Arthritis: What you need to know

 

Osteoarthritis (OA) is the most common type of arthritis, and a leading cause of disability in adults (1). It can lead to pain, swelling, stiffness, and decreased range of motion that often interferes with daily activities (2). Most commonly this presents in the knees, hips, hands, and spine. Recently 43 top arthritis researchers from around the world were surveyed to come up with “a consensus list for essential statements” regarding osteoarthritis that patients should be educated on (3). Also on the panel were 15 patients suffering from OA to help paint a picture that most closely mirrors the patient experience. Here we outline the findings of this study, as well as present other recent evidence on proper arthritis education and management. Our goal is to help you manage your arthritis in and out of the chiropractic clinic, and get you back to doing the things you love in Chilliwack.

The consensus study concluded with 5 main categories of statements. These were disease knowledge, principles of management, exercise, drugs, and surgery. There were overall 21 statements, some of which we’ve highlighted below (3).

•       “Regular physical activity and individualized exercise programs (including muscle strengthening, cardiovascular activity, and flexibility exercises) can reduce your pain, prevent worsening of your osteoarthritis, and improve your daily function”

•      “Joint damage on an x-ray does not indicate how much your osteoarthritis will affect you”

•      “Nondrug treatments have similar benefits for your osteoarthritis symptoms to pain relieving drugs, but with very few adverse side effects”

•      “You should avoid the use of nonsteroidal anti-inflammatory drugs for your osteoarthritis over the long term”

•      “Your osteoarthritis symptoms can often be eased significantly without requiring an operation”

•      “Keyhole surgery (arthroscopy) that involves washout of the joint and joint scraping should not be used to treat your pain unless there is a mechanical blocking of your joint”

Arthritis: Exercise and the role of the Chiropractor

 

A consistent exercise routine, or daily activities that keep you moving are widely regarded as the safest and most effective way to treat, as well as prevent further development of arthritis. For those with minimal to no symptoms this is easy, keep moving! Find physical activities that you enjoy and make time for them. Some options that have been studied include Tai Chi, Yoga, strength training, a regular walking program, and at home exercise programs (4 ,5, 7). Chilliwack has all these services and more. If your symptoms are preventing you from getting started, then a more individualized approach may be more appropriate. Chiropractic management of arthritis including soft tissue therapy, joint manipulation, nutritional supplements, and progression to a graded exercise program have all been shown to help manage these symptoms and get you back on track (4, 5, 6, 7, 8, 9, 10, 11, 12).

 

 

 

Arthritis: Surgery & Medication

 

The study also comments on when to, and when not to get surgery. The authors best outline this: “If you cannot achieve pain relief from your osteoarthritis, have undertaken a sustained period of recommended conservative management, and it is very difficult to perform activities of daily living, joint replacement surgery is an option”.

The authors go on to say that NSAIDs (non-steroidal anti-inflammatory drugs) such as Aspirin, Celebrex, or Ibuprofen are sometimes necessary in managing arthritis symptoms, but caution their use in long-term treatment (3, 14). We make no recommendations for, or against the use of these medications. Talk to your medical doctor to find out what medications are best for you. We do, however, suggest the use of supplements for your joint pain. Research has shown some joint supplements to be as effective as NSAIDs, without the side effects (13, 14). These were glucosamine and chondroitin sulfate (14, 15). Both may be found at your local health food store and have no to little side effects. In office, we often recommend a 2 month trial of 800-1200 mg chondroitin sulfate, or 1500mg glucosamine sulfate taken daily to see if you benefit (16, 17).

 

 

Arthritis and X-rays

 

                  The picture to the right looks scary, right? X-rays and MRI findings leading to diagnoses such as “degenerative disc disease” can seem overwhelming and cause a lot of distress, but researchers point out that when it comes to spinal arthritis, your imaging findings aren’t very predictive of the symptoms you’ll experience (3, 18). In fact, the same is true for other conditions commonly attribute to low back pain such as disc bulges, disc herniations, and facet arthrosis. The most recent evidence shows that 80% of people have OA findings on their spinal x-rays by age 50, regardless of whether or not they have symptoms! For disc bulges this is true for 60 %, for herniations 36%, and for facet arthrosis 32% (18).

“Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient’s clinical condition.” – Brinjikji et al.

This is by no means suggesting that imaging findings aren’t important, but that they must correlate with a clinical picture. After all we treat people, not films! Limiting your activities out of fear for your “degenerating” spine when you don’t feel symptoms can actually result in a cycle of joint disuse. This takes away one of the best tools for preventing symptomatic OA: movement! There are exceptions, of course. If you have moderate to severe OA symptoms then some caution, along with an appropriate management plan, may be necessary.

 

 

 

We hope that this summary has provided you with some tools to tackle your arthritis, or enough information to prevent its progression. If you find yourself struggling with painful arthritis or have further questions about your healthcare, visit your chiropractor for a treatment plan personalized to you.

