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Arthritis

Created By:Nelson Narciso, DNM www.keepwell.ca

Copyright Nelson Narciso 2013

What is Arthritis

• Definition: Any condition that involves joint & musculoskeletal inflammation/painp

• Origins: Greek arthro = joint + itis = inflammation

• Osteoarthritis and Rheumatoid Arthritis are often the only conditions people associate with arthritisthe only conditions people associate with arthritis

• Signs of arthritis include redness, swelling, heatand pain

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What is Arthritis

• Arthritis encompasses over 100 different conditions ranging from:

– Mild forms that are localized like tendinitis and bursitis

– More severe systemic forms, such as rheumatoid arthritis and systemic lupus that involve every part of the body.

Source: http://www.arthritis.ca/aboutarthritis

Types of Arthritis

• Ankylosing Spondylitis

• Behçet's Disease

• Childhood Arthritis

• Paget's Disease

• Polymyalgia Rheumatica

• Polymyositis and Dermatomyositis• Childhood Arthritis

• Diffuse Idiopathic Skeletal Hperostosis (DISH)

• Ehlers-Danlos Syndrome

• Felty's Syndrome

• Fibromyalgia

• Gout

Polymyositis and Dermatomyositis

• Pseudogout

• Psoriatic Arthritis

• Raynaud's Phenomenon

• Reactive Arthritis

• Rheumatoid Arthritis

• Scleroderma

• Infectious Arthritis

• Lupus

• Mixed Connective Tissue Disease

• Osteoarthritis

• Sjögren's Syndrome

• Still's Disease

• Wegener's Granulomatosis

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Statssource: http://www.arthritis.ca/page.aspx?pid=6239

• “4.6 million, or one in six, Canadians aged 15 years and older report having arthritisreport having arthritis.

• By 2031, approximately seven million Canadians (one in five) are expected to have arthritis.”

• “Two-thirds of those affected with arthritis are women.”

• “Among all causes of disability in Canada, arthritis ranks first among women and second among men”

• “...may cost the Canadian economy more than $33 billion annually.

N l th f fi l ith th iti d 65

Statssource: http://www.arthritis.ca/page.aspx?pid=6239

• Nearly three of every five people with arthritis are under 65.

• Over ¼ of men and women with arthritis aged between 25 and 44 years are not in the labour force because of their disease.

• Over 6% of total hospitalizations in Canada are associated with arthritis.

• More Canadians have died from arthritis and related conditions than from melanoma, asthma or HIV/AIDS.

• Almost 1,000 Canadians died from arthritis in 2005.

• Women are about three times as likely as men to die from arthritis.

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Focus

• Given the many forms of this condition yand time constraints I have chosen to focus on the most common...

OsteoarthritisOsteoarthritis

Osteoarthritis (OA)sources: 1. http://www.arthritis.ca/page.aspx?pid=6239

2. http://www.mayoclinic.com/health/osteoarthritis/DS00019

• Most common form of arthritis

• Often called “wear-and tear arthritis” because the cartilage that cushions the ends of the bones wears down over time

• > 10% of Canadian adults affected

• Responsible for > 80% of hip replacement surgery and > 90% of knee replacements in Canada.

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Osteoarthritis (OA)source: http://www.webmd.com/osteoarthritis/guide/osteoarthritis-causes

Etiology (Cause or Origin of Disease)

• “Most of the time the cause of OA is unknown It is• Most of the time, the cause of OA is unknown. It is associated with aging. However, metabolic, genetic, chemical, and mechanical factors can play a role in getting OA.”

Source: University of Maryland Medical Center http://umm edu/health/medical/altmed/condition/osteohttp://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIgo8gzC

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Signs and Symptoms

• Joint pain -- often a deep, aching pain that gets worse when you move and better when you rest the joint. In severe cases, the pain may be constant.

