Osteoarthritis (OA) is the most common form of arthritis. It has been estimated that more than 20 million Americans are afflicted with OA, and that number will rise to 40 million by the year 2020.

In recent months there has been a contentious debate between cardiologists and rheumatologists regarding the use of non-steroidal anti-inflammatory drugs (NSAIDS) for OA. Behind this disagreement is controversy that exists as to the safest and most effective way of treating OA, particularly with respect to the use of NSAIDs, both non-selective and selective (so-called COX-2 selective agents or coxibs). Adverse reactions related to the gastrointestinal tract, particularly with the non-selective NSAIDs, have been described. And, more recently, concerns have been raised regarding cardiovascular events with both groups of agents.

A recent scientific statement from the American Heart Association (AHA) made recommendations with regard to the treatment of OA. (E.M. Antman, J.S. Bennett, A. Daugherty, C. Furberg, H. Roberts, K.A. Taubert, Use of nonsteroidal antiinflammatory drugs. An update for clinicians: a scientific statement from the American Heart Association, Circulation. 2007;113:2906-2913). The recommendations come in the form of guidelines. These include:

COX-2 inhibition can result in an increased risk for thrombosis due to increased activity of thromboxane A2 and reduced activity of prostacyclin. In addition, all NSAIDs can increase sodium and water retention, increasing the risk for exacerbations of hypertension and heart failure. Finally, COX-2 up-regulation may reduce myocardial ischemia and infarction during acute cardiac events, and inhibition of this isoenzyme can increase infarct size and lead to myocardial rupture.

”Nonselective” NSAIDs also differ with regard to COX selectivity. Diclofenac has greater COX-2 selectivity than ibuprofen, which in turn has greater COX-2 selectivity compared with naproxen.

Initial treatment of musculoskeletal pain should include nonpharmacologic therapy, including physical therapy, heat/cold, and orthotics. Acetaminophen and aspirin are probably the best initial choices for analgesia, although these agents should be used at the lowest possible dose for the shortest possible period.

For patients who fail conservative therapy for musculoskeletal pain, NSAIDs may be chosen as a next step. Clinicians and patients should realize that the use of NSAIDs may slightly increase the risk for cardiovascular and cerebrovascular events. With this in mind, clinicians should try to use NSAIDs with lower selectivity for COX-2.

Naproxen is probably the NSAID associated with the lowest risk for thrombosis. The Alzheimer’s Disease Anti-inflammatory Prevention Trial (ADAPT) questioned the safety of naproxen, but this trial had significant limitations.

Patients with a history of gastrointestinal tract bleeding or who are at high risk for bleeding who require analgesia should be prescribed acetaminophen first. For these patients who require NSAID therapy, proton-pump inhibitors have been demonstrated to reduce the risk for recurrent gastrointestinal tract bleeding among patients receiving low-dose aspirin.

Patients with active atherosclerotic processes are at increased risk for the thromboembolic complications of COX-2 inhibitors. Renal function and blood pressure should be monitored during treatment with COX-2 inhibitors.

Ibuprofen, but not acetaminophen or diclofenac, appears to reduce the physiologic efficacy of aspirin in preventing thrombosis. Current recommendations call for delaying ibuprofen dosing until at least 30 minutes after taking aspirin or at least 8 hours prior to aspirin dosing.

The upshot? Use NSAIDS for OA as a last resort!

In an editorial in the journal, Osteoarthritis and Cartilage, a panel of arthritis research experts has vehemently- and not surprisingly- disagreed with these proposals.

The editorial summarizes the outcomes of an international workshop organized by the Osteoarthritis Research Society International (OARSI) and the International COX-2 Study Group, held 24–25 March 2007. (R.W. Moskowitz, S. Abramson, F Berenbaum, L.S.Simon, M. Hochberg, Coxibs and NSAIDS – Is the air any clearer? Perspectives from the OARSI international COX-2 workshop 2007, Osteoarthritis and Cartilage. 2007;15:849-856).

The authors urge that an evidence-based approach must be taken when making recommendations to patients.

