Tag: Osteoarthritis

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Arthritis

Definition:-
Arthritis means inflammation of the joints. Inflammation generally includes symptoms of redness, heat, swelling, and pain. Many different diseases can result in inflammation of the joints. Arthritis is therefore a general term that describes more than one hundred different diseases of the joints of your body.

There are different forms of arthritis; each has a different cause. The most common form of arthritis, osteoarthritis (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Emerging evidence suggests that abnormal anatomy might contribute to the early development of osteoarthritis. Other arthritis forms are rheumatoid arthritis and psoriatic arthritis, autoimmune diseases in which the body attacks itself. Septic arthritis is caused by joint infection. Gouty arthritis is caused by deposition of uric acid crystals in the joint, causing inflammation. There is also an uncommon form of gout caused by the formation of rhomboid crystals of calcium pyrophosphate. This gout is known as pseudogout.

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Types of arthritis
Primary forms of arthritis:-

Osteoarthritis
Rheumatoid arthritis
Septic arthritis
Gout and pseudogout
Juvenile idiopathic arthritis
Still’s disease
Ankylosing spondylitis
Secondary to other diseases:

Lupus erythematosus
Henoch-Schönlein purpura
Psoriatic arthritis
Reactive arthritis
Haemochromatosis
Hepatitis
Wegener’s granulomatosis (and many other vasculitis syndromes)
Lyme disease
Familial Mediterranean fever
Hyperimmunoglobulinemia D with recurrent fever
TNF receptor associated periodic syndrome
Inflammatory bowel disease (Including Crohn’s Disease and Ulcerative Colitis)
Diseases that can mimic arthritis include:

Hypertrophic osteoarthropathy
Multiple myeloma
Osteoporosis
Fifth disease

In some types of arthritis, the cause of the disease is known, but in others it is still unknown. Some types of arthritis come on suddenly, and others develop slowly. Any joint can be affected, including your knees, hips, neck, shoulders, and fingers.

Causes:-

Arthritis involves the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.

You may have joint inflammation for a variety of reasons, including:

*Broken bone

*Infection (usually caused by bacteria or viruses)

*An autoimmune disease (the body attacks itself because the immune system believes a body part is foreign)

*General “wear and tear” on joints

Often, the inflammation goes away after the injury has healed, the disease is treated, or the infection has been cleared.

With some injuries and diseases, the inflammation does not go away or destruction results in long-term pain and deformity. When this happens, you have chronic arthritis. Osteoarthritis is the most common type and is more likely to occur as you age. You may feel it in any of your joints, but most commonly in your hips, knees or fingers.

Risk factors for osteoarthritis include:-

*Being overweight

*Previously injuring the affected joint

*Using the affected joint in a repetitive action that puts stress on the joint (baseball players, ballet dancers, and construction workers are all at risk)

Arthritis can occur in men and women of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people.

Other types or cause of arthritis include:

*Rheumatoid arthritis (in adults)

*Juvenile rheumatoid arthritis (in children)

*Systemic lupus erythematosus (SLE)

*Gout

*Scleroderma

*Psoriatic arthritis

*Ankylosing spondylitis

*Reiter’s syndrome (reactive arthritis)

*Adult Still’s disease

*Viral arthritis

*Gonococcal arthritis

*Other bacterial infections (non-gonococcal bacterial arthritis )

*Tertiary Lyme disease (the late stage)

*Tuberculous arthritis

*Fungal infections such as blastomycosis

Symptoms:-

If you have arthritis, you may experience:

*Joint pain

*Joint swelling

*Stiffness, especially in the morning

*Warmth around a joint

*Redness of the skin around a joint

*Reduced ability to move the joint

Diagnosis:-

Exams and Tests :

First, your doctor will take a detailed medical history to see if arthritis or another musculoskeletal problem is the likely cause of your symptoms.

Next, a thorough physical examination may show that fluid is collecting around the joint. (This is called an “effusion.”) The joint may be tender when it is gently pressed, and may be warm and red (especially in infectious arthritis and autoimmune arthritis). It may be painful or difficult to rotate the joints in some directions. This is known as “limited range-of-motion.”

In some autoimmune forms of arthritis, the joints may become deformed if the disease is not treated. Such joint deformities are the hallmarks of severe, untreated rheumatoid arthritis.