• Stiffness in the morning or after sitting or lying down for more than 15 minutes

• Joint swelling

• Joints that are warm to the touch

• Limited range of motion

• Muscle weakness, caused by favoring the painful joint

• Growth of bony knobs near joints -- such as Heberden's nodes, in which bumps appear on the outermost finger joints

•

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIgPmkF3

Risk Factors

• Being older

• Having OA run in your family

B i i ht• Being overweight

• Injury to the joint

• History of inflammatory joint disease

• Metabolic or hormonal disorders, such as hemochromatosis and acromegaly

• Bone and joint disorders present at birth

• Repetitive stressful joint use - such as athletes or construction workers

• Deposits of uric acid crystals in joints

F l d• Female gender

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIh9HjnL

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Support

Food

Eat More Vegetables & Fruits

Eating more fruits & vegetables may reduce pain & stiffness in adults with osteoarthritis

Source: Nutr Res. 2010 Sep;30(9):601-6. doi: 10.1016/j.nutres.2010.08.010.

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Consider Avoiding Foods From The Nightshade Family

• In the 1950s, Norman Childers, Ph.D. “found that eliminating certain vegetables (known as nightshade vegetables) from the diet could completely eliminate arthritis symptoms in many cases “completely eliminate arthritis symptoms in many cases.

• “According to Dr. Childers, nightshade sensitivity isn’t an allergy but actually a progressive loss of the ability to metabolize substances known as “solanine alkaloids,” which are found in all nightshade vegetables. Unfortunately, there’s no test that can tell you if your arthritis will respond to a nightshade free diet. It’s strictly a “try it and see” situation.”see s tuat o

Source: A Natural Treatment for ArthritisJonathan Wright, M.D. Say goodbye to most arthritis pain for good in eight steps or less

• “Rigid omission of Solanaceae, with other minor diet adjustments has resulted in

Consider Avoiding Foods From The Nightshade Family

minor diet adjustments, has resulted in positive to marked improvement in arthritis and general health.” Source: Journal of Neurological and Orthopedic Medical Surgery (1993) 12:227-231

• Another study that suggests a potential connection. Source: Childers N.F. A relationship of arthritis to the Solanaceae (nightshades). J Intern Acad Prev Med 1979; 7:31-37

•

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• “How do you find out whether nightshades are causing your medical problems? For many, no relief comes until the diet is totally clear of all these nightshades for at least six weeks [some have stated 3 months is necessary]

How To Determine If Nightshades Are Problematic

. Many people notice an improvement in their pain; sometimes it goes away completely.”

• “If the person has strictly avoided the nightshades for six weeks, yet still doesn’t believe their pain has decreased, I suggest that they do a “nightshade party day”: salsa and eggs for breakfast, tomato and eggplant for lunch, potatoes for dinner—just have it all, and have a lot. Eat as much as you can in one day and then watch for symptoms over the next two days. y y y p yOften there is a delayed onset reaction—there is for me.” Source: Garrett Smith, NMD Weston A. Price Foundation

• Great article! http://www.westonaprice.org/food-features/nightshades

Nightshade Plants

- Artichokes- Ashwagandha

- Peppers (all varieties bell pepper, wax pepper, green/red

peppers, chili peppers, cayenne, paprika, etc.) Ashwagandha- Cayenne Pepper- Eggplant - Goji Berries- Cape Gooseberries

- Ground Cherries

- Potatoes (all varieties, NOT sweet potatoes or yams)

- Tobacco

- Tomarillos

- Tomatoes (all varieties, including tomatillos)

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Eliminate Potential Problematic Foods

• In this study an elimination diet was followed (eliminating gluten, beef, eggs, dairy products, nightshade vegetables, refined sugars, and citrus fruit) for 4 months.

• The persons “rheumatological symptoms significantly improved”.

Source: J Altern Complement Med. 2010 Jul;16(7):807-9. doi: 10.1089/acm.2010.0022.

Conflicting Evidence On Nightshades

• “According to the Arthritis Foundation's publicationAccording to the Arthritis Foundation s publication,Arthritis Today, a study found that yellow and purplepotatoes may reduce inflammation in men. Anotherstudy found that people who consumed high amounts oflutein, a compound in tomatoes, were 70 percent lesslikely to have osteoarthritis.”

