Osteoarthritis is a degenerative joint disease that is commonly treated through medications which can have serious side effects, while alternative treatments like exercise, nutritional supplements, and chiropractic care focus on reducing inflammation and maintaining proper joint function and mobility to slow the progression of the disease. Chiropractic care in particular works to correct vertebral subluxations that can immobilize joints and lead to osteoarthritis by restoring proper nerve function and joint movement. Maintaining chiropractic adjustments over a lifetime can help keep osteoarthritis from worsening by preventing permanent joint damage caused by immobilization.

1. Aging, Arthritis and the Chiropractic Lifestyle Presented By: Dr. Tim Henderson

2. What is Osteoarthritis? Historically osteoarthritis has been regarded as a common, slowly progressive disorder seen most often in the elderly that affects the weight bearing joints, the peripheral and axial articulations and the spine. Any notion or thought remotely associated with attenuating, arresting, or most certainly, reversing this condition, has been looked upon until recently as “heresy”.

3. Arthritis Arthritis is the name given to more than 100 different diseases that cause pain, swelling, and limited movement in joints and connective tissue. One out of every six Americans suffers from some form of arthritis, and unfortunately, the condition can last a lifetime. Rao JK, Mihaliak K, Kroenke K, et al. Use of complementary therapies for arthritis among patients of rheumatologists. Annals of Internal Medicine, Sept. 1999: Vol. 131, No. 6, pp409-16

4. Signs of Arthritis Bony enlargement Limitation of range of motion Crepitus (crunching or popping) on motion Tenderness on pressure Pain on motion Joint effusion/swelling Misalignment and/or joint deformity - SUBLUXATION Arthritis Rheum 1995;38(11):1535-1546

5. Symptoms of Arthritis Joint pain Morning stiffness Gel phenomenon Buckling or instability Loss of function Arthritis Rheum 1995;38(11):1535-1546

6. What Causes Osteoarthritis? OA can be divided into two categories, primary and secondary. In primary osteoarthritis, the degenerative process occurs after a person turns 40 or so. There comes a time in middle age when the processes that break down joint structures (catabolism) outpace the process that renews and repairs joint structures (anabolism).

7. What Causes Osteoarthritis? When this occurs, our joint health begins to decline. Primary OA is therefore a classic disease of aging.

8. What Causes Osteoarthritis? Secondary osteoarthritis is associated with macrotrauma from injury or microtrauma from chronic, often minor misalignments or motion aberrations, previous inflammatory joint diseases, or toxic exposures. Such joints tend to become "old" before their time, but the degeneration, though hastened, is believed to be essentially the same.

9. Traditional Treatment Options

10. DRUGS…Not Your Best Choice! Most sufferers continue to seek partial and temporary relief through nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, Motrin, or pain relievers like Tylenol.

11. Nonsteroidal Anti-Inflammatory Drugs "There's an epidemic of adverse drug reactions to NSAIDs. The Food and Drug Administration believes anywhere from 10,000 to 20,000 deaths each year are the result of severe bleeding caused by NSAIDs. It's a big problem.“ Quoted from Dr. James F. Fries, one of the country's leading arthritis experts and a professor of medicine at Stanford University School of Medicine. Marsa L. "America's Other Drug Problem," Los Angeles Times Magazine, September 29 1996.

12. Not Just Stomach Problems… Serious side effects of NSAIDS are not limited to gastrointestinal bleeding and ulceration, but also include hypertension; congestive heart failure; edema; and renal failure.

13. Medications Just averaging two aspirin a day from the age of 25 to 64 increases your chances of kidney disease by 900 percent! The bottom line is that each year, 20,000 die and tens of thousands more are hospitalized because of these medications.

14. What About Vioxx and Celebrex? If you watch any television at all you’ve probably seen the commercials for Vioxx or Celebrex, two extremely popular arthritis drugs. Millions of Americans take these drugs to reduce arthritis and joint pain. Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. Journal of the American Medical Association, August 22/29, 2001:286(8), pp. 954-959.

15. Vioxx & Celebrex These drugs, classified as cyclooxygenase 2 (COX-2) inhibitors, are a second generation of anti-inflammatory drugs that have gained popularity, in part because they do not cause digestive problems, unlike their predecessors. However, new research shows that COX-2 inhibitors may increase your risk of developing a cardiovascular disease. Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. Journal of the American Medical Association, August 22/29, 2001:286(8), pp. 954-959.

16. Vioxx & Celebrex The first study showed that Vioxx increased the risk of cardiovascular events, such as heart attack or stroke, almost two-and-a-half times. Two other smaller studies also suggested a relationship between Vioxx and these conditions. Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. Journal of the American Medical Association, August 22/29, 2001:286(8), pp. 954-959.