Tests vary depending on the suspected cause. They often include blood tests and joint x-rays. To check for infection and other causes of arthritis (like gout caused by crystals), joint fluid is removed from the joint with a needle and examined under a microscope. See the specific types of arthritis for further information.

Treatment:-

Treatment of arthritis depends on the particular cause, which joints are affected, severity, and how the condition affects your daily activities. Your age and occupation will also be taken into consideration when your doctor works with you to create a treatment plan.

If possible, treatment will focus on eliminating the underlying cause of the arthritis. However, the cause is NOT necessarily curable, as with osteoarthritis and rheumatoid arthritis. Treatment, therefore, aims at reducing your pain and discomfort and preventing further disability.

It is possible to greatly improve your symptoms from osteoarthritis and other long-term types of arthritis without medications. In fact, making lifestyle changes without medications is preferable for osteoarthritis and other forms of joint inflammation. If needed, medications should be used in addition to lifestyle changes.

Exercise for arthritis is necessary to maintain healthy joints, relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your exercise program should be tailored to you as an individual. Work with a physical therapist to design an individualized program, which should include:

Range of motion exercises for flexibility
Strength training for muscle tone
Low-impact aerobic activity (also called endurance exercise)
A physical therapist can apply heat and cold treatments as needed and fit you for splints or orthotic (straightening) devices to support and align joints. This may be particularly necessary for rheumatoid arthritis. Your physical therapist may also consider water therapy, ice massage, or transcutaneous nerve stimulation (TENS).

Rest is just as important as exercise. Sleeping 8 to 10 hours per night and taking naps during the day can help you recover from a flare-up more quickly and may even help prevent exacerbations. You should also:

Avoid positions or movements that place extra stress on your affected joints.
Avoid holding one position for too long.
Reduce stress, which can aggravate your symptoms. Try meditation or guided imagery. And talk to your physical therapist about yoga or tai chi.
Modify your home to make activities easier. For example, have grab bars in the shower, the tub, and near the toilet.
Other measures to try include:

Taking glucosamine and chondroitin — these form the building blocks of cartilage, the substance that lines joints. These supplements are available at health food stores or supermarkets. While some studies show such supplements may reduce osteoarthritis symptoms, others show no benefit. However, since these products are regarded as safe, they are reasonable to try and many patients find their symptoms improve.
Eat a diet rich in vitamins and minerals, especially antioxidants like vitamin E. These are found in fruits and vegetables. Get selenium from Brewer’s yeast, wheat germ, garlic, whole grains, sunflower seeds, and Brazil nuts. Get omega-3 fatty acids from cold water fish (like salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.
Apply capsaicin cream (derived from hot chili peppers) to the skin over your painful joints. You may feel improvement after applying the cream for 3-7 days.

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Medications:–

Your doctor will choose from a variety of medications as needed. Generally, the first drugs to try are available without a prescription. These include:

Acetaminophen (Tylenol) — recommended by the American College of Rheumatology and the American Geriatrics Society as first-line treatment for osteoarthritis. Take up to 4 grams a day (2 extra-strength Tylenol every 6 hours). This can provide significant relief of arthritis pain without many of the side effects of prescription drugs. DO NOT exceed the recommended doses of acetaminophen or take the drug in combination with large amounts of alcohol. These actions may damage your liver.
Aspirin, ibuprofen, or naproxen –– these nonsteroidal anti-inflammatory (NSAID) drugs are often effective in combating arthritis pain. However, they have many potential risks, especially if used for a long time. They should not be taken in any amount without consulting your doctor. Potential side effects include heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage. In 2005, the U.S. Food and Drug Administration (FDA) asked makers of NSAIDs to include a warning label on their product that alerts users of an increased risk for heart attack, stroke, and gastrointestinal bleeding. If you have kidney or liver disease, or a history of gastrointestinal bleeding, you should not take these medicines unless your doctor specifically recommends them.
Prescription medicines include:

Cyclooxygenase-2 (COX-2) inhibitors — These drugs block an inflammation-promoting enzyme called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Celecoxib (Celebrex) is still available, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest duration possible. Talk to your doctor about whether COX-2s are right for you.
Corticosteroids (“steroids”) — these are medications that suppress the immune system and symptoms of inflammation. They are commonly used in severe cases of osteoarthritis, and they can be given orally or by injection. Steroids are used to treat autoimmune forms of arthritis but should be avoided in infectious arthritis. Steroids have multiple side effects, including upset stomach and gastrointestinal bleeding, high blood pressure, thinning of bones, cataracts, and increased infections. The risks are most pronounced when steroids are taken for long periods of time or at high doses. Close supervision by a physician is essential.
Disease-modifying anti-rheumatic drugs — these have been used traditionally to treat rheumatoid arthritis and other autoimmune causes of arthritis. These drugs include gold salts, penicillamine, sulfasalazine, and hydroxychloroquine. More recently, methotrexate has been shown to slow the progression of rheumatoid arthritis and improve your quality of life. Methotrexate itself can be highly toxic and requires frequent blood tests for patients on the medication.
Biologics– these are the most recent breakthrough for the treatment of rheumatoid arthritis. Such medications, including etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira), are administered by injection and can dramatically improve your quality of life. Newer biologics include Orencia (abatacept) and Rituxan (rituximab).
Immunosuppressants — these drugs, like azathioprine or cyclophosphamide, are used for serious cases of rheumatoid arthritis when other medications have failed.
It is very important to take your medications as directed by your doctor. If you are having difficulty doing so (for example, due to intolerable side effects), you should talk to your doctor.

Surgery & Other Type of Approach:

In some cases, surgery to rebuild the joint (arthroplasty) or to replace the joint (such as a total knee joint replacement) may help maintain a more normal lifestyle. The decision to perform joint replacement surgery is normally made when other alternatives, such as lifestyle changes and medications, are no longer effective.

Normal joints contain a lubricant called synovial fluid. In joints with arthritis, this fluid is not produced in adequate amounts. In some cases, a doctor may inject the arthritic joint with a manmade version of joint fluid. The synthetic fluid may postpone the need for surgery at least temporarily and improve the quality of life for persons with arthritis.

Prognosis:
A few arthritis-related disorders can be completely cured with treatment. Most are chronic (long-term) conditions, however, and the goal of treatment is to control the pain and minimize joint damage. Chronic arthritis frequently goes in and out of remission.

Possible Complications:

*Chronic pain

*Lifestyle restrictions or disability

Call your doctor if:

*Your joint pain persists beyond 3 days.

*You have severe unexplained joint pain.

*The affected joint is significantly swollen.

*You have a hard time moving the joint.

*Your skin around the joint is red or hot to the touch.

*You have a fever or have lost weight unintentionally.

Prevention :

If arthritis is diagnosed and treated early, you can prevent joint damage. Find out if you have a family history of arthritis and share this information with your doctor, even if you have no joint symptoms.

Osteoarthritis may be more likely to develop if you abuse your joints (injure them many times or over-use them while injured). Take care not to overwork a damaged or sore joint. Similarly, avoid excessive repetitive motions.

Excess weight also increases the risk for developing osteoarthritis in the knees, and possibly in the hips and hands. See the article on body mass index to learn whether your weight is healthy.( Calculate BMI )

Click for Herbal & Alternative Medical help for Arthritis

Treating Arthritis with Acupuncture:

Alternative Arthritis Treatments:->….(1)….(2).…..(3)

DISCLAIMER : This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Arthritis
http://www.nlm.nih.gov/medlineplus/ency/article/001243.htm
http://www.eorthopod.com/public/patient_education/6587/arthritis.html

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Ailmemts & Remedies

Osteoarthritis (OA)

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Alternative Names : Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis – osteoarthritis.

Definition : Osteoarthritis (OA) is the most common joint disorder.
Osteoarthritis (previously called degenerative arthritis, degenerative joint disease) is a chronic disorder of joint cartilage and surrounding tissues that is characterized by pain, stiffness, and loss of function.

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Osteoarthritis also occurs in almost all animals with a backbone—including fish, amphibians, and birds. Because the disorder is so widespread in the animal kingdom, some authorities believe that osteoarthritis may have evolved from an ancient method of cartilage repair.

Many myths about osteoarthritis persist—for example, that it is an inevitable part of aging, like gray hair and skin changes; that it results in little disability; and that treatment is not effective. Although osteoarthritis is more common in older people, it is not caused simply by the wear and tear that occurs with years of use. Instead, microscopic changes in the structure and composition of cartilage appear to be responsible. Most people who have the disorder, especially younger people, have few if any symptoms; however, some older people develop significant disabilities.
Causes:
Most of the time, the cause of OA is unknown. It is mainly related to aging, but metabolic, genetic, chemical, and mechanical factors can also lead to OA.

