Written by Sandy Cho, MD and reviewed by Julie A. Cerrato, PhD
Osteoarthritis (OA) is a slowly progressive degenerative joint disease that commonly affects the middle-aged and elderly population. It is often referred to as “wear and tear” of the joints.
Osteoarthritis tends to affect commonly used joints such as the hands and spine, and the weight-bearing joints such as the hips and knees.
Osteoarthritis natural treatments involve reducing inflammation and providing nutrition to bones and joints. Reducing total body acidity is a must as acidosis can worsen bone health.
Osteoarthritis (OA) is a slowly progressive degenerative joint disease that commonly affects the middle-aged and elderly population. Be aware that young people can also be affected by this condition. It is often referred to as “wear and tear” of the joints. It is characterized by breakdown of the cartilage (the tissue that cushions the ends of the bones between joints), bony changes of the joints, deterioration of tendons and ligaments, and various degrees of inflammation of the synovium (joint lining).
About 27 million Americans are living with osteoarthritis, the most common form of joint disease. It is a main cause of disability in older people. Osteoarthritis tends to affect commonly used joints such as the hands and spine, and the weight-bearing joints such as the hips and knees.
What are the signs and symptoms?
- Joint pain
- Stiffness in the morning or after a period of inactivity
- Limited range of motion or decreased function of the joint
- Swelling may be present
- Cracking noise with joint movement may be present
- Very advanced cases of osteoarthritis can cause significant pain and difficulty walking, especially OA of the hips and knees
Osteoarthritis occurs when the joint cartilage breaks down often because of mechanical stress or biochemical alterations. There is also a component of free radical damage, oxidative stress, and worsening inflammation that also significantly contributes to worsening damage to the joint. Specific risk factors include the following:
- Age: People age 65 or older are at greatly increased risk
- Obesity: The excess weight the person needs to bear on his/her joints adds extra stress on them
- Excessive Joint loading: Manual labor, athletes, etc. In many cases, a person’s occupation or athletic activities require repetitive motions (such as repeated knee bending) that predispose the person to degenerative joint disease in later years
- Trauma: Fractures, ligament injuries
- Altered joint anatomy: Developmental hip dysplasia, dislocation due to trauma, unequal leg length, bowlegs, rheumatoid arthritis, gout
- Deposition diseases: These can cause the cartilage to be stiffer and include hemochromatosis, Wilson’s disease, Gaucher’s disease
- Genetic disposition or family history of osteoarthritis
- Acidic, high-inflammatory diet
What are conventional treatments for osteoarthritis?
Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are initially prescribed for the treatment of OA. Gastrointestinal bleeding is a concern with long-term use of NSAIDs. If an NSAID is to be used, safety is an important issue, especially in the elderly. The risk of NSAID-induced kidney and liver damage is increased in older patients and in patients with preexisting renal or hepatic insufficiency. Thus, it is important to monitor renal and liver function.
Another common class of medications prescribed for the treatment of OA includes narcotics or narcotic-like medications. These medications have the potential to cause significant side effects, including constipation, lethargy and confusion, and depression of the respiratory drive. They are not good long-term solutions for the treatment of pain due to OA.
Topical drugs may be applied directly on the skin over the affected joints. These medicines include capsaicin cream, lidocaine and diclofenac gel.
Intra-articular injections of corticosteroids can be helpful, but more than three to four injections per year is not recommended.
Surgery becomes an option for severe cases in which the joint has serious damage, or when medical treatment fails to relieve pain and you have major loss of function. Surgery may involve arthroscopy. If the joint damage cannot be repaired, you may need a joint replacement.
Part of a holistic treatment plan for OA includes a diet that is anti-inflammatory and alkaline in nature, as well supplementation with key nutrients and minerals for building your bones and promoting joint health.
Alkaline Diet: A typical modern American diet is high in Omega 6 and low in Omega 3 oils which increases the body’s inflammatory load. Increased inflammation is a significant contributor to the development of OA. Animal protein, in particular can be very inflammatory; the animal protein is processed by the body into hydrogen ions. The greater the number of hydrogen ions, the greater the total body acidity. The bone is a buffer for the continued acid load, in addition to the buffers in the blood and in the cells. Alkaline mineral salts, such as magnesium and calcium, are drawn from your bones into the bloodstream to buffer the excess acid that is built up on a daily basis. This weakens the bone over time and increases the risk of developing arthritis and other bone conditions such as osteoporosis.
