Joint Degeneration and Arthritis

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Information Resources: Additional Information and Links to Scientific Studies

  1. A 2015 meta-review of all published scientific studies of arthroscopic surgery to relieve pain in both degenerative osteoarthritic and non-osteoarthritic knee joints with aging, by experts at the University of South Denmark and the University of Lund in Sweden, as well as the hospitals of Copenhagen University and Odense University in Denmark, showed clearly that arthroscopic surgery, the overwhelming choice of medical doctors for knee pain, produces only mild pain relief for the first 6 months, but no benefit at 2 years. This important study, published in the esteemed British Medical Journal (BMJ), demonstrates the urgent need to integrate Complementary Medicine to treat these cases of chronic knee pain. The cynical approach of temporary pain relief and the advice to just ignore appropriate therapy and wait until a prosthetic is needed is neither sensible nor affordable: http://www.bmj.com/content/350/bmj.h2747
  2. Preventive Medicine for Degenerative Joint Disease now has at least 14 potential markers in blood tests that could be utilized to formulate a comprehensive and individualized preventive protocol if a reasonable algorithm is devised, and integrated multidisciplinary care instituted. Here, experts at Pfizer Central Research in Groton, Connecticut, U.S.A. outline the initial criteria for such diagnostic assessment and treatment guidelines. Hopefully, Complementary and Integrative Medicine (CIM) will be included in this preventive protocol, not just new pharmaceuticals: http://www.ncbi.nlm.nih.gov/pubmed/10806045
  3. Experts at Duke University Medical Center, in Durham, North Carolina, U.S.A., in 2006, suggested that 7 biomarkers of Degenerative Joint Disease be instituted in standard assessment of osteoarthritis of the knee, including hyaluronic acid (HA), TGF-beta (transforming growth factor), cartilage oligomeric matrix protein (COMP), keratan sulfate (KS-5D4), type 2 procollagen carbosy-propeptide (CP2), and C-terminal teleopeptides of collagen type 2 (CTX-II), with both blood and urine testing, taken at late midday setpoints to account for diurnal variation. Active metabolite sampling with veinous blood stick and urine blotter may be an inexpensive and easy way to achieve such defined biomarker evaluation, if standard medicine would finally utilize the advances in medical testing pioneered by Zava Research Technology in Portland, Oregon: http://www.ncbi.nlm.nih.gov/pubmed/16868970
  4. A 2014 study at Era's Lucknow Medical College, in Lucknow, India, found that hyaluronic acid (HA) as a biomarker of disease progression in knee osteoarthritis and degenerative joint disease could be very valuable in differentiating stages of the disease and identifying asymptomatic patients with progressive degeneration of the joints: http://www.ncbi.nlm.nih.gov/pubmed/25653977
  5. A 2014 review of scientific study of calcium deposits in degenerative joint cartilage disease found that CPPD crystals (calcium pyrophosphate dihydrate) are seen both in cases of pseudogout and osteoarthritis, but that an array of types of calcium deposits are seen, with calcium phosphates, tricalcium phosphate, and octocalcium phosphate found in synovial fluid and tissues. Carbonate substituted hydroxyapatite, or malformed calcium hydroxyapatite (a type of calcium normal to the bone deposition), is now associated with osteoarthritis, and with more severe cartilage degeneration. Such study should guide a more holistic approach to therapy: http://www.ncbi.nlm.nih.gov/pubmed/24924727
  6. A 2016 meta-review of common pain medications that have been the backbone of standard treatment of osteoarthritis, NSAIDS and acetaminophen, found that acetaminophen has not been supported by evidence and in general provides no proven pain relief greater than placebo, while various NSAIDS provide mild pain relief and some improved function. Diclofenac 150 mg (Voltaren) was found to work best of the NSAIDS. Such study shows that decades of standard care in osteoarthritis have been misleading and not evidence-based, and the experts reviewing against recommending acetaminophen, which is the main ingredient in most opioid pain medications as well, and cautioned that use of NSAIDS should be limited due to the evidence of adverse health effects with chronic constant use. The message is that we need to integrate conservative therapies in the care of osteoarthritis, such as physiotherapies, joint and soft tissue mobilization and acupuncture, as well as herbal and nutrient medicines to aid tissue repair: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2930002-2/abstract