Source: http://abcnews.go.com/Health/top-arthritis-myths/story?id=15510663#2

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Support

Supps

Vitamin D• Patients with osteoarthritis have lower blood levels of vitamin D than

healthy controls (Muraki 2011)

• Decreased risk of rheumatoid arthritis in older womenSource: chttp://www.nlm.nih.gov/medlineplus/druginfo/natural/929.html

• May help prevent the breakdown of cartilage, and decrease the risk of joint space narrowing. Source: http://www.reuters.com/article/2009/05/29/us-vitamin-osteoarthritis-idUSTRE54S4LJ20090529

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Vitamin D

• Anti-inflammatory

R h t N ti l J i h H lth h di d• Researchers at National Jewish Health have discovered specific molecular and signaling events by which vitamin D inhibits inflammation.

• "Patients with chronic inflammatory diseases, such as asthma, arthritis and prostate cancer, who are vitamin D deficient, may benefit from vitamin D supplementation to get their serum vitamin D levels above 30get their serum vitamin D levels above 30 nanograms/milliliter.”

Source: The Journal of Immunology March 1, 2012 vol. 188 no. 5 2127-2135

Group of poliomyelitis and arthritic patients on the sun deckhttp://ihm.nlm.nih.gov/luna/servlet/detail/NLMNLM~1~1~101442826~142607:Group-of-poliomyelitis-and-

arthriti?qvq=w4s:/what/Arthritis/;lc:NLMNLM~1~1&mi=4&trs=6

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Niacinamide

• Anti-inflammatory

• May reduce the need for as many anti-inflammatory medications

• May increase joint mobility in OA patients

Source: Sources: 1. Inflamm Res. 1996 Jul;45(7):330-4

2. McCarty 1999.

From: A Natural Treatment for Arthritis, Jonathan Wright, M.D.

“I recommend using 1 000 milligrams of

Niacinamide

“I recommend using 1,000 milligrams ofniacinamide three times a day (it doesn’t work aswell if you only take it once or twice daily). You’llprobably start feeling results in three to four weeks.Many osteoarthritis sufferers achieve completerelief of pain and swelling as long as they continuerelief of pain and swelling as long as they continueon with niacinamide.”

WARNING: Please consult a health professional before taking such a high dose!

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• “...reduces pain of osteoarthritis in the knee about as well as the over-the-counter pain reliever acetaminophen (Tylenol). It also seems to reduce pain about as much as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Motrin, Advil) and piroxicam (Feldene).

Glucosamine

• But there is a difference between glucosamine sulfate and these drugs in the time it takes to reduce pain. The NSAIDs, such as Motrin, Advil, and Feldene, relieve symptoms and reduce pain usually within about 2 weeks, but the glucosamine sulfate takes about 4-8 weeks.

• In addition to relieving pain, glucosamine sulfate might also slow the breakdown of joints in people with osteoarthritis who take it long-term. Some researchers hope that glucosamine sulfate might keep osteoarthritis from getting worse as quickly as it otherwise might. There is some evidence that people who take glucosamine sulfate might be less likely to need total knee replacement surgery.

• Dosing 500mg 3 times a day or 1500 mg once a daySource: http://www.nlm.nih.gov/medlineplus/druginfo/natural/807.html

Glucosamine Sulfate vs HCL

• “Some researchers think the “sulfate” part of glucosamine sulfate is also important. Sulfate is needed by the body to produce cartilage. This is one reason why researchers believe that glucosamine sulfate might work better than other forms of glucosamine such as glucosamine hydrochloride or N-acetyl glucosamine. These other forms do not contain sulfate.”

• “Trials of glucosamine hydrochloride though have shown it to be no better than placebo.”