Normally, joints have such a low friction level that they are protected from wearing out, even after years of use. Osteoarthritis probably begins most often with an abnormality of the cells that synthesize the components of cartilage, such as collagen (a tough, fibrous protein in connective tissue) and proteoglycans (substances that provide resilience). Next, the cartilage may swell because of water retention, become soft, and then develop cracks on the surface. Tiny cavities form in the bone beneath the cartilage, weakening the bone. Bone can overgrow at the edges of the joint, producing bumps (osteophytes) that can be seen and felt. Ultimately, the smooth, slippery surface of the cartilage becomes rough and pitted, so that the joint can no longer move smoothly and absorb impact. All the components of the joint—bone, joint capsule (tissues that enclose most joints), synovial tissue (tissue lining the joint), tendons, ligaments, and cartilage—fail in various ways, thus altering the joint.

The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.

The disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually form around the joint.

OA can be primary or secondary.

Primary OA occurs without any type of injury or obvious cause.

Secondary OA is osteoarthritis due to another disease or condition. The most common causes of secondary OA are metabolic conditions, such as acromegaly, problems with anatomy (for example, being bow-legged), injury, or inflammatory disorders such as septic arthritis.

Some people who repetitively stress one joint or a group of joints, such as foundry workers, coal miners, and bus drivers, are particularly at risk. Much of the risk for osteoarthritis of the knee comes from occupations that involve bending of the joint. Curiously, long-distance running champions appear not to be at higher risk of developing the disorder. However, once osteoarthritis develops, this type of exercise often makes the disorder worse. Obesity may be a major factor in the development of osteoarthritis, particularly of the knee and especially in women.
Symptoms :

The symptoms of osteoarthritis include:

*Deep aching joint pain that gets worse after exercise or putting weight on it and is relieved by rest.

*Grating of the joint with motion

*Joint pain in rainy weather

*Joint swelling

*Limited movement

*Morning stiffness

Some people might not have symptoms.

Usually, symptoms develop gradually and affect only one or a few joints at first. Joints of the fingers, base of the thumbs, neck, lower back, big toes, hips, and knees are commonly affected. Pain, usually made worse by activities that involve weight bearing (such as standing), is the first symptom. In some people, the joint may be stiff after sleep or some other inactivity, but the stiffness usually subsides within 30 minutes of moving the joint.

As the condition causes more symptoms, the joint may become less movable and eventually may not be able to fully straighten or bend. The attempt of the tissues to repair may lead to new growth of cartilage, bone, and other tissue, which can enlarge the joints. The irregular cartilage surfaces cause joints to grind, grate, or crackle when they are moved. Bony growths commonly develop in the joints at the ends or middle of the fingers (called Heberden’s or Bouchard’s nodes).

Osteoarthritis
In some joints (such as the knee), the ligaments, which surround and support the joint, stretch so that the joint becomes unstable. Alternatively, the hip or knee may become stiff, losing its range of motion. Touching or moving the joint (particularly when standing, climbing stairs, or walking) can be very painful.

Osteoarthritis often affects the spine. Back pain is the most common symptom. Usually, damaged disks or joints in the spine cause only mild pain and stiffness. However, osteoarthritis in the neck or lower back can cause numbness, pain, and weakness in an arm or leg if the overgrowth of bone presses on nerves. The overgrowth of bone may be within the spinal canal, pressing on nerves before they exit the canal to go to the legs. This may cause leg pain after walking, suggesting incorrectly that the person has a reduced blood supply to the legs (intermittent claudication (see Peripheral Arterial Disease: Arteries of the Legs and Arms). Rarely, bony growths compress the esophagus, making swallowing difficult.

Osteoarthritis may be stable for many years or may progress very rapidly, but most often it progresses slowly after symptoms develop. Many people develop some degree of disability.

Diagnosis:

Exams and Tests

A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.