  7. A 2008 NY Times Health article on recent evidence supporting conservative care with meniscus tears: http://www.nytimes.com/2008/12/09/health/09scan.html?partner=rss
  8. A 2011 assessment of the reintroduction of study of Musculoskeletal Medicine into the University Medical School curriculum, by experts at the University of Michigan Medical School, outlines the progress after a committee of orthopedic experts concluded in 2003 that medical schools in the United States had almost eliminated such study and introduced a program to improve medical texts and instruction (MSOP and Project 100). This historical assessment shows that patients need to look outside the box for real help with restorative musculoskeletal pathologies, integrating Complementary Medicine: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261253/
  9. A 2013 randomized controlled human clinical trial and study by the Finnish Degenerative Meniscal Lesion Study (FIDELITY), published in the New England Journal of Medicine December 26, 2013; 369:2515-2524, found that patients with arthroscopic surgery to repair a torn degenerative meniscus in the knee fared equally as patients with a sham procedure, demonstrating that many patients may be better off pursuing conservative physiotherapies and Complementary Medicine: http://www.nejm.org/doi/full/10.1056/NEJMoa1305189
  10. A large randomized controlled human clinical trial of corticosteroid injections for low back and lumbar pain, often with pain radiating down the leg, conducted at the University of Washington, Seattle, Washington, USA, and published in the esteemed New England Journal of Medicine, found that these commonly prescribed injections for lumbar pain provided no benefit over placebo, and no increased benefit when combined with the anesthetic lidocaine over lidocaine injection alone for temporary relief of pain. The lead author for the study, Dr. Janna Friedly, stated: "These (corticosteroid injections) are so commonly used and the steroids do pose an added risk to patients without much benefit." Physicians interviewed after these findings stated that they would probably continue to use corticosteroid injections routinely, despite evidence of adverse health effects and virtually no benefits: http://www.reuters.com/article/2014/07/03/us-spinal-stenosis-epidural-steroids-idUSKBN0F82CY20140703
  11. A thorough explanation for an often overlooked source of lumbar and lumbosacral pain, the posterior tear of the L4-5 disc, is explained by the expert Dr. Michael Brown MD. In this pathology, accumulation of proteins from the inner disc pulposa extruding through the annular fissure, as well as the resulting accumulation of inflammatory chemicals to counter this phenonemon, may result in unexplained lumbar and pelvic pain that is often overlooked and difficult to treat. A thorough conservative treatment protocol to help repair this disc tear in a holistic manner should first be tried, and if this fails, a number of minimally invasive lumbar surgeries have been found to be useful, explained in this paper: http://www.michaelnbrownmd.com/michaelnbrownmd/files/DISC_anular_tear.pdf
  12. A 2012 study at Chiba University School of Medicine, in Chiba, Japan, found that disc degeneration and compression both resulted in accumulation of protein fragments, or peptides, as well as inflammatory mediators, that could explain much of the nerve irritation and pain seen in many cases of lumbosacral joint and disc degeneration. The accumulation of peptides occurred in both types of disc pathology more than the accumulation of pro-inflammatory cytokines, which some studies have now shown become a problem when the immune system, or macrophages, react with IL-6 and PGE2 from the disc degeneration. This study is the first of its kind published, and won the International Society for the Study of the Lumbar Spine yearly prize. Clearly, myofascial release, joint mobilization, use of inflammation modulation with herbal and nutrient chemicals, and acupuncture, are needed to correct these problems: http://www.ncbi.nlm.nih.gov/pubmed/22366969
