Treatment Options for Osteoarthritis
Osteoarthritis, commonly referred to simply as "arthritis" or OA, is the most common joint disorder in North America and can affect upwards of 10% of the population. OA is primarily thought of as a disease of aging, but it can occur earlier due to higher "wear and tear" in populations such as athletes as well as those who engage in physical labour. OA primary affects the weight bearing joints (ie knees and hips) but degeneration can occur in virtually any well-used joint.
OA RISK FACTORS
Some of the key risk factors in developing symptomatic OA include:
Obesity/excess body weight
Repetitive use of joints
Lower bone density
Treatment options for OA depend on age, the severity of degeneration, physical function, and symptom picture. When there is essentially no cartilage left between joints, pain and impaired physical function are likely to be debilitating. Those patients may be candidates of joint replacement surgery. In most instances however, surgery is not necessary. This is where pain management, physical activity, and diet come into play. Pain management is typically achieved through pain killers, either long term or on an as needed basis. Pharmaceutical injections such as corticosteroid injections as well as hyaluronan are used to decrease inflammation/pain and provide lubrication, respectively.
Many people prefer non-surgical and non-pharmaceutical approaches to pain relief, which is where the following is useful:
Acupuncture: Acupuncture has been around for thousands of years, and for good reason. Although in some severe cases acupuncture may not provide pain relief, many people do find symptoms of OA like pain and stiffness improve with treatment (in studies usually 6-8 weeks of treatment).
Boswellia: Components of this herb have been shown to significantly improve pain as well as physical function in comparison to placebo. Studies show benefit after 90 days of use, but clinically you can often see benefit earlier if you use higher quality supplements.
Here are some non-surgical and non-pharmaceutical interventions for osteoarthritis:
Weight management. Since OA mostly affects weight bearing joints, having excess body weight can increase the pressure or load that these joints carry (ie knees, hips). Maintaining a healthy body weight is extremely important to the development of OA in addition to the progression. Significant weight loss can lead to both improvement in pain as well as physical function.
Proper diet and nutrition. Some think this is the same as weight management but it's quite different. Remember that you can be thin and unhealthy. For OA, I like to start with a modified anti-inflammatory diet, which means excluding refined sugars, certain grains, red meat, and low quality dairy products while increasing fiber (through vegetables and fruits), water intake, healthy fats, and lean proteins. Other specific recommendations may be made depending on other individual patient factors.
Stress management/mindfulness: The mental-emotional connection to pain plays a larger role than most people expect. By incorporating mindfulness techniques into your daily life, you can not only manage stress levels better, but you can change the way your brain processes pain.
People are often interested in taking other supplements, such as omega 3, MSM, glucosamine/chondroitin, and curcumin. The prescription of these natural health supplements should be on a case by case basis, after evaluation.
If you have questions, feel free to contact me.
Dr. Cho is a naturopathic doctor practicing in the Yonge and Sheppard area of Toronto. She works in an integrative clinic alongside conventional medical specialists. For more information on the Toronto Specialty Rapid Access Clinic, click here.
Cameron, M and Chrubasik S. "Oral herbal therapies for treating osteoarthritis." Cochrane Database Syst Rev. July 2015.