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Understanding Arthritis
DEGENERATIVE JOINT DISEASE
(also known as OSTEOARTHRITIS)
Degenerative joint disease is characterized by loss of joint cartilage and by hypertrophy of bone. Surveys have estimated that over 55 million Americans have x-ray changes but only 15% of them have pain or symptoms. The exact mechanisms for cartilage loss in Degenerative Arthritis have not been defined.
ETIOLOGY
(how it develops)
The joint cartilage or capping cartilage that covers the bone inside the joint normally dissipates the forces across the joint. The cartilage has properties of compressibility and elasticity due to the structures of collagen and proteoglycans. In arthritis the size and amount of proteoglycans is reduced and the collagen does not work properly. All new treatments are directed at improving the structure of proteoglycans and collegen. This is why Glucosamine Sulphate is effective because it is a building block for proteoglycans.
LIST OF CURRENT TREATMENT OPTIONS AND FUTURE OPTIONS
- ACETAMENOPHEN (tylenol) has been recommended as the first-line agent for treatment of DJD since 1995.
- NSAID (non-steroidal anti-inflammatory drugs) These drugs are the most commonly prescribed medications for arthritis.
A new class of NSAID, COX-2 selective inhibitors, has recently become available for prescription. COX-2 inhibitors appear to be very effective in the treatment of Degenerative Joint Disease. They have a lower toxicity than traditional NSAIDs will a much lower incidence of stomach ulcers. The two named COX-2 inhibitors are CELEBREX and VIOXX.
- WEIGHT LOSS Perhaps the most effective treatment for DJD is weight loss. This has significant benefit for the joint. Since each single pound of weight adds 2.5 pounds of force across the knee joint, you can see how a simple 20 lb. weight loss reduces significantly the knee joint force. This applies to the hip, foot and ankle as well.
- GLUCOSAMINE There are numerous clinical trials that examine the efficacy of glucosamine in treating DJD. The most frequent use of glucosamine is as an oral dose of 1,500 mg of glucosamine sulphate daily. Glucosamine had a significantly better effect on pain relief than 20 mg of feldene per day.
- CHONDROITIN SULPHATE This is less well studied than Glucosamine. Studies at one year however, show that similar to glucosamine, chondroitin may be a disease modifying treatment for DJD. The most frequent doses of chondroitin studied was 800 mg per day.
- STEROID INJECTIONS These have been long known to be effective in treatment for DJD. The quickness by which they work suggest they also act as an acute anti-inflammatory agent, only stronger than orals. The problem is that they effect other organ systems and therefore have the greatest side effect potential.
- VISCOSUPPLEMENTS Hyluronic Acid is the major component of synovial fluid and functions in friction-free joint movement. These supplements act and look similar to Hyluronic Acid and provide a known lubricating function. The exact mechanism of action is still unclear at this time.
SYNVISC and HYALGAN are the names of the two types of current injectable viscosupplements. Both are injected into the knee three times total, once per week over three weeks.
- CAPSAICIN A substance derived from hot chili peppers, can be used to decrease symptoms from DJD by applying topically or directly to the skin. Capsaicin depletes substance P, a neurotransmitter involved in transmitting pain from the arms or legs to the spine. Studies have shown it is better than placebo at reducing symptoms of DJD. Capsaicin is safe and worth trying in knees and the small joint of hands and feet.
- VITAMINS Vitamin A,C, and E possess antioxidation properties that may help in prevention of the breakdown of cartilage. Although there are numerous studies postulating the role of vitamins in influencing arthritis, none have been conclusive in their results to recommend this as a main form of treatment.
- MAGNETS Many testimonies from patients provide major benefit from magnets. Scientific studies have not been completed to date that isolate a pure group of arthritis patients using magnets. This may prove effective, however, due to the magnetic properties found
Organization of Knee Treatment Modalities for patients with DJD
NEW AGENTS CURRENTLY UNDER INVESTIGATION
- MMP INHIBITORS MMPs have been found in synovial fluid to breakdown collagen and other proteins within the joint. MMP3 was found to be significantly higher in arthritis patients that other normal patients. Bayer Corp. has investigated BAY 12-9566 and shown in animal models to reduce cartilage loss by 50% compared with controls.
Currently tetracycline has been used with arthritis because it inhibits MMP.
- NITROUS OXIDE Nitrous Oxide inhibits collagen and proteoglycan synthesis. Nitrous oxide has been found to be increased in joints of patients with DJD. Cyclosporins and tetracycline are capable of inhibiting nitrous oxide and have been shown to protect the joint cartilage cells.
MORE WORK WITH THESE AGENTS IS NEEDED PRIOR TO GENERAL PUBLIC RELEASE.
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