Introduction
Osteoarthritis (OA) is a chronic degenerative disorder of multifactorial aetiology characterized by loss of articular cartilage and periarticular bone remodelling. OA causes joint pain, typically worse with weight-bearing and activity as well as can manifest with stiffness after inactivity. It can present as localized, generalized or as erosive osteoarthritis. Primary osteoarthritis is mostly related to aging, whereas, secondary osteoarthritis is caused by another disease or condition. X-rays, arthrocentesis and arthroscopy remain the main diagnostic tools. Blood tests are performed to exclude diseases that can cause secondary osteoarthritis. The treatment of osteoarthritis includes non-pharmacological management, pharmacological treatment in the form of drugs which can modify symptoms, symptomatic slow acting drugs for OA or structure modifying OA drugs depending upon the clinical requirement of the patient. Patients with persistent pain and progressive limitation of daily activities despite medical management may be the candidates for surgery.
Signs & symptoms
Pain in the joints affected, during or after movement.
Stiffness of Joints especially upon awakening or after being inactive.
Tenderness of affected joints
Loss of flexibility
Sensation of grating or rubbing of bones in joints
Bone spurs
Swelling of the joint
Causes
Degenerative conditions of bone, cartilage and muscular structures due to oss or waer & tear of healthy tissues. Risk factors include:
- Old age
- Gender – women are more prone to OA due to hormonal reasons
- Obesity
- Joint injury
- Joint abnormalities
- Genetic factors
- Other types of joint disease
Pathophysiology
The pathogenesis of OA involves a degradation of cartilage and remodelling of bone due to an active response of chondrocytes in the articular cartilage and the inflammatory cells in the surrounding tissues.
As a chronic & slowly developing disease, it is hard to diagnose. There are no confirmatory blood tests for OA but tests are done to rule out other joint diseases like rheumatoid arthritis
Case taking to confirm any history of trauma
Physical examination to locate the site of tenderness etc.
X ray
USG
MRI
Blood tests to rule out inflammatory diseases or medical conditions like gout
Needle aspiration
Treatments
Treatment of OA is mainly focused on symptomatic approach. Diet and lifestyle modifications show significant result in OA cases.
- Medications
Analgesics
NSAID’s
Anti-inflammatory
Steroids in severe and autoimmune conditions
- Physical therapy
Sometimes physical therapy sessions to strengthen the muscles around the joint will make it more stable and ensure the best mechanical movements. Working with a physical therapist can help avoid injuries or further worsening of the condition.
- Injections
Injecting medications directly into the joint might help in certain situations where not many joints are involved. The two most common injections are corticosteroids and lubricants. Corticosteroid injections can help arthritis and other inflammations of the joints, mainly weight-bearing ones. They usually need to be repeated every few months. Lubricants that are similar to the synovial fluid.
- Surgery
Arthroscopic joint surgery:
It allows the surgeon look inside the joint through a few small holes and an optic fibre camera. The surgeon can repair many of the injuries and remove small pieces of loose bones or cartilage. This is a common outpatient procedure.
Partial joint replacement:
The surgeon replaces the damaged portions of the joint with artificial parts. Only part of the joint is replaced in this procedure.
Total joint replacement:
In this procedure, the knee is replaced with an artificial joint.
Prognosis
The prognosis of patients with osteoarthritis depends on which joints are affected and whether or not they are causing symptoms and impaired function. Some patients are unaffected by osteoarthritis while others can be severely disabled. Joint replacement surgery for some results in the best long-term outcome.
Complications
- Rapid, complete breakdown of cartilage resulting in loose tissue material in the joint (chondrolysis).
- Bone death (osteonecrosis).
- Stress fractures (hairline crack in the bone that develops gradually in response to repeated injury or stress).
- Bleeding inside the joint.
Disease & Ayurveda
Sandhigatavaata
Nidana
Dhaatukshaya(degeneration)
Aavarana(obstruction to channels in the body)
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors Vaata gets vitiated and gets lodged in the joints causing pain and swelling.
Lakshana
Vaatapoornadrutisparsam – Feel of an air-filled bag on touch
Sopham – Swelling
Prasaaranaakunchanayo: savedanaam pravrthim- Painful movements of joints like flexion and extension
Divisions
Not mentioned
Prognosis
Yaapya.
It is saadhya/krichrasadhya if it is new and involves only singe joint.
Chikithsa
Samana
Lepana with soolaharadravyas
Parisheka with soolaha-sothahara dravyas
Upanaha with Vaataharadravyas
Sodhana
Sneha (Anhyanga)
Sweda (Potalisweda)
Vasti
Virechana
Raktamokshana
Commonly used medicines
Maharasnadi kashayam
Amruthotharam kashayam
Dhanwantharam Kashayam
Vidaryadi Kashayam
Amruthaguggulu
Kaisoraguggulu
Guggulutiktakaghrutam
Sahacharadi Tailam
Dhanwanatharm Tailam
Ksheerbala Tailam
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Over-the-counter pain medications can frequently alleviate the pain.
The RICE mnemonic is often helpful, especially when the pain is because of minor injuries:
Rest: Rest the joint, and take a break from your usually activities involving the affected joint.
Ice: Applying ice can help with pain and inflammation.
Compress: A compression bandage can help prevent swelling and help alignment. It should not be tight and should be removed at night.
Elevate: Elevation can help with swelling and resting of the joint.
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha and cause obstruction in channels
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid climbing of stairs.
Yoga
Vigorous exercises are not allowed in painful conditions.
Only stretching, moderate walking, and mild cardio exercises are advised. Also, specific yogacharya including bhujangaasana, salabhasana, vajrasana is recommended. Caution must be there to consider the range of movement and flexibility.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Sookshma vyayama for whole body
Yoga for joint pain and arthritis
Salabhasana
vajrasana
Bhujangasana
exercises for leg pain
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://pubmed.ncbi.nlm.nih.gov/16190135/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com
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