  13. Environmental Health Perspectives gives a peer-reviewed in depth analysis of the benefits of boron supplement at their website. Boron is an often overlooked mineral that is important in the bone matrix, along with calcium hydroxyapatite, magnesium and phosphorus, and may be helpful as part of the treatment of osteoparthritis: http://www.ehponline.org/members/1994/Suppl-7/newnham-full.html
  14. A 2005 study at the Arthritis Research Centre of Canada, in Vancouver, showed that there was little evidence to support oral supplement with glucosamine sulfate to reverse degeneration of the collagen type 2 matrix in knee cartilage in the long-term. On the other hand, collagen degradation products in blood circulation were found to be a significant marker for progression of the disease. While years of advertising have convinced many patients that these oral glucosamine supplements help them greatly, there is very little scientific evidence to back this up objectively, and even in the 1980s the famed Dr. John Lee, pioneer of bioidentical hormone therapies and topical creams had come to the conclusion that glucosamine sulfate and other nutrients should perhaps be delivered topically with a carrier to the joint tissues. Since then, collagen type 2 extracts have been developed as well, with patented encapsulation and delivery systems that are proven to work in human clinical trials at Harvard Medical School: http://www.ncbi.nlm.nih.gov/pubmed/15868627
  15. An initial human clinical trial of purified extract from chicken cartilage showed that this supplement of Collagen type II of bioidentical form can reach the affected joint and both a decrease in autoimmune destruction and repair of the joint: http://chickencartilage.com/harvardstudy/
  16. Serratiopeptidase, a potent proteolytic enzyme that is well studied to clear peptides and fibrins from musculoskeletal and organ tisuse, is clearly explained at thiw website: http://www.purebodysolutions.com/Merchant2/graphics/00000001/PDF/serratiopeptidase.pdf
  17. Hyaluronic acid injections are not the same as prolotherapy; a large randomized trial in France was completed in 2008 and showed no benefits: http://www3.interscience.wiley.com/journal/122220639/abstract?CRETRY=1&SRETRY=0
  18. A 2009 article in the New York Times outlines current research that shows that platelet-rich plasma injections found in rigorous study to provide no better healing than saline injections, and that steroid injections provide temporary benefit, but do not change long-term outcomes of pain and disability. : http://www.nytimes.com/2010/01/13/health/13tendon.html?ref=health
  19. A 2012 study of the effects of acupuncture to improve osteoarthritic conditions of the knees, by the Heidelberg University Hospital, Germany, found that acupuncture both achieved significant pain relief and increased function, with increased flexibility, in randomized double-blinded multicenter human clinical trials. These studies utilized comparisons between so-called modern acupuncture and classical Chinese acupuncture techniques, versus non-specific acupuncture stimulation, previously called sham acupuncture in studies. This study design demonstrated that nonspecific acupuncture stimulation still has benefits, and is not purely a placebo or sham treatment, and that so-called modern acupuncture techniques, often used in study designs, are indeed less effective than the standard classical needle techniques taught in approved TCM medical colleges. The benefits of classical Chinese acupuncture stimulation were over 10 degrees of increased range of motion of the knee, and 73 percent reduction in pain, as measured on the standard WOMAC scale. Such studies demonstrate both the effectiveness of acupuncture in osteoarthritic conditions, and the blatant designed study bias used for many years to deny the proof of benefits: http://www.ncbi.nlm.nih.gov/pubmed/23365608
  20. A 2012 study of the effects of electroacupuncture to improve postoperative healing and recovery from total knee replacement, conducted at Wuhan Puai Hospital, Wuhan, China, showed that HSS scores, VAS pain scores, and functional measurements were markedly improved in the group receiving electroacupuncture combined with standard rehabilitation : http://www.ncbi.nlm.nih.gov/pubmed/22734376
  21. A 2008 study of acupuncture and electroacupuncture for the treatment of the osteoarthritic knee, by the University Hospital Birmingham National Health Service Trust, Department of Rheumatology, United Kingdom, found that acupuncture provides significant relief of symptoms over sham acupuncture, with an average improvement in pain of 95 points with the average baseline of 294, with similar benefits seen in stiffness: http://www.ncbi.nlm.nih.gov/pubmed/18591906
