OSTEOARTHRITIS: THE COMMONEST DISEASE OF JOINTS

-Dr. Gautam Pal, M.D.(Homoeopathy)

Lecturer, National Institute of Homoeopathy, Kolkata

We experience elderly people, especially overweight or obese persons walking in a

peculiar gait. You can say a mixture of limping and waddling gait. Their gait is
sufficient enough to state that they are suffering from some joint problems. Almost two
in five persons complain of pain and stiffness of neck, back and knees. They can not
rotate their joints in full extent of that of normal, can’t sit properly on the ground or
even are unable to walk on staircases. Often they have huge swelling of some joints
with pain. This accompanies now almost every old person in their lonely and
sedentary lives, and young persons too in their stressful and busy lives.
All of them are suffering from osteoarthritis.
Osteoarthritis, the commonest joint disorder as well as the oldest known disease in
the world, is also known as Degenerative Joint Disease. The term ‘osteoarthritis’ is
partially misnomer as though the term contains suffix - ‘itis’ but primarily it is not
inflammatory. Medical literature states about its prevalence in old age (> 65 years) but
it is not uncommon to get younger patients, i.e., of 30 – 40 years of age with clinical
and radiological evidences of osteoarthritis.
The evidences of this oldest disease were found in skeletons of dinosaurs of 50 – 70
million years old, in Egyptian Egyptian mummies etc.

The principal changes are:

1) Degeneration of articular cartilage (Member of synovial joints which prevents
friction between two apposing bones.), and
2) Simultaneous proliferation of bones in terms of formation of ‘osteophytes’.

Homoeopathic system of therapeutics considers that this disease occurs and

intensified due to presence of some predisposing factors or accessory circumstances
and real or fundamental causes, described as ‘miasm’, which reflect the inner trend of
individual person to suffer from a specific group of illnesses, either acquired or
inherited.

For osteoarthritis,
A. Fundamental cause(s): Pseudopsora (Psora + Syphilis) & Sycosis, i.e., tri-
miasmatic with predominance of Syphilis.

[ Pain < motion : Psora, Pseudopsora;

Pain < night : Syphilis;
Pain > rest : Psora, Pseudopsora;
Stiffness of joints < first movement: Sycosis;
Stiffness > continued movement: Sycosis;
Effusion of joints: Pseudopsora;
Deposits of osteophytes: Pseudopsora, Syphilis;
 Nodes on dorsum of finger joints: Pseudopsora, Syphilis;
Deformities: Syphilis, Sycosis.]HA Roberts, Phyllis Speight
B. Predisposing causes/ Accessory circumstances:
1. Physical make – up: Obesity and increased BMI;
2. Age: 7th decade with usual asymptomatic onset in 2nd & 3rd decade;
3. Gender: Earlier onset in males; more generalized and severe in females;
4. Climate: cold and damp;
5. Occupation: farming.

C. Precipitating cause: 1. Trauma.

Osteoarthritis often does present as:

I. General features
1. Pain, initially intermittent, < motion, night; > rest.
2. Mobility of affected joints are restricted, < first movement after prolonged
rest, usually in morning, for 15 – 30 minutes; > continued motion.
3. Tenderness, cracking sounds (due to rubbing of exposed surfaces of bone to
each other) or grating sensation.
4. Repeated and recurrent effusion, usually following minor twists.
5. Enlargement of joints.

II. Specific features

1. Vertebral column: Known as Spondylosis (and not spondylitis.) Mostly
cervical and lumber vertebrae are affected.
i. Radiculopathy, though less but not uncommon, association with Carpal
tunnel syndrome.
ii. Myelopathy including weakness and disuse atrophy.
iii. In severe affection, there may be spondylolysis (i.e., bony defect in pars
interarticularis of the vertebrae) or breach of continuity of posterior part
of vertebral joint. This may lead to anterior slippage of the vertebral body,
pedicles and superior articular facets, leaving the posterior elements
behind (Spondylolisthesis).

2. Knee:
i. Varus deformity (Bow legs), in advanced cases;
ii. Subluxation of joint members;
iii. Inability to walk on staircase;
iv. Tenderness over medial or patello -femoral area.

3. Hands:
i. Formation of nodes, i.e. Bouchard’s and Heberden’s on dorsal aspect of
PIPJ and DIPJ respectively.
ii. Deformity is frequent but disability is rare.
 [Picture from personal collection of author].

