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Osteoarthritis - Diagnosis and treatment

Diagnosis

During the physical examination, the doctor will carefully examine the affected joint, check for pain with palpation, swelling or redness, and test the range of motion of the joint. The doctor can also recommend imaging diagnostics and laboratory tests.



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Tests by images

Images of the affected joint can be obtained by imaging tests. For example:

•     X-rays Cartilage can not be seen on x-rays, but cartilage loss is identified by narrowing the space between the bones of the joint. On an x-ray, you can also see osteophytes around a joint. Some people can get evidence of osteoarthritis by x-ray before presenting symptoms.
•     Magnetic resonance (MR). MRI uses radio waves and a powerful magnetic field to produce detailed images of bones and soft tissues, including cartilage. MRI is usually not needed to diagnose osteoarthritis, but it may help provide more information in complex cases.

Laboratory analysis

Analyzing your blood or joint fluid can help confirm the diagnosis.

•     Blood test. While there is no blood test for osteoarthritis, certain tests can help rule out other causes for joint pain, such as rheumatoid arthritis.
•     Analysis of joint fluid. The doctor may use a needle to remove fluid from the affected joint. Examining and analyzing the joint fluid can determine whether there is inflammation and whether the pain is caused by gout or an infection.

Treatment

Currently, the hidden process of osteoarthritis can not be reversed but, in general, the symptoms can be effectively treated through changes in lifestyle, physiotherapy and other types of therapy, as well as medications and surgery. In general, exercising and having a healthy weight are the most important ways to treat osteoarthritis. The doctor may also recommend the following:
Medicines

The symptoms of osteoarthritis, especially pain, can be improved with certain medications, such as the following:

•     Paracetamol. Paracetamol (Tylenol, others) has been shown to be effective in people with osteoarthritis and with mild to moderate pain. Taking a higher than the recommended dose of paracetamol can cause liver damage.
•     Non-steroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, including ibuprofen (Advil, Motrin IB and others) and naproxen sodium (Aleve and others), taken at the recommended doses, usually relieve the pain of osteoarthritis. The most potent NSAIDs, available by prescription, can also reduce inflammation slightly along with pain relief.
•     NSAIDs can cause upset stomach, cardiovascular problems, bleeding problems and damage to the liver and kidneys. Topical NSAIDs have fewer side effects and can relieve pain just as well.
•     Duloxetine (Cymbalta). This medication is usually used as an antidepressant, but it is also approved to treat chronic pain, including the pain of osteoarthritis.

Therapy

•     Physiotherapy. A physiotherapist can work with you to create an individualized exercise program that will strengthen the muscles around the joints, increase range of motion and reduce pain. Gentle exercises that you do regularly on your own, such as swimming or walking, can be equally effective.
•     Occupational therapy An occupational therapist can help you discover ways to do everyday tasks or do your job without adding extra effort to the already painful joint. For example, if you have osteoarthritis, a toothbrush with a large handle can make you brush your teeth more easily. If you have arthrosis in your knees, a bench under the shower could relieve the pain associated with standing.
•     Taichi and yoga. These movement therapies include stretching and gentle exercises combined with deep breathing. Many people use these therapies to reduce stress in their lives, and research suggests that tai chi and yoga can reduce the pain of osteoarthritis and improve movement. If the instructor in charge has the corresponding knowledge, these therapies are safe. Avoid movements that cause joint pain.

Surgery and other procedures

•     Illustration of knee osteotomy
•     Knee osteotomy
•     Illustration of a hip affected by osteoarthritis before and after hip replacement
•     Artificial hip
•     Images of a knee before and after replacement surgery
•     Knee comparisons

If conservative treatments do not help you, you can consider procedures such as the following:

•     Cortisone injections Injections of corticosteroid medications can relieve pain in the joint. During this procedure, the doctor numbs the area around the joint, places a needle in the space inside the joint, and injects the medication. The number of cortisone injections you can receive per year is usually limited to three or four injections, because the medication can worsen the damage to the joint over time.
•     Injections for lubrication. Hyaluronic acid injections can relieve pain by providing some cushioning in the knee, although, in some investigations, it is suggested that these injections do not relieve pain more than a placebo. Hyaluronic acid is similar to a component that is normally found in the fluid of the joint.
•     Realignment of bones. If osteoarthritis has damaged one side of the knee more than the other, an osteotomy may be helpful. In a knee osteotomy, the surgeon cuts the bone above or below the knee and removes or adds a piece of bone. In this way, the body weight of the worn part of the knee is transferred to the other part.
•     Joint replacement In joint replacement surgery (arthroplasty), the surgeon removes damaged articular surfaces and replaces them with plastic and metal parts. Surgical risks include infections and blood clots. Artificial joints can wear or loosen, so they may need to be replaced over time.

Lifestyle and home remedies

Changes in lifestyle can make a considerable difference in the symptoms of osteoarthritis. There are other home treatments that can help. Here are some steps you can try:

•     Do exercise. Exercise can increase the strength and strength of the muscles that surround the joint, improving the stability of the joint. Try walking, biking or swimming. If you feel a new pain in the joint, suspend physical activity.
•     If you feel a new pain for several hours after exercising, it is likely that you have demanded too much, but it does not mean that you have damaged yourself in an important way or that you should stop exercising. Simply resume physical activity one or two days later with a somewhat lower intensity level.
•     Lose weight Obesity or even a little overweight increases the tension in the joints that support weight, for example, in the knees and hips. Even lowering a few pounds can relieve some of the pressure and reduce pain.
•     Talk to a dietitian about healthy ways to lose weight. Most people combine changes in their diet with a greater amount of physical activity.
•     It uses heat and cold to treat pain. Both heat and cold can relieve joint pain. In addition, heat relieves stiffness, and cold can relieve muscle spasms and pain.
•     Capsaicin Using capsaicin (an active component of hot peppers) topically in a joint with arthritis may be an alternative for people who can not take nonsteroidal anti-inflammatory drugs (NSAIDs). It is possible that, to notice the benefits, it must be applied constantly between three and four times a day for several weeks. Make sure you wash your hands thoroughly after applying capsaicin cream.
•     Apply over-the-counter pain relievers. The creams and gels that can be bought in pharmacies offer temporary relief from the pain of osteoarthritis. Some creams anesthetize pain by creating a sensation of heat or cold.
•     Other creams contain medicines, for example, compounds similar to aspirin, which absorbs the skin. Analgesic creams offer better results if they are applied to joints near the surface of the skin, such as the knees and fingers.
•     Immobilization devices and orthopedic insoles. The doctor may recommend orthotics and other devices that can help reduce pain when you're standing or walking. These devices can immobilize or hold the joint to help reduce the pressure on it.
•     Knee bandage Elastic adhesive tape helps relieve the pain of knee osteoarthritis. Ask a doctor or physiotherapist to tell you what is the best way to attach the adhesive tape.
•     Use assist devices. Assistive devices can ease your movements without putting too much stress on the aching joint. A cane could reduce the weight on one knee or hips when you walk. Take the cane in the opposite hand to the aching leg.
•     Clamping and gripping tools can make work in the kitchen easier if you have arthrosis in your fingers. The doctor or occupational therapist can give you advice on what types of assistive devices can help you. You can also search for ideas in catalogs and pharmacies.

Alternative medicine

Various treatments of complementary and alternative medicine can help relieve the symptoms of osteoarthritis. The treatments that have shown promise for osteoarthritis include:

•     Acupuncture. Some studies indicate that acupuncture can relieve pain and improve function in people with osteoarthritis of the knee. During an acupuncture session, needles as thin as a hair are inserted into precise points of the body.
•     Glucosamine and chondroitin. The results of the studies have been disparate with regard to these nutritional supplements. In a few studies, benefits were found for people with osteoarthritis, while the majority indicate that these supplements do not work better than a placebo.
•     Do not use glucosamine if you are allergic to shellfish. Glucosamine and chondroitin can interact with anticoagulants, such as warfarin, and cause bleeding problems.
•     Unsaponifiable lipids of avocado and soy. This nutritional supplement, a blend of avocado and soybean oils, is widely used in Europe to treat osteoarthritis of the knee and hip. It acts as an anti-inflammatory, and as proven in some studies, can delay or even prevent damage to the joints.

Coping strategies and support

Changes in lifestyle and certain treatments are key to treating pain and disability, but another important component of treatment is your own perspective on life. Your ability to deal with problems despite the pain and disability caused by osteoarthritis often determines how much the disease will affect your daily life. Talk to your doctor if you feel frustrated, since he can give you ideas to deal with problems or refer you to someone who can help you.