  22. A 2007 study at Chongqing Medical University in Chongqing, China, found that electroacupuncture and Chinese physiotherapy, or Tui na (called massage in translation), remarkably suppressed the pro-inflammatory cytokines interleukin-1beta (IL-1b) and TNF-alpha in the synovial membranes of arthritic joints, which is found to drive the degeneration seen in osteoarthritic knee joints: http://www.ncbi.nlm.nih.gov/pubmed/17650656
  23. A 2009 study of the effects of electroacupuncture in treatment of osteoarthritis of the knees, at the Army Medical College Rawalpindi, Pakistan, found that electroacupuncture not only relieved pain in these patients, but significantly reduced plasma cortisol, a marker of inflammation, and increased beta-endorphin, a pain-relieving neurotransmitter: http://www.ncbi.nlm.nih.gov/pubmed/19766392
  24. A 2015 meta-analysis of all published randomized controlled human clinical trials of acupuncture in the treatment protocol for sciatica, by experts at the Nanjing University of Chinese Medicine, in China, found that significant evidence shows that acupuncture is evidence-based and effective for treatment of sciatica. Of course, actual clinical treatment from a TCM physician could include physiotherapies such as Tui na, or soft tissue mobilizaton, as well as herbal and nutrient medicines to speed tissue healing: http://www.ncbi.nlm.nih.gov/pubmed/26425130
  25. A 2008 study at Chongqing Medical University in Chongqing, China, found that electroacupuncture and Chinese physiotherapy, or Tui na (called massage in translation), also raised the beneficial antioxidant activity of super oxide dismutase (SOD) and lowered the reactive oxygen species (ROS) nitric oxide and malondiealdehyde (MDA) in knee joints affected by degenerative osteoarthritis: http://www.ncbi.nlm.nih.gov/pubmed/18630588
  26. A 2013 randomized controlled study at Sichuan University, in Chengdu, China, found that electroacupuncture may also aid rehabilitation of cartilage in postmenopausal and other patients with hormonal imbalance by stimulating increased serum estrogens and decreasing MMP-13, adding to the array of benefits from a single course of treatment: http://www.ncbi.nlm.nih.gov/pubmed/23519019
  27. A 2014 randomized controlled study at Sichuan University, in Chengdu, China, also found that electroacupuncture could improve bone density and estradiol level significantly in laboratory animals with ovaries removed to mimic a post-menopausal state. This treatment was applied at ST35, UB23 and UB20 daily for 14 days at 10Hz: http://www.ncbi.nlm.nih.gov/pubmed/24161996
  28. A 2011 study at Shanghai University, in China, found that Tui na, or joint and soft tissue mobilization, also referred to as naprapathy, stimulated increased integrins, or cell receptors and signaling molecules that coordinate an array of adhesion molecules, collagens, selectins, etc. in the process of cartilage regrowth: http://www.ncbi.nlm.nih.gov/pubmed/21485585
  29. While many patients are still wary of gentle joint manipulation and fearful of what has been called "bone cracking" in the treatments by chiropractors, osteopaths and other physicians practicing physiotherapy, this subject is only now being studied with advanced MRI imaging. This study of the popping of knuckles by the University of Alberta, in Canada, showed that the sound is caused by a sudden vacuum created in the synovial fluid and bursa of the joint, and that such "popping" demonstrated no adverse effects: http://www.sciencedaily.com/releases/2015/04/150415155320.htm
  30. A 2001 study by the Univerisidad Nacional in Lima, Peru, demonstrate that Cat's Claw, or other species of Uncaria, had proven beneficial effects on human study participants with osteoarthritis of the knee, both reducing pain and with antioxidant and anti-inflammatory mechanisms, especially the inhibition of TNFalpha: http://www.ncbi.nlm.nih.gov/pubmed/11603848
  31. A 2001 study at the University of Montreal, in Canada, showed that the Chinese herb Trypterygium wilfordii (Lei gong teng) suppresses the MMP13 pro-inflammatory metalloproteinase that lies at the heart of the pathology of joint degeneration, especially cartilage degeneration, without negatively impacting healthy cartilage cells, or chondrocytes: http://www.ncbi.nlm.nih.gov/pubmed/11306704