17. Vioxx & Celebrex The second study reviewed indicated an increased risk for cardiovascular events in COX-2 users, but was inconclusive because of minimal data. If you currently use either of these drugs, it’s especially important to monitor potential adverse changes to your heart. If possible, find alternative ways to deal with arthritis pain.

18. Alternative Treatment Options

19. The Effects of Exercise on Arthritis… A recent study in the Annals of the Rheumatic Diseases evaluated the effects of an exercise program on hip- and knee-osteoarthritis patients after three months of ongoing exercise therapy, and three and six months after conclusion of therapy. Van Baar ME, Dekker J, Oostendorp RAB, et al. Effectiveness of exercise in patients with osteoarthritis of hip or knee: Nine months' follow up. Annals of the Rheumatic Diseases 2001:60, pp. 1123-1130.

20. The 200 patients were divided into two groups. Both groups were administered education and drug treatment, but only one group completed 12 weeks of therapist-supervised strength, mobility, and coordination exercises, one-to-three times per week. Patients in both groups rated their pain weekly. The Effects of Exercise on Arthritis… Van Baar ME, Dekker J, Oostendorp RAB, et al. Effectiveness of exercise in patients with osteoarthritis of hip or knee: Nine months' follow up. Annals of the Rheumatic Diseases 2001:60, pp. 1123-1130.

21. The exercise group showed decreased pain compared to the non-exercise group during the training period, as expected. However, the maximum beneficial reduction in pain in the exercise group occurred at the end of the exercise program, and declined steadily over the remaining six months of the study. Three months after discontinuing exercise, the exercise group still showed only a "small to moderate" reduction in pain; six months later, both groups showed similar pain levels. The Effects of Exercise on Arthritis… Van Baar ME, Dekker J, Oostendorp RAB, et al. Effectiveness of exercise in patients with osteoarthritis of hip or knee: Nine months' follow up. Annals of the Rheumatic Diseases 2001:60, pp. 1123-1130.

22. These results are similar to those of other studies on the residual effects of exercise on osteoarthritis. If you have osteoarthritis of the hip or knees, maintaining a consistent exercise pattern can reduce your pain. A half-hour of aerobic exercise, three days per week, appears to generate the largest decreases in pain. The Effects of Exercise on Arthritis… Van Baar ME, Dekker J, Oostendorp RAB, et al. Effectiveness of exercise in patients with osteoarthritis of hip or knee: Nine months' follow up. Annals of the Rheumatic Diseases 2001:60, pp. 1123-1130.

23. Nutritional Supplementation The Major Players: Glucosamine Sulfate (GS) Chondroitin Sulfate (CS) Methyl-sulfonyl-methane (MSM) cetyl myristoleate (CM, CMO and CM+). The Minor Players: emu oil; SAM-e; lyprinol; niacinamide; glutathione precursors; enzymes; stabilized orthosilicic acid; or herbs

24. Glucosamine Sulfate (GS) Glucosamine, synthesized from the amino acid glutamine and glucose, is one of the building blocks of connective tissue. (CARTILAGE) It inhibits the breakdown of cartilage, stimulates cells that make cartilage, and helps hydrate the cartilage between the joints.

25. Glucosamine Sulfate (GS) This helps keep them like young healthy cartilage; i.e., moist, springy, smooth and slippery, so to speak. Specifically, glucosamine acts as the foundation for cartilage compounds that trap, hold and structure water in cartilage known as glycosaminoglycans (GAGs), mucopolysaccharides, and proteoglycans.

26. Chondroitin Sulfate (CS) Chondroitin sulfate is the substance that gives cartilage (the spongy portion of bone) its elasticity and fluidity, suggesting its potential usefulness in influencing bone strength. Leeb FG, Scheweitzer H, Montag K, et al. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. Journal of Rheumatology, Jan. 2000: Vol. 27, pp205-211.

27. Chondroitin Sulfate (CS) A recent study reviewed previous controlled trials of CS in the treatment of hip and knee osteoarthritis (OA), finding that: In seven reviewed trials, reported pain was only 57% of original baseline scores in groups taking CS; and Patients taking CS reported reductions in consumption of nonsteroidal anti-inflammatories (NSAIDs) and/or analgesics compared to baseline. Leeb FG, Scheweitzer H, Montag K, et al. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. Journal of Rheumatology, Jan. 2000: Vol. 27, pp205-211.

