Scientific basis for osteoarthritis treatment information
Exercise Therapy for Osteoarthritis of the Hand
Osteoarthritis of the hand can cause stiffness, pain, problems in daily life and many other problems. This article introduces the evidence for exercise therapy, which is practiced in a wide variety of ways.
Studies
Seven studies are included in the review.
Most of the studies were free of selection or reporting bias, but one study was available only as a meeting summary. Blinding of participants to treatment allocation was not possible, and most studies reported blinded outcome assessors, although some outcomes (pain, function, stiffness, and quality of life) were self-reported.
Results may be vulnerable to performance and detection bias due to unblinded participants and self-reported outcomes. Low quality evidence from five trials (381 participants) showed that exercise reduced hand pain after the intervention.
Conclusion.
When pooling the results of the five studies, we found low-quality evidence of a small beneficial effect of exercise on hand pain, function, and stiffness of finger joints. The estimated effect sizes are small, and it may be debated whether they represent clinically important changes; one study reported quality of life, and the effect is unknown; three studies reported adverse events, but these were very few and not serious; and one study reported a decrease in hand pain, but the effect was not statistically significant.
ØsteråsN, Kjeken I, Smedslund G, Moe RH, Slatkowsky-Christensen B, Uhlig T, Hagen KB. Exercise in hand osteoarthritis. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. no.: CD010388. doi: 10.1002 / 14651858.CD010388.pub2.
The association between knee deformity symptoms and depression
Osteoarthritis is a condition in which the shape of the knee bone changes due to a number of factors, and when the knee bone collides with other bones during movement or when there is excessive weight, inflammation may occur, or inflammation may occur in the cartilage tissue of the knee.
It is more common in older women, and many of them are now actively treated to improve their symptoms. To alleviate those symptoms, there is an injection of hyaluronic acid into the knee joint.
This method can be expected to alleviate pain and increase the viscosity of synovial fluid, which is expected to improve knee function, making it a frequently used treatment method. This is the method of choice, but is it related to depression? That seems to be the impression.
The paper studied was done at Wan Fang Hospital in Taiwan in 2016~2018. It was conducted on 108 people.
The patients were checked for knee function and screened for anxiety.
The effect of the injection was to reduce the pain to zero, and while most of the patients were at the level of disappearance, it lasted for two months.
It lasted for two months.
However, although there was no pain for two months, the anxiety did not subside, and after four months, the effects of the injections were mixed.
This suggests that there is a risk of depression with or without pain.
When the effect of the injections began to wear off, anxiety seemed to increase at once. The same is true for knee pain, and back pain, which tends to be the case for many people.
As with knee pain and lower back pain, which is often the case for many people, when the pain is gone to a certain extent, the anxiety of "when will it hurt again? When the pain is gone to a certain extent, we often hear that there is a non-zero sense of anxiety about when the next pain will occur.
For this reason, I feel that cognitive care is even more important in the treatment of symptoms with a risk of recurrence. The author of the paper also suggested the need for patient education before hyaluronic acid injections to avoid anxiety.
Complementary Medicine for Osteoarthritis
Osteoarthritis is one of those conditions where you think the pain has gone away, but it comes back again and again. In general, the incidence of osteoarthritis increases with age, but it is one of the most common arthritic conditions that can be caused by injuries or chronic arthritis, which can limit movement and cause pain.
The Cochrane Review investigated whether pain can be controlled by complementary medicine, a method other than medication.
The Cochrane Review has been studying this issue.
They reviewed experiments involving 5,980 subjects from 49 studies up to August 2013.
The products included were
Boswellia serrata
Avocado soybean unsaponifiables
These were the two products that were targeted.
0 Boswellia serrata
People who used 100 mg of Boswellia serrata extract were 90 percent more likely to have
Those who used 100 mg of Boswellia serrata extract had a 17 point reduction in pain at day 90 compared to placebo.
0 to 100 points within 0 and no pain
Those who used 100 mg of concentrated Boswellia serrata extract
Pain was rated at 23 points.
People who used the placebo formulation rated their pain at 40 points.
People who used 100 mg of enhanced Boswellia serrata extract rated their pain at 90 points compared to placebo. on a 100-point scale (8% absolute improvement) at 90 days, compared to placebo.
