Search for:
Most Effective Ways To Treat Osteoarthritis[OA]-Stagewise

Most Effective  Ways To Osteoarthritis[OA] – Medications

In my last article on Osteoarthritis, I had written about the preventive aspect of the disease- in this article, I will be discussing the medication aspect.

How to treat Osteoarthritis with Medicines-

Before we jump on to the treatment part of osteoarthritis, let’s have a brief look at the picture shown below-

Picture showing changes observed in Osteoarthritis

Now let us see how these changes appear in an X-ray picture of an Osteoarthritis joint-

 

Right knee joint xray showing osteoarthritis changes
X-ray picture of osteoarthritis in right knee joint

The 4 stages of OA-

Before we go on with the medication for osteoarthritis, let us quickly recall the various stages of OA as shown below-

  • Normal Knee joint parts

Why is the staging of OA so important?

Different stages of OA have slightly different modes of treatment. In this article, I intend to inform you on both non-medical and medical line of treatment of all stages except the 4th stage. Stage 4 osteoarthritis mostly requires surgery, especially in the knees,

The stage-wise treatment is as given below:-

A] Stage 1-

In this stage, the treatment is mostly non-medical. Meaning that very few medications are prescribed and they are mostly nutraceuticals. I mostly stress on exercises to relieve the stiffness in OA.

What do I advise my patients?

Medications are bare minimal at this stage. This is what I advise my patients:-

a] Exercises-

  1. Brisk walking for at least 30 to 45 minutes for knee OA.
  2. For early OA of hands, an exercise in a bowl of warm water is very effective[see below]
    • Exercise for Hand OA in warm water
  3. Hip OA pains in the early stages are quite disturbing and exercise can help relieve pain gradually by strengthening the muscles and other structures supporting the hips. Here are 10 exercises which can help relieve pain as well as strengthen the muscles-watch this short video-
  4. For early OA of the spine, popularly known as spondylitis/spondylosis[Cervical{neck} and Lumbar{ lower back}], some of the exercises shown above work very well.
  5. Neck OA or cervical spondylitis pain can be relieved by these exercises as shown below-
    • Neck Exercise No.1
      Neck Exercise No.1
  6. For OA of the lower back, I suggest this simple exercise-
    Exercise For OA of Back
    A simple exercise for OA of Back

    Here is one more short video that shows that exercise helps in a lot in Osteoarthritis –

Are there any items to reduce/ease the pain?

Apart from exercises, I have used these items to relieve pain and stiffness in my knee joint-Kneecap for Osteoarthritis

A good pair of Knee caps for Knee Osteoarthritis
A good pair of Knee Caps for Osteoarthritis [Click Here for details]

A pair of self-heating Knee straps for Osteoarthritis
A pair of Self-heating Knee Straps for Osteoarthritis[Topurchase Click Here]
Both these items help in relieving pain and stiffness in osteoarthritis of the knees. They can be worn while walking. The self-heating knee straps can be removed after getting sufficient heat-it should not be worn while sleeping. These straps contain a substance called tourmaline which heats up when in contact with our skin. The magnets in the strap help in healing the damaged cartilage.

  1. For Stage1 OA of the neck spine or Cervical spondylitis, I usually prescribe a Cervical collar to prevent  excessive movement [as shown below ]     
    Cervical collar for neck spondylitis
    Cervical collar for neck spondylitis[Click here to buy]
  2. Similarly, for pain or back spasm, I have prescribed a lumbosacral [LS] belt and a heating pad to some of my patients.  They give very good relief from stiffness and pain. Have a look-
    Heating pad for backache
    Heating pad for chronic backache due to OA of the lumbar spine.[Click Here to purchase]

b] Medications-

Pain in joints[hands, hips, knees, or the back] is the sole reason why patients visit me for treatment at my Clinic.

Medicines are prescribed mostly to relieve pain, stiffness, and swelling if any. However, they should be taken only under the supervision of your healthcare provider. These are some of the medicines which I regularly prescribe-

1] Non-steroidal Anti-inflammatory Drugs[NSAID]-

Drugs like diclofenac sodium [Voveran], naproxen[Naprosyn], ibuprofen[Brufen], nimesulide[Nise/Nimulid] etotodolac[Proxym ER 300] etc., come under NSAIDs[pronounced N-seds].

These medicines have got the ability to reduce pain as well as inflammation of the joints in Osteoarthritis. They should always be consumed after food, preferably with a little milk because they have the tendency to cause acidity and gastritis.

