Archive for osteoarthritis
Alternative Therapies for Traditional Disease States: Osteoarthritis
This is a nice review article for some of the natural approaches to OA. However, they don’t mention MSM, which is an important sulfur donor (sulfur is needed to form cartilage).
Alternative Therapies for Traditional Disease States: Osteoarthritis – January 15, 2003 – American Family Physician
Glucosamine Sulfate Use Delays Progression of Knee Osteoarthritis
While this is probably not a surprise to many, I thought I would include this. For the amount of evidence supporting its safety and effectiveness, this nutrient is still not used to the full extent it should be. Interesting that there are no huge news releases from major orthopedic associations such as “glucosamine use should be expanded to include patients with these indicators…” such as we see frequently with pharmaceutical drugs such as cholesterol lowering meds.
Epidurals are handed out like candy in this country. We assume that, much like surgery and medications, that there are hordes of research studies documenting the effectiveness of this intervention.
Regular readers of the Rantings and any chiropractor out there will tell you this couldn’t be further from the truth.
Yet this doesn’t seem to stop primary care doctors from referring patients out for epidurals long before they would consider a referral to a chiropractor (data from a major insurance company in the US notes that a measly 6.6% of non-surgical spine episodes that do not begin with a chiropractor will ever be referred to one for care, and even then this is VERY late in the episode).
Possibly this lack of referral is because primary care doctors don’t think there is research supporting chiropractic care (not true). But this doesn’t seem to halt the referral to pain management centers to perform expensive, invasive procedures with evidence actually against their use that carries a much higher risk than manipulation.
Just seems strange to me.
That’s not to say that I don’t believe epidurals have a place in medicine, because I do. I have referred non-responsive patients out for them in the past, but they are few and far between and always for leg pain that is consistent with a disc herniation. This scenario is a far cry from what is happening in the arena of low back pain in mainstream medicine today.
I can’t tell you how many times I’ve had patients sent for epidurals for isolated low back pain with no leg pain involvement. Ugh!!
But what about leg pain associated with spinal stenosis-a condition where advanced arthritis of the spine begins to choke off the room for the nerves going into the leg?
Just recently I had just such a case. After the 2nd visit using Flexion-Distraction he had absolutely no response to treatment. So on the 3rd visit I really ramped up the agressiveness of the treatment with instructions to only return for additional treatment if he noted improvement after this visit.
I was fully expecting to have a discussion about a referral to pain management for this patient. Luckily, that last treatment broke through the barrier and he had a pretty substantial improvement. His outcome is going to be good.
But what if it wasn’t? What if the 3rd visit didn’t help? I’ve had stenosis patients in the past who did not have a strong response. They are few, but they happen. An epidural would seem to me to be a better option than referring that patient out for a surgical consult.
At least that’s what I thought until I came across this particular article.
The premise of this study was that the use of an epidural spinal injection for spinal stenosis patients would lower the need for, or at least delay, surgery. Boy, were they surprised.
In looking at a group of patients who had an epidural spinal injection in the first 3 months of the trial versus those who did not, there were some enlightening findings:
- Those who received the epidurals had a much higher preference for avoiding surgery (62% versus 33%).
- In those who got the epidural but ultimately ended up in surgery there was a 26-minute increase in operative time and an increased length of stay by 0.9 days.
- Over 4 years, there was 34% less improvement in overall quality of life (measured using the 36-Item Short Form Health Survey (SF-36) Physical Function) among the epidural patients that ended up having surgery.
- There was less improvement in the epidural patients (56% less on Body Pain and 64% Physical Function).
- Of the patients who were initially in the non-surgery group, those who had an epidural were 45% more likely to switch to the surgical group.
- On the only positive note, the patients who were originally in the surgery group who got the epidurals were 1/3 less likely to actually follow through with surgery.
Wow! Talk about nullifying a hypothesis!
I think that we, as a society, need to really rethink what steroids might be doing to our ability to heal, and accept the fact that the use of steroids applied directly to sensitive spinal structures may very well be doing far more harm than good.
Just my two cents (and a lot of medical research, too…).
Fitness, fatness, activity as predictors of bone density in older persons
This article may be surprising to some, but really fits right in with research that has been piling up in regards to exercise in our senior population. This study does not show a protective effect of light aerobic exercise on bone mass. This supports the need for weight/resistance training in all age groups. I’ve really began pushing the addition of this type of training in all my senior patients. I do find that the more exercise a patient does as they get older, the healthier, happier and less medicated they are. My favorite story I like to relay is about Jim, a patient in his upper 70′s. He relays how much weight he lifts daily in the thousands of pounds (all added up, it’s not an unrealistic number at all). He has arthritis but never feels it, no medications and is mentally as alert as any fifty year old.
Green Tea Inhibit Bovine, Human Cartilage & Collagen Degradation
Add green tea to the list of chondroprotective substances. I always strongly recommend green tea as a substitute for those patients desperately looking to cut back on soda.
Nutrition.org — Abstracts: Adcocks et al. 132 (3): 341.
Hyaluronate Sodium Injections for Osteoarthritis
This is a nice review on this subject. Unfortunately, the results do not appear to be quite favorable. I have seen mixed results in patients that have had this procedure done. If anyone does ask me about this procedure, I always try to push them towards the preparation without the formaldehyde (hyaluronic acid) vs the formulation with (Syn-Visc). I do hope that this idea can somehow be modulated in the near future to increase the efficacy of the procedure.
Hyaluronate Sodium Injections for Osteoarthritis: Hope, Hype, and Hard Truths.