Preparation for the consultation

While you may initially see your GP, he may refer you to a doctor who specializes in joint disorders (rheumatology) or orthopedic surgeries.

What can you do

You may want to write a list that includes:

•     Detailed descriptions of your symptoms
•     Information about health problems that you have had
•     Information about the health problems of your parents or siblings
•     All over-the-counter and prescription medications and dietary supplements you are taking, and doses
•     Questions you want to ask the doctor

What to expect from the doctor

The doctor can ask you some of the following questions:

•     When did your joint pain start?
•     Is the pain continuous, or does it appear and disappear?
•     Does any particular activity improve or worsen the pain?
•     Have you ever injured this joint?

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Joint pain and what to take to avoid its effects

Arthritis and osteoarthritis are the two diseases that most affect the joints, especially when a certain age is reached. However, many people often confuse these two concepts, which are different from each other. First of all, it should be said that osteoarthritis, according to the Spanish Society of Rheumatology, is caused by lesions in the cartilage of the joints that give rise to pain and lack of mobility. Also, arthritis causes swelling and stiffness in these areas and, although it is known that these symptoms are due to the attack of the immune system to the cartridges, it is unknown what causes it.



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Natural remedies for joint pain

Nature offers magnificent solutions to alleviate the symptoms associated with both arthritis and osteoarthritis. Although they do not have the capacity to heal the problem, the reality is that they are capable of slowing down their progress. For example, turmeric, when combined with pepper, exerts a potent anti-inflammatory effect on the affected joint. The same happens with ginger, a root so powerful that it has nothing to envy to many chemical medicines.

On the other hand, the harpagofito, the root of a plant of the same name, thanks to its special active principles, besides relieving the swelling, also calms the pain. Also, omega 3 and, specifically, the EPA, is very effective in this regard, so that people suffering from arthritis or arthritis should include in their diet foods containing it in large quantities. Finally, there is only mention of honey with cinnamon, a natural remedy that, since time immemorial, is used to treat these problems and that has its origin in oriental medicine.

Other supplements to treat arthritis and osteoarthritis
There are many other healthy substances for the body that can help improve the symptoms of these diseases.

The most outstanding are:

• - Hyaluronic acid : Since it is part of the synovial fluid and cartilage, it helps to improve the mobility of the joints.
• - Collagen . Collagen is the main component of cartilage and, therefore, its consumption helps delay its degeneration.
• - Glucosamine . Another component of cartilage is very important. Taking this substance helps improve the process of tissue recovery and decreases pain. Currently, it is sold in many stores as a food supplement. Glucosamine HSNstore is an excellent example of this.
• - Silicon . Another component of the cartilage whose consumption is recommended with preventive character.
• - Chondroitin This compound should be combined with hyaluronic acid to be more effective. Ideal to reduce inflammation and pain.

In short, arthritis and osteoarthritis are serious problems that seriously affect the quality of life of people who suffer from them. However, thanks to these substances, which can be taken through food supplements, it is possible to delay their progress and ostensibly reduce the associated symptoms.

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Treatment and care for Arthritis

Treatment of arthritis depends on its particular cause, where the joints are affected, their severity, and how the disease affects their daily activities. Your age and profession will also be taken into account when the doctor works with you to create a treatment plan.

If possible, the treatment will focus on eliminating the underlying cause of the arthritis. However, the cause can NOT necessarily be cured, as is the case with osteoarthritis and rheumatoid arthritis. Treatment, therefore, aims to reduce pain and discomfort and prevent further disability.



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

Exercise for arthritis is necessary to maintain joint health, relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your exercise program should adapt to you as an individual. Work with a physiotherapist to design an individualized program, which should include:

•     Low impact aerobic activity (also called resistance exercises)
•     Mobility exercises for flexibility
•     Resistance training for muscle tone

A physiotherapist can apply heat and cold as needed and measure braces or devices of orthosis (straightening) to support and align the 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 as important as exercise. Sleeping 8 to 10 hours at night and taking naps during the day can help you recover from an outbreak more quickly and may even help prevent exacerbations. Should also:

•     Avoid holding a position for too long.
•     Avoid positions or movements that exert additional stress on the affected joints.
•     Modify your home to make activities easier. For example, have support bars in the shower, tub, and near the toilet.
•     Reduce stress, which can aggravate the symptoms. Try meditation or guided visualization. And check with your physical therapist about yoga or tai chi.

Other measures may include:

•     Apply capsaicin cream (derived from chili) on the skin over the joints that hurt. You can feel improvement after applying the cream for 3-7 days.
•     Eat a diet rich in vitamins and minerals, especially antioxidants such as vitamin E. They are found in fruits and vegetables. The selenium sources of brewer's yeast, wheat germ, garlic, whole grains, sunflower seeds and Brazil nuts. Obtain omega-3 fatty acids from cold-water fish (such as salmon, mackerel and herring), flax seed, rapeseed (canola), oil, soy, soybean oil, pumpkin seeds and nuts.
•     Take glucosamine and chondroitin - these form the building blocks of cartilage, the substance that lines the joints. These supplements are available in health food stores or supermarkets. While some studies show that these supplements can reduce the symptoms of osteoarthritis, others show no benefit. However, since these products are considered safe, they are reasonable to try and many patients find that their symptoms improve.

MEDICINES

Your doctor will choose from a variety of medications when necessary. In general, the first drugs that are tested are available without a prescription. These include:

•     Acetaminophen (Tylenol) - recommended by the American College of Rheumatology and the American Geriatrics Association as a first-line treatment for osteoarthritis. Take up to 4 grams a day (two Tylenol for Arthritis every 8 hours). This can provide significant relief from arthritis pain without many of the side effects of prescription medications. Do not exceed the recommended dose of acetaminophen or take the drug in combination with large amounts of alcohol. These actions can damage the liver.
•     Aspirin, ibuprofen or naproxen - these nonsteroidal anti-inflammatory drugs (NSAIDs) are often effective in the fight against 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. Possible side effects include myocardial infarction, stroke, stomach ulcers, bleeding from the digestive tract and kidney damage. In 2005, the US Food and Drug Administration. (FDA) asked NSAID drug manufacturers to include a warning label on their product that alerts users of an increased risk of heart attack, stroke and gastrointestinal bleeding. If you have kidney or liver disease, or a history of gastrointestinal bleeding, you should not take these medications unless your doctor recommends it.

Prescribed medications include:

•     Biological These are the most recent advances for the treatment of rheumatoid arthritis. Such medications, including etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira), are given by injection and can greatly improve your quality of life. Most recent biologics include Orencia (abatacept) and Rituxan (rituximab).
•     Corticosteroids ("steroids") - These are medications that suppress the immune system and the symptoms of inflammation. It is often injected into joint pain with osteoarthritis. 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 bones, cataracts and increased infections. The risks are more pronounced when steroids are taken for long periods of time or in high doses. Close supervision of a doctor is essential.
•     The inhibitors of cyclooxygenase-2 (COX-2) . These drugs block an inflammation-promoting enzyme called COX-2. This class of medicines Initially it was believed that they worked the same as the traditional ones, but with less stomach problems. However, numerous reports of heart attacks and strokes have led the FDA to reassess the risks and benefits of COX-2. Celecoxib (Celebrex) is still available, but with strong warning labels and a recommendation that it be prescribed at the lowest possible dose for the shortest possible time. Talk to your doctor about whether COX-2 is recommended for you.
•     Disease modifiers antirheumatic drugs - these have traditionally been used to treat rheumatoid arthritis and other autoimmune causes of arthritis. These medications include gold salts, penicillamine, sulfasalazine and hydroxychloroquine. More recently, methotrexate has been shown to decrease the progression of rheumatoid arthritis and improve their quality of life. Methotrexate itself can be highly toxic and requires frequent blood tests for patients on medication.

Immunosuppressants These medications, such as azathioprine or cyclophosphamide, are used for severe cases of rheumatoid arthritis when other medications have failed.

It is very important that you 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 AND OTHER APPROACHES

In some cases, surgery to rebuild the joint (arthroplasty) or replace the joint (such as a total joint knee replacement) can help maintain a more normal lifestyle. The decision to perform joint replacement surgery is usually 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, the doctor may inject the arthritic joint with an artificial version of the joint fluid. Synthetic fluid may postpone the need for surgery, at least temporarily, and improve the quality of life of people with arthritis.