2] Proteolytic Enzymes-

A very good class of drugs-they have the ability to reduce swelling by breaking down the proteins which cause inflammation in OA. Examples of proteolytic enzymes are-

  • Serratiopeptidase[ Emanzen, Cipzen]
  • Trypsin  Chymotrypsin[Chymoral, Enzoflam CT]
  • Bromelain, Rutoside[these two can be used with trypsin chymotrypsin for better effect]. These are enzymes derived from the plants with excellent anti-inflammatory and antioxidant activities.

All of the above medicines, when combined with NSAIDs, have a very good pain-relieving and anti-inflammatory effect in Osteoarthritis.

3] Nutraceuticals-

Nutraceuticals[word derived from nutrition and pharmaceuticals] are substances that are derived from food that we eat, albeit in a concentrated form. They have been combined together in a tablet form for consumption. These are some of the nutraceuticals that I recommend regularly to my patients with Stage 1 OA-

a]Glucosamine Sulfate, Chondroitin Sulfate, and MSM[Methyl-Sulofonyl-Methane] -a boon for Osteoarthritis treatment-

All the above-mentioned substances are present naturally in the cartilages[read about it here] in most of our joints. They are a group of substances called Proteoglycans and they help in building and constantly repairing damaged cartilage. Thus consuming them becomes a part of Osteoarthritis treatment.

b] Curcumin, Omega 3 fatty acids –

Curcumin is easily available in our food as turmeric. Omega 3 fatty acids are available in fish oils as well as flaxseed oil and soybean oil.

These nutrients have both anti-inflammatories as well as painkilling properties. These are available in purified powdered form and are used for fortifying glucosamine and chondroitin tablets.

c] Collagen-

This is a protein that is found in skin, nails, tendons, bone, etc. Out of this, that found in the cartilage is called Undenatured Type II collagen. This collagen helps by relieving pain and stiffness, and improving mobility of the joints. They are used in conjunction with the above 2 mentioned nutraceuticals.

 How do these nutraceuticals work in Osteoarthritis?

All these nutraceuticals are derived from cartilages of animals like cows, pigs, etc. They can also be manufactured artificially.

Most of these have similar properties and they help to-

  • Reduce pain and inflammation
  • Build new cartilage
  • Repair the damaged cartilage

These medicines are available as Jointace C2+, Durajoint in the medical stores, and can be purchased without a prescription. However, I would advise you to consult your family physician regarding dosage which can vary from person to person.

Do I recommend Nutraceuticals for OA?

Yes, I do, and that too strongly.

There are many contrasting views regarding the use of these substances in the treatment of OA. But my experience is that they are very good. In my previous article on preventive management of OA, I had mentioned that I was diagnosed with knee OA Stage 2 in December 2016 after which I was advised to undergo TKR[total knee replacement] surgery after 2 years. I was practically limping while walking at that time.

What else do I recommend?
  1. Oils and liniments or rubefacients- Massaging at the site of joint pains with liniments and oils give relief in the form of providing warmth to the joint. Many such herbal oils are available in the market place and they provide excellent relief. I have personally used liniments like Arnopen[Phytopharma], Pain Relief[20 Microns], and ointments like Arthrella[Charak]. That brings me to the next medication-
  2. Ayurvedic preparations- The above-mentioned companies producing liniments also produce tablets and capsules which they claim to be effective. They contain ingredients like Boswellia Serrata, Curcumin, etc., which help in reducing pain and inflammation, albeit gradually. I recommend them to patients who are afraid to consume allopathic pain killers because of their side effects.

Here is a very good article that will help you overcome pain of Arthritis.

Finally, I would recommend you to listen to this interesting 🤔 podcast- link

How did I  treat my knee Osteoarthritis?

I followed this method to reduce pain and stiffness and I advise my patients to do the same.

  1. Exercise to reduce my weight-I was 15% above my ideal body weight of 72 kg. I realized that this was putting tremendous stress on my knees.[For every extra Kg of body weight, the stress on knees increases by four folds]. Brisk walking for 45 to 6o minutes daily for 5 to 6 days a week helped me reduce this excess weight by 50%.   I started noticing the effect it had on my knee pain-it had almost disappeared.
  2.  Proxym ER 300 once a day and Zymogesic DS twice a day were taken to relieve pain and swelling. One month later the pain improved substantially.

What more did I do for my Knee Osteoarthritis?

With the above two regimens, I added a nutraceutical-Jointace C2+- which I am having to date. My pains, as well as limp, have gone and I still walk briskly daily.