An alkaline-based diet is rich in fruits and vegetables. An alkaline-based diet consists of foods high in antioxidant value that not only counter inflammation, oxidative stress, and acidosis but also provide significant nutrients that most of us are lacking.
Many over-the-counter nutrition supplements have been used for treatment of osteoarthritis. Among the most widely used are glucosamine/chondroitin sulfate, calcium and vitamin D, and omega-3 fatty acids. To ensure safety and avoid drug interactions, consult your doctor or pharmacist before using any of these supplements. This is especially true when you are combining these supplements with prescribed drugs. Adding the right supplements to your treatment plan is important for not only providing nutrition to your joints (yes, your joints need nourishment as well) but also reducing inflammation that can help reduce pain and restore function.
Supplements That Provide Nutritional Support to the Bone and Joints
Being deficient in Vitamin D is associated with the development of worsening hip and knee pain. Given that millions of people are deficient in this important vitamin, supplementation is vital. The usual recommended dose is 1000 units of Vitamin D3 taken with food to enhance absorption. Remember that your healthcare provider can measure levels of Vitamin D3 and adjust the amount you need to take.
Remember that Vitamin C is an antioxidant; in terms of cellular health, because it is an electron donor, it helps to reduce oxidative stress and keep the cells in a reduced or natural state. In one study, it was felt that Vitamin C may have a role in preventing osteoarthritis of the knee.
- The ester form of Vitamin C is better absorbed than other formulations.
- Vitamin C at a dose of 2000 mg a day is a good starting dose.
Vitamin K2 is very beneficial for bone health. It helps in maintaining the integrity of the bones and joints. It is integral in preventing calcium loss from the bone. It also helps to maintain the health of the blood vessels by preventing calcium influx into the blood. It also is very likely to be helpful in the treatment of osteoarthritis. One study demonstrated that joints that were affected with advanced OA were associated with lower levels of Vitamin K2.
Be aware that in addition to Vitamins C, D and Vitamin K2, that trace minerals are also important for bone health. These include Boron, Selenium, Zinc, Manganese, and Magnesium.There are several good supplements out there that are good for bone health.
Supplements that Reduce Inflammation and Lessen Pain
Glucosamine and Chondroitin
A large clinical trial called the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) that examined whether or not Glucosamine/Chondroitin together were effective in treating the pain associated with knee arthritis and if they could be used to treat the structural damage associated with OA was conducted. The authors concluded that these supplements were as effective as NSAIDS in treating pain. They also found that that they provided benefit for those experiencing moderate to severe pain. Another study concluded that chondroitin and glucosamine also helped reduce joint knee swelling. Glucosamine and chondroitin can also reduce total body inflammation, including lowering C-reactive protein levels.
The use of this supplement, especially when used in combination with Glucosamine and Chondroitin, has been shown in studies to reduce the pain of osteoarthritis as well as help restore clinical functioning. In one clinical trial, the effects of 3 grams of MSM taken twice a day compared to placebo demonstrated a significant improvement in pain and clinical functioning.
Arnica montana may be especially effective for the treatment of knee and hand osteoarthritis. It has been demonstrated for reducing inflammation of the joints. The application of Arnica topically to the hands or knees can be very effective in reducing pain and inflammation.
Avocado-Soybean Unsaponifiable (ASU)
Several clinical studies have demonstrated the efficacy of ASU for the treatment of OA, especially hip OA which can be especially debilitating. In one study, approximately 400 patients were randomized to be given either 300 mg of ASU or placebo and followed over a three-year period. The authors felt that the ASU helped to reduce the joint space narrowing in the hip, meaning that it helped to reduce the degree of structural damage when compared to the placebo group.
The main ingredient of the commonly used spice turmeric, this antioxidant can help reduce the pain and inflammation associated with OA. It helps to reduce inflammation by reducing certain cellular pathways of inflammation, including Nf-KappaB. Another inflammatory pathway that Curcumin can inhibit is the cyclooxygenase enzyme, which is the same enzyme that is inhibited by NSAIDS. Curcumin also has other potential effects including improving heart health and has anti-cancer properties as well.
The use of antioxidants are important in reducing inflammation and combating the free radical load and oxidative stress that can accompany osteoarthritis. Consider adding a supplement high in antioxidant value to your daily regimen.