Source: http://www.nlm.nih.gov/medlineplus/druginfo/natural/807.html

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• “Persons with underlying poorer insulin sensitivity are at risk for worsening insulin resistance and vascular function with the use of glucosamine in d d t t t t th iti ”

Glucosamine & Insulin Resistance

doses used to treat osteoarthritis.”Source: Am J Med Sci. 2007 Jun;333(6):333-9.

• “Based on our results, we think it is unlikely that long-term treatment regimens or the use of glucosamine in diabetic subjects would lead to adverse effects on glucose metabolism. However, since we did not study these specific conditions, definitive conclusions on these issues warrant further study ” Source: Diabetes Care June 2003 vol 26 no 6 1941 1942further study. Source: Diabetes Care June 2003 vol. 26 no. 6 1941-1942.

• “Oral Glucosamine for 6 Weeks at Standard Doses Does Not Cause or Worsen Insulin Resistance or Endothelial Dysfunction in Lean or Obese Subjects” Source: Diabetes November 1, 2006 55:3142-3150.

Glucosamine and Chondroitin

• Results “ Our results demonstrated a highly significant efficacy of glucosamine [sulfate] on all outcomesefficacy of glucosamine [sulfate] on all outcomes, including joint space narrowing and WOMAC. Chondroitin [sulfate] was found to be effective on Lequesne Index, visual analog scale pain, mobility, and responding status. Safety was excellent for both compounds.”

• Source: Arch Intern Med. 2003;163(13):1514-1522. doi:10.1001/archinte.163.13.1514.

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Chondroitin Sulfate

• “ effective in reducing functional• ...effective in reducing functional impairment and relieving pain over 6 months in knee osteoarthritis patients, without any safety concerns.”

• Dosage 300-400mg 2-3 times/day

Probiotics• “probiotic strains such as L. acidophilus and B. bifidum have been shown to have

anti-inflammatory activity.”

• “GIT function and integrity may influence the therapeutic efficacy of glucosamine. ...Gut microbial metabolism of nutraceuticals such as gluconsamine may be critically important for efficacy outcomes.”

• “L.casei in combination with collagen and glucosamine was more effective at reducing pain than, cartilage destruction and lymphocyte infiltration than the treatment of glucosmaine or L. casei alone.

• Source: Glucosamine and Probiotics: for Osteoarthritis Joint Pain Relief entre for Integrative Clinical and Molecular Medicine, School of Medicine, the University of Queensland, , y Q

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Natural Eggshell Membrane

• Reduces Tumor Necrosis Factor-alpha (TNF-α), a key player in the inflammatory process.Reduces joint pain and stiffness may be a result of its ability to (J Med Food. 2012 April; 15(4): 360–368.)

• Reduced both joint pain and stiffness significantly (Clin Rheumatol. 2009 Aug;28(8):907-14. doi: 10.1007/s10067-009-1173-4. )

• Significantly reduced pain, both rapidly (seven days) and continuously (30 days) Clin Interv Aging. 2009;4:235-40. Epub 2009 Jun 9.

• Dosage: 500 mg taken once daily

– effective in the treatment of rheumatoid arthritis d t th iti (OA)

Undenatured Type II Collagen

and osteoarthritis (OA)

– showed “significant enhancement in daily activities suggesting an improvement in their quality of life.”

– More effective than the combination of Glucosamine HCL and chondroitin

Source: Int J Med Sci 2009; 6(6):312-321.

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SAMe(s-adenosyl-L-methionine)

• SAMe (s-adenosyl-L-methionine), 600 - 1200 mg daily.

– Can help reduce OA pain.

– In one study, SAMe relieved pain as well as NSAIDs.

– In another study of people with knee OA. SAMe worked as well as Celebrex in lessening pain and improving joint function, although it took longer to feel the benefits.

– People with bipolar disorder should not take SAMe because of the risk of mania. Ask your doctor before taking SAMe.

•

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIi8TY3I

MSM(methylsulfonylmethane)

• MSM may have anti inflammatory activity• MSM may have anti-inflammatory activity properties.

