How to Treat and Prevent Osteoarthritis

It’s not just the simple wear and tear of daily living. The condition stems from microscopic damage in the structure and makeup of cartilage, the soft, slippery tissue that covers the ends of bones in a joint. This damage may be triggered in part, or exacerbated by, oxidation by free radicals. The damage impairs the ability of cartilage cells to repair and maintain cartilage.

When cartilage is healthy, your bones glide smoothly over one another, the cartilage acting as a kind of shock absorber. But with osteoarthritis, that surface layer of cartilage has worn down, allowing the bones to rub together. The result? Pain, swelling, and loss of motion. Over time, bone spurs called osteophytes might grow on the edges of the joint, and bits of bone or cartilage can even break off and float inside the joint space, increasing the pain.

Inflammation isn’t a major player in the development of the disease (unlike in rheumatoid arthritis), but it can contribute to the pain, so many of our Best Remedies are aimed at reducing it.

Do This Now

When your arthritis pain flares, follow this advice for relief.

1. Take 700 to 1,000 milligrams Tylenol and 200 milligrams Aleve three times a day.
2. Begin taking 1,500 milligrams a day of glucosamine, either at one time or in three divided doses. It also comes in a powdered formulation.
3. Massage a sports cream like Ben Gay or a natural product like Tiger Balm or White Flower oil (available at health food stores) into the sore area.
4. If joint stiffness is the main problem, wet a thin towel with very warm water, wring it out, and apply to the affected joint, then cover with plastic wrap and lay a hot water bottle or heating pad atop the wrap for added effect. If the joint seems swollen, however, apply an ice pack instead of heat.
5. Head to your local pool for a gentle water workout.

Why It Works

A large review of numerous studies on the use of acetaminophen (Tylenol) and nonsteroidal anti-inflammatories (like Aleve) for osteoarthritis concluded that while the NSAIDs were slightly better at relieving pain, the acetaminophen did a better a job at restoring function. We recommend taking both during an acute attack (not long term) to get both benefits.

Glucosamine is the most important, noninvasive treatment that is available for osteoarthritis. It provides an important building block for substances required to maintain and grow healthy cartilage. There is some evidence that it can not only preserve joint function but also reduce the destruction of cartilage. In fact, it is the only oral treatment, conventional or alternative, found to actually alter the course of the disease. Commercial glucosamine is made from shellfish products, so don’t use it if you’re allergic to shellfish. Give glucosamine up to four weeks to begin working,

The salves we recommend contain aromatic oils that dilate blood vessels and speed the removal of toxins. They also create a sensation of heat or coolness depending on the oil used, which distracts you from the underlying pain. Some of the salves also contain topical pain relievers or muscle relaxants.

Wet heat is wonderful for relaxing the muscle around the joint and bringing more blood to the area. Heat tends to change the perception of pain in the joint (making it hurt less), while the moisture helps the heat penetrate more deeply. The ice numbs the pain by reducing swelling and increasing your pain threshold (so it takes more pain before you feel it). As little as 20 minutes of ice massage five days a week will significantly increase function, according to studies.

Studies find that any type of aerobic and/or resistance exercise improves the pain and disability of osteoarthritis as well as slows the progression of the disease. Exercise helps strengthen muscles, thus taking some load off joints, and increases flexibility, thus reducing strain on joints. It also helps you maintain a healthy weight.

We recommend pool exercises, which many YMCAs and health clubs offer specifically for people with arthritis, because they’re gentle on the joints while still giving you and your muscles a workout. One study of 106 people with osteoarthritis of the hip and/or knee found those who exercised in the pool two hours a week for one year significantly improved their physical function and reduced their pain compared to a placebo group. Talk to your doctor before beginning any exercise program.

Other Medicines
 

Herbs and Supplements

Willow bark extract. Aspirin was first derived from this bark, and the extract is often used as an alternative to aspirin and similar pain relievers in Europe. A handful of studies in people with knee and hip osteoarthritis found it reduced pain much more than a placebo did, although not nearly as well as a prescription drug did. However, unlike most NSAIDs, willow bark is gentle on the stomach and doesn’t interfere with blood clotting. The pill form is sold under the name Asalixx, available online at www.bionoricausa.com or by calling 800-264-2325. Give it time to work; it could take up to six weeks before you see its full benefits.

Devil’s claw. This bitter-tasting African herb is often used to reduce inflammation.

A study that compared devil’s claw to a prescription anti-inflammatory found similar benefits between the two, with fewer side effects from the supplement. Take 2.6 grams a day of an extract standardized to 3% iridoid glycosides in divided dosages.

Boswellia. This traditional Ayurvedic herb has strong anti-inflammatory properties, and thus works well for arthritis pain. In one study involving 30 people with osteoarthritis of the knee, those who took the herb had less pain and greater range of movement and could walk farther than those who took a placebo.