The editorial questions the recommendation made in the AHA statement which described a stepped care approach to pharmacologic therapy for musculoskeletal diseases.

The authors also strongly recommend that several aspects of the AHA statement be reconsidered. For example, they urge that the AHA withdraw their non-evidence-based recommendations that high-dose aspirin be administered alone as a first line therapy for patients with chronic pain and arthritis.

Dr Roland W. Moskowitz, Professor of Medicine at Case Western Reserve University/University Hospitals of Cleveland and the lead author of the editorial commented, “Careful review of the pros and cons of using these agents, and the situations in which they are most safely and effectively used, is required to help us understand how best to take advantage of their availability”.

The upshot of this whole discussion is that rheumatologists and cardiologists differ in their approach. It becomes an issue of gut feeling versus evidence. What needs to be considered is not only data regarding cardiovascular risk which is still far from clear but also the effects on the quality of life for patients with OA. Stay tuned!

Osteoarthritis also called degenerative joint disease is the most common type of joint disease . It is characterized by the progressive erosion of articular cartilage. Billions of dollars are spent annually for its treatment and for lost days of work. The term osteoarthritis implies an inflammatory disease. Although inflammatory cells may be present osteoarthritis is considered to be an intrinsic disease of cartilage in which biochemical and metabolic alterations result in its breakdown.

In the great majority of instances , osteoarthritis appears insidiously, without apparent initiating cause as an aging phenonmenon (idiopathic or primary osteoarthritis). In these cases, the disease is usually oligoarticular ( affects few joints) but may be generalized. In about 5% of cases osteoarthritis may appear in younger individuals having some predisposing conditions, such as previous macrotramatic or repeated microtramatic injuries to a joint; a congenital developmental deformity of a joint(s) or some underlying systemic disease such as diabetes, ochronosis, hemochromatosis, or marked obesity. In these settings, the disease is called secondary osteoarthritis and often involves one or several predisposed joints- witness the shoulder or elbow involvements in baseball players and knees in basketball players. Gender has some influence on distribution. The knees and hands are more commonly affected in women and the hips in men.

The association between osteoarthritis and aging is nonlinear the prevalence increase exponentially beyond the age of 50. About 80% to 90% of individuals of both male and female have evidence of osteoarthritis by the time they reach age 65. Thus osteoarthritis joins heart disease and cancer as one of the dividends of growing older. The age related changes in cardilage include alterations in proteoglycans and collagen which decrease tensile strength and shorten fatigue life. Despite this relationship, it is an over simplification to consider osteoarthritis as merely a disease of cartilage wear and tear. Chondrocytes play a primary role in the process and constitute the cellular basis of the disease. For example chondrocyte in osteoarthritic cartilage produce IL-1 TNF-alpha which are known to stimulate the production of catabolic metalloproteinases and inihibit the synthesis of both type 2 collagen and proteoglycans. The effects of these cytokines are potentiated because their receptors show increased sensitivity Other mediators such prostaglandin derivatives and IL. 6, also have a role in this cascade of matrix degradation. Most of these cytokines also have proinflammatory properties and inflammatory cells are present in many osteoarthritic joints. The precise events that lead to the secretion of cytokines however are not clear.

Clinical Course

Osteoarthritis is an insidious disease. Patients with primary disease are usually asymptomatic until they are in their fifties. If a young patient has significant manifestations of osteoarthristis, a search for some underlying cause should be made. Characteristic symptoms include deep,achy pain that worsen with use morning stiffness crepitus and limitation of range of movement. Impingement on spinal formina by osteophytes results in cervical and lumbar nerve root compression with radicular pain muscle spasms, muscle atrophy and neurologic deficits. Typically only one or a few joints are involved except in the uncommon generalised variant. The joints commonly involved include the hips , knees lower lumbar and cervical vertebrate, proximal and distal interphangeal joints of the fingers, first carpometacarpal joints, and first tarsometartarsal joints of the feet.