They rated their physical functioning 8 points better (2 to 14 points better) at 90 days compared to placebo. People who used 100 mg of concentrated Boswellia serrata extract rated their physical function as 25 points better.
Those who used a placebo rated their physical functioning as 33 points.
Avocado soybean unsaponifiables (ASU) product Piascledine®.
People who used 300 mg of ASU had an 8-point reduction in pain (1-16 points lower) on a 100-point scale (8% absolute improvement) at 3-12 months compared to placebo. People using 300 mg of ASU had a pain rating of 33 points.
Those who used placebo rated their pain at 41 points.
People using ASU 300 mg compared to placebo at 3 to 12 months
Rated physical function as 7 mm (2-12 mm improvement) on a 100 mm scale.
Those who used 300 mg of ASU rated their physical function at 40 mm.
Those who used placebo rated their physical function at 47 mm.
The quality of these evidences is of moderate quality that Boswellia serrata slightly improved pain and function. This is expected to change depending on the results of further research.
Avocado - Soybean unsaponifiables (ASU) probably improved pain and function slightly, but There is medium quality evidence that it may not preserve joint space.
This is also subject to evaluation depending on the results of additional studies as well. There are no reports of serious side effects from these results.
There is no data on X-rays to measure the space between the joints.
Cameron M, Chrubasik S. Oral herbal remedies for treating osteoarthritis. Cochrane Database of Systematic Reviews 2014, No. 5. Number: CD002947. doi: 10.1002 / 14651858.CD002947.pub2.
Herbal Remedies for the Treatment of Osteoarthritis
Even though we don't know the exact mechanism of action, it seems to be related to inflammatory mediators. I will introduce the evidence of herbal remedies that are often used.
Studies
49 randomized controlled trials (33 interventions, 5980 participants) were included.
The meta-analysis was
Boswellia serrata (monoherb)
Avocado-soybean unsaponifiables (ASU)
The meta-analysis was limited to the following products
Five studies of three different extracts from Boswellia serrata were included.
Moderate quality evidence from two studies (85 participants) showed that treatment with 100 mg of Boswellia serrata concentrate for 90 days improved symptoms compared to placebo.
With the Boswellia serrata-enriched placebo, the mean pain was 40 points on a 0-100 point VAS scale. (0 means no pain)
The average pain was reduced by 17 points.
Six studies investigated the ASU product Piasclidine®.
Moderate-quality evidence from four studies (651 participants) showed that ASU 300 mg produced small improvements in clinically suspicious symptoms and probably no increase in adverse events compared with placebo after 3 to 12 months of treatment. The mean pain for placebo was 40.5 points on the VAS 0-100 scale (0 being no pain). ASU 300 mg reduced pain by an average of 8.5 points (95% CI 1-16 points). All other herbal interventions were investigated in a single study and conclusions were limited.
No serious side effects associated with the plant products were reported.
Conclusion.
The evidence for the proprietary ASU product Piasclidine® in the treatment of osteoarthritis symptoms appears to be moderate for short-term use, but the studies for long-term and apparently active control are less convincing. extracts of Boswellia serrata There is moderate quality evidence of a trend toward benefits for several other medicinal plant products, including Boswellia serrata, which warrants further investigation in light of the fact that the risk of adverse events appears to be low. There is limited evidence that Piasclidine® significantly improves joint structure and prevents joint space narrowing. Structural changes have not been tested with other herbal interventions. Further research is needed to determine the optimal daily dose that will provide clinical benefit without adverse events.
Cameron M, Chrubasik S. Oral herbal therapy for treating osteoarthritis. Cochrane Database of Systematic Reviews 2014, Issue 5. art. No.: CD002947. doi: 10.1002 / 14651858.CD002947.pub2.
Chondroitin for Osteoarthritis
The source information comes from the Library of Congress
Here is what is being discussed from a different perspective.
I thought so, but...
Osteoarthritis → 6 months of oral intake seems to alleviate some of the symptoms. In addition, when combined with glucosamine, there is a possibility of preventing osteoarthritis. That's about it. There is also an ointment type, but the effectiveness of this type has not been confirmed.
