The document discusses osteoarthritis (OA), a degenerative joint disease characterized by cartilage alteration, with various treatment options available that do not rely solely on medications. Key treatment strategies include physical therapy, dietary changes, ergonomic adjustments, and supplementation, aiming to manage pain and preserve joint function. The importance of early diagnosis and lifestyle modifications to prevent joint degeneration is emphasized, along with resources for further support.

1. OsteoarthritisAdam Rinde, NDNaturopathic PhysicianSound Integrative Health7/11/08 @ Natures Pantry

2. Key PointsPain relief is available in a non-pill form!Joint replacement can be preventedYou can take charge of your pain

3. Osteoarthritis: DescriptionOsteoarthritis: a disease effecting any joint with associated alteration of cartilageAlso known as:Degenerative Joint DiseaseOsteoarthrosisHypertrophic Osteoarthritis.

4. Osteoarthritis

5. OsteoarthritisPrimary Osteoarthritis:Associated with gradual aging-related destruction of cartilage in joint-space.Secondary OsteoarthritisUsually secondary to trauma/overuse, repetitive strain, and subsequent faulty repair and regeneration of cartilage.

6. Epidemiology of OAThe #1 joint-causing disorder that begins asymptomatically in the 20’s and 30’s and becomes extremely common by the age of 70.By the age of 40 most people have some change in weight bearing joints, although relatively few have symptoms. OA affects almost all vertebrates

7. Osteoarthritis: Epidemiologyoccurs in whales, dolphins, and porpoises.Does not occur in Bats which hang upside down. This finding suggest that it is an ancient Paleozoic mechanism of repair and remodeling rather than a disease in the usual sense.

8. Osteoarthritis: how does it happenA Cartilage trauma combined withFaulty repairFaulty regenerationFaulty remodelingLeading to Deformed cartilage frictionLoss of function

9. OA SymptomsGradual onset usually involving one or a few jointsPain is the earliest symptom and is usually worsened with exercise and relieved by restMorning stiffness follows inactivity but lasts <15-30 minutes and lessens with movementAs OA progresses joint motion diminishes, tenderness and crepitus sensations appear and flexion contractures may occur.Pathologic changes can cause joint enlargement

10. OA symptomsOA of the cervical and lumbar vertebrae can lead to myelopathy or radiculopathyHip OA isCharacterized by gradually increasing rigidity and loss of range of motion.Pain may be felt in the inguinal (groin) area or referred to the kneeKnee OACartilage is lost in the medial aspect in 70% of the casesThe ligaments become lax and the joint less stable with local pain arising from the ligaments and tendonsTenderness on palpation and pain on passive motion are relatively late signsHandsthe base of the thumb, where the thumb and wrist come together (the trapezio-metacarpal, or basilar, joint)at the end joint closest to the finger tip (the distal interphalangeal or DIP joint)at the middle joint of a finger (the proximal interphalangeal or PIP joint)It also often develops in the wrist.

11. Osteoarthritis: DiagnosisDiagnosis is confirmed by x‑rays.Report may describe degree of joint space narrowingSubchondral SclerosisPresence of osteophytesPeriodic X-rays useful in tracking progress of therapies.

12. Treatment Options for Osteoarthritis

13. Therapeutic GoalsPreserve Quality of Life by reducing disabilityReduce Pain and InflammationPrevent/Arrest cartilage degeneration (joint space narrowing)Utilize conservative therapies for long-term management Reduce reliance on NSAID Or OpiodsPrevent need for higher invasive therapies

14. OA Treatment StrategyReduce aggravating factors promoting destruction of joint cartilage Restore and maintain healthy joint biomechanicsReduce pain and modulate chronic inflammatory state.Stimulate healthy cartilage regeneration and repair

15. OA Treatment: ErgonomicsConsider home devices such as grab bars in the tub enclosure, raised toilet seatsAvoid soft deep chairs and recliners from which arising is difficultAvoid pillows under the knees as this encourages contracturesSit in straight chairs without slumping