Characteristic in women but not in men are Heberden nodes in the fingers representing prominent osteophytes at the distal interphalangeal joints. The wrists, elbows, and shoulders are usually spread. There are still no statisfactory means of preventing primary osteoarthritis and there are no methods of halting its progression. The disease may stabilize for years halting its progression. The disease may stabilize for years at any stage but more often is slowly pregressive over the remaining year of life and is second only to cardiovascular disease in causing long term disability.

The effectiveness of herbal remedies for arthritis sufferers varies from person to person, so you may need to experiment a bit. Try one of the following treatments.

Take a combination tincture of meadowsweet, willow bark, black cohosh, prickly ash, celery seed, and nettle to help temper arthritis symptoms. To make the blend, mix equal amounts of the tinctures; take 1 teaspoonful of the mixture 3 times daily. The blend is safe and can be taken for a period of time.

Use yucca and devil’s claw to reduce inflammation. Other herbs to try include licorice, alfalfa, turmeric, ginger, skullcap, and ginseng.

Rub a tincture of lobelia and cramp bark over the sore areas to decrease muscle tension.

Take a combination of 2 parts of willow bark, 1 part of black cohosh, and 1 part of nettle to ease aches and pains.

Rub cayenne over the affected joints to lessen pain.

Herbal products are available in health food stores and in some pharmacies and supermarkets. Follow package for specific directions.

Homeopathy

Osteoarthritis may respond to homeopathic treatment. However, the selection of a remedy-more than one is available-depends on your symptoms and the stage of the condition. Don’t try treating this disorder yourself. See a homeopathic professional.

Hydrotherapy

Warm, moist heat packs used for 10 to 20 minutes every 4 hours can bring Welcome relief from stiffness and deep pain. Exercises performed in heated water and swimming have also been effective. Drink distilled water to help absorb and eliminate mineral salts and other waste products throughout the skin.

Traditional Chinese Medicine

Acupuncture According to the WHO, acupuncture is a vital addition to the arthritis fighting arsenal. Acupuncture can be used to help restore the body’s energy balance, and it can also help lessen the pain and inflammation that commonly occur in the hands, hips, knees, and spinal joints of osteoarthritis patients. Many doctors now use acupuncture in conjunction with chiropractic techniques when treating osteoarthritis, and it has been used for centuries with Chinese manipulative techniques.

To treat hand and finger pain, the practitioner may focus on Small Intestine 7 (located on the forearm) and the Shang Pa Hsieh sites that lie between the fingers. Additional points may be added, depending on where in the hand the arthritis is located. More than six different acupoints are stimulated in the treatment of hip pain, and up to 12 points may be manipulated to alleviate arthritis related knee pain.

Acupressure To lessen the severity of arthritis symptoms, a practitioner may use acupressure on points that correspond to the liver, gallbladder, kidneys, bladder, stomach, and the governing vessel. The practitioner also may massage the points that correspond to the affected area to relieve pain and inflammation.

Chinese Herbal Therapy Chinese herbalists consider osteoarthritis to be a y inrelated “external damp” illness, and treat the disease by concocting a remedy that will nourish yin and dispel the damp wind while it alleviates swollen, painful joints.

Asarum Sieboldi may be helpful in relieving joint pain; take 3 to 4 grams daily. Foxnut has analgesic properties and is used to reduce pain and inflammation. It can be taken in pill form (9 to 15 grams per day) or as a 10-to 20-gram daily decoction. polygonatum cirrhifolium is said to not only cure arthritis, but to combat premature aging.

If the pain shifts from one joint to another, Corydalis Tuber Forumula may be helpful. For fixed pain accompanied by heavy, swollen joints, try Tu-Huo and Loranthus Formula or Stephania and Astragalus Combination (by mail order). Most of these remedies can be found in health food stores.

Yoga and Meditation

Exercise plays an important role in improving circulation and helping the body eliminate waste. Yoga poses improve flexibility, yet place little stress on joints. Focus on gentle poses, such as the Tree, Triangle, Forward Bend, Spinal Twist, Boat, Bow, Camel, Cow, Locust, Moon Salutation, Chest-Knee, Maha Mudra, and Half Bridge.