An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone spurs.
The doctor makes the diagnosis based on the characteristic symptoms, physical examination, and the x-ray appearance of joints (such as bone enlargement and narrowing of the joint space). By age 40, many people have some evidence of osteoarthritis on x-rays, especially in weight-bearing joints such as the hip and knee, but only half of these people have symptoms. However, x-rays are not very useful for detecting osteoarthritis early because they do not show changes in cartilage, which is where the earliest abnormalities occur. Also, changes on the x-ray correlate poorly with symptoms. For example, an x-ray may show only a minor change while the person is having severe symptoms, or an x-ray may show numerous changes while the person is having very few, if any, symptoms.

Magnetic resonance imaging (MRI) can reveal early changes in cartilage, but it is rarely needed for the diagnosis. Also, MRI is too expensive to justify routine use. There are no blood tests for the diagnosis of osteoarthritis, although blood tests may help rule out other disorders

Treatment :
The goals of treatment are to relieve pain, maintain or improve joint movement, increase the strength of the joints, and reduce the disabling affects of the disease. The treatment depends on which joints are involved.

MEDICATIONS:
The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen.

Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. Manufacturers of NSAIDs include a warning label on their products that alerts users to an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding.

Other medications used to treat OA include:

  • COX-2 inhibitors (coxibs). Coxibs block a substance called COX-2 that causes swelling. This class of drugs was first thought to work as well as other NSAIDs, but with fewer stomach problems. However, reports of heart attacks and stroke have led the FDA to re-evaluate the risks and benefits of the COX-2s. Celecoxib (Celebrex) is still available at the time of this report, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest possible period of time. Ask your doctor whether the drug is right and safe for you.
  • Steroids. These medications are injected right into the joint. They can also be used to reduce inflammation and pain.
  • Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage.
  • Artificial joint fluid (Synvisc, Hyalgan). These medications can be injected into the knee. They may relieve pain for up to 6 months.

LIFESTYLE CHANGES
Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.

Applying heat and cold, protecting the joints, using self-help devices, and rest are all recommended.

Good nutrition and careful weight control are also important. If you’re overweight, losing weight will reduce the strain on the knee and ankle joints.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3-6 weeks, then it likely will not work at all.

BRACES
Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.

SURGERY
Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:

  • Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty,hip arthroplasty)
  • Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
  • Cartilage restoration to replace the damaged or missing cartilage in some younger patents with arthritis
  • Change in the alignment of a bone to relieve stress on the bone or joint (osteotomy)
  • Surgical fusion of bones, usually in the spine (arthrodesis)

Prognosis:
Your movement may become very limited. Treatment generally improves function.

Possible Complications :
Decreased ability to walk
Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
Adverse reactions to drugs used for treatment
Surgical complications
When to Contact a Medical Professional

Complementary or alternative therapies for osteoarthritis

.Alternative Therapies

Use of Alternative Therapy, Quality of Life, And Healthcare Spending in Chinese Patients with Osteoarthritis.
Acupuncture Therapy , methods

Call your health care provider if you have symptoms of osteoarthritis.

Prevention :
Weight loss can reduce the risk of knee osteoarthritis in overweight women.
How to Live With Osteoarthritis :

*Exercise affected joints gently (in a pool, if possible)

*Massage at and around affected joints (this measure should preferably be performed by a trained therapist)

*Apply a heating pad or a damp and warm towel to affected joints

*Maintain an appropriate weight (so as not to place extra stress on joints)

*Use special equipment as necessary (for example, cane, crutches, walker, neck collar, or elastic knee support to protect joints from overuse; a fixed seat placed in a bathtub to enable less stretching while washing)

*Wear well-supported shoes or athletic shoes


Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm
http://www.merck.com/mmhe/sec05/ch066/ch066a.html

 

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Standing Tall, Walking Erect

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Joints are constantly used during a lifetime of activity. Worn out cells are efficiently replaced. If the rate of repair falls below the rate of damage, painful degenerative osteoarthritis sets in. This generally occurs earlier in overweight individuals, smokers and those with complicating medical illnesses such as diabetes.

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Around 75 per cent of the population over the age of 65 has X-ray evidence of osteoarthritis in the hips or knees. Such people may complain of stiffness, especially after a period of inactivity. There may be difficulty in standing up, stepping and walking. The gait may be waddling and abnormal. There may be dull ache or a sharp, stabbing radiating pain. The knees may be obviously deformed and bent. Balance becomes a problem and frequent falls may occur.