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Glucosamine - Uses and properties

Glucosamine is a substance that is found naturally in the body can be found in the fluid that surrounds and protects the joints. It can be found in the form of Glucosamine Sulfate in nutritional supplements that aim to improve the joints together with other components such as type II collagen or hyaluronic acid .



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Although glucosamine can be found in seafood shells, its presentation in sulphate format is produced in pharmaceutical laboratories, as well as other variations such as its hydrochloride or acetylated form.

It is also found in some of the everyday foods, for example in dishes that include healthy cartilage of animals such as sausages which contain ear or pork snout.

In addition to improving the functioning of the joints, glucosamine sulfate is present in remedies to treat osteoarthritis , arthritis and osteoarthritis, and can be found in capsules or creams.

Glucosamine - Remedy for osteoarthritis

Degenerative joint injuries caused by advancing age or poorly performed exercises compromising movement, are factors by which the joints may be fragile and susceptible to pain, so it is important to protect them to delay the degenerative process.

In order to relieve pain and slow down the degradation of joint fluid, glucosamine sulfate is often used to fight osteoarthritis, especially if the affected area is the knee. Its effect is not immediate, but in the same way, its benefits extend over time.

We can find it combined with chondroitin, a very poluar formula that we can find in different compositions since its benefits have direct improvement on the liquid that surrounds the joints.

• Glucosamine and chondroitin are two substances in the joints whose function is to nourish and maintain healthy joints.
• How glucosamine works
• Glucosamine sulfate

Glucosamine is produced in the human body and is essential for the synthesis of collagen regeneration of the same avoiding the degradation of cartilage , hence its importance in the joints.

When there is damage to the cartilaginous area that protects the joints, collagen ceases to be as effective, which can lead to greater problems of elasticity or sharp pains in everyday movements such as flexing the knees or lifting the arm.

This is where when glucosamine sulfate works by stimulating the production of the cells responsible for creating and regenerating the cartilage, thus preventing its wear through a natural process.

Some studies show that it may have an effect in reducing pain and increasing joint mobility in cases of previously diagnosed osteoarthritis .

Properties of Glucosamine Sulfate

•     Its action and functionality allows to keep the joints healthy and healthy , so it is recommended for people who exercise.
•     It also allows to prevent joint injuries or aggravation of them contributing to the reduction of pain in cases of arthritis or osteoarthritis.
•     Stimulates the formation and repair of articular cartilage : glucosamine sulfate is essential to maintain the cartilage of your knees, hands and ankles in good condition.
•     It provides elasticity to the cartilage and, therefore, prevents the wear of the joints.
•     It has an anti-inflammatory effect and is used for arthritis and for osteoarthritis. It is therefore effective against joint pain.
•     Glucosamine is especially interesting for cases of steoarthritis in the knees and elbows.
•     It also helps by acting on the inflammation of the varicose veins in the legs.

For whom is glucosamine recommended?

•     For people whose wear due to age is high. They do not necessarily have to suffer a pain diagnosed as osteoarthritis or arthritis.
•     For athletes whose physical activity involves the joints during prolonged sessions of time, such as runners in the background, speed athletes, marathoners, soccer, cycling, lifting weights, etc.

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Diet against arthritis

What is it?

Arthritis is the general medical term that designates inflammation in the joints or a disorder characterized by such inflammation. Dietary therapies for osteoarthritis (OA) and rheumatoid arthritis (RA) -the two most common forms of arthritis-fall into three main categories:



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The conventional treatment strategy focuses on weight reduction and a balanced diet to relieve the tension of damaged joints and slow down the progression of arthritis.
Some dietary supplements analyzed in clinical trials have been shown to be beneficial for some patients.
Approaches to alternative medicine are supported by dietary adjustments (including elimination diets) and / or traditional plant remedies to treat arthritis.

The role of diet and nutrition in the types of arthritis OA and AR has been studied since the 1930s, but despite this, there is little consensus on the details of adequate dietary therapy for these disorders. What has been clear, after decades of studies, is the importance acquired by the reduction or maintenance of weight for the treatment of patients with arthritis OA. Another of the agreed findings for both types of arthritis is the need to consume a nutritionally balanced diet and follow healthy eating patterns.

What benefits does it provide?

Osteoarthritis

•     The reduction of weight in overweight people and with OA can lead to a remarkable relief of their discomfort and an improvement in the mobility of the affected joints.
•     The benefits of dietary supplement intake vary from one patient to another, depending on the joints specifically affected and the degree of erosion of the cartilage.

Rheumatoid arthritis

•     The benefits of introducing dietary adjustments, or the intake of dietary supplements to alleviate the effects of RA, vary considerably from one patient to another.
•     Maintaining a balanced diet is important in preventing the nutritional deficiencies that sometimes occur in patients with RA due to the side effects caused by the medication.
•     It has been possible to associate a deficiency of vitamin B6 with the development of RA, and supplements of vitamin B6 can reduce the levels of inflammation.

What risks do you pose and what precautions should be taken?

• Before starting any type of diet or supplement regimen it is important to consult with the doctor.
• Before starting any kind of dietary treatment for joint pain, consult a doctor to obtain an accurate diagnosis of the type of arthritis that causes the pain. If there is a suspicion of AR arthritis, it is essential to follow a systemic treatment as soon as possible to minimize potential long-term health damage.
• Check with your doctor before taking any dietary supplement, as it may interact with certain medications (with prescription and without it). Chondroitin sulfate, for example, may prolong the bleeding time in some people, especially if taken with aspirin.
• Buy dietary supplements only from trusted brands that can support the quality of their products.
• Do not stop taking any medication prescribed by your doctor without your consent.
• If you follow a diet fundamentally vegetarian, do not forget that iron deficiency can develop.
• In the case of patients with RA with a healthy weight, it is not recommended to lose weight. Excessive weight loss, especially caused by stopping many foods or following fast diets, can worsen the symptoms of AR arthritis.

Dietary supplements

•     People with diabetes should check their blood sugar levels more often if they take glucosamine, since it is an aminosaccharide.
•     Those who take blood thinning medications should periodically check their blood clotting time if they take chondroitin sulfate.
•     In some people, glucosamine and chondroitin sulfate cause intestinal gas or mild diarrhea. In some people, the unsaponifiables of avocado and soy (ISA), cause nausea and skin rashes.
•     In some people, vegetable oils that contain gamma linolenic acid (FFA) can cause intestinal gas, bloating, diarrhea and nausea. In addition, these oils may interact with other medications, especially blood thinners.
•     Some preparations of borage oil contain ingredients called pyrrolizidine alkaloids (AP); These can damage the liver or worsen liver diseases. Only borage oil should be used with certification that proves to be free of pyrrolizidine alkaloids.
•     Evening primrose oil can interact with a group of tranquilizers used in the treatment of schizophrenia, known as phenothiazines. This group of medicines includes chlorpromazine and prochlorperazine.
•     In some people, fish oil can affect the rate of blood clotting and cause nausea or fishy odor on the breath.
•     Fish oils with high levels of vitamin A can cause vitamin A toxicity in some people.
•     People who take fish oil supplements should normally take them for several months to notice their beneficial effects.

How does it work?

Osteoarthritis

Weight reduction

•     The best dietary recommendation that conventional medicine approves for patients with OA is to maintain a healthy weight. A few extra pounds can increase the pressure on damaged joints.
•     Although some doctors recommend trying a vegetarian or vegan diet as a safe way to lose weight for patients with OA, most of them consider appropriate any low calorie and nutritionally adequate diet that goes well with the particular patient.

Alterations in the diet

•     Some people believe that elimination diets can help reduce the symptoms of OA, although there is no scientific evidence of the effectiveness of any of these diets.
•     Dong's diet requires the patient to eliminate all fruits, red meat, alcohol, dairy products, herbs and all foods containing additives or preservatives from their diet.
•     The belladonna elimination diet requires eliminating all forms of belladonna from the diet, including various herbs, potatoes, tomatoes, peppers and aubergines.
•     There is no clinical evidence that people with OA benefit from the elimination of these foods, and vegetables with belladonna may even help reduce the symptoms of arthritis.