Osteoarthritis is a challenging medical condition to live with. While there are phrama drugs available to treat it, can Qigong, a traditional Chinese practice effective enough to relieve the patients?

The practice of Qigong refers to a large variety practices, which can be classified as alternative medicine, that entail methods for accumulating, circulating, and working with Qi, or the energy within the body. It usually includes a set of exercises, physical movements, and meditation.

If the scientists at the University of Medicine and Dentistry of New Jersey (UMDNJ) are to be believed, then Qigong therapy might very well be a potential complementary treatment for osteoarthritis but depending upon the ability of the trainer.

On the face of it the findings appears to be clouded with a halo of skepticism with which most alternative and complementary medicine practices are perceived. And there’s a good reason for it, because in today’s science based technological society all claims require proofs, while there are only a numbered evidence based claims supporting the efficacy of alternative treatments, when compared to the conventional musculoskeletal medicines.

However, the researchers at the from NJ also have good reasons to present the findings of the study titled, Effects of external Qigong therapy on osteoarthritis of the knee.”

The Acid Test Of Qigong

To test the effectiveness of Qigong, researchers engages two Qigong therapists who performed hand movements akin to therapeutic touch, acupressure on specific points, focused attention etc. Following which the OA patients reported a good degree of pain reduction and and improved functionality in varying degrees.

The philosophy of Traditional Chinese medicine (TCM) reasons that good health exists because “qi,” the body’s inherent energy is well-balanced. And there’s disease when there’s a blockage of the “qi” flow, or its balance is disturbed.

While the mechanism underlying the patients reports may not be well-known, they did report improvement. Perhaps it’s just a placebo effect, or relaxation induced by the treatment, the critics might question. I think that more research needs to be conducted, which would throw more light on its effectiveness. And the researchers have themselves stated that further research needs to be conducted.

And if further results also support the therapy’s efficacy, then patients would have a proven alternative or complementary treatment option along with pharmaceutical drugs.

With all the news about the FDA pulling Cox 2 Inhibitors such a Celebrex, Vioxx and Bextra off the market because of possible side effects that can effect the heart, we are becoming more aware of the risks involved with taking drugs to treat arthritis. Even though I have long been an advocate of using natural medicine to supplement modern medicine treatment of arthritis or in some cases to replace it, I am sad to see these drugs taken off the market. While they are not perfect and like any other drug comes with the risk of potentially dangerous side effects, they are still much safer, in my opinion, than the over the counter alternatives.

Millions of people have been taken off these drugs and are now in the position trying to find safe and effective treatments for their arthritis. The good news is there are many things you can do with natural medicine to help control the pain of arthritis. The effectiveness of these options depends on the type and severity of the arthritis. You can find a lot of help for osteoarthritis and some help for autoimmune types of arthritis such as rheumatoid arthritis.

Before I start with the list of natural options I would like to point out that in spite of what you may see promoted on the internet none of these options are a cure for arthritis. It is safe to say that both studies and observation are finding that a lot of people find significant to moderate relief from the options listed below.

Therapies to help with arthritis.

Exercise. I list this first because it is the safest and most important natural treatment for arthritis. Lack of use of joints effected by arthritis will only make the condition worse. Proper exercise helps control the range of motion and the amount of inflammation in your joints. I believe that everyone who suffers with arthritis should see a physical therapist. I bet you did not know that a Physical Therapist is a natural health practitioner. A Physical therapist can evaluate the way that arthritis is effecting you particular body and show you exercises to help strengthen the muscles and tendons around the effected joints. Also in learning the proper way of using an effected joint can reduce the wear and tear on the joint and cartilage associated with it.

Acupuncture. I know it sounds crazy to suggest that having needles stuck in your body can help control pain. There are many studies in the last few years showing that many people do find pain relief from acupuncture. In fact now many chronic pain clinics include it as on of their options for controlling pain. Acupuncture does not work for everyone and certain types of arthritis respond better to it than others. Patients with osteoarthritis and fybromyalgia and is less effective on autoimmune types of arthritis such as rheumatoid and lupus.

