HELP FOR

OSTEOARTHRITIS
HOW TO HELP COMMON
ARTHRITIS
At the end of this presentation:

●1. Know what

osteoarthritis is.
●2. Know how to find
out if you have this
condition.
●3. Know what
treatment options are.
●4. Know how to
prevent osteoarthritis.
 DISCLAIMER:

●YOU WILL NOT BE

AN EXPERT ON
THE DIAGNOSIS
AND TREATMENT
OF
OSTEOARTHRITIS!
 Definition of Osteoarthritis

Osteoarthritis is a
degeneration of synovial
joints characterized by
focal degeneration of
articular cartilage,
subchondral bone
thickening and marginal
osteochondral
outgrowths.
 Signs and Symptoms of
Osteoarthritis
●1. Pain and swelling
in joints.
●2. Obesity has twice
the incidence.
●3. By age 55 to 65
years, 85% of
people have xray
evidence of
osteoarthritis.
OSTEOARTHRITIS (OA) IS:
●The most common joint disease
●Knee OA is the leading cause of chronic
disability in developed countries.
●100,000 in U.S.A. can’t get from bed to
bathroom independently due to knee
OA.
●OA is the commonest cause of limitation
of activity among older persons.
Predisposing Factors in OA:
●1. Injury (meniscal tear or fracture)
●2. Loads (obesity, valgus, varus)
●3. Infection (cartilage destruction)
●4. CNS disease
●5. Rheumatoid arthritis
●6. Gouty arthritis
●7. Osteonecrosis (dissicans) Turek 4th
edition page 1367-8.
Synovial Fluid Markers of OA
●Norwegian Col. Veterinary Med. Vet-
Surg. 1995 May-Jun;24(3):255-62
●Cartilage degradation products
●Chondrocytic anabolic activity
●Literature Review - potential markers for
OA need further study.
OA Effect on Disability and
Health Care in Canada
●OA is most frequently reported reason
for longterm disability.
●Ontario >= 16 years OA in 18% of pop.
with 2.5% of pop. longterm disability.
●Longterm Disability -> disabilities in
walking, ADL, dependence, social
isolation, and low income.
OA in the Tropics
●Baillieres-Clin-Rheumatol. 1995
Feb;9(1):65-74
●Lower incidence of OA in Tropics than
in Western Countries.
●Different pattern in tropics : less
involvement of the hip relative to the
knee and polyarticular OA is
uncommon. OA in tropics is secondary
Strategies for Prevention of
OA
●Int-J-Tissue-React. 1993; 15(3):93-7.
●Current Research Findings give hope
for prevention and effective treatment
for the future.
●Reduction of Obesity in the community.
●Changing certain high-risk occupations
●reducing the incidence of joint trauma
Nailfold Capillary Circulation in
OA
●Br-J-Rheumatol. 1993 Dec; 32(12):
1062-5
●Nailfold capillaries in 28 patients with
DIP joint OA compared with 23 age- and
sex-matched controls without OA.
●OA patients showed a significantly
lower density of capillaries in their
nailfolds with more haemorrhage, ‘drop
Is OA a Preventable Disease?
●J-Rheumatol-Suppl. 1991 Feb;27:2-3
●“Since most of the pathophysiological
steps of the initiation of OA are not
understood, its prevention can only
mean decreasing or abolishing its risk
factors.”
●Decrease occupational or sports
hazards & avoiding overweight.
Patterns of OA in West African
Teaching Hospital.
●Ann-Rheum-Dis. 1991 Jan; 50(1):20-2
●140 patients with 252 OA joints
●Knee - most commonly affected joint
●Hip and hand as well as Heberden’s
nodes were uncommon.
●No patient had three or more joints
affected.
 Subclinical OA
●J-Rheumatol. 1987 May; 14 Spec No: 88-90
●“I submit that all OA is secondary, the
inception being remote in time and, unless
dramatic, being forgotten or never even
noticed.”
●“An understanding of some of the mechanical
features that characterize the progression to OA
and mechanism of pathogenesis should lead to
earlier diagnosis and possible application of
Prevalence of Knee OA in the
Elderly
●Arthritis-Rheum. 1987 Aug; 30(8):914-8
●Framingham Heart Study cohort during the
18th biennial examination.
●History, physical examination, standing
Xrays of knees on 1,424 people 63-94
years age (mean 73).
●34% women and 31% men had Xray OA
●11% of women; 7% men were symptomatic.
Knee Washout for OA Rx
●U. Utah Med. Cent. Salt Lake City Am-
J-Sports-Med. 1995 May-Jun;
23(3):345-9
●29 knees in 23 patients with OA had 3 L
lactated Ringer’s arthoscopic washout.
●1 year : 25/29 knees good-excellent
●2 years: 17/21 knees good-excellent
Knee Washout vs Saline
Injection
●Clin-Rheumatol. 1987 Mar; 6(1):61-3
●20 patients with OA Knee
●random allocated saline washout or
control of intra-articular saline injection.
●Both groups benefited equally.
●Conclusion: Washout conferred no
more benefit than intra-articular saline
injection.
 VITAMIN C
●Framingham Osteoarthritis Cohort Study
underwent knee evaluations by radiography
at examinations 18 (1983-1985) and 22
(1992-1993). A 3-fold reduction in risk of
osteoartharitis progression was found. “High
intake of antioxidant micronutrients,
especially vitamin C, may reduce the risk
of cartilage loss and disease progression
in people with osteoarthritis.” McAlindon TE,Jacques
The Common Thread in
Osteoarthritis and Osteoporosis.
Imbalance between input
and output:
●Osteoarthritis results when
joint break down exceeds
repair.
●Osteoporosis results when
bone removal exceeds
repair.
The Cause of Pain in
Osteoarthritis
●1. Inflammation causes pain through the
build up of pain chemicals, swelling and
associated stiffness.
●2. Inflammation can be caused by
mechanical breakdown of the joint
surface. The breakdown debris irritates
the synovium causing inflammation.
●3. Chemical irritation or infection of the
What can be done for OA?