Lifestyle modifications are required for the management of osteoarthritis, and this may include cessation of smoking, treatment of underlying diseases and weight loss.

A common misconception is that exercise will “wear out” an osteoarthritic joint. Low-impact exercises such as walking and cycling are actually beneficial. Physiotherapists can teach effective quadriceps-strengthening exercises (for the knees) and hip motion exercises. These increase flexibility. Strengthening the muscles surrounding an affected joint helps to hold the bones in place, reduces pain and maintains mobility. Exercises must be performed every day for them to be effective. If discontinued, accrued benefit disappears in three days. Patients who participate in exercise programmes have less pain and depression and improve faster than those who rely on medications alone.

Topical application of creams and ointments containing capsaicin (an extract of green pepper), applied four times daily, provide excellent pain relief.

Many patients with osteoarthritis of the hip and knee are more comfortable if they wear slippers with good shock-absorbing properties.

Canes are an excellent aid when held on the unaffected side of the body. For maximum effectiveness, the top of the cane’s handle should reach the patient’s wrist crease (when the patient is standing with arms straight down). Such canes can reduce hip and knee weight bearing by 20 to 30 per cent.

If the person is still incapacitated, medications can be used. In older individuals, dosage has to be carefully monitored to prevent kidney or liver damage.

Paracetamol is the probably the safest drug. It provides excellent pain relief. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibubrufen or diclofenac can be used for a short time. The “Cox” group, which includes celecoxib, is also effective.

Anecdotal evidence suggests that “food supplements” such as glucosamine sulphate and chondroitin sulphate are safe and effective in patients with osteoarthritis. Actual studies, however, have not demonstrated any proven benefit.

If there is pain and disability despite these simple measures, affected joints can be injected with steroids or hyaluronic acid analogues.

Surgical intervention is also an option. The joint can be viewed, lavaged and debrided through an arthroscope.

Hips and knees can now be replaced. This should be considered if there is severe persistent pain, loss of motion, inability to stand or climb stairs, deformity and if all other therapies have failed. Earlier, replacement was an option reserved primarily for severely affected adults over 60 years. The artificial joints were heavy and maladroit, and the surgery was long and complicated. But now, research has converted the clumsy, original hinge joint into an engineering marvel. Lightweight biocompatible and durable materials such as plastic, titanium and stainless steel are now used. They resist corrosion, degradation and wear. Surgeons no longer need to make 12-inch incisions to replace the joints. Keyhole surgery is possible.

Replacement surgery is successful in more than 90 per cent of patients. Age is no bar to this procedure though it is marginally riskier in older people with other complicating illnesses. (Britain’s Queen Mother underwent the surgery at the age of 95, and survived for six years after that). If the surgery is performed in active, younger individuals, the replaced joint itself can get worn out after 15 or 20 years, requiring a second surgery.

Physiotherapy speeds recovery and strengthens the muscles supporting the new joint, enabling rapid mobilisation. Within a few days, sitting up or even supported walking with crutches or a walker is possible. Eventually, within a month, unsupported walking is possible.

Squatting is not possible after replacement surgery. High-impact activities such as running are better avoided but swimming, walking and cycling are possible.

Two joints should not be operated simultaneously. There should be least a month’s gap in between surgeries.

Walking is an essential function for all age groups. Effortless walking requires coordination and unhindered functioning of the bones and joints involved. Replacement surgery does this, giving patients a new lease of life.

Sources:The Telegraph (Kolkata,India)

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Herbs & Plants

Devil’s Claw

Botanical Name: Harpagophytum
Family: Pedaliaceae
Genus: Harpagophytum
Kingdom: Plantae
Order: Lamiales

Common Name:Devil’s claw

Other Names: Harpagophytum procumbens, Grapple Plant, Wood Spider

Habitat: Devil’s claw is native to southern Africa. It is mainly found in the eastern and south eastern parts of Namibia, Southern Botswana and the Kalahari region of the Northern Cape, South Africa. Harpagophytum zeyheri is found in the northern parts of Namibia (Ovamboland) and southern Angola.

