:: September 2005 Volume 4/Number 6

RESEARCH BRIEF
PROFILE OF ARTHRITIS.

By Felicia M. Tomasko

Arthritis afflicts more than 43 million American adults, and numbers are increasing. Osteoarthritis, the most common form, currently affects approximately 21 million U.S. adults. According to the CDC (Centers for Disease Control and Prevention), arthritis is not just linked to age; nearly two-thirds of people affected are younger than 65. It is one of the most frequent causes of disability in adults.

Osteoarthritis
In osteoarthritis, the cartilage in the joint wears away or the body is not able to replace it quickly enough, disrupting normal joint lubrication, causing pain or debility.

From an Ayurvedic perspective, osteoarthritis is a disturbance of vata dosha. The three doshas are Ayurvedic categories of physiological processes, physical structure and function and psychological tendencies. The three doshas (vata, pitta and kapha) are associated with different elements and embody the related elemental qualities. Vata is the dosha of air and ether (empty space). Accumulation of vata leads to excessive dryness in the body and mind, giving rise to conditions such as osteoarthritis (dryness in the joints), osteoporosis (reduction in bone density), constipation (dryness in the digestive system), malabsorption, dry skin, hair, or nails, anxiety, fear or insomnia.

Ayurvedic treatments vary depending on the particular diagnosis and the individual. But, current medical research into arthritis treatments utilizing complementary modalities based on traditional therapies including acupuncture, yoga, and Ayurvedic and other herbs and natural substances while still preliminary, are promising.

Bio-Medicine and Arthiritis
Bio- medicine has no cure for arthritis. Some of the most common pharmaceuticals reduce pain, but do not repair the condition. Most common pain-relieving treatments are controversial because of their dangerous side effects. Many COX-2 inhibitors, members of a class of non-steroidal anti-inflammatory (NSAID) pharmaceutical drugs, are the drugs of choice. But recently, Vioxx (rofecoxib) and Bextra (valdecoxib) were removed from the market due
to their potential for increasing risk of developing cardiovascular problems, leaving only Celebrex (celecoxib), albeit with black-box safety warnings.

Other pain-relievers (including Naprosyn, Indocin, Mobic and even Advil) are also now mandated to carry warnings for side effects. Taking steroids orally has not shown to be effective, from the standpoint of evidence-based medicine.1 There is some evidence that injectable steroids reduce local inflammation.
More than 170,000 joint replacement (particularly of knees and hips) surgeries are performed each year in the U.S., primarily for people with arthritis. While there is still more research needed, complementary therapies are showing promise without the side effects or dangers of bio-medicine.

Acupuncture and Arthritis
Acupuncture has been used traditionally for thousands of years for pain reduction. It is currently being studied for its efficacy in the treatment of arthritis, with promising results. Two recent studies, both published in 2004, found that acupuncture was more effective than placebo for reducing pain and increasing function in people with knee osteoarthritis.

Herbs, Supplements and Arthritis
Guggulu preparations are a traditional Ayurvedic remedy for treating joint diseases, and specifically osteoarthritis. Guggulu is a resin from the tree Commiphora mukul. Researchers at the Southern California University of Health Sciences in Orange County have investigated the use of guggulu in a case study and larger research study. After one and two months of taking 500mg of the herb three times a day, people experienced reduced stiffness and pain along with improvement in physical function and increased walking ability, without side effects. People still maintained this improvement even one month after discontinuing the herbal supplement.

Boswellia serrata is another Ayurvedic resin that has been shown to be effective for decreasing pain and swelling and increasing the ability of people with arthritis to walk functionally.6
Capsules of the popular Ayurvedic herb ginger were shown to be more effective than a placebo in this ability to decrease pain associated with knee osteoarthritis over a six-month timespan.7
Other complementary treatments are promising; two well-publicized supplements are glucosamine and chondroitin. Glucosamine is extracted from shellfish shells. A number of research studies have demonstrated its effectiveness in reducing pain and swelling and improving function. While most studies have focused on knee arthritis, there is evidence that glucosamine can be helpful in arthritis of the low back or hip. It may not be as effective for long-standing arthritis or arthritis in people who are older or heavier. There is no research showing that glucosamine creams are effective.

