AN APPLE A DAY By Dr. Tyrone M. Reyes writing in The Philippine Star and updated November 08, 2011 presents the following:
Half of all adults and two-thirds of obese adults will develop arthritic knees during their lifetime, researchers estimate. Yet, despite those growing numbers and the considerable pain and disability the condition causes, treatment remains frustrating and confusing.
Medical therapies for osteoarthritis, including pills, rubs, and shots, offer limited benefits and can cause side effects. New research findings seem to dash any hopes that the most popular supplements thought to combat arthritis do any good. And while joint replacement surgery can help many people with advanced disease, recent reports have raised concerns about one form of the operation.
“No one therapy is as effective as we’d like,” says Roy D. Altman, MD, a professor of medicine at the University of California, Los Angeles. “So, patients are often best served by combining treatments.” And because people respond differently to the treatments, they often have to mix and match until they find a combination that works for them. Below, we examine the choices to help you decide which ones might work for you.
Lifestyle changes
Wear-and-tear injuries and excess weight can erode the cartilage that lines the bone surfaces between joints. That causes aching, stiffness, and swelling in the joints, and sometimes, a grating sensation. If you experience any of these symptoms for more than two weeks, consult a doctor, who should rule out other causes of joint pain, such as gout or rheumatoid arthritis. If you have osteoarthritis, start with these measures:
• Weight control. The first scientifically proven thing you can do to ease arthritis pain is simply to lose weight. Shedding just 10 pounds of excess weight can take about 40 pounds of pressure off the knees, research suggests, and dropping 15 pounds can cut knee pain in half. If you are overweight, try to lose at least five percent of your body weight, especially if you have arthritis in weight-bearing joints.
• Physical activity. Exercise strengthens the muscles around your joints; strong muscles keep joints from rubbing against one another, which wears down cartilage. Exercise relieved the pain of knee arthritis as effectively as medication in a recent Cochrane review of 32 studies. Aerobic exercise keeps joints flexible and lubricated, while strength training builds the supporting muscles. Aim for at least 30 minutes a day, five days a week of low-impact aerobics such as walking, water exercise, and cycling, plus two days of strength training.
• Supportive devices. Ask your doctor about a cane, crutch, or walker to take the load off painful hips and knees. Braces can ease pain in people whose arthritis is mostly on one side of a knee. Experts suggest first trying a ready-made knee sleeve with straps and a knee-cup opening. It should fit comfortably, neither too tight nor loose. If that doesn’t help, ask your doctor about a customized brace.
• Heat and cold. To relax muscles and soothe stiff, sore joints, apply a moist, hot pad or a warm, damp towel, or take a warm bath or shower. To reduce acute pain and swelling, use ice packs.
Alternative therapies
Nontraditional treatments are widely used for arthritis despite inconclusive evidence. The following measures might help, but make sure you inform your doctor first.
• Glucosamine and chondroitin. In a landmark meta-analysis of 10 placebo-controlled trials of glucosamine and chondroitin that researchers said should “close the book” on whether these popular supplements actually help arthritis sufferers, Peter Juni, MD, of the University of Bern in Switzerland, and colleagues concluded, ”Our findings indicate that glucosamine, chondroitin, and other combinations do not result in a relevant reduction of joint pain or affect joint-space narrowing compared with placebo … We believe it unlikely that further trials will show clinically relevant benefit of any of the evaluated preparations.”
Despite the researchers’ suggestion that their meta-analysis might be the last word on glucosamine and chondroitin, a possibly even more definitive trial is already underway: Results are expected any time soon from the Long-Term Evaluation of Glucosamine Sulfate (LEGS) study, which will also test chondroitin with glucosamine among 600 arthritis patients.
In the meantime, Dr. Juni and his team conceded in the British Medical Journal (September 16, 2010 issue), “We see no harm in having patients continue these preparations as long as they perceive a benefit…” Given that these supplements are expensive, however, arthritis sufferers may want to consider options such as dietary changes and exercise that science has not debunked.
• Acupuncture. Some research suggests this helps some people. But the best studies, in which some people get real acupuncture and others get sham procedures (where practitioners insert needles into non-acupuncture points or use blunt needles without penetrating the skin), have found only marginal benefits.
• Massage. Eight weeks of massage therapy relieved painful knees for participants in a small trial published in the Archives of Internal Medicine. However, if massage hurts, stop the treatments and don’t massage a joint that’s very swollen or painful.
. Also helpful in maintaining current strength of arthritis sufferers is the Tutor system.
The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key therapy tool in neuromuscular rehabilitationand physical therapy for patients with spinal cord/brain injuries, Parkinson’s, CP, MS, stroke, hand/arm surgeries and others. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The Tutor system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation. See www.handtutor.com
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