  32. A 2009 NY Times article reveals manipulation of FDA approval of new biologic surgical devices: http://www.nytimes.com/2009/09/25/health/policy/25knee.html
  33. A study in Japan, published in the Journal of Bone and Mineral Metabolism, found that AGEs (advanced glycation endproducts) were highly associated with osteoporotic vertebral microfractures in a large study of aging women: http://www.springerlink.com/content/3058213826n8404j/
  34. A 1975 study at the Pritzker School of Medicine at the University of Chicago found that enzyme therapy was an essential cofactor of stimulation of increased chondroitin sulfate proteoglycan production by cartilage cells, or chondrocytes: http://informahealthcare.com/doi/abs/10.3109/03008207509152169
  35. A 2011 study at Case Western Reserve University Department of Rhematology, in Cleveland, Ohio, found that a combination of the amino acid L-leucine with 3 standard Chinese herbs, Ru xiang (boswellia), Gou teng (Uncaria), and Ting li zi (Lepidium) reversed the destruction of cartilage (catabolic chondrocyte gene expression) to a regenerating pathway (anabolic chondrocyte expression), via both cartilage protective and anti-inflammatory mechanisms: http://www.ncbi.nlm.nih.gov/pubmed/21854562
  36. A 2011 study at Laila Impex Research and Development in Vijayawada, India, found that boswellia extracts exhibit potent anti-inflammatory and anti-arthritic potential, aiding recovery of cartilage and protecting against proteolytic degradation in osteoarthritis and rheumatoid arthritis: http://www.ncbi.nlm.nih.gov/pubmed/21479939
  37. A 2010 study at Cardiff University School of Biosciences, in the United Kingdom, found that boswellia extracts prevent collagen degeneration, inhibit inflammation, and has great potential as a treatment for arthritis and degenerative joint disease: http://www.ncbi.nlm.nih.gov/pubmed/19943332
  38. A 2010 study at the University of Liege, Institute of Pathology, in Liege, Belgium, found that curcumin (turmeric, E zhu, Yu jin) protects cartilage cells (chondrocytes) from degeneration (catabolism) by inhibiting pro-inflammatory cytokines and other chemicals, and promoting chemicals, such as MMP-3 and caspase-3, that aid cartilage repair and regeneration: http://www.ncbi.nlm.nih.gov/pubmed/19836480
  39. A 2012 study at Sichuan University in Chengdu, China, found that a chemical in the herb Epimedium, or Yin yang huo, icariin, accelerated cartilage growth, synthesis of glycosaminoglycans and collagen type 2: http://www.ncbi.nlm.nih.gov/pubmed/22308065
  40. A 2011 study at Huazhong University of Science and Technology, and Hubei Key Laboratory of Natural Medicinal Chemistry, in Wuhan, China, found that the Chinese herb Arisaema (Xue li jian, or Dan nan xing) demonstrated significant anti-inflammatory and anti-arthritic activity, and suppressed the progression of collagen-induced arthritis: http://www.ncbi.nlm.nih.gov/pubmed/21029771
  41. A 2010 study at Fujian University of Traditional Chinese Medicine (TCM), in Beijing, China, analyzed a common TCM formula used to treat or prevent osteoarthritis, Jingzhi Tougu Xiaotong Granule, and found that this formula of herbs delivered 514 known chemicals, many of which have therapeutic actions that target 35 beneficial chemical targets seen in pharmaceutical research. This shows the broad therapeutic potential of Chinese herbal formulas to deliver a thorough, holistic and effective treatment, covering all aspects of the disease mechanism. The herbs in this formula are: Morindae officianalis (Ba ji tian), Caulis sinomenii (Sinomenium acutum, or Fang ji, Stephania root), Paeoniae alba (Bai shao), and other typical anti-arthritic herbs: http://www.whxb.pku.edu.cn/EN/abstract/abstract26943.shtml
  42. A 2009 study at Fujian University of Traditional Chinese Medicine (TCM), in Beijing, China, analyzed a common TCM formula used to treat or prevent osteoarthritis, Jingzhi Tougu Xiaotong Granule, and found that this formula of herbs targeted inhibition of many important enzymes, especially MMP-3, related to joint degeneration, as well as pro-inflammatory cytokines, oxygen free radicals, and peptide radicals, potentially postponing degeneration of cartilage in osteoarthritis : http://www.ncbi.nlm.nih.gov/pubmed/19802542
  43. A 2011 study at Keio University and Tokyo Medical and Dental University found that procyanidin B3 in grape seed extract significantly reduced cartilage degeneration, mainly through suppression of inducible nitric oxide synthase (iNOS), the main stimulant of excess matrix metalloproteinases (MMPs) seen in osteoarthritis : http://www.plosone.org/article/info