4. Hip:
i. Gradual increase of rigidity and decrease in range of motion.
ii. Referred pain in inguinal region, via Obturator nerve.

This clinical spectrum can be confirmed by x –ray having features of degeneration of

articular cartilage (“Narrowing of joint space”) and proliferation of bone, usually
horizontal (“Osteophytes”/ “Spurs”, “Sclerosis” = when increased density of bone).

Spurs

Reduced
space

1. 2.
 Spurs + Sclerosis

Spurs

3. 4.

[1. X –ray of L-S Spine, AP view, 2. L-S Spine, Lateral view, 3. Hip joint, 4. Cervical spine, Lateral view. All
these photographs are from personal collection of author.]

MANAGEMENT OF OSTEOARTHRITIS

I. Medicinal
It is a well known fact that homoeopathy differs from other modes of treatment by its
principles like ‘Law of similia’, ‘Wholism/ Totality of symptoms’ and ‘Individualisation’.
Therefore, in homoeopathy there is no specific medicine for any ‘disease’ of specific
nosological nomenclature, but for a specific and individual patient. Thus it is advised
to take treatment from a doctor only.
Calcarea carbonica, Kali bichromicum, Kali carbonicum, Lycopodium, Mercurius,
Silicea, Sulphur, Phosphorus, Acid nitric, Calcarea phosphorica etc. are usual and
effective medicines for the patients suffering from osteoarthritis chosen according to
similarity with manifested symptoms of the patient. In acute exacerbation for
temporary management Bryonia, Ledum palustre, Arnica etc. are used.
More minutely, we can consider the following medicines with corroborating aetiology,
symptoms along with presence of their characteristic / identifying symptoms.

1. Joints with cracking sounds on motion:

Calcarea carbonica, Kali bichromicum, Kali carbonicum, Ledum palustre,
Mercurius, Natrum sulphuris, Nitric acid, Petrolium, Phosphorus, Sepia,
Sulphur, Thuja etc.;
 2. Osteoarthritis of hands with nodes:
Calcarea carbonica, Calcarea fluorata, Calcarea phosphorica, Causticum,
Rhododendron, Silicea, Sulphur etc.;
3. Joints with effusion:
Apis mellifica, Bryonia, Calcarea carbonica, Causticum, Mercurius, Natrum
muriaticum, Silicea, Sulphur etc.;
4. Stiffness of joints:
Calcarea carbonica, Kali bichromicum, Ledum palustre, Staphisagria etc.;
5. Pain in affected joints which are aggravated at night:
Bryonia, Calcare carbonica, Kali bichromicum, Kali carbonicum, Lachesis,
Lycopodium, Mercurius, Natrum muriaticum, Nitric acid, Phosphorus, Sulphur,
Thuja etc.;
6. Pain in affected joints aggravated by motion:
Bryonia, Kali bichromicum, Ledum palustre, Lycopodium, Phosphorus etc.