Massage Therapy. Everyone knows how relaxing a nice massage can be. Did you know that it could also be therapeutic? Message Therapy can help stimulate circulation of blond to help control inflammation and relax tense muscles that aggravate an inflamed joint.

Supplements to help the symptoms of arthritis.

Fatty Acids: There are several studies out that show the effectiveness of fatty acids such as omega 3 and 6 in reducing inflammation. Fish oil, which is high in omega 3 fatty acid, has long been used to treat arthritis. I no longer recommend fish oil concentrates as a source of omega 3 because of the mercury and lead showing up in fish. There are many good omega 3 supplements on the market that come from plant sources.

Cetyl Myristoleate. Cetyl Myristoleate is the most effective supplement I have found in treating the symptoms of arthritis especially osteoarthritis. It is a cetylized form of fatty acid. This is the supplement I use to control my osteoarthritis.

Curcumin: Curcumin is the active ingredient in turmeric. Turmeric is the substance in curry that gives it its yellow color. Resent studies have shown Curcumin to be a powerful anti-inflammatory. Several studies have shown it to be effective in treating the inflammation due to arthritis.

The nice thing about the supplements listed above is that they are not expensive. There are very expensive versions of these products touted as being better than similar products but that is just hype. That is not to say that there are not inferior products on the market because they are. But if you stay with well established companies you should have no problem finding a quality product at a reasonable price. For example there are Cetyl Myristoleate products that sell for over $100. The product I take. Naturols CetylPure retails for $29.95 and I buy if online for under $15.

OSTEOARTHRITIS

This disease is most common in middle age and older people.

Symptoms of osteoarthritis are: persistent pain, stiffness in and around joint, soreness, swelling and difficulty in moving joints. Diagnosis can be made by physical examination, x-rays, and laboratory test

The treatment for Osteoarthritis:

Osteoarthritis a degenerative joint disease is the most common of all arthritic disorders. Treatment for this type of arthritis can include drug therapy such as analgesics (pain killers) such as paracetamol which reduces pain. Anti inflammatory drugs (NSAIDs) such as ibuprofen which reduces stiffness and swelling joints. Anti inflammatory creams rubbed into affected area. Disease modifying drugs such as sulfasalazine which suppresses arthritis reducing damage to joints. Asteroids an anti-inflammatory agent can be injected into joints or used as tablet form under careful medical supervision. Surgery may be done in severe damage or when treatment is not reducing joint pain. short periods of rest. Long periods of rest causes joint stiffness or muscle waste. Excessive or improper exercise exacerbates the inflammatory process and increases joint damage. Exercise such as swimming, dancing, walking and cycling.

Natural treatment for arthritis Heat- warm baths or showers should be taken to relieve morning s. Cold- cold compresses for acute pain. Diet-a diet of oily fish, fish oils less animal fats, and vegetables with plenty fruits and fiber may reduce joint inflammation.

RHEUMATOID ARTHRITIS: Rheumatic disease is a more serious disease. It can occur at any age from infancy to late adulthood; this disease is more common in women than men.

More than 90 percent of people over the age of 50 will eventually develop some type of arthritis and that type is usually osteoarthritis (OA). OA preferentially attacks the weight bearing areas of the skeleton including the neck, low back, hips, knees, base of the big toe, and base of the thumb.

OA develops because of the loss of cartilage, the gristle that caps the ends of long bones within a joint. Cartilage consists of a matrix consisting of glycosaminoglycans. Within this matrix are cells called chondrocytes that help make new cartilage.

OA develops when there is an imbalance between the normal synthesis and the normal breakdown of cartilage. Certain components within the glycosaminoglycan matrix are lost, water accumulates, and enzymes such as matrix metallo-proteinases begin to chew away at cartilage. The end result is cracking and wearing away of cartilage.