  44. A systematic review of 1151 clinical trials of non-steroidal anti-inflammatory drugs (NSAIDS), the only real allopathic medicine commonly prescribed for osteoarthritic degeneration and pain, by the esteemed Cochrane Database Systematic Review, found that there were consistent inadequecies in these studies. The array of studies from 1966 to 1995 utilized double-blinded placebo-controlled human trials, but only 22 were found that targeted osteoarthritis of the knee, and only 16 filled the criteria for a sound study. The study design in these trials was rated poor (3/8 on a scale of 1-8), and efficacy of specific NSAID medications was indeterminate, with a criteria being likelihood of withdrawal from the study due to lack of efficacy. Only 2 studies showed a statistically different effect in pain relief between NSAIDS, and in these trials the targeted NSAID, etolodac (Lodine) was prescribed in dosages 25-44 percent higher than the NSAID used as a comparative. The warnings for etolodac (Lodine) include increased risk of stroke or heart attack, gastric and intestinal bleeding, shortness of breath, unusual sweating, and changes in mental function: http://www.ncbi.nlm.nih.gov/pubmed/17636601
  45. Other diagnoses should be considered when the degenerative joint pathology is not clear, and persistence is sometimes necessary to accomplish this task. For instance, this 2010 article from experts at the University of Melbourne, Australia, describe a more rare knee arthropathy that is difficult to diagnose, poorly understood, and progressive, called Charcot knee, or neuropathic arthropathy. Other relatively rare disorders include Chronic Regional Pain Syndrome (Reflex Sympathetic Dystrophy or Causalgia), and Osteomyelitis. Often the occurrence of dysfunction related to the nervous system and immune system is both peripheral and central, often with underlying health problems, and difficult to categorize in many cases due to the wide array of presentations. In this case, standard diagnosis may not be effective, the patient may need to explore specialists, and the difficulties in diagnosis may be frustrating. In such cases, the standard treatment options may be insufficient as well, or employ harsh pharmaceuticals, and the exploration of competent holistic care from a knowledgeable Licensed Acupuncturist integrated into care at an early stage would be sensible: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143972/
  46. A 2011 explanation of the myths about laser spine surgery is presented here by the Princeton Brain and Spine Care surgeon, Dr. Mark McLaughlin, with a link to an article in Bloomberg News that reflects the large number of malpractice lawsuits emerging in the laser spine surgery arena, and the huge profits that are driving the quick expansion of this field: http://www.princetonbrainandspine.com/subject.php?pn=laser-spine
  47. A 2013 follow-up to study of potential pathological problems associated with metal flaking from metal-on-metal hip prosthetics, by experts at Otto-Von-Guericke University, in Magdeburg, Germany, and published in the Journal of Bone and Surgery American Volume, of the American Orthopaedic Association, found that, while metal flaking of Cobalt Chromium and Moybdenum has not been found to be directly cancer causing or causing of fetal defects, that accumulation in tissues around the joint prosthetic eventually result in accumulation in macrophages, and fibrin exudation, which may have implications of immune dysfunction and musculoskeletal problems in the future. These experts found that blood serum testing is not predictive : http://www.ncbi.nlm.nih.gov/pubmed/24005196
  48. A 2013 study of the deleterious effects of Cobalt Chromium (CoCr) metal particles accumulating in tissues surrounding the metal-on-metal hip prosthetics, by the University of Leeds, Leeds, United Kingdom, found that at 40 weeks after exposure of significant accumulation, heavy metal toxins were not significant in blood circulation, and did not result in localized inflammation, but died result in increased DNA damage in the bone marrow and frontal cortex of the brain, and immune hypersensitivity to these heavy metal toxins, particularly chromium oxide (CrIII), resulted in a Th1 driven immune hypersensitivity that could contribute to eventual autoimmune disorder: http://www.ncbi.nlm.nih.gov/pubmed/23932295