The term ‘arthritis’ literally means ‘joint inflammation’. Technically, ‘arthritis’ includes over 100 different conditions from gout to tennis elbow. However, typically when we talk about arthritis we are talking about one of two different types: osteoarthritis or rheumatoid arthritis. Osteoarthritis is often related to aging or an injury. This is the type of arthritis that most often affects baby boomers and thus will be the type of arthritis we will focus on here. Osteoarthritis is a chronic condition where the cartilage between the joints breaks down. The cartilage, which usually sits in between two bones that meet, provides a cushion and prevents bones from rubbing together. Rheumatoid arthritis is a disease of the immune system, where the immune system begins to attack your body’s own tissues.

Treatment Goals 

The American   College of Rheumatology ( ACR ) has given us guidelines on the treatment of osteoarthritis. In general, the main goal in treating osteoarthritis is to provide pain relief . When the pain is gone, you can move better and generally improve your quality of life. Pain is a funny thing. The perception of pain varies from person to person. Other goals when treating osteoarthritis include: maintaining function and mobility, minimizing deformities and slowing the progression of the disease.

Non-drug Management of Osteoarthritis

Interestingly enough, the more severe your osteoarthritis, the more you will rely on non-drug therapy.¹  Using non-drug therapies can decrease your need for medication and decrease your number of office visits. Non-drug therapies also improve the outcomes of joint replacement surgery.  They have also been shown to improve your general feeling of wellbeing and alleviate the depression that sometimes accompanies dealing with chronic pain.²  

In addition to the non-drug therapies listed below, the ACR recommends that patients participate in the Arthritis Foundation Self-management Program or a similar program. The Centers for Disease Control (CDC) also has an arthritis support program. It has been shown that people who participate in such programs report decreases in joint pain and frequency of arthritis-related office visits. They also reported increases in physical activity and overall improvements in quality of life.³

Table 1:  Non-drug therapies for arthritis³:

Physical strengthening though aerobic activity, physical therapy, range-of-motion exercise and strengthening exercises have been shown to relieve pain and increase mobility.^4,5 There seems to be a correlation between how weak your muscles are and how likely you are to experience pain.  For example, your quadricep muscle is the large muscle located just above each knee. Weak quadricep muscles seem to be associated with increased knee pain in those with osteoarthritis of the knee.  For these patients, studies have shown that strengthening the quadricep muscles through walking or other training improves pain relief.^6,7-12   Swimming pool therapy may also be beneficial as it can provide strengthening but tends to be easier on your joints.

 Devices that help you move like canes and walkers can help take weight off of the affected joints. This can reduce pain, increase mobility and help prevent further inflammation and damage to the joint. Other devices such as braces or insoles and techniques such as taping of the patella (knee cap) can help in certain situations.  Before trying to use any of these devices such as a cane or insole, or attempting to tape your knees, it is important to consult with your physician. If used improperly, these devices can actually worsen your condition. It is also important to make sure you get the right size of these devices for your body frame and get fitted if necessary.

The ACR guidelines also recommend weight loss, if needed, for those patients with knee or hip osteoarthritis. Obesity can increase the load on these joints, further stressing them. This can cause the arthritis to progress, increasing pain and immobility. Studies have shown a relationship between weight loss and an improvement of symptoms.¹³  Even better, combining weight loss with aerobic exercise has been shown to be more effective than either weight loss or aerobic exercise alone in controlling arthritis symptoms.¹⁴     

Alternative Non-Drug Therapies for Osteoarthritis

There is a plethora of alternative methods available out there for treating osteoarthritis from yoga and acupuncture to magnetic bracelets and leeches!  There have been some promising studies done on some of these therapies. For example, one study comparing the use of a popular arthritis drug alone to a combination of the drug plus acupuncture showed a significant decrease in pain after 12 weeks in the combination group.¹⁵ Another study showed that yoga may help with pain relief in people with osteoarthritis.¹⁶  And yet another study showed a reduction in pain when using hypnosis and relaxation techniques.¹⁷           

Although none of these therapies are officially endorsed by the ACR , they are not necessarily discouraged either. If you are considering trying one of these alternative therapies, you may want to discuss it with your doctor first to just make sure it won’t worsen your condition. Everyone’s body is different.

Alternative Supplements and Herbals  

There are a few over-the-counter supplements available to help with osteoarthritis pain. One must keep in mind that the FDA has not evaluated these products to make sure they do what they claim to do. Side effects for these substances have not been well established. As such, they should be used with caution, if used at all.

Glucosamine and Chondroitin

These two substances are available over-the-counter and are typically combined together.  They are usually combined because studies have shown that generally either ingredient alone is not particularly effective. Despite this, studies have also shown, that a combination of the two ingredients may provide pain relief for osteoarthritis sufferers.

If you are diabetic, you should talk with your doctor before taking glucosamine and chondroitin. There is some evidence that shows these supplements can increase your blood sugar. There have also been reports of stomach upset, constipation, diarrhea, and insomnia. Also, because the effects of these substances on the kidney and liver are not known, you should probably avoid them if you have kidney or liver disease.

Flavocoxid  

Flavocoxid (Limbrel®) is available by prescription. It is marketed as a ‘medical food’. Because it is marketed as a ‘medical food’, it does not go through the same stringent approval process that prescription drugs go through. It is  thought that flavocoxid acts like both and traditional NSAID and COX-2 inhibitor. This is somewhat concerning because we know that there are a number of side effects associated with NSAIDs and COX-2 inhibitors. Despite this, the side effects for flavocoxid have not been well established. There has been some evidence that shows flavocoxid can put you at risk for GI bleeds like NSAIDS can.

Other Alternative Substances

There are many over-the-counter substances available for treating osteoarthritis pain. Curcumin, boswellia, phenylalanine and devil’s claw are just a few of these substances. There is currently no concrete evidence available to show any of these ingredients to be safe or effective. Much of the marketing for these substances is done on the internet and is based on anecdotal evidence and testimonials. One should be especially careful because many of these substances have been shown to have blood-thinning properties. Further, many of these formulations contain other additives that have not been evaluated for safety or effectiveness as well.

Osteoarthritis sufferers have more treatment options available today than ever before. Fortunately, disease progression with osteoarthritis is usually slow. Changes typically take place over years or even decades. This will make it easier for you and your doctor to stay on top of your symptoms. When starting a program for the treatment of your osteoarthritis, remember that education is key. Make sure you have a good relationship with your doctor and that she includes you as a part of the decision-making process. She should make decisions regarding your therapy using evidence-based medicine. Make sure she is clear with you on what to expect in the way of pain relief . Your doctor should also talk with you about how safe and effective your medications will be and what you can expect in the way of improvement in function. Your doctor should be familiar with non-drug therapies as well. Working closely with your doctor, pharmacist and the rest of your health care team should help increase your chances of success.

Author: Christi Larson, Pharm. D.

References

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