Dietary supplements

To treat the discomfort caused by OA and / or to slow the rate of cartilage deterioration, the intake of some dietary supplements is usually recommended:

•     Chondroitin sulfate is a compound that is naturally present in a protein in the body that provides elasticity to cartilage. The supplement form is a derivative of animal or shark cartilage.
•     Glucosamine is a form of aminosaccharide which is thought to contribute to the formation and repair of cartilage. It can be obtained from the shell of crab, shrimp or lobster.
•     Some naturopaths recommend the ingestion of extracts of cassava, devil's claw, hawthorn berry, cranberry and cherry. It is believed that these extracts reduce inflammation in the joints and promote the formation of cartilage.
•     Some doctors recommend increasing the daily intake of vitamins C, E, A and B6, necessary to preserve the cartilaginous structure.
•     The unsaponifiables of avocado and soy (IAS) are a compound obtained from fractions of avocado oil and soybean oil left over after the soap making process. They contain one part of avocado oil and two of soybean oil.

Rheumatoid arthritis

Dietary treatment of RA mainly accompanies pharmaceutical treatment, since the disease can not be treated by applying only nutritional changes.

Alterations in the diet

•     A well-balanced and healthy diet can help prevent nutritional deficiencies generated by certain medications.
•     There are indications that patients with RA may benefit from reduced consumption of red meat or switch to a vegetarian or vegan diet.
•     Another adjustment in the diet that seems to benefit some people with RA is to stop cooking with oils with a high content of omega 6 fatty acids (which increase inflammation) and replace them with oils with a high content of omega 3 fatty acids (which reduce inflammation). ). The recommended oils are olive oil, rapeseed oil and flaxseed oil.

Dietary supplements

Among the dietary supplements most commonly recommended for patients with RA include:

•     Fish oils Cold-water fish oils appear to reduce inflammation and relieve joint pain in some patients with RA. The recommended daily dose is 1 to 2 teaspoons. Eating fatty fish (such as salmon, trout and sardines) may also help reduce the risk of heart disease, which is higher in people with arthritis.
•     Vegetable oils. Different studies suggest that vegetable oils with a high content of gamma-linolenic acid (GLA) reduce inflammation of the joints. These vegetable oils include evening primrose oil, borage oil and black currant oil. The recommended daily dose is usually 200 to 300 mg (0.2 to 0.3 g).
•     Green Tea. It is believed that the intake of four glasses of green tea a day can benefit people with RA, thanks to the effect it produces in reducing the inflammation of the joints.

What is a typical meal?

• In general, foods to fight arthritis consist of a variety of healthy foods, including different fruits, vegetables, whole grains, semi-skimmed dairy products and lean meats. A healthy meal could include, for example:
• A turkey sandwich with lettuce and tomato on wholemeal bread
• Carrot sticks
• Apple
• Water or skimmed milk

What do the experts think?

•     Doctors recommend weight loss as a positive way to decrease joint pain and improve the overall health of people with OA.
•     There are no clinical studies demonstrating that OA patients can benefit from an elimination diet.
•     Regarding dietary supplements, the results are varied. A comprehensive study of glucosamine and chondroitin sulfate supplements, the GAIT study (Glucosamine / Chondroitin Arthritis Intervention Trial), showed that the combination of these two supplements seemed to benefit a small subgroup of patients with OA with moderate pain to severe. In people with mild discomfort only, the glucosamine / chondroitin supplement did not produce pain relief other than a simple placebo effect.
•     After reviewing 35 studies on medicinal herbs used to treat OA, it was concluded that, although the IAS are possibly beneficial, it is necessary to carry out a more exhaustive study that can determine what those benefits are.

Rheumatoid arthritis

•     Few quality studies have been published regarding dietary treatments to treat RA in people.
•     Some studies indicate that patients with RA can benefit from a vegetarian, vegan or Mediterranean diet.
•     It is possible that fish oil supplements are encouraging, however, it is necessary to conduct more studies in this regard. Fish oils appear to reduce the risk of heart attacks in patients with RA, and relieve joint pain and inflammation.
•     It has been discovered that green tea and turmeric help reduce inflammation of the joints in animals, although there are no scientific studies on the subject in humans.

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What to try and what not even treat for arthritis

If you are one of the more than 30 million Americans with osteoarthritis (OA), the most common form of arthritis, you have probably considered treatments in addition to medications to relieve pain . Approximately 40% of people who have arthritis have tried complementary or alternative therapy such as acupuncture or yoga, according to the Centers for Disease Control and Prevention (CDC).



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"When conventional medicine fails for the relief of arthritis pain , many people suffering from this disease look for alternative methods," says Dr. Marvin M. Lipman, MD, chief medical advisor at Consumer Reports. "Not only is there little evidence to support many of these treatments, but some are not even regulated."

Medications that affect your senses

Is there any that is useful? "These do not have a radical effect," says Dr. Richard Panush, MD, a professor at Keck School of Medicine at the University of Southern California. " Some at most may have small effects in some circumstances for some people."

3 that could help

Massage. A review of the studies published in the scientific journal Mayo Clinic Proceedings suggests that massage therapy can relieve the pain and stiffness of OA of the knee. Researchers in one study recommended a weekly 60-minute session with a certified massage therapist. (Look for one at amtamassage.org .)

Tai Chi. The Chinese exercise with its slow and rhythmic movements demonstrated in a review of 54 studies of 2015 that it slightly reduces the pain of arthritis. But it was less effective than aerobic and strengthening exercises. (Get more information on americantaichi.org .)

Yoga. A review of 17 studies published in the journal Musculoskeletal Care found that yoga reduced the pain of OA. Our experts recommend avoiding Bikram (hot yoga) if you have joint problems. The heat can make you feel like you can stretch more than you should, which could further damage your joints.

Acupuncture. Research suggests that this traditional Chinese therapy, which includes inserting thin needles into the body at specific points, reduces the discomfort of OA for some people. One theory is that it can trigger the release of hormones that inhibit pain, called endorphins. Or maybe it could provide a placebo effect, helping you to feel better without a medical reason. Make sure you receive the treatment with a certified professional. (Look for one in mx.nccaom.org/findapractitioner.aspx. )

And 3 therapies that you should avoid

Chiropractic manipulation. Some research suggests that the "realignment" of the spine by a chiropractor can relieve some of the general pain in the back and neck. But a 2012 review, published in the journal Rheumatology, found no evidence that therapy effectively reduces the pain of OA.

Dietary supplements. Some people use supplements such as glucosamine and chondroitin (often together) or fish oil for joint pain. So far, studies have shown that glucosamine and chondroitin are not more effective than a placebo.

High doses of fish oil can relieve joint pain caused by rheumatoid arthritis, an autoimmune condition. But its effect on OA is not clear. In addition, fish oil supplements can cause side effects such as diarrhea and stomach pain. And dietary supplements are not well regulated by the Food and Drug Administration (FDA), so you can not be sure that the one you're taking contains what the label says.

Homeopathy. The principle behind homeopathy is that some highly diluted substances can cure the disease. For example, rhus toxicodendron , made from poison ivy, has been touted as a treatment for OA. But Lipman says there is no good evidence to support the use of homeopathic remedies for arthritis or for any other condition.

Low-fat diets, do they really work?

3 smart strategies

Lose weight if you need it. Work to lose extra pounds. Excess weight puts extra pressure on the ankles, hips and knees, which can severely increase the pain of arthritis.

Do the right type of exercise. Activities that strengthen muscles, improve your range of motion and increase your cardiovascular activity can help. In addition to tai chi and possibly yoga, consider a regular walking or swimming program. Learn more about the right exercises for arthritis at arthritis.org/ living-with-arthritis / exercise.

Talk with your doctor. If you decide to try an alternative therapy, it is advisable to inform your doctor in advance that you can refer you to a trusted professional in the area. Your doctor can also tell you about any potential danger or if there could be interactions with your regular medication.

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Arthritis of the shoulder

In 2011, more than 50 million people in the United States reported that they had been diagnosed with some form of arthritis, according to the National Health Interview Survey. Defined in simple terms, arthritis is the inflammation of one or more of your joints. In a diseased shoulder, inflammation causes pain and stiffness.



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Although there is no cure for shoulder arthritis, there are many treatment options available. Using these options, most people can manage pain and remain active.

Anatomy

Your shoulder is made up of three bones: the upper arm bone (humerus), the shoulder bone (shoulder blade), and the neck bone (clavicle).

The head of the arm bone fits into the rounded cavity of the shoulder blade. This is called the glenoid cavity. A combination of muscles and tendons keeps the bone in your arm centered in the shoulder cavity. These tissues are called the rotator cuff.

There are two joints in the shoulder and both can be affected by arthritis. An articulation is located where the clavicle meets the tip of the scapula (acromion). This is called acromioclavicular joint (AC joint).