This herb has also demonstrated effectiveness for the treatment of OA. In one study examining Devils’ Claw in the treatment of hip and knee OA, the authors noted the effectiveness in reducing pain and improving joint mobility.
Omega 3 fish oil
Supplementation with Omega 3 fish oil can decrease the inflammation and reduce the pain associated with OA. In one study, the use of Omega 3 fish oil and glucosamine together markedly showed a decrease in stiffness and pain compared to those who just received glucosamine.
- A good anti-inflammatory dose is at least 3-4 grams a day to start and slowly increase to a maximum of 7-8 grams.
- As this supplement can thin the blood, if you are on any blood thinners, you may wish to start at a lower dose and increase upwards.
Morinda citrifolia (Noni)
This is a tropical plant from East Asia that has been used for many years. It has anti-inflammatory properties and can help in the treatment of pain due to osteoarthritis.
- Noni can come in capsule or juice form. If you take the juice form, consider beginning at 1 oz twice a day and increase slowly to 4-6 oz a day.
- Some forms of Noni can have a high potassium content so if you have kidney disease you need to be mindful of this.
- Extremely high doses of this may have an adverse effect on the liver, although this is controversial. The several ounces a day that we mention here is very low dosage of this supplement.
This is an herb that has anti-inflammatory properties, especially in the treatment of arthritis. It can help maintain the structural health of the joint cartilage.
Ginger may provide significant pain relief for osteoarthritis. Its effects appear to be attributable to inhibition of the pain pathway involving cyclooxygenase and lipoxygenase. Effective doses range from 170 mg ginger extract 3 times per day to 250 mg 4 times per day.
Note that there are many formulations that combine many of these important supplements that can reduce pain and inflammation. There are also wonderful bone and mineral formulations that can provide the nutrients to the bones that are so desperately needed in OA.
In addition to proper nutrition and supplementation discussed above, exercise in its different forms provide much benefit to those struggling with osteoarthritis. Furthermore, proper devices, fittings, and adjustments to one’s needs provide a wealth of support and ease.
Weight loss and exercise are very beneficial in osteoarthritis. There is a longitudinal association between obesity and osteoarthritis of the knee in men and women, although obesity is a greater risk factor in women. Excess weight puts stress on your knee joints and hips and lower back. For every 10 pounds of weight you lose over 10 years, you can reduce the chance of developing knee osteoarthritis by up to 50%. The goals of an exercise program are to maintain range of motion, muscle strength and general health. For instance, those with osteoarthritis of the knee should be taught quadriceps-strengthening exercises and should be encouraged to perform them every day.
You can further manage how osteoarthritis affects your lifestyle by making small modifications each day. These include the following:
- Properly position and support your neck and back while sitting or sleeping.
- Adjust furniture, such as raising a chair or toilet seat.
- Avoid repeated motions of the joint, especially frequent bending.
Participating in a water-based exercise program can be very beneficial if you have OA. Exercising in the water is not only rejuvenating, but as it reduces the wear, tear, and constant pounding on the joints, it is an ideal choice, especially if you are suffering from arthritis or have difficulty walking. If you have a pool at home, just walking in the water for five minutes a day can help improve strength and mobility in your muscles and joints. Going to your local YMCA or YWCA or using the pool at your local gym may be an option. Check to see if there is an aquatic-based exercise program in your area. It is not difficult to develop on your own.
Many people with osteoarthritis of the hip and knee are more comfortable wearing shoes with good shock-absorbing properties or orthoses. Others also find the support of assistive devices such as braces or a walking cane helpful as they can help with performing daily activities.
You might want to work with a physical therapist or occupational therapist to learn the best exercises and to choose arthritis assistive devices. An occupational therapist can determine whether the patient needs assistive devices such as a raised toilet seat. In addition, special splints can be designed to stabilize or reduce inflammation of particular joints, such as the first carpometacarpal joint or the base of the thumb.
Other beneficial therapies include spa (hot tub), massage, acupuncture, osteopathic and chiropractic manipulation which can help to relieve pain, improve mobility, and keep your body in alignment. These therapies can help to improve total body flexibility. Remember OA can alter how you move and walk. Perhaps you favor one hip or one knee over the other. Over time this can completely disrupt your back and hip mechanics and cause your body to go out of alignment. These therapies can be invaluable in that regard.
Updated: March 2019
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