Antioxidants. Because a growing body of evidence links osteoarthritis to damage from oxidation, we recommend supplementing daily with antioxidants to help prevent further damage. Take a supplement that contains 250 milligrams vitamin C, 400 IU or less vitamin E, 2,500 IU beta-carotene, 200 micrograms selenium, and 15 to 25 milligrams zinc. You can add a separate vitamin C supplement for a total of 1,500 milligrams vitamin C supplement daily in divided doses (no more than 500 milligrams at a time).

SAMe (S-adenosyl-L-methionine). This supplement, often used for mild depression, turns out to be very beneficial for osteoarthritis. Studies comparing it to two different NSAIDs found it worked just as well at relieving pain after a month, with fewer side effects. We’re not quite sure how it works, but it may play a role in cartilage development. Take 600 to 800 milligrams along with a B50 complex vitamin to increase the amount of SAMe your body absorbs.

Over-the-Counter Drugs

Capsaicin cream. Sold as Zostrix, this cream comes in two strengths, 0.025% and 0.075%. It works by depleting a chemical known as substance P that contributes to pain perception. You need to apply the cream several times a day, and it may take several days before you feel relief. Start with the lower dose, watch out for skin irritation (this stuff has the same ingredients as hot peppers), and wash your hands well after applying it. Some researchers are now experimenting with injecting capsaicin into the joint itself; a single injection has been found to reduce pain for up to two weeks.

Other Approaches

Weight loss. Losing weight is, without a doubt, the best thing you can do to reduce the pain and disability from osteoarthritis (and reduce your risk of developing the disease). Even losing just 5 percent of your body weight can help.

Anti-inflammatory diet. Even though inflammation doesn’t contribute to the disease directly, it does contribute to the pain. Following an anti-inflammatory diet can not only help reduce inflammation but also increase your levels of antioxidants and the B vitamin folate, both of which may slow the progression of osteoarthritis, some studies suggest.

Medical equipment. Using a cane or crutches, or putting special inserts in your shoes, can improve shock absorption and take pressure off an arthritic knee or hip.

Acupuncture. There’s good evidence for acupuncture’s benefits in treating osteoarthritis. In one well-designed study published in a major medical journal, people who received acupuncture 23 times over 26 weeks had significantly less pain and better function than those who received sham treatments.

The Arthritis Self-Management Program. This is a program available through hospitals and local Arthritis Foundation chapters that teaches you how to manage your disease. One study found that after four years in the program, participants had far less pain, made fewer visits to the doctor, and spent fewer days in the hospital than those who weren’t in the program.

Surgery. The most common surgical procedures involve cleaning out and/or repairing existing cartilage (arthroscopy) or replacing the entire joint (arthroplasty). They’re pretty good at improving function and reducing pain, but, over time, may need to be repeated. However, if your cartilage is completely gone, and bone pain has made it hard for you to exercise or enjoy daily life, then surgery is a good option.

Prescription Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs). Even though one category of NSAIDs, the COX-2 inhibitors (which included Vioxx), has nearly disappeared from the market, there are dozens of other prescription NSAIDs that work just as well. And despite some marketing claims that the COX-2s were easier on the stomach than other pain relievers, the evidence for that claim is weak. So talk to your doctor about some of the older prescription NSAIDs, like Voltaren, Daypro (oxaprozin), Relafen (nabumetone), Lodine (etodolac), and Indocin (indomethacin).

Steroid or anesthetic injections. With this treatment, the drug is injected directly into the joint. It’s only recommended in the case of severe pain and only for the short term, because long-term use can damage the joint. Plus, it’s dangerous to numb a joint-if you can’t feel pain, you could hurt yourself and not know it.

Magnets. One of the few placebo-controlled studies to evaluate the use of magnets on arthritis involved 194 people with osteoarthritis of the hip or knee. Participants wore either a strong magnetic bracelet, a weak magnetic bracelet, or a dummy bracelet for 12 weeks. Those with the magnets (strong or weak) had less pain.

Physical therapy. Physical therapy ranges from the use of ice and heat to exercises designed to improve your joint function and range of movement. You’ll need a doctor’s prescription and should be prepared to commit several hours a week. Different forms of physical therapy affect different types of arthritis in different ways. For instance, one study found manual therapy (a hands-on approach that includes stretching, therapeutic massage, and joint movement) worked better for people with osteoarthritis of the hip than exercise therapy.

Prevention

Maintain a normal weight. If you’re overweight, you can significantly cut your risk of arthritis by slimming down.

Get enough vitamin C. We only have studies in animals to go on, but it appears that maintaining a high vitamin C intake may reduce your risk of developing osteoarthritis. Ideally, get your vitamin C from your diet, in citrus fruits, red and green peppers (sweet or hot), spinach, broccoli, and other fruits and vegetables.

Keep moving. Just as exercise helps reduce osteoarthritic pain and disability by strengthening the muscles around the joint, it can help prevent joint breakdown by keeping muscles strong and taking some of the stress off the joints.