This how I beat OA of my knees. I have pushed my TKR till further date i.e. as and when my OA pops up again or becomes unbearable.

There are a host of companies providing nutraceuticals for Osteoarthritis with different combinations. Here are some of the commercially available nutraceuticals for OA- Click Here.

To know more about these nutraceuticals click here

B] Stage 2 OA-

This stage usually occurs in the 30s and 40s. Treatment of this stage is the same as that of Stage 1 with an increased period of anti-inflammatory and proteolytic medication.

During this stage, I advise my patients a few more things to do-

  1. Avoid squatting. Squatting causes more wear and tear of an already degenerating knee and hip joint.
  2. Carry out quadriceps muscles strenghtening exercise- it helps reduce pain as well as increase mobility [ read here]
  3. Replace the Indian style commode by a western style one- this has the same effect as avoiding squatting.

I also prescribe a Calcium and Vitamin D supplement as I have observed changes of Osteoporosis[brittle bones] in these patients.

C] Stage 3 OA-

As we age, the metabolic process in our body slows down. This stage mostly occurs in the early 40s and 50s. The pain starts becoming unbearable. The disability increases.

The joint gets deformed due to fraying of cartilage[shown below]-

Bowed legs in osteoarthritis of Right Knee
Osteoarthritis -Right Knee showing bowing of legs

 

At this stage, I recommend all the medications in Stage I & II OA along with-

  1. Calcium supplements- to increase the density of bones around the joint
  2. Wearing of braces to correct the bowing of joints and use of a cane for support while walking[as shown below]-

These are very helpful to maintain balance in Stage 3 OA as patients tend to lose balance and can easily fall causing injury in the form of bone fracture as at this stage there is an increase of porosity of bones due to calcium deficiency. This is especially more so in women of post-menopausal age.

Braces to prevent splaying in knee Osteoatrhritis
Braces to prevent splaying of the knee joint in Osteoarthritis 
Walking stick for OA of knees
Walking stick to help relieve pain in Osteoarthritis of knee

D] Stage 4 OA-

In this stage, the cartilage is almost absent[as shown in the X-ray picture at the beginning of the article]. The pain is more severe and patients have sleep disturbance.

There is no point in continuing the nutraceuticals. So along with anti-inflammatory pain killers, I recommend additional narcotic pain killers like Tramadol[Tramazac], Tapentadol[Tapnex ER 50], and liniments and oils.

These medications help in improving the quality of sleep as well as relieving pain substantially.

At this stage, I usually recommend that patients should go for TKR  i.e. Total Knee replacement.

What is TKR?

TKR means replacing the damaged knee joint or hip joint by cutting the bones[ femur and tibia] at the joint level and replaced with artificial parts or prosthesis. By undergoing this operation, the patient gets tremendous relief from pain. The effectiveness of the operation depends on many factors such as-

  • Age of the patient-the more aged the patient, less effective is the replacement
  • Weight of the patient-obesity and overweightedness causes failure of TKR in most cases
  • Bone density of femur and tibia- Very important as the strength of the new joint depends on the strength of bones holding it.
What’s the latest news in the treatment of OA?

Research is on for a pain killer for Stage 3 and 4 OA. One such drug which is doing the rounds is Tanezumab- an injection that is administered subcutaneously[below the skin] in a dosage of 5mg/week.

Another interesting piece of news is that research is going on for using stem cells to regenerate the degenerated joint tissue of Osteoarthritis. For details, Click Here to read.

This medication though showing great promise, is still under clinical trials. If approved, it can be a boon to those who could not be operated.

With this, I come to the end of my series of articles on Osteoarthritis. If you have any questions or queries, you can join me by discussing the topic in the comment section of the blog.

Be sure to provide your e-mail address so that I can contact you personally to help you sort out your OA problems.

For more on Osteoarthritis, you can Read Here

And for all things to do about pain management Read here.

To learn about other people’s experiences Click here.

I take a multivitamin, I take extra C, I take chondroitin and glucosamine for my joints, I take calcium for my bones. And by the way, weight-bearing exercises can help ward off osteoporosis and yoga helps ward off arthritis. Raquel Welch Click To Tweet

 

 

 

 

Osteoarthritis- Part 2- Management-Prevention

MANAGEMENT OF OSTEOARTHRITIS(OA)-Prevention

Author Photo

Introduction-

In this article, we will learn the management of osteoarthritis-its prevention in the first place, and if you are already into it, how to manage it depending upon the various stages. In my last post, I have discussed what happens in Osteoarthritis.