28. According to the European Journal of Rheumatological Inflammation (13:7-16, 1993) and others, NSAIDs impair glycoaminoglycan (GAG) production from cartilage-producing cells known as chondrocytes. In other words, GS and CS reduce pain and protect joint health, whereas NSAIDs reduce joint pain but likely compromise joint health. Naprosyn, for example, is known to increase the speed of deterioration of the hip joint, necessitating hip replacement surgery sooner then might otherwise be the case.

29. Chondroitin Sulfate Dosage Dosage is related to size, and is usually from 1,200 to 2,000 mg for 6-8 weeks. It takes about that long for it to work. If it does not work by then, it likely won't. If it does, the dosage is continued long-term at 400 to 800 mg per day.

30. Methyl-sulfonyl-methane (MSM) An organic source of sulfur and a relative of DMSO, the infamous solvent liniment used on racehorses with joint pains. Because sulfur is necessary for the formation of connective tissue, and because MSM is 34 percent organic sulfur, MSM has been widely studied for its use in arthritis and other complications of joint inflammation.

31. Methyl-sulfonyl-methane (MSM) The results of several studies showed that when supplementing with MSM, joint degeneration and inflammation was significantly decreased.1,2,3 MSM is found in some unprocessed, uncooked foods, especially unpasteurized milk, with small amounts in fruits, vegetables and grains. 1. Ann of the NY Acad of Sciences. 411, 1983. 2. Fed Proc. 44:530m, 1985. 3. J Lab Med.110:1,1987.

32. Methyl-sulfonyl-methane (MSM) Sulfur is vital for healthy skin, nails and hair, and is an essential nutrient for joint tissue, where it functions in the stabilization of the "ground substance," the connective tissue matrix of cartilage, tendons and ligaments. Sulfur is necessary for the production of the disulfide bonds responsible for the rigidity and strength of connective tissue. Sulfur is needed for the body to make chondroitin sulfate!

33. Cetyl Myristoleate (CM, CMO and CM+) In recent human studies, cetyl-myristoleate has proven effective when given orally. A double-blind, placebo-controlled multi-center hospital human study with 431 arthritic patients revealed that 63 percent of those who took 18 grams per month (two capsules, 500 mg, yielding 100 mg pure CMO, three times daily) of the cetyl-myristoleate formula had an improvement in symptoms. Murray RK, Granner DK, Mayes, PA & Rodwell VW. Harper's Biochemistry. 1993. pp. 131-141.

34. Cetyl Myristoleate (CM, CMO and CM+) These results were significantly enhanced when the patients applied a CMO cream topically and supplemented with a complementary joint formula containing glucosamine sulfate. An astounding 87 percent of the patients showed improvement when they utilized the three-step cetyl-myristoleate and glucosamine sulfate protocol. Murray RK, Granner DK, Mayes, PA & Rodwell VW. Harper's Biochemistry. 1993. pp. 131-141.

35. Aging, Arthritis & The Chiropractic Lifestyle

36. Alternative Medicine In 1997, Americans made an estimated 629 million visits to practitioners of "complementary and alternative medicine" (CAM), compared with just 388 million visits to primary care physicians that same year. A study published in the Annals of Internal Medicine found that many arthritis patients used CAM, and that chiropractic was the most frequently used type of care. Rao JK, Mihaliak K, Kroenke K, et al. Use of complementary therapies for arthritis among patients of rheumatologists. Annals of Internal Medicine, Sept. 1999: Vol. 131, No. 6, pp409-16

37. Arthritis & Chiropractic Care Before we can understand the connection between arthritis, aging and chiropractic care, we must first understand what coordinates every function within the body.

38. The Nervous System “Every function of the human body is under the control of the nervous system. Its function is to coordinate all the other organs and structures and to relate the individual to his environment.” Gray’s Anatomy, 29th edition, p. 4

39. The Nervous System The Brain is protected by the skull, and the spinal cord is surrounded by 24 moveable vertebrae – these are like the circuit breakers of the nervous system. Your brain monitors every cell, muscle, gland, organ, and system in your body by sending and receiving information via the spine. Cervical Region Thoracic Region Lumbar Region

40. Normal vs. Abnormal

41. That’s where Chiropractic comes in! Chiropractors are the only doctors in the world that are specifically trained to locate, analyze, and correct vertebral subluxations . Subluxations are vertebrae that have misaligned and cause nerve interference.

42. Vertebral Subluxations When vertebrae (our body’s circuit breakers) become misaligned (subluxated), they interfere with our nervous system and therefore the brain’s ability to send and receive essential information.