MEDICINE DISEASE FEATURES INDIVIDUAL FEATURES

 Pain as if dislocation, in hip,
knees, feet; <walking, night,
Calcarea change of weather;
carbonica  Arthritic nodosities of wrists
and finger joints;
 Rigidity of neck, pain in back <
night.
 Pain in shoulders, wrists,
fingers; cracking of all joints,
<Motion;
Kali  Stiffness of shoulder and right
bichromicum arm, <morning;
 Stiffness of neck < bending
forward;
 Violent aching pain in sacrum,
throbbing pain, < night.
 Pain in all joints< night;
 Weakness, rigidity, want of
Silicea flexibility in fingers <motion;
 Inflammatory swelling of knee,
painful;
 Nodosities over fingers.
 Stiffness of neck;
 Sacral pain with rigidity <
walking upright;
Bryonia  Cracking and stitching pain in
hip joint < walking, extending
to knee;
 Weariness and instability of
legs< upstairs;
 Aversion to work;
 Apprehensive and fearful, <
evening;
 Desire to take egg, aversion for
milk, meat;
 Obesity and tendency to grow fat.
 Anthropophobia,
 Vanishing of thoughts;
 Rheumatic complaints alternate
with gastric symptoms;
 < Heat.
 Nervous, starts at least noise;
 Mental labor very difficult;
 Very chilly;
 Sweat of body very offensive;
 Desire to be magnetized.
 Dryness of mouth with great
thirst, large quantities at long
interval;
 Mentally irritable, angry.
  Pains < motion, > rest;
 Stiffness of neck,
Kali  Stitching and shooting pain in
carbomicum back upto gluteal region or
hips;
 Acute pain in hips, toes, legs <
night;
Lycopodium  Stiffness, induration of one side
of neck;
 Distortion of spine;
 Arthritic nodosities and
stiffness in fingers;
 Curvature and stiffness of the
knees. Swelling of knees.
Mercurius  Sharp pain in shoulders and
arms, < night, motion;
 Swelling of joints of fingers;
 Sharp pain in hip joints,
thighs, knees, < night, motion.
Phosphorus  Rigidity of neck;
 Sensitiveness of spinous
processes of dorsal vertebrae to
pressure;
 Stiffness of joints< morning;
 Pain in joints < night, > heat;
 Arthritic rigidity of knees.
Causticum  Tearing, drawing pain in the
muscular pain, with
deformities about joints;
 Painful stiffness in back , rising
from chair;
 Stiffness and pain in joints of
legs;
 Arthritic nodosities on finger
joints;
 Swelling of joints.
Ledum  Cracking of the joints, <
palustre motion;
 Arthritic nodosities in joints of
hands and fingers;
 Pain in hip, knee, foot joints,
<motion, night, warmth, >cold.
 Can not bear to be touched;
 Great aversion to being alone;
 Easily catches cold.
 Pain chiefly on right side;
 Irritable, peevish in morning,
can not endure opposition,
greedy;
 Waking at night feeling hungry;
 Desire warm foods, sweet;
 < 4 PM – 8 PM
 Sensation of coldness of affected
parts;
 Profuse sweat, <
 Profuse, coppery, foetid, metallic
– tasting saliva;
 Large, flabby tongue, imprinted.
 Delicate, sensitive, easy
perception;
 Desire for cold food and drink,
refreshing things, ice cream;
 < Thunderstorm, before
midnight;
> Lying on right side, cold
water.
 Sad, hopeless;
 Intense sympathy for others;
 Can not cover too warmly, but
warmth does not >;
 Thinking of complaints <.
 Emaciation of affected parts;
The above treatment with homoeopathy has been accepted and established as effective
to reduce pain, stiffness, effusion with some radiological improvement especially of
regeneration of articular cartilages too.

II. Non – medicinal management: Exercise

Principles:
A. Reduction of excessive loading of affected joints;
B. Correction of poor posture;
C. Reduction of body weight;
D. Reduction of much strain of affected joints, like prolonged standing, keeling and
squatting for affection of knee;
E. Reinforcement of muscles of affected joints.

Measures:
i. Lumber lordosis – Correction of poor posture;
ii. Knee and Hip joints – Restriction of prolonged standing, kneeling, squatting;
iii. Hand - Rest;
iv. Use of heat – on all affected joints;
v. Exercise of affected joints – for a. Preventing disuse muscular atrophy,
b. Strengthening muscles to protect articular
cartilage from stress.
But it is advised to exercise under strict guidance and vigil of qualified physiotherapist
only.

CASE

Ms. M. B., Regn No. 06022494, aged 18 years in 2006 came with severe pain in
back, pityriasis, hypothyroidism with symmetrical goitre (adolescent?) and
menstrual abnormalities suggestive of PCOD. X- ray of Lumbo – sacral spine
revealed with minimal posterior slipping of L 5 on S1 with H/O trauma few years ago.
With mixed miasmatic features, chilliness and desire for sour, Sepia – 0/1 was
prescribed.
Without any marked relief, the patient came after 3 months on 09.11.2006. With the
present totality of symptoms, i.e., pain in head > by vomiting, pain in left side of
neck, extending to left hand, pain and bleeding from rectum, goitre, Desire for meat
and predominance of sycosis, Thuja - 0/1 was prescribed. After Thuja – 0/4, pain was
subsided, goitre and hypothyroidism became normal.
The problems of PCOD remained with mild alteration but thereafter there was no
pain in back. Though X –ray was not repeated, but the patient got married and was
living a happy life without pain of waist.