Osteo-Arthritis

Primarily a disorder of hyaline cartilage and subchondral
bone, though all tissues in and around involved joints are hypertrophic.


Osteo-Arthritis (Degenerative Joint Disease) is the most common form
of arthritis, affecting about one out of every six Americans, including
80 percent of persons over the age of 70. Most have few, if any associated
symptoms, and the disease is diagnosed only because X rays of the vertebrae
show characteristic spurs or because the fingers are knobbed by bony proliferations
(Heberden’s nodes) at the distal interphalangeal joints. In some the spurs
encroach on nerves as they emerge from the spinal canal and produce nerve-root
syndromes. In others, the malpositioned joints are a source of ligamentous
strain and abnormal muscular tension. The result is pain that becomes worse
as the day goes on.


These degenerative processes are in part caused by wear and tear. They affect
primarily weight-bearing joints and joints subject to trauma or to malpositioned
anatomy. Joints damaged by other forms of arthritis are prone to later degenerative
joint disease. Heberden’s nodes are more prominent in the right hand of
right-handed individuals and in the fingers of typists. Traumas produce
microfractures in the cartilage that lines the articulating surfaces exposing
raw underlying bone. The bone cells then release enzymes that destroy the
protein and polysaccharide components of bone. Frayed pieces of cartilage
may be taken up by white blood cells and thus add an element of inflammation.


A number of predisposing factors can hasten this degenerative process, even
in young people. If these are in play then the preventive work suggested
below is vital. They include:

  • obesity (more stress on weight- bearing joints),

  • bone deformities (abnormal mechanical forces across the joint),

  • previous cartilage injury,

  • joint infection,

  • certain types of inflammatory arthritis (rheumatoid, gout),

  • diabetes mellitus,

  • acromegaly (excess growth hormone),

  • repetitive occupational or exercise-related joint movements.


Osteo-Arthritis is usually experienced as aching joints and stiffness. The
pain is aggravated by movement and weight-bearing on the involved joint.
Although swelling may occur, warmth and redness usually imply an inflammatory-type
of arthritis. The hips, knees, ankles, neck, low back and hands are the
most common joints affected. Hip pain can be especially severe, making walking
difficult. The fingers often develop a knobby and gnarled appearance (Heberden’s
nodes). Osteo-arthritis of the spine is a common cause of chronic pain and
decreased neck and back mobility. In some cases, large bone spurs may compress
the spinal cord or pinch its nerves.


Physical examination reveals joint enlargement, tenderness and sometimes
swelling. X-rays may show narrowing of the joint space and new bone formation
adjacent to the joint. Many individuals with abnormal X-rays experience
few, if any, symptoms, and other types of arthritis may produce similar
X-ray findings.


Actions indicated for the processes behind this disease:

Anti-Rheumatics will usually help but their selection must
be based upon a sound therapeutic rationale.

Anti-Inflammatories are fundamental as their use will not only ease
the symptom picture but help to stop the degenerative changes to bony tissue.
In O.A., the salicylate based herbs are especially helpful.

Alteratives are the key to any attempt at transforming the systemic
problem (if present). If the O.A. has its roots in physical wear and tear
they will not be quite so fundamental.

Anti-Spasmodic will lessen the impact of physical friction through
relaxing the muscular envelop around the arthroses.

Circulatory Stimulants will benefit the healing process through increase
the flow through of blood, thus facilitating all the work this amazing tissue
fulfills.

Rubefacients can be especially useful for local stimulation of circulation
and inflammation reduction.

Analgesic will possibly ease the patients discomfort, but must not
replace appropriate treatment.

Diuretics help the kidney do its cleansing work.

Nervines will usually be relevant because of the many ways they in
which a stressed patient can benefit from such support. The relaxants also
act as anti-spasmodics, the tonics will help the person deal with the constant
stress of the pain and discomfort. Hypnotics will help them sleep in the
face of pain.