• 2 studies showed MSM modestly reduced pain and swelling, but did notreduced pain and swelling, but did not relieve joint stiffness.

Source: http://osteoarthritis.about.com/od/alternativetreatments/a/supplements.htm

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Hyaluronic Acid

• HA may interfere with pain mediators and redcue the prodcution ofenzyms that damage healthy cartilage. (Palmieri 2010).

• “In a randomized, placebo-controlled, double-blind study of 20human patients with OA of the knee, subjects received 80 mg of aspecially formulated, orally ingested hyaluronic acid supplementcalled Hyal-Joint™ or a placebo daily for eight weeks. Thetreatment group had a greater magnitude of improvement in bodilypain and social functioning (Kalman 2008).”

Source: www.lef.org

Omega-3 FatsMore Effective For RA

• Omega-3 fatty acids, help decrease inflammation. Source: http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIiIJTTzp

Omega-3 fatty acids have also been shown to reduce the amounts of certain proteins that are important in the pathology of OA (Zainal 2009). In the clinical setting, the combination of omega-3 fatty acids with glucosamine was more effective at reducing morning stiffness and pain than glucosamine alone (Gruenwald 2009). www.LEF.org

• Omega-3 Fatty Acids Shown to Prevent or Slow Progression of Osteoarthritis. In animal study reduced risk of developing disease by 50% compared to a diet lacking fish oil Source: http://www.sciencedaily.com/releases/2011/10/111017111600.htm

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Evening Primrose Oil (EPO)

• EPO is rich in polyunsaturated omega-6 fatty acids that can helpomega 6 fatty acids that can help in the regulation of pain and inflammation with no major safety problems.

• Source: Arthritis Research UK Complementary and alternative medicines.

Astaxanthin

• May have anti-inflammatory activity and “may be beneficial in alleviating pain and improvingbe beneficial in alleviating pain and improving the ability to perform daily activity in patients with rheumatoid arthritis.”

Source: http://www.naturalmedicinejournal.com/article_content.asp?article=293

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Avocado Soybean Unsaponifiables

• “A few preliminary studies suggest that this natural vegetable extract may help reduce the symptoms of OA and maybe even slow progression of the p y p y p gdisease. More research is needed to know whether ASUs can actually stop joint damage.”

• “ASUs increase the risk of bleeding, especially if you also take blood-thinners such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin.”

• Made from avocado and soybean oils

• Dosage: 300 - 600 mg daily

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIiUXaXL

Green-Lipped Mussel

How it works is poorly understood, but it contains omega-3 fatty acids, which have anti-inflammatory and joint-protecting properties. Current evidence suggests that this compound mightproperties. Current evidence suggests that this compound might be of some benefit to people with osteoarthritis when taken along with paracetamol or NSAIDs; however, it’s not effective in treating rheumatoid arthritis.

Source: Arthritis Research UK. Complementary and alternative medicines.

http://www.arthritisresearchuk.org/~/media/Files/Arthritis-information/Additional-items/CAM%20Report.ashx

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Enzymes• Bromelain, 250 mg twice a day. This enzyme that comes from

pineapples reduces inflammation.

• Bromelain increases the risk of bleeding, especially if you also take blood-thinners such as clopidogrel (Plavix), warfarin(Coumadin), or aspirin. People with stomach ulcers should avoid bromelain. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger.

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIicUEPl

Systemic Enzymes Wobenzym

http://www.systemicenzymesupport.org/conditions/osteoarthritis.htm

• “A 2006 six week phase III, randomized, double blind, parallel group study compared systemic enzyme support with diclofenac the generic name for a nonsteroidal anti-inflammatory drug that is widely used to treat arthritis.” (Clin Exp Rheumatol. 2006 Jan-Feb;24(1):25-30.)

• “A 2004 randomized, double-blind, parallel group trial by a different group of researchers came to the same conclusion. Within the six week observation period, they noted that that systemic enzyme support “can be considered as an ff ti d f lt ti t NSAID h di l f i th t t t feffective and safe alternative to NSAIDs such as diclofenac in the treatment of

painful episodes of OA of the knee.” Clin Rheumatol. 2004 Oct;23(5):410-5. Epub 2004 Jul 24.