There is no evidence that chondroitin is effective in the prevention of cataracts, although it is said that chondroitin solution can help protect the eyes during surgery.
0No rationale or under study
Dry eyes, muscle pain after exercise, interstitial cystitis, Kashinbeck's disease, heart attack, redness of the skin, osteoporosis, high blood pressure, hypercholesterolemia
Combinations with medications that you are taking
Warfarin is a well-known drug that slows down blood clotting, but it has been reported that it interferes with the action of warfarin and weakens its action when taken together with chondroitin.
Viscotherapy for knee osteoarthritis
This section presents evidence on visco-therapy and intra-articular supplementation.
Study details
Seventy-six trials with a median quality score of 3 (range 1-5) were identified.
The follow-up period varied from the date of the last injection to 18 months.
Forty trials included hyaluronic acid/hirane vs. placebo (saline or arthrocentesis), and Ten trials included comparisons of intra-articular (IA) corticosteroids, and
Six trials included comparisons of nonsteroidal anti-inflammatory drugs (NSAIDs), and Three trials included a comparison of physical therapy, and Two trials included exercise comparisons. Two trials included a comparison of arthroscopy, and Two trials included a comparison of conventional treatment, and 15 trials included a comparison of other hyaluronic acid/hylanes.
A pooled analysis of the effects of Visco supplements versus "placebo" controls generally supported the efficacy of this class of interventions.
Notably, at 5 to 13 weeks post-injection, the rate of improvement in pain from baseline ranged from 28 to 54%, and the rate of improvement in function ranged from 9 to 32%. In general, comparable efficacy was found for NSAIDs, and long-term benefits were observed compared to IA corticosteroids.
In general, few adverse events have been reported in the hyaluronic acid/hylan studies included in these analyses. Equivalent efficacy was observed for NSAIDs, and long-term benefit was observed compared to IA corticosteroids.
Conclusion
Based on the foregoing analysis, viscosupplementation is an effective treatment for OA of the knee and has beneficial effects. on pain, function, and overall assessment of the patient. The time period after injection varies, especially from 5 to 13 weeks after injection. note that the magnitude of the clinical effect, expressed as standardized mean difference (SMD) from WMD and RevMan 4.2 outputs, varies by product, comparison, time point, variables, and study design. However, because there are few randomized direct comparisons of different visco-supplements, the reader should exercise caution in drawing conclusions about the relative value of different products. The clinical effects of some products on placebo, and some variables at some point in time, range from moderate to large effect sizes. The reader is encouraged to refer to the relevant tables for specific details, given the heterogeneity of effects across product classes and some discrepancies found between the RevMan 4.2 analysis and the original publication. Overall, the analysis performed is positive for the HA class and particularly positive for some products with respect to certain variables and time points, such as weight-bearing pain from 5 to 13 weeks post-injection. In general, sample size limitations prohibit explicit comments on the safety of products in the HA class. However, within the constraints of the test design employed, no major safety issues were detected. In some analyses, the efficacy of visco-supplements was comparable to that of systemic active interventions, with more local reactions and fewer systemic adverse events. In other analyses, HA products were more effective over a longer period of time than IA corticosteroids. Overall, the aforementioned analyses support the use of HA class products in the treatment of knee OA.
Bellamy N, Campbell J, Welch V, Gee TL, Bourne R, Wells GA. viscosupplementation for the treatment of knee osteoarthritis. Cochrane Database of Systematic Reviews 2006, Issue 2. Number: CD005321. DOI: 10.1002 / 14651858.CD005321.pub2.
Tramadol for osteoarthritis
Compared to NSAIDs, tramadol may have fewer side effects in relieving the symptoms of osteoarthritis. The following is a paper that studies tramadol, which may have fewer side effects than NSAIDs.
The research
22 RCTs were included, 21 of which were meta-analyses of 3871 participants randomized to tramadol alone or in combination with tramadol and other analgesics and 2625 participants randomized to placebo or actual drug control.
Tramadol doses ranged from 37.5 mg to 400 mg daily.
Most studies were multicenter trials with a mean duration of two months.
Participants were primarily women with osteoarthritis of the hip or knee, with a mean age of 63 years, and moderate to severe pain.