According to the WHO, 9.6% of men and 18% of women above 60 years of age have osteoarthritis all over the world. The scenario in India is that OA is the second most prevalent arthritis with figures of 22% to 39% in a population suffering from arthritis of any kind.

Out of these, nearly 45% of women aged above 65 years have symptoms, while 70% of those above 65 years also show changes in their X-rays of the affected joint/s.

Here is where the management of osteoarthritis, particularly its prevention comes into play.

What did I do to prevent the progression of my Osteoarthritis?

In December 2016 I was having difficulty climbing stairs, even though I stayed on the first floor of the building. I noticed that I had put on weight more than 10 kg. Even though my diet was as it was before I had put on weight.

I was also getting pain in the knees while climbing down. I was getting the feeling of something grating inside my knee. A time came when I had to take the support of a friend to walk me home, even though the distance was only a few furlongs from my clinic.

I was then advised by a friend of mine, who runs a pathology lab to get some blood tests done. It was then that I found out that I had Hypothyroidism which was the cause of my weight gain.

Later on, I went on to get my knee X-rays which showed that I had early signs of Osteoarthritis. Next, I sought the help of a senior orthopedic surgeon friend of mine who confirmed the OA and advised me to come for Total Knee Replacement[TKR] surgery after 2 years.

Hearing about TKR, I decided that I should do something to prevent the further progression of my osteoarthritis and I began learning more about it.

So what did I do next?

This prompted me to write an article on Osteoarthritis management so that I can help people to overcome the difficulties faced by them when they get OA. In my first article, I have described how OA happens and after doing some research into it, I have come out with ways to prevent it as well as treat it if you get it.

As said above, after I was advised TKR, I went about treating myself after getting relief from pain. At that time I was walking[rather limping] with difficulty. So I searched on Amazon and purchased-

    1. A pair of good quality knee caps which I am using even today while I go for my morning walk.
    2. A pair of self-heating knee straps, which helped me get relief from constant pain.

I was advised not to stop walking. The reason being, walking prevented stiffness of the joint as well as improved the lubrication of my knee joint and circulation of blood to the joints.

As was in the early stage of osteoarthritis, I took some nutraceutical capsules which helped me to regenerate the cartilage in my joints to some extent and prevented further damage. I will come to this in the treatment part of the article.

How to Prevent  OA:-

These are a few measures to prevent OA:-

1.Regular exercise like brisk walking/cycling-

Brisk Walking for Good Health
A Brisk Walk in the Park

In today’s busy life, people have a sedentary lifestyle wherein they barely walk. Because of the time shortage due to the heavy working schedule and deadline given to them, people prefer to travel to work even if it is a short distance to cover.

This results in the muscles and bones not getting the much-needed exercise to keep tuned up. We also put on more weight. As we age, this causes muscles to stiffen, giving rise to cramps in the calves and pain in the knee joints leading to osteoarthritis.

Brisk walking can prevent this, at the same time having beneficial effects on other parts of the body, including your mind.

Other important exercises that can prevent osteoarthritis are cycling and swimming.

Man using bicycle as exercise
Cycling for good health

Some other benefits of exercise in Osteoarthritis-

According to research, apart from strengthening our muscles and joints, exercise also helps in –

  1. Reducing stress on your knee joints. Research has shown that 1 kg reduction in weight can reduce the pressure on your knee joint by 9 kg. That means, if you reduce 5 kg weight, the stress on your knees reduce by a whopping 45 kg, thereby reducing pain and inflammation of osteoarthritis substantially.
  2. Body-weight has a direct impact on the health of your knee joint. A person with normal BMI has approximately 3 to 4 percent chance of getting OA whereas the one with BMI in the range of 30 to 35 ( grossly obese) has almost 20 percent chance of getting OA.
  3. Increasing hormones like endorphins sand melatonin. Endorphins are natural pain killers and melatonin helps in getting good sleep.

Both exercises like cycling and swimming help in reducing pain as well as building your quadriceps muscles as shown in the picture below-[click the picture to know how it works]

Quadricep Muscle of the Thigh
Quadricep Muscle of the thigh holding the bones of the knee joint

To know more about the benefits of walking, Click here1 & 2

2. Reduce weight-

It is very important to reduce your weight and bring it to your Ideal Body-weight if you are grossly overweight.

Bodyweight has a direct impact on the health of your knee joint. A person with normal BMI has approximately 3 to 4 percent chance of getting OA whereas the one with BMI in the range of 30 to 35 ( grossly obese) has almost 20 percent chance of getting OA.

