Overview: Osteoarthritis

• Osteoarthritis (OA) is a slowly progressive degenerative disease of the joints that afflicts approximately 27 million people in the United States.

• OA is already the most frequently reported chronic condition in older adults, and with the aging of the baby boom population and increased rates of obesity, investigators estimate that by 2030, more than 67 million people in the United States (25% of the population) will have OA.

• The costs of OA in terms of human suffering are extremely high. Because conventional therapies for OA have limited effectiveness, and toxicities associated with suitable drugs often limit use, many patients are left to face surgery or chronic pain, muscle weakness, lack of stamina, or loss of function.

• OA of the hip or knee is particularly disabling because it limits ambulation, but OA also strikes the hands, spine, feet, and other joints with the same destructive process. The end point of the OA disease process is total loss of joint cartilage in the affected area with the need for joint replacement.

Important points to consider

• A 10% reduction in weight in obese individuals can lead to a 28% improvement in function.

• Exercise is the most effective nonpharmacologic treatment for reducing pain and improving function. Some form of physical activity should be done on most days, with a more formal exercise routine at least three days per week.

• Acupuncture has been shown to improve both pain and function in ostertheils of the knas. Sie or more treatments are often required before efficacy can truly be summed.

• To encourage production of S-adenosylmethionine in the body, patients with osteoarthritis who have low folic acid levels should consider increasing these levels through higher consumption of dark green leafy vegetables or supplementation.

Prevention Prescription

• Maintain appropriate weight.

• Exercise regularly with a combination of aerobics, resistance training, and stretching.

• Consider glucosamine and chondroitin sulfate if at high risk for osteoarthritis.

• Avoid excessive trauma to the joints.

Integrative therapeutics review

Nutrition

• Antiinflammatory diet: individualized

• Weight loss: individualized program

Exercise

• Aerobic exercise: 1-hour sessions, three times weekly

• Resistance training/muscle strengthening 1-hour sessions, three times weekly

• Flexibility exercise: two to three times weekly

Mind-Body Therapy

• Telephone interventions: twice weekly for 6 months

• Group programs: group course with experienced teacher twice weekly for at least 12 weeks

• Yoga: 1 hour weekly for 8 weeks

Physical Modalities

• Knee bracing: as needed

• Heat applications: as needed

• Cold applications: 20 to 30 minutes, reapplied every 2 hours

• Transcutaneous electrical nerve stimulation: 15-minute to 4-hour session, daily to six times daily

• Swedish massage therapy: 60 minutes weekly

• Acupuncture: 15- to 30-minute sessions, weekly to three times weekly

Supplements

• Glucosamine sulfate and chondroitin sulfate: glucosamine sulfate, 500 mg three times daily, and chondroitin sulfate, 400 mg three times daily, both for a minimum of 6 weeks

• S-Adenosylmethionine: 400 to 1600 mg daily: common regimen, 600 mg twice daily

• Methylsulfonylmethane: 1000 to 3000 mg three times daily

Pharmaceuticals

• Acetaminophen: 325 to 1000 mg every 4 to 6 hours, maximum, 4 g/day

• Tramadol: 50 to 100 mg every 4 to 6 hours; maximum, 400 mg/day

• Nonsteroidal antiinflammatory drugs:

• dose variable by drug

• Opioid analgesics: doses and routes variable

• Capsaicin cream (topical): thin film of cream (0.025%, 0.075%) applied to the symptomatic joint four times daily

• Diacerein: 50 mg twice daily

Injections

• Intra-articular steroid injections

Surgery

• Knee replacement

Key Web Sources

• http://www.hopkins-arthritis.org/patient-corner/disease-management/exercise.html

• http://www.hopkins-arthritis.org/patient-corner/disease-management/yoga.html

• http://www.arthritistoday.org/index.php

• http://nccam.nih.gov/health/acupuncture/

• http://www.braceshop.com/