The place where the head of the humerus fits into the shoulder blade is called the glenohumeral joint.

• To indicate an effective treatment, your doctor will need to determine which joint is affected and what type of arthritis you have.
• Los huesos y las articulaciones del hombro.
• The bones and joints of the shoulder.
• Reproduced with the permission of J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopedic Surgeons, 2003.

Description

Five main types of arthritis typically affect the shoulder.

Osteoarthritis

Also known as "wear and tear arthritis", osteoarthritis is a condition that destroys the smooth outer covering (articular cartilage) of the bone. As the cartilage wears out, it deteriorates and becomes rough, and the space of protection between the bones decreases. During movement, the bones of the joint rub against each other, causing pain.

Osteoarthritis usually affects people older than 50 years and is more common in the acromioclavicular joint than in the shoulder glenohumeral joint.
( Left ) An illustration of damaged cartilage in the glenohumeral joint. ( Right ) This X-ray image of the shoulder shows osteoarthritis and reduced joint space ( arrow ).
Illustration on the left reproduced with the permission of JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopedic Surgeons, 2010.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic disease that attacks multiple joints throughout the body. It is symmetrical, which means that it generally affects the same joint on both sides of the body.

The joints of your body are covered with a membrane, called the synovium, which lubricates the joint and facilitates movement. Rheumatoid arthritis causes the membrane to swell, which causes pain and stiffness in the joint.

Rheumatoid arthritis is a disease caused by autoimmunity. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection are those that damage normal tissue (such as cartilage and ligaments) and weaken the bone.

Rheumatoid arthritis is equally common in both shoulder joints.

Post-traumatic arthritis

Post-traumatic arthritis is a form of arthritis that develops after an injury, such as a fracture or dislocation of the shoulder.

Rotator cuff tear arthropathy

Arthritis can also develop after a large and prolonged tear of the rotator cuff tendon. The torn rotator cuff can no longer support the head of the humerus in the glenoid, and the humerus can move up and rub against the acromion. This can damage the surfaces of the bones, causing the development of arthritis.
Artropatía del manguito rotador.

Rotator cuff arthropathy.

The combination of a large tear of the rotator cuff and advanced arthritis can lead to severe pain and weakness, and the patient may not be able to raise the arm.
Avascular necrosis

Avascular necrosis of the shoulder (AVN) is a painful condition that occurs when the blood supply to the head of the humerus is altered. Bone cells die without blood supply, so AVN can eventually lead to destruction of the shoulder joint and arthritis.

Avascular necrosis develops in stages. As it progresses, the dead head gradually collapses, damaging the articular cartilage that covers the bone and leads to arthritis. Initially, the AVN affects only the head of the humerus, but as the AVN progresses, the collapsed head of the humerus can damage the glenoid cavity.

The causes of AVN include the use of high doses of steroids, excessive alcohol consumption, sickle cell anemia and traumatic injuries, such as shoulder fractures. In some cases, a cause can not be identified, this is called idiopathic AVN.


Pain. It is the most common symptom of arthritis of the shoulder, aggravates with activity and progressively worsens.

•     If the shoulder glenohumeral joint is affected, the pain is centered in the back of the shoulder and may intensify with changes in weather. Patients complain of deep pain in the joint.
•     Arthritis pain in the acromioclavicular joint (AC) is concentrated in the upper part of the shoulder. This pain can sometimes radiate or travel to the side of the neck.
•     A person with rheumatoid arthritis may have pain around the shoulder if both joints, the glenohumeral and the AC joint, are affected.

Limited range of movement. Limited movement is another common symptom. You may find it more difficult to raise your arm to comb your hair or reach a shelf. You may hear squeaks, clicks, or cracks (joint crepitus) when moving the shoulder.

As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping can be difficult.

Medical exam
Medical history and physical examination

After discussing your symptoms and medical history, your doctor will examine your shoulder.

During the physical examination, your doctor will look for:

•     Weakness (atrophy) of muscles
•     Pain on palpation
•     Amplitude of the range of passive (assisted) and active (self-directed) movement
•     Any sign of injury to the muscles, tendons and ligaments that surround the joint
•     Signs of previous injuries
•     Involvement of other joints (an indication of rheumatoid arthritis)
•     Joint crepitus (sensation of noises and irritation within the joint) with movement
•     Pain when pressure is applied to the joint

X-rays

X-rays are tests with the use of images that create detailed figures of dense structures such as bone. They can help distinguish between various forms of arthritis.

The X-rays of an arthritic shoulder will show a narrowing in the joint space, changes in the bone and the formation of bone spurs (osteophytes).
Estos rayos X muestran osteoartritis severa de la articulación glenohumeral.
These X-rays show severe osteoarthritis of the glenohumeral joint.
Reproduced with the permission of Crosby LA (ed): Total Shoulder Arthoplasty. Rosemont, IL, American Academy of Orthopedic Surgeons, 2000, p. 18.

To confirm the diagnosis, your doctor may inject a local anesthetic into the joint. If it temporarily relieves pain, it supports the diagnosis of arthritis.

Treatment
Non-surgical treatment

As with other arthritic conditions, the initial treatment of arthritis of the shoulder is non-surgical. Your doctor may recommend the following treatment options:

•     Rest or a change in activities to avoid causing pain. You may need to change the way your arm moves to do things.
•     Physical therapy exercises that could improve the range of motion in your shoulder.
•     Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may reduce inflammation and pain. These medications can irritate the lining of the stomach and cause internal bleeding. They should be taken with food. Consult your doctor before taking over-the-counter NSAIDs if you have a history of ulcers or are taking blood-thinning medications.
•     Injections of corticosteroids in the shoulder can drastically reduce inflammation and pain. However, the effect is often temporary.
•     Humid heat.
•     Application of ice on the shoulder for 20 to 30 minutes two or three times a day to reduce inflammation and relieve pain.
•     If you have rheumatoid arthritis, your doctor may prescribe a medication that modifies the disease, such as methotrexate.
•     Dietary supplements, such as glucosamine and chondroitin sulfate can help relieve pain. (Note: there is little scientific evidence to support the use of glucosamine and chondroitin sulfate to treat arthritis, and the Food and Drug Administration does not control dietary supplements, which could cause negative interactions with other medications. to your doctor before taking dietary supplements).

Surgical treatment

Your doctor may consider surgery if the pain causes you disability and you have no relief with the non-surgical options.

Arthroscopy Cases of mild glenohumeral arthritis could be treated with arthroscopy. During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera obtains images that are displayed on a television screen and the surgeon uses these images to guide miniature-sized surgical instruments.

Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts) instead of the larger incision needed for standard open surgery.

During the procedure, your surgeon can debride (clean) the inside of the joint. Although the procedure relieves pain, it will not eliminate arthritis from the joint. If arthritis progresses, another surgery may be needed in the future.

Replacement of the shoulder joint (arthroplasty). Advanced arthritis of the glenohumeral joint can be treated with shoulder replacement surgery, in which the damaged parts of the shoulder are removed and replaced with artificial components, called prostheses.

( Left ) A conventional total shoulder replacement ( arthroplasty ) mimics the normal anatomy of the shoulder. ( Right ) In a total inverse shoulder replacement, the plastic capsule is inserted into the humerus and the screws of the hemispherical metal component into the shoulder cavity

Surgical replacement options include:

•     Hemiarthroplasty. Only the head of the humerus is replaced with an artificial component.
•     Total shoulder arthroplasty. The head of the humerus and the glenoid cavity are replaced. A plastic cavity ("cup") fits into the glenoid cavity and a metal hemisphere attaches to the upper part of the humerus.
•     Total reverse arthroplasty of the shoulder. In a total inverse shoulder replacement, the cavity and the metal hemisphere are opposite to a conventional total shoulder arthroplasty. The metal hemisphere is fixed to the glenoid cavity, and the plastic cavity (cup) is attached to the upper end of the humerus. A total reverse shoulder replacement works best for people with arthropathy due to a tear in the cuff because it is supported by different muscles - not the rotator cuff - to move the arm.

Resection arthroplasty. The most common surgical procedure used to treat arthritis of the acromioclavicular joint is a resection arthroplasty. Your surgeon may choose to perform this surgery arthroscopically.

In this procedure, a small amount of bone is removed from the end of the clavicle, leaving a space that gradually fills with scar tissue.