The study showed that tramadol alone and in combination with acetaminophen had no significant benefit in pain relief compared to placebo control.
15 of 100 patients in the tramadol group improved by 20% compared to 10/100 in the placebo group. 12 of 100 patients in the tramadol combined with acetaminophen group improved by 20% compared to 7 of 100 in the placebo group.
The three most frequent adverse events were nausea, dizziness, and fatigue.
Conclusion.
Moderate-quality evidence indicates that compared with placebo, tramadol alone or in combination with acetaminophen probably does not provide a significant benefit in mean pain or function in patients with osteoarthritis, but slightly more people in the tramadol group reported a significant improvement (20%) defined as 20% or more)). Moderate-quality evidence indicates that substantially more participants are likely to stop taking tramadol due to adverse events. The increase in serious adverse events with tramadol is less certain because of the small number of events.
Toupin April K, Bisaillon J, Welch V, Maxwell LJ, JüniP, Rutjes AWS, Husni ME, Vincent J, El Hindi T, Wells GA, Tugwell P. Cochrane Database of Systematic Reviews 2019, No. 5. Number: CD005522. doi: 10.1002 / 14651858.CD005522.pub3.
Exercise intensity selection for osteoarthritis
Deformed joints are classified as a chronic disease and can occur in the hip, knee, hand, and spine. The cartilage in the joints is damaged and painful most of the time, and non-pharmacological therapies such as exercise therapy may be chosen to manage the chronic pain.
The review to be presented will be one that examines the choice of exercise intensity, which may be helpful to those who deal with it.
The study
We were reviewing six randomized controlled trials with 656 participants.
Five studies (620 participants) involved patients with knee osteoarthritis, and one study (36 participants) involved patients with osteoarthritis of the knee or hip.
More women than men were included in these studies. (3:7)
Measured on a scale of 0-20 points (the lower the better, the less pain), those who took the high intensity exercise program rated 0.84 points lower on the scale than those who took the low intensity exercise program.
Patients who took the low-intensity exercise program rated their pain at 6.6 points.
On a scale of 0 to 68 points (the lower the better the functionality), those who took the high-intensity exercise program rated it 2.65 points lower than those who took the low-intensity exercise program.
Those who did the low-intensity exercise program rated their pain at 20.4 points.
On a visual analog scale of 0 to 200 mm (higher is better functionality), those who took the high-intensity exercise program rated their quality of life 4.3 mm higher (6.5 to 15.2 mm) than those who took the low-intensity exercise program.
Patients who took the low-intensity exercise program rated their quality of life 66.7 mm higher. The number of people adversely affected by high-intensity exercise increased by 2%, with 17/100 people reporting.
-39/100 people reported adverse effects associated with a high intensity exercise program.
-22/100 people reported adverse effects associated with a low-intensity exercise program.
Adverse events were incompletely reported for each group because they were not systematically monitored.
None of the included studies reported serious adverse events.
Evidence based on the results of these studies is that high intensity exercisers with osteoarthritis may experience slight improvement in knee pain and function at the end of the exercise program (8-24 weeks) compared to low intensity exercise programs. It is not clear whether high-intensity exercise improves quality of life or increases the number of people who experience adverse events.
Reviewer's conclusion
We found very low to low quality evidence of no significant clinical benefit of high intensity compared to low intensity exercise programs in improving pain and physical function in the short term. There was not enough evidence to determine the effectiveness of different types of intensity exercise programs.
It is unclear whether high-intensity exercise programs may cause more detrimental effects than low-intensity exercise programs. This must be assessed by further research. Withdrawals due to adverse events were not adequately monitored and were not systematically reported by each group. Due to the risk of bias, inconsistency, and imprecision, we downgraded the evidence to low or very low.
The few studies comparing high-intensity and low-intensity exercise programs for osteoarthritis highlight the need for further research investigating the dose-response relationship of exercise programs. In particular, further research is needed to establish the minimum intensity exercise program required for clinical efficacy and the maximum intensity that can be tolerated by patients. Larger studies should comply with the Consolidated Reporting and Testing Standards (CONSORT) checklist and systematically report harm data to assess the potential impact of maximum intensity exercise programs in people with joint injuries.
