Addressing Osteoarthritis with Naturopathy and Holistic approaches. Also includes a reveiw of conventional treatment options. Presentation by Adam Rinde, ND, a Naturopath based in Kirkland, Washington.

1. Osteoarthritis Adam Rinde, ND Naturopathic Physician Sound Integrative Health 7/11/08 @ Natures Pantry

2. Key Points Pain relief is available in a non-pill form! Joint replacement can be prevented You can take charge of your pain

3. Osteoarthritis: Description Osteoarthritis: a disease effecting any joint with associated alteration of cartilage Also known as: Degenerative Joint Disease Osteoarthrosis Hypertrophic Osteoarthritis .

4. Osteoarthritis

5. Osteoarthritis Primary Osteoarthritis: Associated with gradual aging-related destruction of cartilage in joint-space. Secondary Osteoarthritis Usually secondary to trauma/overuse, repetitive strain, and subsequent faulty repair and regeneration of cartilage.

6. Epidemiology of OA The #1 joint-causing disorder that begins asymptomatically in the 20’s and 30’s and becomes extremely common by the age of 70. By the age of 40 most people have some change in weight bearing joints, although relatively few have symptoms. OA affects almost all vertebrates

7. Osteoarthritis: Epidemiology occurs in whales, dolphins, and porpoises. Does not occur in Bats which hang upside down. This finding suggest that it is an ancient Paleozoic mechanism of repair and remodeling rather than a disease in the usual sense.

8. Osteoarthritis: how does it happen A Cartilage trauma combined with Faulty repair Faulty regeneration Faulty remodeling Leading to Deformed cartilage friction Loss of function

9. OA Symptoms Gradual onset usually involving one or a few joints Pain is the earliest symptom and is usually worsened with exercise and relieved by rest Morning stiffness follows inactivity but lasts <15-30 minutes and lessens with movement As OA progresses joint motion diminishes, tenderness and crepitus sensations appear and flexion contractures may occur. Pathologic changes can cause joint enlargement

10. OA symptoms OA of the cervical and lumbar vertebrae can lead to myelopathy or radiculopathy Hip OA is Characterized by gradually increasing rigidity and loss of range of motion. Pain may be felt in the inguinal (groin) area or referred to the knee Knee OA Cartilage is lost in the medial aspect in 70% of the cases The ligaments become lax and the joint less stable with local pain arising from the ligaments and tendons Tenderness on palpation and pain on passive motion are relatively late signs Hands the base of the thumb, where the thumb and wrist come together (the trapezio-metacarpal, or basilar, joint) at the end joint closest to the finger tip (the distal interphalangeal or DIP joint) at the middle joint of a finger (the proximal interphalangeal or PIP joint)It also often develops in the wrist.

11. Osteoarthritis: Diagnosis Diagnosis is confirmed by x‑rays. Report may describe degree of joint space narrowing Subchondral Sclerosis Presence of osteophytes Periodic X-rays useful in tracking progress of therapies.

12. Treatment Options for Osteoarthritis

13. Therapeutic Goals Preserve Quality of Life by reducing disability Reduce Pain and Inflammation Prevent/Arrest cartilage degeneration (joint space narrowing) Utilize conservative therapies for long-term management Reduce reliance on NSAID Or Opiods Prevent need for higher invasive therapies

14. OA Treatment Strategy Reduce aggravating factors promoting destruction of joint cartilage Restore and maintain healthy joint biomechanics Reduce pain and modulate chronic inflammatory state. Stimulate healthy cartilage regeneration and repair

15. OA Treatment: Ergonomics Consider home devices such as grab bars in the tub enclosure, raised toilet seats Avoid soft deep chairs and recliners from which arising is difficult Avoid pillows under the knees as this encourages contractures Sit in straight chairs without slumping

16. OA Treatment :Ergonomics Sleep in a firm bed with a bed board Use a car seat designed for comfort

17. OA treatment: Exercise Exercise/Physical therapy: Daily stretching important Local application of moist heat especially before exercise s Perform postural exercise Resistance Training Quadriceps strengthening important (for Hip and Knee) Try not to immobilize (stay active) Rest every 4-6 hours in the daytime to allow rehydraton of cartilage and balance with exercise and use

18. OA treatment: Exercise Cardiovascular Exercise to promote weight reduction/weight management At least 5 days per week of 30 minutes at 70% of your maximum Heart Rate Choose low impact forms of exercise Walking, Golf, bicycle, elliptical, swimming, cross country skiing nordic-track Water jogging

20. Active Isolated Stretching

22. Building a strong foundation of joint support

24. Diet: Low-inflammatory Omega-3-rich diet Wild-caught salmon COD Organic Vegetables and Fruit 5-7 servings are fruits and vegetables a day Kiwi, Papaya, Pineapple Limited Chicken and Cow Intake Avoid Food Sensitivities (especially Nightshades) Fiber rich (at least 30 g/day) Low processed foods Low simple sugars No Transfats

25. Neutraceuticals for OA Glucosamine and Chondrotoin Sulfate Niacinamide May raise liver enzymes Vitamin D (check levels through your Dr.)

26. Polyunsaturated Fatty Acids (PUFAS) Fish Oil Contains omega-3 essential fatty acids Choose mercury free Marine Lipid Extract Perna canniliculus Green lipped mussels Another form of PUFA’s Always discuss Fish Oil supplementation with your Dr. as Fish Oil may interact with Blood Thinners.

27. Supplementation: Cartilage protective/stimulatory? Avocado Soybean Unsulfoniables (ASU) A phytosterol that has been studied reduce pain and inflammation in OA. It may protect further cartilage damage.

28. Anti-inflammatory Proteolytic enzymes Bromelain Papain Rutin Peptizym

29. OA treatments;Botanical Medicine Anti-inflammatory herbs Devils Claw Willow Bark Ginger Turmeric Note: some of these may interact with anti-coagulants, check with physician

30. Antioxidant Supplementation Usually can be obtained through a quality daily multivitamin Vitamin C Vitamin A Vitamin K Vitamin E Selenium Zinc

31. Reduce InflammationIntraarticular Injections Prolotherapy growth factors or growth factor stimulator injections Viscosupplemention Hylagen (injectable synthetic hyularonic acid) FDA approved for knee injection Show effective for Knees (not yet for hips) Corticosteroid Injections

32. Drug interventions Simple Analgesic Acetaminophen (Tylenol) OTC pain relievers Can prolong the halflife of warfafin NSAID Cox-2 Inhibitors (Celebrex) Know the warnings (ie. Cardiovascular/Gastroinestinal) Be assessed for risk of GI bleeding before taking Know the risks of taking long term Know when they are beneficial and when they are not. Try and use for the shortest amount of time possible at the lowest effective dose. Tramadol Synthetic Central Acting Opoid Used for severe pain

33. Surgery Knee Arthroplasty Replacement usually has road-life of 10-12 years Hip Arthroplasty Usually last 20 years

34. OA resources Arthritis Foundation-Local Chapter National Institute for Arthritis,Skin, and Musculoskelatal Disorders. Health Clubs (International Health and Racquet Club) Vitalchoices.com Pioneer Grocery

35. Adam Rinde, ND Contact Information Appointments: 425-889-5894 Email:drrinde@soundintegrative.com Sound Integrative Health