Description:  Devil’s claw (Harpagophytum procumbens) is an African plant whose fruit looks like a giant claw. The plant grows in an arid climate and is found in Namibia, Madagascar, the Kalahari Desert, and other areas on the African continent. The tuberous roots are used in traditional medicine. The root is collected when the rainy season ends. The root is chopped and dried in the sun for three days……...click & see

click to see the picture

Its name comes from the small hooks on the plant’s fruit. The active ingredients in devil’s claw are believed to be iridoid glycosides called harpagosides, which are found in the secondary root.

Most of the world’s supply of devil’s claw comes from Namibia, with lesser amounts coming from South Africa and Botswana.

General Use
Devil’s claw has been used for thousands of years in Africa for fever, rheumatoid arthritis, skin conditions, and conditions involving the gallbladder, pancreas, stomach and kidneys.

In the early 1900’s, devil’s claw was brought to Europe. It is used to improve digestion, as the bitter taste of devil’s claw tea is thought to stimulate digestive juices.

However, the primary use of devil’s claw today is for conditions that cause inflammation and pain:
Back pain, Neck pain, Rheumatoid arthritis, Osteoarthritis and Tendinitis

According to a study in the Journal of Ethnopharmacology, sales of devil’s claw in Germany were estimated to be $30 million euros in 2001, accounting for 74% of the prescriptions for rheumatism.

Devil’s claw has been used for numerous conditions in several areas of the world. In South Africa, the root and tuber have been used for centuries as an all-purpose folk remedy. Devil’s claw has been used to reduce fever and pain, to treat allergies and headache, and to stimulate digestion. Traditional healers also used devil’s claw to treat inflammatory conditions such as arthritis, rheumatism, and lower back pain. Devil’s claw has also been used as a remedy for liver and kidney disorders.

Devil’s claw root was also used in folk medicine as a pain reliever and for complications with pregnancies. In addition, an ointment made from devil’s claw was used for skin injuries and disorders.

European colonists brought the African plant back to their continent where it was used to treat arthritis. In the United States, use of devil’s claw dates back to the time of slavery. The slaves brought herbs and herbal knowledge with them to the new continent.

Devil’s claw has been used as an herbal remedy in Europe for a long time. Current uses for devil’s claw are much the same as they were centuries ago. In Europe, the herb is still a remedy for arthritis and other types of joint pain, such as rheumatoid arthritis, osteoarthritis, and gout (a painful joint inflammation disease).

Devil’s claw is also used for soft tissue conditions with inflammation, like tendinitis and bursitis. The bitter herb is also used as a remedy for loss of appetite and mildly upset stomach.

The herb is currently used for other conditions such as problems with pregnancy, menstruation, and menopause. Devil’s claw is also regarded as a remedy for headaches, heartburn, liver and gallbladder problems, allergies, skin disorders, and nicotine poisoning.

European research during the late 1990s indicated that devil’s claw relieved arthritis and joint pain conditions. The herb also helped with soft muscle pain such as tendinitis. However, there is no evidence that proves devil’s claw is an effective remedy for other conditions such as difficulties during pregnancy and skin disorders.

Preparations:

Several forms of devil’s claw are used. In Europe, doctors treat some conditions like arthritis with an injection of devil’s claw extract. The herb is taken internally as a tea or in capsule form. When taken for pain relief, devil’s claw must be taken regularly for up to one month before results are seen. An ointment form of devil’s claw can be applied to the skin to treat wounds or scars.

Research work on devil’s claw:
There is some evidence for the use of devil’s claw, however one larger, randomized controlled trial found only a modest benefit.
A German study examined the use of devil’s claw for slight to moderate back, neck, and shoulder muscle tension and pain. In the 4-week study, 31 people took 480 mg twice a day and 32 people took a placebo. The results showed there was a significant reduction in pain in the people taking devil’s claw compared to the placebo group.

A study published in the journal Rheumatology compared a devil’s claw extract providing 60 mg harpagosides a day and and 12.5 mg a day of the anti-inflammatory Vioxx (now off the market) for 6 weeks in 79 patients with an acute exacerbation of low back pain. Devil’s claw was as effective as Vioxx in reducing pain.

A study published in the journal Joint Bone Spine compared six 435 mg capsules of powdered devil’s claw extract a day (which provides about 60 mg per day of harpagosides) with 100 mg a day of a European osteoarthritis drug called diacerhein in 122 patients with osteoarthritis of the knee or hip. After four months, devil’s claw was as effective as the diacerhein at relieving pain, improving mobility, and reducing the need for back-up medication (such as anti-inflammatory and analgesic drugs). Although this sounds great, the results aren’t as impressive in light of a 3-year placebo-controlled study found diacerhein was ineffective at reducing osteoarthritis symptoms.