• “A 2001 randomized, controlled, single-blind study of seven weeks duration found that systemic enzyme support “is as efficacious and well tolerated as diclofenac” in the management of active osteoarthritis.”J Assoc Physicians India. 2001 Jun;49:617-21.

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Creatine• Creatine supplementation shown to decrease

soreness in arthritis sufferers.

C ti t d i ifi tl d d k• Creatine group reported significantly reduced knee pain (44% lower), less knee stiffness (50% lower), and less limitation of physical function related to arthritis (40% lower). While the placebo group also showed improvement on all three measures, the degree of improvement was not as pronounced (33%, 16% and 32%, respectively).

• Authors of study concluded, “The main finding of this study was the positive effect of CR [creatine] supplementation on physical function in women with knee OA undergoing a resistance training program.”

Support

Herbs

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Boswellia Serrata• The compound 3-O-acetyl-11-keto-beta-boswellic acid

(AKBA) inhibits the action of 5-lipoxygenase, an enzyme that leads to inflammationthat leads to inflammation.

• Benefits: Anti-inflammatory and pain-relieving properties

• Dosage: 250 mg/day

Source: Sengupta K, Alluri KV, Sathis AR, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin ® for treatment of osteoarthritis of the knee. Arthritis Research & Therapy 2008; July 30.

Turmeric (Curcuma longa)• “Meriva® significantly reduced pain and stiffness and improved joint function. All WOMAC

scores were improved by the treatment with Meriva®, including social and emotional function. The improvement of physical function was also noteworthy. Finally, the markers of inflammation were significantly decreased in the treatment group between enrollment and after 8 months of treatment.” Source: Springerplus. 2013 Dec;2(1):56. Epub 2013 Feb 18.

• Significant improvements of both the clinical and biochemical end points were observed for Meriva compared to the control group. This, coupled with an excellent tolerability, suggests that Meriva is worth considering for the long-term complementary management of osteoarthritis. Source: Altern Med Rev 2010;15(4):337-344

• Arantal® (Brand name, Flexofytol®, Tilman S.A., Somme-Leuze, Belgium), the high bioavailable turmeric extract. Also showed benefit in treating OA. Source: Springerplus. 2013 Dec;2(1):56. Epub 2013 Feb 18.; ( ) p

• Look for a formula that contains “BCM-95” the most biovailable form on market today.

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Cat's Claw (Uncaria tomentosa)

• Standardized extract, 30 mg three times a day, has been used traditionally for OA pain. In one study, 100 mg per day of cat’s claw taken for 4 weeks relieved pain better than a placebo.

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIiy85Y3

Devil's claw (Harpagophytum procumbens)

• “Standardized extract, 100 - 200 mg one to two times daily. Devil's claw has also been used traditionally to relieve pain. One study found that more than 50% of

l i h OA f h k hi l b k i h k d il' lpeople with OA of the knee or hip or low back pain who took devil's claw reported less pain and better mobility after 8 weeks.”

• “Devil's claw may increase the risk of bleeding, especially if you also take blood-thinners. It may also interact with several other medications, including those used to treat diabetes. Devil's claw may affect blood pressure and heart rate, so people with heart disease should ask their doctor before taking it.” p p g

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIiy85Y3

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Ginger (Zingiber officinale)• “Up to 2 g per day in divided doses, may reduce joint

inflammation and pain. One study found that ginger extract blocked COX-2, a chemical in the body that causes pain.” y p

• “Ginger may increase the risk of bleeding, especially if you also take blood-thinners such as clopidogrel (Plavix), warfarin(Coumadin), or aspirin.”

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIiy85Y3

Willow Bark (Salix alba)• Standardized extract, 500 mg up to three times daily.

• Willow acts similar to aspirin.Willow acts similar to aspirin.