Effectiveness of Leech Therapy in Osteoarthritis of the Knee
Okay. I’m not saying I am going to start using this in my office, but I thought the article was quite interesting. Many times, gross, disgusting approaches are actually quite effective. Maggots have been used to save limbs that would otherwise have been lost to infection. I remember when my wonderful keeshound had severely injured his tail this summer. It did not look good and I kept it wrapped. To my dismay, several days later I unwrapped the bandage to replace it and maggots had infested the bandage. However, the wound was looking incredibly well.
Ann Intern Med — Abstracts: Michalsen et al. 139 (9): 724.
Everyone wants an MRI. It’s cool to take a peek inside your body without the downsides of autopsy. But for knee osteoarthritis symptoms does an MRI help anything?
Regular readers of the Rantings know how I feel about ordering imaging before it’s necessary. It doesn’t matter what region of the body it’s in; sometimes TOO much information is not a good thing.
We have already seen studies suggesting that the rates of knee replacements are increasing, but there has been no change in the amount of knee osteoarthritis seen on imaging. What this strongly suggests is that knee osteoarthritis may not be the problem in a large chunk of the cases of knee pain.
For those providers that treat the soft tissues (and no–I’m not talking about exercises and electric stim here–these techniques do NOT treat the soft tissues), this comes as no surprise at all.
I firmly believe, based on the research and my own clinical experience, that most knee pain does not come from arthritis, but rather from pain being created in the soft tissues (muscles, ligaments, tendons, fascia) surrounding the knee joint as well as the imbalance and altered stress placed upon the joint by these damaged soft tissues.
This particular study adds weight to my thought process. Researchers looked at a group of patients who were older than 50 and had no signs of knee osteoarthritis on X-rays. They then examined this group using MRI images of knee and looked for findings that are consistent with osteoarthritis. These included:
- osteophytes (also known as bone spurs)
- cartilage damage
- bone marrow lesions
- subchondral cysts
- meniscal lesions (usually described as a torn meniscus)
- attrition (a wearing down of the joint surface)
- ligament lesions
What they were basically doing was looking at MRI as a tool to see how well findings on an MRI compared with what the patient was experiencing. Here’s what they found:
- 89% of the group had at least one abnormality noted above (osteophytes were the most commonly found at 74%, followed by cartilage damage in 69% and bone marrow lesions in 52%.
- As expected, the higher the age, the higher the prevalence of abnormalities.
- The likelihood of at least one type of abnormality was high in both painful (97%) and painless (88%) joints.
The last point being the most important. Basically, over the age of 50, a MRI becomes less and less important, and may actually lead the unsuspecting physician to recommend a more invasive procedure (injection or worse–knee replacement).
The bottom line is that just because you have something wrong on your MRI, particularly as you get older, does not really mean anything. If you have knee pain, my biased opinion would be to find a chiropractor that specializes in soft tissue treatment (Graston, Nimmo / Trigger point, NMR, Active Release, Fascial Manipulation, etc…) before you do anything else.
It is always worth trying this approach first. If it does not help, you can still opt for more invasive procedures. But the reverse doesn’t work so well…
If you had a knee replacement, was soft tissue treatment recommended to you before the surgery?
Telopeptides as markers of bone turnover in rheumatoid arthritis and osteoarthritis
This is an interesting route of attack on a different way to measure disease severity with RA. Using the breakdown products of bone in the urine as a way to check bone status is by no means new. But in this study, these bone turnover markers were used to determine the severity of inflammation in rheumatoid arthritis, since RA attacks the cartilage of a joint and to a certain extent the underlying bone.
Telopeptides as markers of bone turnover in rheumatoid arthritis and osteoarthritis – Internal Medicine Journal, Vol 34, Issue 9-10, pp. 539-544 -
We want to live life to our fullest; this means no arthritis pain. Many use drugs for arthritis relief, but safety is a concerns. Is ginger good for joint relief?
Mother Nature knew what she was doing. Us–not so much.
It seems like anytime we try to mess with nature we screw things up. Anti-inflammatories are certainly on this list. Here is how things usually work:
- Nature makes a compound that positively effects some pathway in our body. This effect is usually subtle and takes time for the effect to show, but has a very good safety profile for long term use.
- Scientists find said natural compound and modify it so that it has a strong short term effect but thus becomes dangerous in the long run.
Overall, the drug companies try to find compounds that have the greatest effect at the lowest concentrations. They want compounds with as high of a LD50 as possible (the LD50 is the level at which the compound kills 50% of the study participants). But they all will kill at high enough dosages (even water can kill if you stuff enough of it in our bloodstream).
While the list of problems associated with anti-inflammatories (specifically the NSAID class of drugs) is quite long and has been addressed in prior posts that can be read here, suffice it to say that I consider this one of the most dangerous classes of drugs, resulting from a combination of the broad spectrum of subtle side effects combined with the near-universal belief in their safety by the general population.
There are many natural, unadulterated compounds that have been shown to lower inflammation and have solid research behind them. Curcumin / turmeric, boswellia, cat’s claw and proteolytic enzymes to name a few. Ginger is also on the list.
This particular study looks at the effectiveness of ginger to both control pain associated with arthritis as well as protect the lining of the stomach (a MAJOR concern with NSAIDs). It was compared with diclofenac (Voltaren), a common anti-inflammatory used for arthritis pain.
The safety profile of ginger was, as expected, much better on the stomach than the diclofenac. Surprisingly, the pain relief was equivalent in both groups (as measured by the Visual Analog Scale, or VAS).
If you have tried ginger for arthritis relief, what was your experience?