In a European Journal of Anaesthesiology 4-week study, 197 people with back pain rated at 5/10 or higher on a pain scale received a standardized daily dose of 50 mg or 100 mg harpagosides or placebo. Devil’s claw seemed to reduce pain more than placebo.
Devil’s claw appears to work in the same way as Cox-2 anti-inflammatory drugs such as Celebrex and also produce changes in leukotrienes, another group of molecules involved in inflammation.

Herbal Tea and Tincture:

Devil’s claw tea is prepared by pouring 1.25 cups (300 ml) boiling water over 1 tsp (4.5 g) of the herb. The mixture, which is also called an infusion, is steeped for eight hours and then strained. The daily dosage is 3 cups of warm tea.

For most conditions, the average daily dosage is 1 tsp (4.5 g) of devil’s claw herb. However, the amount is reduced to 1/3 tsp (1.5 g) when devil’s claw is taken for appetite loss.

In a tincture, the herb is preserved with alcohol. The tincture steeps for two weeks and is shaken daily. It is then strained and bottled. When devil’s claw tincture is used as a remedy, the dosage is 1 tsp (4.5 g) taken three times per day for a specified period.

Tea and tincture should be consumed 30 minutes before eating. This allows for better absorption of the herb.

Devil’s Claw Capsules:

The anti-inflammatory properties of devil’s claw are attributed to two constituents, harpagoside and beta sitoserol. If a person takes devil’s claw capsules or tablets as a remedy, attention should be paid to the harpagoside content. The daily amount of harpagoside in capsules should total 50 mg.

Combinations

For arthritis treatment, devil’s claw can be combined with anti-inflammatory or cleansing herbs. In addition, devil’s claw can be combined with bogbean or meadowsweet. An herbalist, naturopathic doctor, or traditional healer can provide more information on herb combinations appropriate for a specific condition.

Precautions

Devil’s claw is safe to use when proper dosage recommendations are followed, according to sources including the PDR (Physician’s Desk Reference) for Herbal Medicines, the 1998 book based on the 1997 findings of Germany’s Commission E.

Although devil’s claw has not undergone the FDA research required for approval as a remedy, other studies in Europe confirm that devil’s claw is safe for most people. However, people with ulcers should be cautious because the herb stimulates the production of stomach acid.

Furthermore, it is not known if devil’s claw is safe for people with major liver or kidney conditions. In addition, devil’s claw could cause an allergic reaction.

There is some debate in the alternative medicine community about whether pregnant women can use devil’s claw as a remedy. Some researchers say that the herb is safe to use; others say that not enough research has been done to prove that the herb is safe for pregnant women. There appears to be no scientific proof that using devil’s claw could result in miscarriages.

Side Effects
Devil’s claw has been known to trigger an allergic reaction.

Some studies have reported stomach upset, a sensation of fullness, tinnitus (ringing in the ears), and headache.

In animal studies, there is a small risk of changes in blood pressure, heart rhythm, and blood glucose. One study found that it enhanced the action of GABA in the brain and depressed the central nervous system. It is not known whether these effects may also occur in humans.

Devil’s claw could cause an allergic reaction or mild gastrointestinal difficulties.

Safety

Devil’s claw should not be used by people with gastric or duodenal ulcers.

People with gallstones should consult a doctor before using devil’s claw.

People with diabetes or who are taking medication that affects their blood sugar should only use devil’s claw under the supervision of a qualified health practitioner. In one study, devil’s claw extract resulted in reductions in blood glucose in fasted normal and diabetic animals.

Devil’s claw should not be used by people who are or may be pregnant, as it is believed to cause uterine contractions.

Interactions

No interactions between other medications and devil’s claw have been reported according to the PDR for Herbal Medicines. However, the herb may possibly block the effect of medication taken to correct abnormal heart rhythms.

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Disclaimer:
The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.

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Resources:
http://en.wikipedia.org/wiki/Harpagophytum
http://altmedicine.about.com/od/herbsupplementguide/a/DevilsClaw.htm
http://www.answers.com/topic/proboscidea-garden-annual

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