16. OA Treatment :ErgonomicsSleep in a firm bed with a bed boardUse a car seat designed for comfort

17. OA treatment: ExerciseExercise/Physical therapy: Daily stretching importantLocal application of moist heat especially before exercise sPerform postural exerciseResistance Training Quadriceps strengthening important (for Hip and Knee)Try not to immobilize (stay active)Rest every 4-6 hours in the daytime to allow rehydraton of cartilage and balance with exercise and use

18. OA treatment: ExerciseCardiovascular Exercise to promote weight reduction/weight managementAt least 5 days per week of 30 minutes at 70% of your maximum Heart RateChoose low impact forms of exerciseWalking, Golf, bicycle, elliptical, swimming,cross country skiing nordic-trackWater jogging

19. Manual Therapy Muscle Release Therapy

20. Active Isolated Stretching

21. Neuromuscular ReeducationTherapeutic ExerciseRe-conditioning compensated muscle groups

22. Building a strong foundation of joint support

23. Reducing excess force on jointsAcupunctureMay promote healingMay provide pain relief and improved joint function

24. Diet: Low-inflammatoryOmega-3-rich dietWild-caught salmonCODOrganic Vegetables and Fruit5-7 servings are fruits and vegetables a day Kiwi, Papaya, PineappleLimited Chicken and Cow IntakeAvoid Food Sensitivities (especially Nightshades)Fiber rich (at least 30 g/day)Low processed foodsLow simple sugarsNo Transfats

25. Neutraceuticals for OAGlucosamine and Chondrotoin Sulfate Niacinamide May raise liver enzymesVitamin D (check levels through your Dr.)

26. Polyunsaturated Fatty Acids (PUFAS)Fish OilContains omega-3 essential fatty acidsChoose mercury freeMarine Lipid ExtractPerna canniliculusGreen lipped musselsAnother form of PUFA’sAlways discuss Fish Oil supplementation with your Dr. as Fish Oil may interact with Blood Thinners.

27. Supplementation: Cartilage protective/stimulatory?Avocado Soybean Unsulfoniables (ASU)A phytosterol that has been studied reduce pain and inflammation in OA.It may protect further cartilage damage.

28. Anti-inflammatory Proteolytic enzymesBromelainPapainRutinPeptizym

29. OA treatments;Botanical MedicineAnti-inflammatory herbs Devils ClawWillow Bark GingerTurmericNote: some of these may interact with anti-coagulants, check with physician

30. Antioxidant SupplementationUsually can be obtained through a quality daily multivitaminVitamin CVitamin AVitamin KVitamin ESeleniumZinc

31. Reduce InflammationIntraarticular InjectionsProlotherapygrowth factors or growth factor stimulator injectionsViscosupplementionHylagen (injectable synthetic hyularonic acid)FDA approved for knee injectionShow effective for Knees (not yet for hips)Corticosteroid Injections

32. Drug interventionsSimple AnalgesicAcetaminophen (Tylenol) OTC pain relieversCan prolong the halflife of warfafinNSAIDCox-2 Inhibitors (Celebrex)Know the warnings (ie. Cardiovascular/Gastroinestinal)Be assessed for risk of GI bleeding before taking Know the risks of taking long termKnow when they are beneficial and when they are not.Try and use for the shortest amount of time possible at the lowest effective dose.TramadolSynthetic Central Acting Opoid Used for severe pain

33. SurgeryKnee ArthroplastyReplacement usually has road-life of 10-12 yearsHip ArthroplastyUsually last 20 years

34. OA resourcesArthritis Foundation-Local ChapterNational Institute for Arthritis,Skin, and Musculoskelatal Disorders.Health Clubs (International Health and Racquet Club)Vitalchoices.comPioneer Grocery

35. Adam Rinde, NDContact InformationAppointments: 425-889-5894Email:drrinde@soundintegrative.comSound Integrative Health