Osteoarthritis with Naturopathic Medicine

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Addressing Osteoarthritis with Naturopathy and Holistic approaches. Also includes a reveiw of conventional treatment options. Presentation by Adam Rinde, ND, a Naturopath based in Kirkland, Washington.

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Osteoarthritis with Naturopathic Medicine

  1. 1. Osteoarthritis<br />Adam Rinde, ND<br />Naturopathic Physician<br />Sound Integrative Health<br />7/11/08 @ Natures Pantry<br />
  2. 2. Key Points<br />Pain relief is available in a non-pill form!<br />Joint replacement can be prevented<br />You can take charge of your pain<br />
  3. 3. Osteoarthritis: Description<br />Osteoarthritis: a disease effecting any joint with associated alteration of cartilage<br />Also known as:<br />Degenerative Joint Disease<br />Osteoarthrosis<br />Hypertrophic Osteoarthritis<br />. <br />
  4. 4. Osteoarthritis<br />
  5. 5. Osteoarthritis<br />Primary Osteoarthritis:<br />Associated with gradual aging-related destruction of cartilage in joint-space.<br />Secondary Osteoarthritis<br />Usually secondary to trauma/overuse, repetitive strain, and subsequent faulty repair and regeneration of cartilage.<br />
  6. 6. Epidemiology of OA<br />The #1 joint-causing disorder that begins asymptomatically in the 20’s and 30’s and becomes extremely common by the age of 70.<br />By the age of 40 most people have some change in weight bearing joints, although relatively few have symptoms. <br />OA affects almost all vertebrates <br />
  7. 7. Osteoarthritis: Epidemiology<br />occurs in whales, dolphins, and porpoises.<br />Does not occur in Bats which hang upside down. <br />This finding suggest that it is an ancient Paleozoic mechanism of repair and remodeling rather than a disease in the usual sense.<br />
  8. 8. Osteoarthritis: how does it happen<br />A Cartilage trauma combined with<br />Faulty repair<br />Faulty regeneration<br />Faulty remodeling<br />Leading to <br />Deformed cartilage<br /> friction<br />Loss of function<br />
  9. 9. OA Symptoms<br />Gradual onset usually involving one or a few joints<br />Pain is the earliest symptom and is usually worsened with exercise and relieved by rest<br />Morning stiffness follows inactivity but lasts <15-30 minutes and lessens with movement<br />As OA progresses joint motion diminishes, tenderness and crepitus sensations appear and flexion contractures may occur.<br />Pathologic changes can cause joint enlargement<br />
  10. 10. OA symptoms<br />OA of the cervical and lumbar vertebrae<br /> can lead to myelopathy or radiculopathy<br />Hip OA is<br />Characterized by gradually increasing rigidity and loss of range of motion.<br />Pain may be felt in the inguinal (groin) area or referred to the knee<br />Knee OA<br />Cartilage is lost in the medial aspect in 70% of the cases<br />The ligaments become lax and the joint less stable with local pain arising from the ligaments and tendons<br />Tenderness on palpation and pain on passive motion are relatively late signs<br />Hands<br />the base of the thumb, where the thumb and wrist come together (the trapezio-metacarpal, or basilar, joint)<br />at the end joint closest to the finger tip (the distal interphalangeal or DIP joint)<br />at the middle joint of a finger (the proximal interphalangeal or PIP joint)It also often develops in the wrist. <br />
  11. 11. Osteoarthritis: Diagnosis<br />Diagnosis is confirmed by x‑rays.<br />Report may describe degree of joint space narrowing<br />Subchondral Sclerosis<br />Presence of osteophytes<br />Periodic X-rays useful in tracking progress of therapies.<br />
  12. 12. Treatment Options for Osteoarthritis<br />
  13. 13. Therapeutic Goals<br />Preserve Quality of Life by reducing disability<br />Reduce Pain and Inflammation<br />Prevent/Arrest cartilage degeneration (joint space narrowing)<br />Utilize conservative therapies for long-term management <br />Reduce reliance on NSAID Or Opiods<br />Prevent need for higher invasive therapies<br />
  14. 14. OA Treatment Strategy<br />Reduce aggravating factors promoting destruction of joint cartilage <br />Restore and maintain healthy joint biomechanics<br />Reduce pain and modulate chronic inflammatory state.<br />Stimulate healthy cartilage regeneration and repair<br />
  15. 15. OA Treatment: Ergonomics<br />Consider home devices such as grab bars in the tub enclosure, raised toilet seats<br />Avoid soft deep chairs and recliners from which arising is difficult<br />Avoid pillows under the knees as this encourages contractures<br />Sit in straight chairs without slumping<br />