Regnaux JP, Lefevre-Colau MM, Trinquart L, Nguyen C, Boutron I, Brosseau L, Ravaud P. High-intensity versus low -intensity physical activity or exercise in people with hip or knee osteoarthritis. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD010203. DOI: 10.1002/14651858.CD010203.
Exercise Therapy for Osteoarthritis of the Knee
Have you ever heard of osteoarthritis of the knee?
As the name suggests, the knee joint is deformed for some reason, and this deformity usually causes pain because the axis of the knee is misaligned and muscle equilibrium is disturbed. In this article, I would like to introduce some good exercise therapy for this condition.
Contents of the study
This study was designed to evaluate and compare the effectiveness of 12 weeks of open, closed, and combined kinetic chain exercises (OKCE, CKCE, and CCE) on quadriceps muscle strength and thigh girth in patients with knee osteoarthritis (OA).
The randomized clinical trial included 96 patients with knee osteoarthritis, participants who were randomly assigned to either the OKCE, CKCE, or CCE groups.
Participants' static quadriceps muscle strength (SQS), dynamic quadriceps muscle strength (DQS), and quadriceps muscle (TG) were assessed at baseline and at the end of weeks 4, 8, and 12, respectively, using a cable tension gauge, a single repetition method, and an inelastic tape measure.
As a result, the three groups were comparable with respect to the demographic and dependent variables at baseline. There was a significant time effect as all three measures increased significantly over time from baseline to 12 weeks.
The effect of the interaction of intervention and time was not significant for all three measures. The changes in SQS, DQS, and TG between baseline and week 12 were also not significantly different between the three groups.
The conclusion was that the three intervention methods, exercise therapy, were effective.
Exercise therapy
The exercise therapies that were recommended are as follows
Group/week OKCE CKCE CCE
Week 1 (a) Quadriceps setting (10 repetitions)
(b) Cycling in the air (2 minutes in a match) (a) Quadriceps setting (10 repetitions)
(b) Wall slides (10 repetitions) (a) Straight leg raises (10 repetitions)
(b) CKC quadriceps set (10 repetitions)
Week 2 (a) Quadriceps setup (10 repetitions)
(b) Cycling in the air (2 minutes in a match)
(c) Straight leg raises (10 repetitions) (a) Quadriceps set up (10 repetitions)
(b) Wall slides (10 repetitions) (a) Straight leg raises (10 repetitions)
(b) CKC quadriceps setting (10 repetitions)
(c) Wall slides (10 repetitions)
Week 3 (a) Quadriceps setting (10 repetitions)
(b) Cycling in the air (match is 2 minutes)
(c) Weighted straight leg raise (new 10 RM) (a) Quadriceps set up (10 repetitions)
(b) Weighted wall slide (new 10 RM) (a) Weighted straight
Leg raises (new 10 RM) (b) CKC quads set (10 repetitions)
(c) Weighted wall slide (new 10 RM)
Week 4 (a) Quadriceps set (10 repetitions)
(b) Cycling in the air (2 minutes in a match)
(c) Straight leg raises with weights (new 10 RM)
(c) Straight leg raises with weights (new 10 RM) (d) Full arc extensions with weights (new 10 RM) (a) Quadriceps set (10 repetitions)
(b) Wall slide with weight (new 10 RM) (a) Straight leg raise with weights (10 RM)
Leg raises (10 RM) (b) CKC quadriceps set up (10 repetitions)
(c) Wall slide with weights (new 10 RM)
(d) Full arc extension (using new 10 RM as weights)
Week 5 (a) Quadriceps set up (10 repetitions)
(b) Cycling in the air (2 min in a match)
(c) Straight leg raises with weights (new 10 RM)
(c) Straight leg raises with weights (new 10 RM) (d) Full arc extensions with weights (new 10 RM) (a) Quadriceps set (10 repetitions)
(b) Wall slide with weight (new 10 RM) (a) Straight leg raise with weights (10 RM)
Leg raises (10 RM) (b) CKC quadriceps set up (10 repetitions)
(c) Wall slide with weights (new 10 RM)
(d) Full arc extension (using new 10 RM as weights)
Week 6 (a) Quadriceps set up (10 repetitions)
(b) Cycling in the air (2 min in a match)
(c) Straight leg raises with weights (new 10 RM)