Recovery. The surgical treatment of shoulder arthritis is usually very effective in reducing pain and restoring movement. Recovery time and rehabilitation plans depend on the type of surgery performed

Complications As with all surgeries, there are some risks and possible complications. Potential problems after shoulder surgery include infection, excessive bleeding, blood clots, and damage to blood vessels or nerves.

Your surgeon will discuss possible complications with you before your operation.

Future developments

Research is being done on arthritis of the shoulder and its treatment.

•     In many cases, it is not known why some people develop arthritis and others do not. Research is being done to discover the causes of shoulder arthritis.
•     Joint lubricants, which are currently being used for the treatment of knee arthritis, are also being studied in the shoulder.
•     New drugs are being investigated to treat rheumatoid arthritis.
•     Much research is being done on shoulder joint replacement surgery, including the development of different prosthetic designs for joints.
•     The use of biological materials for the resurfacing of an arthritic shoulder is also being studied. Biological materials are tissue grafts that promote the growth of new tissues in the body and stimulate healing.

Source: Department of Research & Scientific Affairs, American Academy of Orthopedic Surgeons. Rosemont, IL: AAOS; January 2013. Based on data from the National Health Interview Survey, 2008-2011; US Department of Health and Human Services, Centers for Disease Control and Prevention; National Center for Medical Statistics.

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Medications, injections and supplements for arthritis

The pain, swelling and stiffness of arthritis can limit your movement. Medications can help you manage your symptoms so you can continue to lead an active life. Talk to your health care provider about medications that are right for you.



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Over-the-counter pain killers
Over-the-counter pain relievers can help with your arthritis symptoms. "Over-the-counter" means that you can buy these medications without a prescription.

Most doctors recommend paracetamol (such as Tylenol) first. It has fewer side effects than other drugs. DO NOT take more than 3 grams (3,000 mg) per day. If you have liver problems, talk to your doctor first about how much paracetamol is right for you.

If the pain continues, the doctor may suggest non-steroidal anti-inflammatory drugs (NSAIDs). Types of NSAIDs include aspirin, ibuprofen, and naproxen.

Taking paracetamol or another analgesic before exercise is OK. But DO NOT exercise excessively because you have taken the medication.

Both NSAIDs and acetaminophen in high doses, or taken for a long time, can cause serious side effects. If you are taking painkillers on most days, tell your provider. You may need to be monitored for side effects. Your provider can monitor you with certain blood tests.

Capsaicin (Zostrix) is a skin cream that can help relieve pain. You may experience a feeling of warmth and itching when you apply the cream for the first time. This sensation disappears after a few days of use. Pain relief usually begins in 1 to 2 weeks.

NSAIDs that come in the form of a skin cream are available over the counter or with a prescription. Ask your provider if these may be appropriate for you.


Steroid injections for arthritis
Medications called corticosteroids can be injected into the joint to help with swelling and pain. The relief can last several months. More than 2 or 3 injections a year can be harmful. These injections are usually applied in the doctor's office.

When the pain seems to disappear after these injections, it may be tempting to return to activities that may have caused pain. When you receive these injections, ask the doctor or physiotherapist for exercises and stretches that decrease the likelihood that the pain will return.

Other injections for arthritis of the knee
Hyaluronic acid is a substance already present in the fluid of the knee. It helps to lubricate the joint. When you have arthritis, the hyaluronic acid in your joint becomes thinner and less effective.

The doctor can inject a form of hyaluronic acid into your joint to help lubricate and protect it. This is sometimes called artificial joint fluid or viscosupplementation.

These injections can not work for all people. When they are effective, relief can last from 3 to 6 months. The use of hyaluronic acid is approved only for knee arthritis.

Supplements
The body produces glucosamine and chondroitin sulfate naturally. They are important to have healthy cartilage in your joints. Both substances come in the form of a supplement and can be purchased without a prescription.

Glucosamine and chondroitin sulfate supplements can help control pain; however, they do not seem to help the joint develop new cartilage or prevent arthritis from getting worse. Some doctors recommend a 3-month trial period to see if glucosamine and chondroitin help.

The s-adenosilmethionine (SAMe for its acronym in English and pronounced as "Sammy") is an artificial form of a natural chemical in the body. The claims that s-adenosylmethionine can help arthritis are not well proven.

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Scientifically proven remedies to relieve arthritis pain

1. Sips of ginger tea

Numerous studies have found that ginger can mimic Non-Steroidal Anti-Inflammatory Drugs, first-line drugs for the relief of arthritis pain. They act practically the same as medicines, but without the side effects. Use ginger powder, fresh, raw or a little cooked in food. Make your own tea: place slices of ginger for 15 minutes in a couple of cups of boiling water, or buy tea bags at the supermarket.



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2. Eat foods that fight inflammation

Forget about fast food, scrap, fried foods or processed foods. A Swedish study of patients with rheumatoid arthritis found that those who changed their style of eating to a more Mediterranean concept (with more fresh fruits, vegetables, whole grains, fish, olive oil, nuts, garlic, onions and herbs) had less inflammation and regained some physical abilities and mobility .

3. Smell fragrant spices

Pleasant scents such as lavender can alter the perception of pain, as some studies reveal. Japanese researchers found that lavender reduces levels of the stress hormone (cortisol), which will make you feel relaxed and less aware of pain .

Korean researchers found that patients with arthritis experienced less pain and felt less depressed when exposed to a variety of spice flavors you can find in the kitchen, including marjoram, rosemary and mint.

For a soothing aromatherapy treatment, add a teaspoon of one of these dried herbs to a quarter cup of vegetable oil and occasionally inhale its fragrance several times.

4. Wash the dishes by hand

It sounds contradictory, but if you have pain in your hands, this simple task can relieve the pain of arthritis . First, submerging your hands in hot water can help relax muscles and joints and relieve stiffness at the same time. Second, exercise will help you keep your hands and fingers moving.

5. Make your own heat pad

Fill a cotton sock with any type of raw rice and seal it. Put it in the microwave at maximum power for about 2-3 minutes. When it cools a little, but it is still warm, place it in a rigid joint in which you have pain to relieve it. It should stay warm for about half an hour. You will love the way the rice molds your body and provides a soft heat . If you have lavender or other aromatic herbs on hand, put a few drops in the sock to get some relaxing aromatherapy.

6. Make your own capsaicin cream

This home remedy reduces the levels of a compound called substance P, which transmits pain signals to the brain. You can do a little mixing a bit of ground cayenne with 3 tablespoons of olive oil. Apply gauze on clean skin to painful joints several times a day. The first dose will cause a mild burning sensation, but you will get used to it after about a week . Just keep it away from the mouth, eyes and other mucous membranes.

7. Apply a patch of chamomile tea

Chamomile tea is an anti-inflammatory that can help relieve arthritis pain . Prepare a strong infusion with four bags of chamomile tea in a cup (or less) of hot water. Let it stand, covered, for 20 minutes, then squeeze and extract the tea bags. Soak a clean cloth in the liquid and apply it to the sore joint.

8. Give a cold-heat treatment to your joints

You need two containers. Fill one with cold water and ice cubes and the other with hot water at a temperature that you can tolerate to the touch. Submerge the joint with pain in the cold water, for a minute, then change to the hot water container and submerge for 30 seconds. Then change the affected joint from cold to warm for about 15 minutes, leaving it in each for about 30 seconds. When finished, leave it submerged in cold water for one minute.

9. Go swimming

Swimming has been recommended for a long time as a good exercise for people with arthritis; the weightlessness of water reduces the impact on the joints . One study found that Taiwanese who rehabilitate themselves in the water significantly improve flexibility in the knees and hips, as well as strength and aerobic capacity.

Another Australian study found that such programs also resulted in decreased pain and better joint function in general. Ask your health center, hospital, or local pool if there are classes designed specifically for people with arthritis.
swim

10. Take 4 cups of green tea a day

Researchers from Case Western Reserve University supplied a group of mice with the equivalent of four cups of green tea a day. They then gave the mice a substance that would normally produce rheumatoid arthritis. Mice that drank green tea were much less likely to develop arthritis than mice that drank only water. Other research found that the antioxidant polyphenols in green tea are anti-inflammatory, improve the immune response related to arthritis and significantly reduce cartilage damage.

11. Add turmeric to your food

It contains a powerful compound called curcumin, which inhibits enzymes and proteins that promote inflammation. Several studies have found that it reduces pain and inflammation in patients with arthritis . In a study of people with osteoarthritis of the knee, those who ate only 2 grams a day (less than a teaspoon) had pain relief and increased mobility equal to those who took 800 milligrams of ibuprofen.