●Symptomatic is the
only treatment
available once
established.
●Prevention is the
answer. Early OA
may possibly
reverse in some
cases.
 PREVENTIVE &
CURATIVE TREATMENT
OPTIONS:
●1. Unrefined plant diet.
●2. Outdoor exercise.
●3. Avoid coffee,
alcohol, and cola
beverages and ASA
and NSAIDs.
●4. Experimental
cartilage replacement
therapy.
Why an Unrefined Plant Diet Helps
OA

●Prostaglandins from animal sources

increase inflammation.
●Prostaglandins from plants decrease
inflammation.
●Plant foods rich in prostaglandins are
avacodos, olives, and nuts.
●Prostaglandins are chemical
messengers that turn up or turn down
 CONCLUSIONS:
●1. Optimal Diet is
unrefined and plant
based and will protect
from OA and
osteoporosis.
●2. Exercise protects us
from OA and
osteoporosis.
●3. Water intake help
prevent OA and
Questions?
 soybean and
avocado
●Patients with osteoarthritis in their knees
or hips may benefit from a combination of
soybean and avocado oils, according to
new research. At six months, the 75
patients taking avocado and soybean
derivatives in capsule form scored better
on measures of joint function, pain and
overall disability than the 69 patients
 soybean and
avocado
●They also used less pain medication--
48% of those given the avocado and
soy capsule used ibuprofen or other
nonsteroidalanti-inflammatory drugs
(NSAIDs) to treat osteoarthritis
pain,compared with 63% of those given
placebo.Arthritis and Rheumatism
(1998;41:81-91)
high-heeled shoes
●Twenty healthy women who were
comfortable wearing high-heeled shoes
were studied. When these subjects
walked with their own high-heeled shoes
and barefoot, it was found that increased
force across the patellofemoral joint and
a greater compressive force on the
medial compartment of the knee
high-heeled shoes
●occurred during walking in the high-
heeled shoes compared to being
barefoot. This can alter forces on the
knees which may predispose to
degenerative changes in the joint.
"Knee Osteoarthritis and High-Heeled
Shoes," Kerrigan, D. Casey, et al,
TheLancet, May 9, 1998;351:1399-1401
 OSTEOARTHRITIS -
Niacinamide, Vitamin B3
●Seventy-two patients with osteoarthritis
received either niacinamide at 3000 mg
per day (6 tablets) for 12 weeks or a
placebo. Global arthritis improved 29%
in those on the niacinamide and
worsened by 10% in the placebo
subjects. Pain levels did not change but
the niacinamide group reduced their
 OSTEOARTHRITIS -
Niacinamide, Vitamin B3
●Niacinamide reduced erythrocyte
sedimentation rate by 22% and
increased joint mobility by 4.5 degrees
over controls. Side effects were mild but
higher in the niacinamide group. This
medication appears to be safe with mild
GI side effects. The Effect of Niacinamide on
Osteoarthritis: A Pilot Study," Jonas, W. B., et
al, Inflammation Research, 1996;45:330-334.
 moderate exercise
●Data suggests that moderate exercise does not
worsen the disease but results in improvement
in pain scores with no changes in x-ray scores.
"A Randomized Trial Comparing Aerobic
Exercise andResistance Exercise With a Health
Education Program in OlderAdults With Knee
Osteoarthritis: The Fitness Arthritis andSeniors
Trial (FAST)," Ettinger, Walter H., Jr., M.D., et
 PEARL:
●Physical activity enhances mental health,
improves healthy muscles,bones and joints,
and reduces the symptoms of osteoarthritis.
●Thirty minutes of brisk walking 6 to 7 days a
week is a significant time commitment. I think
the most important thing is to build a habit in
patients to see exercise as a part of their life
and not something they are doing as therapy
for a disease state. It may take 6 to 12 months
to build the habit so that when individuals don't
OSTEOARTHRITIS - Vitamin
D
●In evaluating 556 subjects from the
Framingham Study, osteoarthritis was
found in 75 knees and progressive
osteoarthritis in 62 knees. The data
showed that the risk for progression
increased three-fold in those who were in
the middle and lower tertiles for both
intake and serum levels of vitamin D
 OSTEOARTHRITIS - Vitamin
D
●compared to those who were in the upper tertile.
Low serum levels predicted loss of cartilage and
osteophyte growth. Low intake and low serum
levels of vitamin D appear to be risk factors for
the progression of osteoarthritis of the knee.
Relation of Dietary Intake and Serum Levels of
Vitamin D to Progression of Osteoarthritis of the
Knee Among Participants in the Framingham
Study," McAlindon, T.,et al, Annals of Internal