(c) Straight leg raises with weights (new 10 RM) (d) Full arc extensions with weights (new 10 RM) (a) Quadriceps set (10 repetitions)
(b) Weighted wall slide (new 10 RM)
(c) Step up and step down (a) Straight with weights
(a) Leg raises (10 RM) (b) CKC quads set (10 repetitions)
(c) Wall slide with weights (new 10 RM)
(d) Full arc extensions (using new 10 RM as weights)
Weeks 7-12 (a) Quadriceps setup (10 repetitions)
(b) Cycling in the air (2 minutes in a match)
(c) Straight leg raises with weights (new 10 RM)
(c) Straight leg raises with weights (new 10 RM) (d) Full arc extensions with weights (new 10 RM) (a) Quadriceps set (10 repetitions)
(b) Weighted wall slide (new 10 RM)
(c) Step up and down with weight (new 10 RM) (a) Straight with weights
(a) Leg raises (10 RM) (b) CKC quadriceps set (10 repetitions)
(c) Wall slide with weights (new 10 RM)
(d) Full arc extension (using new 10 RM as weights)
Olagbegi OM, Adegoke BO, Odole AC. Effectiveness of three modes of kinetic-chain exercises on quadriceps muscle strength and thigh girth among individuals with knee osteoarthritis. Arch Physiother. 2017;7:9. Published 2017 Jul 19. doi:10.1186/s40945-017-0036-6
Osteoarthritis and venous insufficiency
Osteoarthritis (OA) used to be defined as a disease characterized mainly by cartilage degeneration, but in recent years it has been considered as a joint defect involving the entire joint, including cartilage, synovium, subchondral bone, and ligamentous tissue. Regarding the pathophysiology of OA, results regarding circulatory disturbances and their effect on the subchondral bone microenvironment are limited.
Vessels are specifically located at sites of bone resorption, and alterations in bone perfusion have been shown to cause hypoxia in the subchondral bone, leading to intraosseous hypertension and increased bone resorption.
Increased subchondral bone resorption has been associated with subchondral osteosclerosis and cartilage thinning. Osteoarthritis and chronic venous disease share common risk factors such as obesity and prolonged standing, and chronic venous disease, especially venous insufficiency (VI), is associated with venous hypertension.
Several studies have evaluated the contribution of circulatory disturbances in the pathophysiology of OA, and the study presented here investigates this relationship.
The studies
Between February 2012 and May 2013, 103 participants were included in the study.
The study group included 59 patients diagnosed with knee OA, and the control group included 44 healthy volunteers with no knee joint complaints. Demographic and clinical characteristics of all participants were recorded, and the venous system of the lower extremities was assessed by Doppler ultrasonography.
All knees were assessed using conventional radiography based on the Kellgren-Lawrence (K&L) grading system and ultrasonography. Pain severity was assessed using the Likert pain scale and function was assessed using the Western Ontario, McMaster University Osteoarthritis Index (WOMAC).
For venous insufficiency.
40.6% of the OA group
15.9% of the control group
Venous insufficiency was detected in (p = 0.007)
There was no statistically significant difference between cartilage thickness and K&L grading for the presence of VI. However, the percentage of medial tibial sclerosis on radiographs was higher in patients with VI in the OA group (60%), resulting in a higher WOMAC pain score in patients with deep VI, although the total WOMAC score was similar in both groups.
Conclusion and Summary
The results of increased radiographic medial tibial sclerosis and higher WOMAC pain scores in patients with venous involvement in OA may lead to the hypothesis that venous system pathology affects the intraosseous microenvironment of the bone, resulting in pain and early subchondral bone involvement, which in turn manifests as "subchondral sclerosis".
Güneş S, Şehim K, Cüneyt K, Gökmen D, Küçükdeveci AA. Is there a relationship between venous insufficiency and knee osteoarthritis? Turk J Phys Med Rehabil. Turk J Phys Med Rehabil. 2020;66(1):40-46. Published 2020 Mar 3. doi:10.5606/tftrd.2020.5110