Sprinkle ½ teaspoon of turmeric in your rice or vegetables daily. Another option is to bring some mustard packs in your pocket to add them to your food; they are the perfect dose.

12. Make sure you get enough vitamin C

Vitamin C not only helps produce collagen, a major component of the joints, it also spreads through the body avoiding the damage of destructive free radicals, which are harmful to the joints. One of the most well-known studies looking at the relationship between vitamin C and arthritis, found that people whose diets usually included large amounts of vitamin C, significantly decreased the risk that their arthritis progressed .

Extend consumption throughout the day, because your body does not store vitamin C; Rather, it takes what it needs from the blood at a given moment and eliminates the rest. So a mega-dose in the morning, actually does not do as much good as you might think . It is advisable to enjoy citrus drinks or eat fruits and vegetables rich in vitamin C, such as strawberries or melon, broccoli or sweet peppers throughout the day.

13. Add cloves to your diet

The cloves contain eugenol, a popular anti-inflammatory chemical that interferes with the body process that causes arthritis . A study done with animals, showed that it prevents the release of COX-2, a protein that stimulates inflammation (the same protein in which inhibitory drugs such as Celebrex).

Cloves also contain antioxidants, which are important in delaying cartilage and bone damage caused by arthritis. It is advisable to consume ½ to 1 teaspoon a day .

14. Recharge yourself from omega-3

It is excellent for relieving inflammation and joints. Some fish such as salmon and tuna are some of the best sources of this fatty acid. However, your body may need more omega-3 than you get from consuming only fish, so talk to your doctor about prescribing an omega-3 supplement. And when cooking, always prefer canola oil before corn . Canola contains omega-3, while corn oil contains omega-6, which can actually make the inflammation and pain of arthritis worse.

15. Eat less allergenic foods

Food allergies can play an important role in autoimmune diseases such as rheumatoid arthritis. Researchers at the University of Oslo in Norway found that people with autoimmune diseases had higher levels of antibodies to cow's milk, eggs, cod and pork compared to people who did not have the disease.

In one study, people with rheumatoid arthritis followed a diet where they eliminated the common foods associated with allergies, such as grains (especially products containing wheat gluten), nuts, milk and eggs, after a lapse of 10 to 18 days had a significant improvement in symptoms. When they started eating these foods again, they felt worse. Other studies have found that corn, wheat, oranges, oats, rye, eggs, beef, and coffee can also be problematic foods, because many of these foods help produce arachidonic acid, a chemical in our body linked to inflammation.

16. Make yourself a paste of ginger

Applying crushed ginger to a joint with pain can deplete the body's stores of substance P , a brain chemical that carries pain signals to the central nervous system. A study of 56 people found that ginger relieved the symptoms of people with osteoarthritis by 55% and 74% in people with rheumatoid arthritis .

To make a paste, peel and finely chop a medium piece of fresh ginger. Mix with enough olive oil to form a paste, then apply it to the aching joint. Depending on where the pain is, you may have to wrap the joint with the plaster, using gauze or bandage. Leave on for 10 to 15 minutes.

17. Increase the volume

Listening to your favorite music can relieve pain (usually because it raises hormone levels that reduce your sensitivity to pain). In a Cleveland Clinic Foundation study of people with persistent pain in the back, neck or joints, one group was assigned a playlist of soothing melodies, while a second group chose their own soundtrack, and a third was not prescribed with any music. The two groups that listened to music had lower rates of arthritis pain, depression and disability compared to the group without music, which experienced an increase in pain. The study also indicated that the type of music you listen to does not matter, as long as you like it . People who chose their own melodies experienced greater reduction in pain, depression and disability than those who listened to generic relaxing music.

18. Goodbye to shoes

Walking naturally reduces the load on the knee joints, which minimizes the pain and disability caused by osteoarthritis by 12% compared to when walking with shoes on, according to a study by Rush University Medical Center. to 75 people with osteoarthritis. When you have to wear shoes, look for those who intend to imitate the natural contour of the heel and arch and avoid the heels, because they only generate more pressure on the joints. Orthopedic shoes can also be another good option.

19. Opt for spicy food

Spices such as cayenne pepper, ginger and turmeric contain compounds that reduce inflammation and block brain chemicals that transmit pain signals . Eat some Mexican, Indian and Thai recipes (or always keep a bottle of hot sauce on the table!)

20. Increase your calcium intake

Taking too little calcium increases the risk of osteoporosis, a disease in which the bones become brittle, and which accelerates if you have rheumatoid arthritis. All women should consume about 1,200 milligrams of calcium per day after 50 years of age. Dairy is the most famous source of calcium, but cooked milk-based foods can be a very good source as well (a large cookie can contain up to 12% of the recommended daily intake of calcium). Calcium is also found in vegetables such as cauliflower, cabbage, Brussels sprouts, kale, broccoli and turnip. These foods have less calcium than dairy products, but they contain it in a way that the body can absorb it much more easily.

21. Sunbathe

Many people with arthritis have a deficiency of vitamin D, which plays an important role in the production of collagen in the joints. Studies have found that generating more vitamin D can protect the joints from the damage of osteoarthritis. To increase your vitamin D levels, just take the sun for 10 to 15 minutes, two or three times a week. That's all your body needs to raise the vitamin D it needs. Dairy products are also a great source of this vitamin.

22. Get a massage with spices from your pantry

Add a little pepper, rosemary or thyme to ½ cup of olive or vegetable oil and use it for a relaxing massage. It will be very healing, since all these herbs have soothing properties.

23. Take these supplements into account

Ask your doctor if any of these supplements may be right for you.

Ginger extract twice a day . Researchers from the University of Miami found that ginger significantly reduced knee pain in patients with osteoarthritis , and that it contributed significantly to improving mobility since ginger has anti-inflammatory effects, which work in the body such as ibuprofen.

Fish oil capsules. A British study found that 86% of people with arthritis who took cod liver oil had far fewer harmful cartilage enzymes, compared to those who only received a placebo. In addition to that, there was also a decrease in the enzymes that cause pain . Cod liver oil is an oil of natural origin, so its use as a supplement does very well.

Vitamin E with pure alpha-tocopherols. A German study found that taking 1,500 IU of vitamin E daily, significantly reduces stiffness and pain and improves grip strength in people with rheumatoid arthritis, as do some prescription medications.

Glucosamine / chondroitin . This combination of supplements can provide long-term pain relief and delay cartilage degeneration . (Tends to help some patients and others do not, if it works for you, you should experience relief within two to three months, but if you do not see a benefit by then, it's probably not going to work for you.). It has also been found that glucosamine and chondroitin, can actually repair damaged cartilage.

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Glucosamine in the treatment of osteoarthritis

Arthrosis is a degenerative disease of the articular cartilage that affects almost 50% of those over 65 years of age 1 . Of the total affected, approximately 20% will develop symptoms such as joint stiffness, pain and functional impotence. This disease is responsible for 30% of visits to the general practitioner in older adults and the second cause of disability in the elderly after cardiovascular disease. It also represents an important cause of work absenteeism.



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The key site of the damage is the articular cartilage, where a progressive degeneration associated with a chronic inflammation that causes stiffness and pain occurs. The cause of joint deterioration is not known but certain predisposing factors such as advanced age and obesity have been identified.

The classic treatment has been aimed at improving symptoms, generally using anti-inflammatory drugs such as NSAIDs and other important measures: weight control, exercise, kinesiotherapy and local treatments with capsaicin and infiltrations with corticosteroids. These measures are effective in controlling pain in the medium term but chronic therapy with NSAIDs can cause gastrointestinal and renal adverse effects that limit their use.

In recent years, drugs have appeared that act at the level of cartilage, interacting with components such as proteoglycans and interfering with the oxidative mechanisms dependent on free radicals, which are thought to be related to the state of inflammation and chronic degeneration. Among them is Glucosamine Sulfate, a compound derived from glucosamine which is a normal component of cartilage and joint fluid. This drug is postulated as a disease modifier, since it interferes with the aforementioned degenerative mechanisms and could alter the long-term prognosis in addition to alleviating the symptoms.

The evidence on this compound has been increasing, and there are currently three published systematic reviews and a three-year follow-up clinical trial that provide data in favor of the efficacy of 1500 mg daily of this drug. These four works are summarized in the following table.