 

 

 

 

Written by: Cornelius van de Wall, and Spencer Devenney, DC

References:

1. Johnson, VL, “The epidemiology of osteoarthritis.” Best Practice & Research, Clinical Rheumatology, 2014 Feb;28(1):5-15

2. Song, Jing, Rowland W. Chang, and Dorothy D. Dunlop. “Population Impact of Arthritis on Disability in Older Adults.” Arthritis & Rheumatism 55.2 (2006): 248-55.

3. French, Simon D., Kim L. Bennell, Philippa J. A. Nicolson, Paul W. Hodges, Fiona L. Dobson, and Rana S. Hinman. “What Do People With Knee or Hip Osteoarthritis Need to Know? An International Consensus List of Essential Statements for Osteoarthritis.” Arthritis Care & Research 67.6 (2015): 809-16.

4. Røgind, Henrik, Birgitte Bibow-Nielsen, Bodil Jensen, Hans C. Møller, Hans Frimodt-Møller, and Henning Bliddal. “The Effects of a Physical Training Program on Patients with Osteoarthritis of the Knees.” Archives of Physical Medicine and Rehabilitation 79.11 (1998): 1421-427.

5. Mcquade, Kevin James, and Anamaria Siriani De Oliveira. “Effects of Progressive Resistance Strength Training on Knee Biomechanics during Single Leg Step-up in Persons with Mild Knee Osteoarthritis.” Clinical Biomechanics 26.7 (2011): 741-48.

6. “Beating OsteoARThritis”: Development of a Stepped Care Strategy to Optimize Utilization and Timing of Non-surgical Treatment Modalities for Patients with Hip or Knee Osteoarthritis.” Clinical Rheumatology. U.S. National Library of Medicine, n.d.

7. Evcik, Deniz, and Birkan Sonel. “Effectiveness of a Home-based Exercise Therapy and Walking Program on Osteoarthritis of the Knee.” Rheumatology International 22.3 (2002): 103-06.

8. “Massage Therapy for Osteoarthritis of the Knee: A Randomized Controlled Trial.” Obstetrics & Gynecology 109.3 (2007): 758.

9. Bervoets, Diederik C., Pim Aj Luijsterburg, Jeroen Jn Alessie, Martijn J. Buijs, and Arianne P. Verhagen. “Massage Therapy Has Short-term Benefits for People with Common Musculoskeletal Disorders Compared to No Treatment: A Systematic Review.” Journal of Physiotherapy 61.3 (2015): 106-16.

10. Gottlieb, MS., “Conservative management of spinal osteoarthritis with glucosamine sulfate and chiropractic treatment.” J Manipulative Therapeutics, 1997, July-August;20(6):400-14

11. Beyerman, Kathleen L., Mark B. Palmerino, Lee E. Zohn, Gary M. Kane, and Kathy A. Foster. “Efficacy of Treating Low Back Pain and Dysfunction Secondary to Osteoarthritis: Chiropractic Care Compared With Moist Heat Alone.” Journal of Manipulative and Physiological Therapeutics 29.2 (2006): 107-14.

12. Poulsen, E., J. Hartvigsen, H.w. Christensen, E.m. Roos, W. Vach, and S. Overgaard. “Patient Education with or without Manual Therapy Compared to a Control Group in Patients with Osteoarthritis of the Hip. A Proof-of-principle Three-arm Parallel Group Randomized Clinical Trial.” Osteoarthritis and Cartilage 21.10 (2013): 1494-503.

13. Hochberg, M.c., J. Martel-Pelletier, J. Monfort, I. Maller, P. Du Souich, and J.-P. Pelletier. “Randomized, Double-blind, Multicenter, Non Inferiority Clinical Trial with Combined Glucosamine and Chondroitin Sulfate vs Celecoxib for Painful Knee Osteoarthritis.” Osteoarthritis and Cartilage 22 (2014): n. pag.

14. Zeng, Chao, Jie Wei, Hui Li, Yi-Lun Wang, Dong-Xing Xie, Tuo Yang, Shu-Guang Gao, Yu-Sheng Li, Wei Luo, and Guang-Hua Lei. “Effectiveness and Safety of Glucosamine, Chondroitin, the Two in Combination, or Celecoxib in the Treatment of Osteoarthritis of the Knee.” Scientific Reports 5 (2015): 16827.

15. Tsuji, T., “Effects of N-acetyl glucosamine and chondroitin sulfate supplementation on knee pain and self-reported knee function in middle-aged and older Japanese adults: a randomized, double-blind, placebo-controlled trial”., Aging Clinical and Experimental Research. 2016 Apr;28(2):197-205

16. Reginster JY, Deroisy R, Rovati L, et al. Long-term effects of glucosamine sulfate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001;357:251-6.

17. Bourgeois P, Chales G, Dehais J, et al. Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3X400 mg/day vs placebo. Osteoarthritis Cartilage 1998;6(Suppl A):25-30.

18. Brinjikji, W., P. H. Luetmer, B. Comstock, B. W. Bresnahan, L. E. Chen, R. A. Deyo, S. Halabi, J. A. Turner, A. L. Avins, K. James, J. T. Wald, D. F. Kallmes, and J. G. Jarvik. “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.” American Journal of Neuroradiology 36.4 (2014): 811-16.