• Do not take white willow if you are also taking aspirin or blood-thinners. Do not take willow bark if you are allergic to aspirin or salicylates.

• Willow should not be given to children under the age of 18.

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIiy85Y3

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Capsaicin (Capsicum frutescens)• “Applied to the skin (topically). Capsaicin is the main component in hot

chili peppers (also known as cayenne). Applied to the skin, it is believed to temporarily reduce amounts of "substance P," a chemical that contributes to inflammation and pain in arthritisto inflammation and pain in arthritis.

• Several clinical studies have shown that capsaicin cream provided better pain relief than a placebo. But it doesn't improve joint swelling, grip strength, or function for people with OA. Pain generally starts to get better 3 - 7 days after applying the capsaicin cream to the skin.

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIiy85Y3

Support

Mi d & B d P tiMind & Body Practices

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Tai Chi

• Tai Chi May Benefit Older Adults With Knee Osteoarthritis.

• “Greater improvement in measures of pain, physical function, self-efficacy (belief in one's own abilities), depression, and h lth l t d lit f lif ”health-related quality of life”

Source: http://nccam.nih.gov/research/results/spotlight/011510.htm

Mind & Body Practices

• Acupuncture, massage, qi gong, and yoga—have been studied for OAbeen studied for OA.

• Results from clinical trials suggest that acupuncture may be beneficial for some OA symptoms.

• There are a limited number of quality studies for tai chi, qi gong, and yoga

http://nccam.nih.gov/health/arthritis/osteoarthritis

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Chiropractic

• “Chiropractic, especially when combined with glucosamine supplements and stretches and exercise helps treat OA ”exercise, helps treat OA.

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIjVdAlR

Hydrotherapy / Balneotherapy• One of the oldest forms of therapy for pain relief for

people with arthritis.

• Bathing in thermal or mineral waters. Sulfur-containing mud baths, for example, have been shown to relieve symptoms of arthritis.

• Improving range of joint motion

• Increasing muscle strength

• Eliminating muscle spasm

• Enhancing functional mobility

• Easing pain

• “Although balneotherapy is most often used for psoriatic or rheumatoid arthritis, some medical experts believe that it may help people with OA as well. However, one large review of clinical trials found little evidence to support its use.”

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIiy85Y3

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Transcutaneous Nerve Stimulation (TENS) & Electroacupuncture

• “In a well-designed trial comparing the effectiveness of TENS, electroacupuncture, and ice massage for the treatment of knee OA, each of these methods were found gto:”

• Reduce pain at rest

• Reduce stiffness

• Boost walking speed

• Increase quadriceps muscle strength

• Increase knee range of motion

• “Many physical therapists use TENS. When the nerve stimulation of TENS is applied to acupuncture points, it is called electroacupuncture.”

Source: University of Maryland Medical Center http://umm.edu/health/medical/altmed/condition/osteoarthritis#ixzz2dIk29qV1

Homeopathy• Homeopathic Arnica

• Arnica gelSamuel Hahnemann

Arnica gel– Topical application of Arnica montana gel for 6 weeks was a safe, well-tolerated, and

effective treatment of mild to moderate OA of the knee. Source: Advances in Therapy September/October 2002, Volume 19, Issue 5, pp 209-218

• Traumeel– Traumeel may be considered as an anti-inflammatory agent that is at least as effective

and appears to be better tolerated than NSAIDs Source: Int J Gen Med 2011; 4: 225–234and appears to be better tolerated than NSAIDs Source: Int J Gen Med. 2011; 4: 225–234.

• Zeel– A clinical study1 of Zeel® showed that patients who received 2 to 10 injections had the

best results. 89% of the patients showed significant improvement after receiving 5 injections. 67% of the patients reported a significant change in their pain symptoms after receiving 2 to 5 injections. Source: Gottwald R, Weiser M. Treatment of Osteoarthritis of the Knee with Zeel® T. Medicina Biologica 2000; Vol. 13 No. 4: 109-113.