  16. 16. OA Treatment :Ergonomics<br />Sleep in a firm bed with a bed board<br />Use a car seat designed for comfort<br />
  17. 17. OA treatment: Exercise<br />Exercise/Physical therapy: <br />Daily stretching important<br />Local application of moist heat especially before exercise s<br />Perform postural exercise<br />Resistance Training <br />Quadriceps strengthening important (for Hip and Knee)<br />Try not to immobilize (stay active)<br />Rest every 4-6 hours in the daytime to allow rehydraton of cartilage and balance with exercise and use<br />
  18. 18. OA treatment: Exercise<br />Cardiovascular Exercise to promote weight reduction/weight management<br />At least 5 days per week of 30 minutes at 70% of your maximum Heart Rate<br />Choose low impact forms of exercise<br />Walking, Golf, bicycle, elliptical, swimming,<br />cross country skiing nordic-track<br />Water jogging <br />
  19. 19. Manual Therapy<br /><ul><li> Muscle Release Therapy
  20. 20. Active Isolated Stretching
  21. 21. Neuromuscular Reeducation</li></li></ul><li>Therapeutic Exercise<br /><ul><li>Re-conditioning compensated muscle groups
  22. 22. Building a strong foundation of joint support
  23. 23. Reducing excess force on joints</li></li></ul><li>Acupuncture<br />May promote healing<br />May provide pain relief and improved joint function<br />
  24. 24. Diet: Low-inflammatory<br />Omega-3-rich diet<br />Wild-caught salmon<br />COD<br />Organic Vegetables and Fruit<br />5-7 servings are fruits and vegetables a day <br />Kiwi, Papaya, Pineapple<br />Limited Chicken and Cow Intake<br />Avoid Food Sensitivities (especially Nightshades)<br />Fiber rich (at least 30 g/day)<br />Low processed foods<br />Low simple sugars<br />No Transfats <br />
  25. 25. Neutraceuticals for OA<br />Glucosamine and Chondrotoin Sulfate <br />Niacinamide <br />May raise liver enzymes<br />Vitamin D (check levels through your Dr.)<br />
  26. 26. Polyunsaturated Fatty Acids (PUFAS)<br />Fish Oil<br />Contains omega-3 essential fatty acids<br />Choose mercury free<br />Marine Lipid Extract<br />Perna canniliculus<br />Green lipped mussels<br />Another form of PUFA’s<br />Always discuss Fish Oil supplementation with your Dr. as Fish Oil may interact with Blood Thinners.<br />
  27. 27. Supplementation: Cartilage protective/stimulatory?<br />Avocado Soybean Unsulfoniables (ASU)<br />A phytosterol that has been studied reduce pain and inflammation in OA.<br />It may protect further cartilage damage.<br />
  28. 28. Anti-inflammatory Proteolytic enzymes<br />Bromelain<br />Papain<br />Rutin<br />Peptizym<br />
  29. 29. OA treatments;Botanical Medicine<br />Anti-inflammatory herbs <br />Devils Claw<br />Willow Bark <br />Ginger<br />Turmeric<br />Note: some of these may interact with anti-coagulants, check with physician<br />
  30. 30. Antioxidant Supplementation<br />Usually can be obtained through a quality daily multivitamin<br />Vitamin C<br />Vitamin A<br />Vitamin K<br />Vitamin E<br />Selenium<br />Zinc<br />
  31. 31. Reduce InflammationIntraarticular Injections<br />Prolotherapy<br />growth factors or growth factor stimulator injections<br />Viscosupplemention<br />Hylagen (injectable synthetic hyularonic acid)<br />FDA approved for knee injection<br />Show effective for Knees (not yet for hips)<br />Corticosteroid Injections<br />
  32. 32. Drug interventions<br />Simple Analgesic<br />Acetaminophen (Tylenol) OTC pain relievers<br />Can prolong the halflife of warfafin<br />NSAID<br />Cox-2 Inhibitors (Celebrex)<br />Know the warnings (ie. Cardiovascular/Gastroinestinal)<br />Be assessed for risk of GI bleeding before taking <br />Know the risks of taking long term<br />Know when they are beneficial and when they are not.<br />Try and use for the shortest amount of time possible at the lowest effective dose.<br />Tramadol<br />Synthetic Central Acting Opoid <br />Used for severe pain<br />
  33. 33. Surgery<br />Knee Arthroplasty<br />Replacement usually has road-life of 10-12 years<br />Hip Arthroplasty<br />Usually last 20 years<br />
  34. 34. OA resources<br />Arthritis Foundation-Local Chapter<br />National Institute for Arthritis,Skin, and Musculoskelatal Disorders.<br />Health Clubs (International Health and Racquet Club)<br />Vitalchoices.com<br />Pioneer Grocery<br />
  35. 35. Adam Rinde, ND<br />Contact Information<br />Appointments: 425-889-5894<br />Email:drrinde@soundintegrative.com<br />Sound Integrative Health<br />

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