43. How Does This Relate To Arthritis? The journal Clinical Biomechanics reported as far back as 1987 that joint immobility, such as that which occurs in the Vertebral Subluxation Complex, can lead to permanent damage in as little as two weeks. “ With respect to patients, it can be postulated that immobilization, for whatever cause, will initiate a pathogenic [disease producing] chain of musculo-skeletal degenerative changes.”

44. How Does This Relate To Arthritis? A joint immobilized (as in a subluxation) one day a week for 14 weeks shows the same amount of damage as one immobilized for 14 days in a row. The damage accumulates over all the time the joint was immobilized.

45. How does this relate to Chiropractic? When a spinal subluxation occurs, the joints become stuck or immobile, unable to move in their normal range of motion and the degenerative process known as osteoarthritis begins…

46. Normal vs. Abnormal

47. How does this relate to Chiropractic? According to Videman, if this immobility is not corrected within two weeks, the osteoarthritis becomes PERMANENT. These permanent changes can't be reversed but they can be kept from getting worse by restoring the mobility to the stuck joint.

48. This is one reason why a lifetime of Chiropractic Wellness Care is so important.

49. Chiropractic Care The September 21, 1999 issue of The Annals of Internal Medicine reports that chiropractic is the most popular and by far the most effective of the wellness disciplines for patients suffering from rheumatologic diseases such as arthritis and fibromyalgia.

50. Chiropractic Care The reasons given by the patients for incorporating the wellness disciplines into their treatment plan were: To alleviate their pain; Their medication wasn’t working; They heard it helped someone else; It’s safe

51. Chiropractic Care Chiropractic users were less likely to have been hospitalized, less likely to have used a nursing home, more likely to report a better health status, more likely to exercise vigorously, and more likely to be mobile in the community. In addition, they were less likely to use prescription drugs COULTER, I.; HURWITZ, E.; ARONOW, H.; CASSATA, D.; BECK, J.; Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion Program TOPICS IN CLINICAL CHIROPRACTIC. 1996 JUN Vol. 3(2) Pgs. 46-55

52. Chiropractic Care A study published in the October, 1995 New England Journal of Medicine finds that patients are much more satisfied with the care given them by their Chiropractor than those who went to medical doctors. The Outcomes and Costs of Care for Acute Low Back Pain among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons; Timothy S. Carey, M.D., M.P.H., Joanne Garrett, Ph.D., Anne Jackman, M.S.W., Curtis McLaughlin, D.B.A., John Fryer, Ph.D., Douglas R. Smucker, M.D., M.P.H., for The North Carolina Back Pain Project ; NEJM, Volume 333:913-917 October 5, 1995 Number 14

53. Chiropractic Care Chiropractic patients not only reported less pain than hospital patients at six weeks, but three years later chiropractic patients reported a 29% greater improvement with chiropractic compared to hospital treatment. The most dramatic improvements were associated with pain reduction, but many of the factors that contribute to the quality of life were affected by chiropractic care. Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up; T W Meade, Sandra Dyer, Wendy Browne, and A O Frank; BMJ 1995; 311: 349-351

54. Chiropractic Care Sitting for more than a short period of time and sleeping showed the most significant improvement, but scores such as personal care, lifting, walking, standing, sex life, social life, and ability to travel also improved. Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up; T W Meade, Sandra Dyer, Wendy Browne, and A O Frank; BMJ 1995; 311: 349-351

55. In Summary: To delay, or even reverse the structural and functional decline associated with aging, one must facilitate anabolic processes and inhibit catabolic processes. To accomplish this, the following should be considered as part of an overall joint anti-aging program: Supporting anabolic processes Resisting catabolic processes Optimizing internal anti-inflammatory potential

56. Anabolic Processes Support anabolic processes that support cartilage, tendon and ligament renewal and repair by: Maintaining moderate activity, enjoying adequate rest, and good nutrition; Supplementing glucosamine, chondroitin sulfate and/or MSM; and Maintaining the anabolic hormones of youth, specifically growth hormone, which may have a complementary role.

57. Catabolic Processes Resist catabolic processes by: Minimizing oxidative stress via good health habits; and Maximizing antioxidant status via dietary and supplemental antioxidants.

58. Internal Anti-Inflammatory Potential Optimize internal anti-inflammatory potential by: Controlling saturated fat intake; and Optimizing omega-3 fatty acid intake.

59. Pre-existing OA Should symptomatic OA already exist, or continue in spite of the above joint nutrition and health program: Consider natural products that control inflammation that are low in side effects and positively effect joint health, over side-effect-laden nsaids, which have long-term negative impact on joint repair mechanisms.

60. Chiropractic Care Chiropractic adjustments maintain proper nerve supply and spinal integrity. It's never too late to start.

61. ANY QUESTIONS?