Chondroitin is another complementary treatment that has received positive attention. It is derived from animal cartilage, making it unsuitable for vegetarians. While research does not indicate that it prevents arthritis, it does seem to slow progression of the disease. Taken orally, it is experimentally shown to decrease pain and improve joint function. Studies show it is often necessary to take chondroitin for at least 6–8 weeks before noticing results.

Yoga Asana and Exercise
Exercise is frequently shown to be effective in reducing pain and increasing muscular strength and function in arthritis. Even so, research by Barbara Resnick at the University of Maryland reveals that the majority of adults with arthritis do not participate in an exercise program; their reasons include: thinking they need to rest, pain or fear of pain with activity and lack of information or education about appropriate exercise or yoga. Resnick found that exercise programs incorporating both stretching and strengthening of the muscles around the affected joint have the best effect. These are characteristic of most yoga routines.

Yoga is beginning to be specifically investigated in arthritis management. People with osteoarthritis in their hands who participated in a yoga asana (posture) and relaxation program experienced reduced pain and increased range of motion.12
A recent pilot program examined the ability of yoga for alleviating low back pain; the practice improved balance and flexibility and decreased disability for people with chronic back problems.13
Exercise and yoga programs can be one of the least dangerous additions to an arthritis-management program, but be certain to find an instructor who is skilled at modifying postures or movements as needed.

As always, check with your healthcare provider before beginning any new forms of treatments.

References
1 The Cochrane Library. 2004. Evidence Based Medicine Guidelines, Osteoarthritis.

2 Berman, B.M., Lao, L., Langenberg, P., Lee, W.L., Gilpin, A.M., and Hochberg, M.C. 2004.
Effectiveness of acupuncture as adjunctive t
herapy in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine. 141(12): 901-10.

3 Vas, J., Mendez, C,. Perea-Milla, E., Vega, E., Panadero, M.D., Leon, J.M., Borge, M.A., Gaspar, O., Sanchez-Rodriguez, F., Aguilar, I., and Jurado, R. 2004. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. British Medical Journal. 20;329(7476):1216.

4 Singh, B.B., Mishra, L., Aquilina, N. and Kohlbeck, F. 2001. Usefulness of guggul (Commiphora mukul) for osteoarthritis of the knee: An experimental case study. Alternative Therapies in Health and Medicine. 7(2):120, 112-4.

5 Singh, B.B., Mishra, L.C., Vinjamury, S.P., Aquilina, N., Singh, V.J. and Shepard, N. 2003. The effectiveness of Commiphora mukul for osteoarthritis of the knee: an outcomes study.
Alternative Therapies in Health and Medicine. 9(3):74-9.

6 Kimmatkar, N., Thawani, V., Hingorani, L. and Khiyani, R. (2003). Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee — a randomized double blind placebo controlled trial. Phytomedicine, 10(1):3-7.

7 Wigler, I., Grotto, I., Caspi, D., and Yaron, M. 2003. The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthtis and Cartilage. 11(11):783-9.

8 Wigler, I., Grotto, I., Caspi, D., and Yaron, M. 2003. The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthtis and Cartilage. 11(11):783-9.

9 Uebelhart, D., Malasie, M., Marcolongo, R.,
DeVathaire, F., Piperno, M., Mailleux, E., Fiorvanti, A., Matoso, L., and Vignon, E. 2004. Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a one-year, randomized,
double-blind, multicenter study versus placebo.
Osteoarthritis and Cartilage. 12(4):269-76.

10 Leeb, B.F., Schweitzer, H., Montag, K.,
and Smolen, J.S. 2000. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. Journal of Rheumatology. 27(1):205-11.

11 Resnick, B. 2001. Managing Arthritis with
Exercise. Geriatric Nursing. 22(3): 143-50.

12 Garfinkel, M.S., Schumacher, H.R. Jr, Husain, A., Levy, M. and Reshetar, R.A. 1994. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. Journal of Rheumatology. 21(12):2341-3.

13 Galantino, M.L., Bzdewka, T.M., Eissler-Russo, J.I., Holbrook, M.L., Mogek, E.P., Geigle, P., and Farrar, J.T. 2004. The Impact of Modified Hatha Yoga on Chronic Low Back Pain: A Pilot Study. Alternative Therapies in Health and Medicine. 10(2): 56-9.

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