Other Actions bitters, hepatics, expectorants,
emmenagogues etc.. The whole digestive process must be working
well and not damaged by side effect reactions to non-steroidal anti-inflammatories.


System Support

In addition to musculo/skeletal attention, the digestive system needs especial
care. Beyond that it will depend upon the individuals specific case. Always
remember the general principles of good elimination, without resorting to
strenuous `purging & puking’.


Specific Remedies

Both Menyanthes trifoliata and Harpagophytum procumbens could
be considered as almost specifics here. However, the multi-factorial causation
must be remembered, highlighting the unlikelihood of one total specific.
Urtica dioica is a traditional remedy throughout Europe, used internally
and externally as a rubifacient. This external use, with fresh raw leaf,
is not a treatment for the fainthearted!


One possible prescription:

Menyanthes trifoliata 2 parts

(Harpagophytum procumbens)

Filipendula ulmaria 11/2 parts

(Salix spp.)

Cimicifuga racemosa 1 part

Zanthoxylum americanum 1 part

Apium graveolens 1 part

Angelica archangelica 1 part

Achillea millefolium 1 part in tincture to 5ml.

three times a day

(Harpagophytum & Salix may be used as equivalent alternatives
if necessary)



External treatments as indicated.


If there is any associated stomach irritation due to the harshness of the
Menyanthes, then add Althaea. In this combination we are combining
anti-rheumatics that provide a range of relevant actions:

  • alterative remedies: Menyanthes trifoliata, Cimicifuga
    racemosa

  • salicylate anti-inflammatories: Filipendula ulmaria

  • general anti-inflammatories: Angelica archangelica, Menyanthes
    trifoliata
    , Cimicifuga racemosa

  • nervine anti-spasmodics: Cimicifuga racemosa &
    Apium graveolens

  • peripheral vaso-dilator: Zanthoxylum americanum

  • diuretics: Apium graveolens & Achillea millefolium

  • `stomachics’, in this case carminative and intestinal anti-inflammatory
    :

    • Angelica archangelica, Apium graveolens

  • bitter tonics: Menyanthes trifoliata, Achillea
    millefolium



Broader Context of Treatment

Nutritional factors are very important in the successful treatment of these
problems. As has been pointed out repeatedly, there are many ideas about
which foods or supplements to use for any condition, and I do not want to
enter such confused debates at this stage. Whilst staying clear of such
controversies, it is appropriate to focus on which foods to avoid as they
definitely aggravate arthritic problems. A basic exclusion diet would Include:

  • Coffee, wether decaf. or regular. * Red meat of any kind in any form.

  • Vinegar and anything based upon vinegar such as pickles. Apple cider
    vinegar may possibly be an exception.

  • Vegetables that contain high levels of plant acids. e.g. Tomatoes and
    Rhubarb.

  • Berries rich in fruit acids such as Gooseberries, Red and Black Currants

  • Refined white sugar and products that contain it.

  • Refined white flour and its multitude of products.

  • Artificial additives, flavorings and preservatives.

  • Processed foods. * Red wine, port and sherry.

  • Carbonated drinks. * Shell fish

  • Any food or beverage that causes the patient specific problems.


Such diets will produce the best results in the earlier, more painful stages
of this long drawn out disease. In the extreme of long standing O.A., there
is a balance that must be found between nutritional dogma that might not
be too effective and eating habits that have a positive psychological effect
on the patient.


Attention must be given to physical aids & support for the patient who
is becoming disabled by this disease. There are a wealth of simple devices
available that ease the simple daily tasks of life that have become taxing
for the patient. These range from specially designed kitchen devices such
as cutlery, can openers and faucet grips, to brushes with extended handles
and adaptations to telephones. Using such devices can ease the patients
experience of life enormously.

Known as Activities of Daily Living (A.D.L.) devices, they are the field
of Occupational Therapists and other physical therapy specialists. More
information can be obtained through the publications of the National Arthritis
Foundation and local official agencies on aging.

David L. Hoffmann BSc Hons MNIMH Written by David L. Hoffmann BSc Hons MNIMH

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