The most commonly used first-line medications are acetaminophen and nonsteroidal anti-inflammatory drugs, such as ibuprofen. Unfortunately, medications mostly treat the symptoms of pain and inflammation.
However, the primary objectives in treating osteoarthritis should also include improving quality of life, slowing progression of the disease process, and reducing its disabling effects.
Over the last five years or so, the medical community has gone from believing that vitamin D was potentially the solution to many diseases to wondering whether, in some cases, low levels were indicative of disease, but repletion was not a change-maker.
Well, in a randomized controlled trial (RCT) published in the Journal of the American Medical Association (JAMA), vitamin D had no beneficial symptom relief, nor any disease-modifying effects over a two-year study of almost 150 men and women.
There is raging debate about whether glucosamine is an effective treatment for osteoarthritis. In the latest installment, a RCT showed that glucosamine hydrochloride was not effective in treating osteoarthritis.
In the trial, 201 patients with either mild or moderate knee pain drank diet lemonade with or without glucosamine hydrochloride.
There was no difference in cartilage changes in the knee nor in pain relief in those in the placebo or treatment groups over a six-month duration. Bone marrow lesions also did not improve with the glucosamine group.
This does not mean that glucosamine does not work for some patients. Different formulations, such as glucosamine sulfate, were not used in this study.
This could not be a column on osteoarthritis if I did not talk about weight. In a study involving 112 obese patients, there was not only a reduction of knee symptoms in those who lost weight, but there was also disease modification, with reduction in the loss of cartilage volume.
On the other hand, those who gained weight saw the inverse effect. A reduction of tibial cartilage is potentially associated with the need for knee replacement.
Exercise and diet
In a study published in JAMA, diet and exercise trumped the effects of diet or exercise alone.
Patients with osteoarthritis of the knee who lost at least 10 percent of their body weight experienced significant improvements in function and a 50 percent reduction in pain, as well as reduction in inflammation, compared to those who lost 5 to 10 percent and those who lost less than 5 percent.
The diet and exercise group and the diet-only group lost significantly more weight than the exercise-only group, 23.3 pounds and 19.6 pounds versus 4 pounds. The diet portion consisted of a meal replacement shake for breakfast and lunch and then a vegetable-rich, low-fat dinner.
Low-calorie meals replaced the shakes after six months. The exercise regimen included one hour of a combination of weight training and walking three times per week.
Therefore, concentrate on lifestyle modifications if you want to see potentially disease-modifying effects. And remember, the best potential effects shown are with weight loss and with a vegetable-rich diet.
For further information, visit medicalcompassmd.com or consult your personal physician.