First, calculate your ideal body weight by using this gadget

Just put in your height in centimeters and click the submit button. This will show your ideal body weight. Below this will be a range of this weight depending upon your build.

Next, calculate how much weight you have to lose by subtracting this weight from your present weight. You will know the excess weight you are carrying which may be a probable cause of your Osteoarthritis pain and/swelling.

How can you do this?

This is a plan which I follow daily-

    • After my morning rituals after getting up, I go for a walk. The time of the walk and the distance covered varies from day-to-day. A look at the screenshot shown below will give you an idea of how I do it –
Screenshot of the steps covered by walking
Screenshot of Steps covered by walking
    • I avoid taking pain killers for my knee pain unless it becomes unbearable. Then I use some safe pain killer like tramadol ( Ultracet) temporarily. Having pain is a signal that something is wrong with the joint that should not be neglected. At the same time, a range of joint movement should be carried out to keep that joint moving.
    • I have strengthened my quads( quadriceps muscles) by doing these exercises-
  • Avoid squatting on the floor if you feel you are going in for OA. This is known to damage the cartilage of the knee joint.
  • Use Western-style commode instead of an Indian style toilet as shown below.

This will also prevent damage to the cartilage.

Remember, exercise builds strong muscles and bones in the long run,  so do it even if there is a slight pain. This pain will disappear in the course of time.

Having said this, in the early stages of arthritis( see the stages of OA here) we should not slow down but try some exercise like stationary bike cycling or walking in a swimming pool. While walking,  you can listen to some podcasts on OA – this will encourage you how to deal with the OA pain.

Work out in an open-air gym –

Open_air Gym for increasing muscle mass
Open Air Gym

It is important to increase muscle mass surrounding the joint. In most parks, we are provided with open-air gyms that are gentle on our ailing joints and at the same time helping us to gain muscle mass. Make a point to use them regularly.

For more about exercise for OA, you can visit this website.

3. Eating right-

‘What we eat is what we become ‘ is a saying which is true to its last word. Many a time we like to binge on our favorite food without thinking of the consequences of eating the wrong type of food. Eating a well- balanced diet will help you overcome-

  • Unwanted weight gain
  • Thereby reducing the load on affected joints
  • And ultimately, reduction in joint pains.

So, eating the right types of foods and in the right quantity goes a long way in preventing the progress of osteoarthritis. Your food should be a proper balance of all the macronutrients as well as vitamins and minerals.

How do I know how much to eat-

Depending upon your age and weight, I would suggest you get your energy requirements right. First, you should calculate your BMR [click here] and then calculate your energy requirement as per the table given below:-

Calculation of your daily energy requirement based on your activity and BMR
Your total Energy Requirement depending on your activity.

After calculating the amount of energy you need, break it up into 4 to 5 portions viz. breakfast, brunch, lunch,  evening tea, dinner- and allot the food quantity accordingly. For example,  if your total energy requirements are 2200 calories per day, you can divide it as follows-

  1. Breakfast- 20%- 440 cals
  2. Brunch- 10%- 220 cals
  3. Lunch- 40%- 880 cals
  4. Tea- 10%- 220 cals
  5. Dinner- 20% – 440 cals.

This way, you will be able to reduce the workload on your digestive system and also get a restful sleep at night.

Which foods should I eat or avoid-

There are a variety of foods that you can enjoy in osteoarthritis. And there are some types of foods that you should avoid to prevent flare-ups of inflammation in OA. This website will show you the best choices- the good as well as the bad ones- Click Here.

Friends, apart from my clinical experience, a lot of research has gone into writing this article. In the course of writing, I have referred 2 books which have given me many an insight to Osteoarthritis.

I would like to share the name of books which I have referred here-

Books about arthritis
Books about arthritis

You can get these books on Amazon as a Paperback or as a Kindle ebook-

Book on Osteoarthritis
Book on Osteoarthritis

This book is available free on Kindle Unlimited if you are a member and can be downloaded on the free kindle app on your smartphone, tablet, or desktop.
Having said this, I  invite you to share with me your overall personal experience of preventing osteoarthritis if either you or relative is suffering from it.

For further information on Osteoarthritis, you can visit some or all of these sites:-

 1.Creaky joints.org

2. Living with Arthritis

3. Beating OA blog

You can also learn a lot more about Osteoarthritis by listening to this podcast on the topic here.

Dr. K. P. V. Rao's Health Blogs
%d bloggers like this: