bracelets in the treatment of arthritis has a long history due to its mild anti-inflammatory effects. |
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Nutrient |
TMG (Tri-methyl-glycine) / SAMe| | 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 |
Topical Applications| | Mineral-rich mud compresses were used daily (5 times per week) for 3 weeks in a blinded trial of 58 patients. Reduced knee pain was reported, which lasted up to 3 months. [J Clin Rheumatol 2002;8(4): pp.197-203] |
Hydrotherapy| | The Cochrane reviewers analyzed six trials that had 800 participants who all were living with osteoarthritis. Four studies included patients with osteoarthritis of either the knee or hip, one study followed patients with only hip arthritis and one included patients with only knee arthritis.
In the studies, some patients did aquatic exercises for different lengths of time and numbers of sessions per week, while other patients did no exercise or exercised on land. Most of the studies measured patients after three months of therapy.
Based on the studies' results, the reviewers said, "In people with osteoarthritis of the hip or knee, pain may decrease by 1 more point on a scale of 0 to 20 with aquatic exercise, and function may improve by 3 more points on a scale of 0 to 68."
"There is gold-level evidence that for osteoarthritis of the hip or knee, aquatic exercise probably slightly reduces pain and slightly improves function over three months," the reviewers wrote. "Based on this, one may consider using aquatic exercise as the first part of a longer exercise program for osteoarthritis patients."
The reviewers were unable to find evidence on whether aquatic exercise affected patients' walking ability or stiffness after treatment sessions.
Wanda Evans, a physical therapy resource specialist at Kaiser Permanente, said that her clinic uses aquatic therapy to treat 80 percent to 90 percent of patients with hip and knee osteoarthritis and "100 percent" of them experience some improvement.
"Oftentimes, aquatics are the primary course of treatment if the patient is obese and 80 percent of our patients with this diagnosis are obese," Evans said. "Otherwise, it is considered an adjunct to the primary course of treatment, which is land-based exercises." [Cochrane Library, October 2007] |
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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 comes 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] |
Not recommended:
 Surgery| | An estimated 12% of Americans aged 65 and older have osteoarthritis of the knee. A popular operation for arthritis of the knee worked no better than a sham procedure in which patients were sedated while surgeons pretended to operate, researchers are reporting. Tests of knee functions revealed that the operation had not helped, and those who got the placebo surgery reported feeling just as good as those who had had the real operation.
Placebo studies of surgery are almost never done. Many doctors consider them unethical because patients could undergo risks with no benefits. [NEJM July 11, 2002;347: pp.81-88, 132-133]
This supports the idea that what you think is sometimes reflected in your experience. |
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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]
Wayne Jonas from the NIH Office of Alternative Medicine conducted a 12 week, double-blind, placebo controlled study of 72 patients to assess the validity of Dr. Kaufman’s earlier work with niacinamide and osteoarthritis. Using a dose of 3 grams of niacinamide per day, they found that overall disease severity was reduced by 29%, inflammation was reduced by 22% and the use of anti-inflammatory medication was reduced by 13%. Patients taking the placebo, on the other hand, either had no improvement, or actually worsened. |
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.
However, two years of supplementation with vitamin E (500IU per day) had no effect on symptoms or cartilage loss in a randomized, double-blind, placebo-controlled study of 136 patients with knee osteoarthritis. [J Rheumatol 2002;29(12): pp.2585-91] |
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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 | | | May have adverse consequences |
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