• RCT = Controlled and randomized clinical trial ; NS = Not significant; IC = Confidence interval; RA = Absolute risk; RR = Relative risk; RRA = Absolute risk reduction; NNT = Number needed to treat
• 1 Evaluated by validated scales; 2 The results were reported in this paper as a difference in effectiveness between interventions.
• 0 = no difference 0.5 = mild efficacy 1 = moderate efficiency 1.5 = important efficacy
• 3 Effectiveness is reported as effect size
• 0 = effect equal to placebo 0.2 = mild effect 0.5 = moderate effect 0.8 = important effect

Both meta-analyzes found methodological difficulties in the studies that evaluated chondroitin, so it is difficult to interpret the results related to this drug (they are not included in the table)

4 It was used as a measure of joint structural change. The cutoff point for a significant reduction was 0.3 mm.

In the three meta-analyzes 2-3-4 , similar results were obtained regarding the efficacy of glucosamine; it was mild or at best moderately better than Aines or placebo to control pain, joint stiffness and improve overall function. It is convenient to consider, however, that rescue studies were allowed in most studies, so the efficacy to reduce pain and improve joint function is difficult to evaluate. It should also be noted that the studies that evaluated chondroitin (another compound frequently used and that comes from the articular cartilage) included few patients and in the majority significant methodological flaws were detected that prevent valid conclusions.

In 2001, a clinical trial was published in the Lancet 5 that evaluated 212 patients over 50 years of age with osteoarthritis of the knee randomized to receive glucosamine sulphate versus placebo, with three years of follow-up. This study is important because until then there was only data from a few weeks of follow-up. The primary end point was the average width of the joint space in the medial compartment of the knee, which they used as a measure of structural change in the joint. The limit of 0.3 mm was taken as a limit of significant reduction of the joint space. Another final point was the change in scales of pain, rigidity and functional limitation, items evaluated at the beginning of the study, the year and the three years.

At the end of the study, the average decrease in joint space of the glucosamine group was not significant, while those assigned to placebo showed an average decrease at three years of 0.31 mm (CI -0.48 to -0.13). .

Treating 1500 mg of glucosamine daily for three years resulted in an absolute risk reduction of joint space narrowing of 16% and it would be necessary to treat 6 patients for three years to prevent a significant decrease in joint space (NNT). 6).

The patients assigned to glucosamine had a mild to moderate improvement in the symptoms at three years and those who received placebo did not present changes in relation to the basal scales. There were no differences in the stiffness scales and the two groups consumed the same amount of rescue Aines. There were also no differences in relation to the adverse effects and these were mild and not clearly related to the treatment. The authors concluded that long-term glucosamine treatment can prevent structural changes related to osteoarthritis of the knee and significantly improve symptoms.

The most recent meta-analysis 4 was published in July of this year and included 15 studies that evaluated the efficacy in controlling symptoms and modifying the joint structure of both glucosamine and chondroitin. This review found that glucosamine treatment had a significant effect on the articular cartilage modifier compared to placebo, but not chondroitin. Also those treated with glucosamine improved the symptoms in relation to the placebo (see table).

According to the information provided by these four studies, glucosamine can be considered a valid and safe option for the symptomatic treatment of patients with osteoarthritis, and there would also be a modifying effect of the joint architecture, although there is still no clear the utility of this parameter in the evaluation of the effectiveness of the treatment. It is not possible to say the same about chondroitin; Studies with more patients are required, longer follow-up and better methodological quality to draw conclusions about this drug.

While these studies show that glucosamine improved symptom scores, the changes were at best moderate and it is not clear yet what the actual clinical translation of this difference is.

In addition, we must bear in mind that glucosamine treatment is more expensive than using some NSAIDs; the approximate monthly cost of a treatment with 1500 mg daily of glucosamine is $ 57, four times more expensive than paracetamol and almost twice as much as ibuprofen at adequate doses. Another point to consider is that glucosamine takes a little more than a month to start acting, so it is not recommended as rescue medication, and the actual amount of glucosamine that exists in commercial preparations is not completely clear. that it comes in the form of salt and there is a lot of variability between the different preparations.

For these reasons, the US NIH study that is already in the patient recruitment phase will be very welcome; this work will compare glucosamine sulphate with placebo and other long-term Aines and hopefully clarify these unresolved points.

As a practical conclusion, we have good quality evidence to indicate 1500 mg daily of glucosamine to a patient who has contraindicated Aines or in whom these drugs have not been effective, although the role of glucosamine as the first line of Treatment is not yet clear, especially due to the lack of long-term efficacy and safety studies and their high cost.

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Alternative treatments for arthritis: What works and what does not

According to the latest estimates , more than 91 million adults in the United States may suffer from arthritis, mainly osteoarthritis, which can cause pain and damage the joints. If you are one of them, you may have considered alternative treatments for arthritis.



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According to the Centers for Disease Control and Prevention (CDC) almost 40% of those suffering from arthritis have tried an alternative or complementary therapy such as acupuncture or yoga.

"When conventional medicine fails to relieve pain, many seek alternative methods," says Marvin M. Lipman, MD, chief medical consultant for Consumer Reports. "But not only is there very little evidence to support many of these treatments, some are not even regulated."

Do any of them work? "These really do not cause a radical change," says Richard Panush, MD, a professor at the Keck School of Medicine at the University of Southern California. "For some people, at best, these alternatives may have a slight effect under certain circumstances."

Below you will find what the investigations showed.

4 Alternative treatments for arthritis that can help you

Massage. A review of studies published in the Mayo Clinic Proceedings journal indicates that massage therapy can help relieve the pain and stiffness of knee osteoarthritis. In one study, the researchers recommended a 60-minute session per week with an accredited massage therapist. (Find one in American Massage Therapy Association ).

Tai Chi. A review of 215 out of 54 studies indicated that this Chinese exercise , which is slow and with rhythmic movements, slightly decreases the pain caused by arthritis. But, it was less effective than aerobic and strength exercise (For more information visit the American Tai Chi and Qigong Association ).

Yoga. A review of 17 studies published in the Musculoskeletal Care journal indicated that yoga decreases the pain of osteoarthritis. But our experts recommend avoiding Bikram (hot yoga) if you have joint problems. The heat can make you feel that you can stretch more than you should, which could cause damage later in the joints.

Acupuncture. Research suggests that for some people, this traditional Chinese therapy that involves inserting fine needles into certain points of the body, decreases the discomfort of osteoarthritis . One theory is that it can trigger the release of hormones called endorphins that inhibit pain. Or it can simply cause a placebo effect, making you feel better without any medical reason. If testing, be sure to be treated by an accredited professional. (Find one in the National Certification Commission for Acupuncture and Oriental Medicine ).

3 therapies you should avoid

Chiropractic manipulation. Some research suggests that the "realignment" of the spine by a chiropractor can improve some neck and back pain . But, in a 2012 review published in the journal Rheumatology we found no evidence that the therapy effectively decreases the pain of osteoarthritis.

Dietary supplements. Some people take supplements such as glucosamine and chondroitin (often together) or fish oil for joint pain. So far, studies have shown that glucosamine and chondroitin are not more effective than a placebo. Some research suggests that high doses of fish oil can help improve the joint pain of rheumatoid arthritis, an autoimmune condition. But the effects on osteoarthritis are not very clear. In addition, fish oil supplements can cause side effects, such as diarrhea and stomach pain. And dietary supplements are not well regulated by the Food and Drug Administration (FDA), so you can not be sure if what you take is what the label says. (See our report " Supplements can make you sick ").

Homeopathy. The underlying principle of homeopathy is that certain very dilute substances can cure diseases. For example, rhus toxicodendron, made from poison ivy, is marketed as a treatment against osteoarthritis. But Lipman says there is no evidence to support the use of homeopathic remedies for arthritis or any other condition.

3 Smart strategies

Before taking any alternative treatment for arthritis, Lipman recommends that you try to combat the known factors that contribute to the pain and aches of the musculoskeletal system.

Lose weight if you need it. Excess weight adds pressure on the ankles, hips and knees, which increases the intensity and pain of arthritis.

Do the right kind of exercise. The activities that strengthen the muscles and improve your range of movement and stimulate your cardiovascular activity can help you. In addition to taichi and possibly yoga, consider walking regularly or a swimming program. To learn more about the exercises that help with arthritis, click here .

Check with your doctor. If you decide to try an alternative therapy, tell your doctor before you start. You can refer to a reliable professional. Your doctor can also tell you about the potential dangers or if the therapy can interact with your usual medications.