The diagnosis of OA is established through a careful history and physical examination. Standard x-rays and sometimes ultrasound or magnetic resonance imaging can better quantify the degree of damage the arthritis has caused.

Treatment of this order involves modalities requiring medication and those that dont. Non drug therapies consist of patient education, exercise, physical and occupational therapy, assistive devices such as canes, walkers, thermal modalities (heat or ice), and weight loss, if indicated.

Medications used to treat OA include analgesics, non-steroidal-anti-inflammatory drugs, topical analgesics, and joint injections with either glucocorticoid (steroid) or hyaluronan (lubricants).

Some work has been done to try and develop drugs that block the effects of matrix-metalloproteinase inhibitors.

Surgical procedures such as arthroscopic debridement and total joint replacement also have a role in treatment.

More recently, devices such as polymer spacers have been used in some joints.

A current type of treatment for younger osteoarthritis patients is to harvest cartilage cells from nearby healthy cartilage and transplant them into the affected area. This procedure has limitations because only a limited number of cells can be generated.

A more exciting development is the role of stem cells.

Scientists at Britains Cardiff University have identified a type of stem cell that can be transformed into cartilage cells (chondrocytes).

If this research pans out, it should be possible to create enough new chondrocytes to have a real therapeutic effect in osteoarthritis patients. Immature stem cells have the ability to become any tissue in the body. Whats interesting about the British study is that the cells they have discovered are at a more advanced stage. While they no longer have the ability to differentiate into any cell, they do have the ability to become a chondrocyte when properly cultured in the lab.

In essence, by culturing these cells, scientists will be able to grow a substantial number of cartilage cells that can be transplanted.

In addition to the stem cells, addition of growth factors from substances like platelet rich plasma (PRP) may hasten the growth of cartilage.

The Cardiff team is now conducting tests in animals, with the hope of initiating a clinical trial in the near future.

Although diagnosed in over 20 million people, it is estimated that half the population has osteoarthritis in at least one or more joints. Basically, it is a very common affliction and risks increase as we age. And unfortunately, osteoarthritis is common in both men and women. Oddly enough, however, the condition is more common in men before the age of forty-five. After 45, osteoarthritis is more prevalent in women.

So how exactly does osteoarthritis affect the body? Well, the disease mainly affects the cartilage in our bodies. Cartilage is important to us because it is what covers the ends of our bones. Those bones come together in joints and the cartilage is what prevents them from rubbing together. Cartilage is also a natural shock absorber and helps our bodies weather the physical activity we put them through.

However, osteoarthritis causes the surface layer of the cartilage to break down and dissipate. What then happens is the bones no longer have the same level of protection so when they rub together. The result will be painful and a person will lose movement as the disease progresses.

The joint itself will actually start to lose its shape as osteoarthritis progresses. This may then allow bone spurs to grow on the edges of the joints. When these bone spurs break off, they may become lodged in the joint and cause further discomfort and injury. In time, osteoarthritis can all but incapacitate a person and leave them immobile.

Unfortunately, there is not a lot physicians can do in order to stop the progression of osteoarthritis. Anti-inflammatories like ibuprofen will generally help alleviate the swelling in the joints and thus lessen pain, but no actual treatment exists. However, research has shown that maintaining a healthy diet and active lifestyle tend to delay the onset of the condition.

Osteoarthritis is a very painful and debilitating disease that afflicts millions of people every year. As our population ages and the baby boomers begin to retire in force, osteoarthritis will become an even larger health issue. Research is currently being conducted that hopes to one day be able to repair the cartilage itself and thus repair the damage caused by osteoarthritis. For now, those with the condition should consult with their physicians in order to determine the best pain management strategy for their osteroarthritis.

The two most common types of arthritis are osteoarthritis, a degenerative joint disease, and rheumatoid arthritis, an autoimmune disease.

Osteoarthritis is the most prevalent, caused by wear and tear on the joints and affecting mostly older people. Osteoarthritis affects the knees, hips, hands, and spine of sufferers, and results from the degeneration of joint cartilage. This form of arthritis can be the result of strains and injuries caused by repetitive movement, and can be suffered by sportsmen and women.

Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. Sufferers can be any age. Rheumatoid arthritis can also cause inflammation of the tissue around the joints, and can affect other organs in the body.

Rheumatoid arthritis is a chronic disease but patients may have long periods of remission without symptoms.

So, how is arthritis diagnosed? Let us concentrate on osteoarthritis.

The diagnosis of arthritis is a complex matter, as so many factors have to be taken into account.

The age and sex of the patient, the joints affected, the speed of onset, and whether there are any related symptoms.

X-rays of the affected joints, and blood tests will be necessary to correctly diagnose the type of arthritis, and to accurately determine the extent of any damage to the joints.

As with all medical conditions, there are new methods of diagnosis and treatment being made available for arthritis all the time, so patients should be made aware of these by their medical practitioner.

Once a patient has been diagnosed, a treatment decision will be made depending on the precise type of arthritis, and there are many options. Most patients will be offered drug therapy to reduce inflammation and manage pain, and it may take a time to find the correct combination of medication for each individual.

A number of patients suffering from arthritis will also benefit from physiotherapy and gentle physical exercise under medical supervision.

Alternative Remedies

Alternative treatment options and dietary supplements have become popular for arthritis and osteoarthritis in particular.

The problem is, there are as many alternative treatments around as there are stars in the sky!

What works

While more than half of patients older than 65 years of age have osteoarthritis changes in the their knees on x-ray, osteoarthritis is not considered a “normal” part of aging.

Certain activities and occupations increase the likelihood of osteoarthritis. For instance baseball players have an increased incidence of osteoarthritis in the elbows and shoulder. Football players have an increased incidence of osteoarthritis in the hips and knees. And ditch diggers have an increased incidence of osteoarthritis in their wrists.

Obesity is a risk factor for osteoarthritis developing in the knees.

Osteoarthritis is a disease that arises from biochemical changes in cartilage which include a decrease in glycosoaminoglycans, an important constituent of collage, an increase in water content, and an increase in the content of destructive enzymes such as matrix metalloproteinases.

These changes lead to structural weakening of cartilage. Small fissures develop, then larger cracks and irregularities also occur. Ulceration of cartilage and further deterioration occurs. The end result is a premature wearing away of cartilage with exposure of underlying bone. Along with this wearing away of cartilage is an increase in inflammation of the lining of the joint, the synovium.

The joints that are affected most in osteoarthritis are weight-bearing areas such as the neck, low back, hips, and knees.

Stiffness and pain are the moist common symptoms.

On physical exam, there are signs that point towards the diagnosis including bony swelling, and distribution of joint problems.

Laboratory testing is usually normal. X-rays may show changes.

Treatment for osteoarthritis is aimed at five primary goals. They are relief of pain, maintenance of function, prevention of disability, control of co-morbid conditions, and avoidance of medication side effects.

Non-drug therapies include patient education, physical therapy, thermal modalities, weight loss if indicated, and exercise.

Drug therapies include non-steroidal anti-inflammatory agents, injections of glucocorticoids or viscosupplements (lubricants), and disease-modifying drugs.

Alternative therapies such as acupuncture, balneotherapy (spas), glucosamine/chondroitin, massage, chiropractic, etc. all have their advocates.

One area that has received much attention is the use of mechanical shifting devices that can unload specific joints. For instance osteoarthritis of the knee, a common problem, has received much scrutiny lately.

A recent study showed that the use of shoes that mimic barefoot walking may help because there is more pressure placed on the middle of the knee joint when people wear shoes as opposed to when they walk barefoot.

Also, the use of a simple device like a cane also reduced the load on the knees.
(Kemp G, et al Arthritis Care and Research 2008; 59: 609-614).

Other studies have found that lateral wedge insoles worn inside shoes can also reduce the load on the medial side of the joint.

Until the day comes when new cartilage can be grown… and that day may be closer than we think, particularly with the emphasis on stem cell research, the above modalities may have to do.