Arthritis

By | 2011-06-06

Definition and cause

Arthritis is a degenerative, progressive disease of the cartilage and synovial surface of the joint. Although arthritis is distinguished from immune-mediated arthritis because it is classified as non-inflammatory, inflammation is believed to be an important part of the initiation and ongoing breakdown of tissue in the joint. Arthritis in dogs and cats is assumed to be related to the aging process as well as secondary to other factors such as injury, physical deformity, overuse, and other diseases such as dental disease. Continual loss or breakdown of the joint surface often leads to pain, inflammation, and permanent deformity.

Medical therapy rationale, drug(s) of choice, and nutritional recommendations

More integrative options exist for arthritis than any other disease condition. The conventional approach is the use of antiinflammatory and pain-suppressing drugs such as corticosteroids and NSAIDs. The potential side effects from the chronic use of these drugs have led to alternative approaches such as reconstructive surgical procedures and joint replacement. Dietary management is most commonly used for weight reduction. The newer trend in arthritis management is toward chondroprotective agents such as Adequan®, and nutraceuticals such as glycosaminoglycan (glucosamine), pain-relieving agents such as methyl sulfonyl methane (MSM), and free radical scavengers such as superoxide dismutase (SOD).

Anticipated prognosis

Arthritis is a progressive degenerative disease. The approach of medically addressing the symptoms and surgically correcting the problem simply corrects the associated symptoms. The addition of chondroprotective agents, nutraceuticals, and a weight loss program greatly increases the likelihood of control of the disease and offers a much improved prognosis. Arthritis offers a good example of the proven effects of the integrative approach to treating a disease condition.

Integrative veterinary therapies

The conventional medical approach to arthritis focuses upon the signs and symptoms of the disease. While the degenerative process is physically located in the joints, the underlying mechanism begins with an inflammatory process at the cellular level. This process initiates the pain and swelling, but also results in the decrease in synovial fluid production, leading to further friction, inflammation, and degeneration. Adding nutritional and alternative therapies helps to reduce free radical production, decrease inflammation, enhance synovial fluid production, and slow or prevent further degeneration. In addition, if started early, it can reduce the dependence upon or minimize the use of medications.

Nonsteroidal antiinflammatory drugs frequently have adverse effects, now more commonly known by consumers. They are useful for short-term therapy and in cases of severely advanced osteoarthritis in which safer therapies no longer suffice.

Nutrition

General considerations / rationale

Nutritional and gland support are directed toward reducing inflammation and protecting cells and tissue. Medication, on the other hand, covers up the inflammation; however, it does not get to the underlying cause nor does it confer cellular protection. Nutritional therapies also focus upon improving nutrient flow to the cells and tissues of the joints and help to prevent a decrease in the production of synovial fluid.

Appropriate nutrients

Chondroprotective agents: The body uses glucosamine to make and repair joint tissue and cartilage. Glucosamine has been clinically proven to significantly reduce the pain, inflammation, and swelling associated with osteoarthritis in both people and animals. Glucosamine has been shown to have none of the side effects of drugs, and can be as effective as prescribed medications.

Several studies have demonstrated the effectiveness of glucosamine and chondroitin in the management of arthritis in dogs. Setnikar et al. (1986) has described how these compounds actually stimulate the body’s own repair mechanism and help in the process of developing new cartilage. Numerous double-blind studies have compared the effectiveness of glucosamine against various NSAIDs, resulting in as good or, in many cases, even better pain control and removal of the clinical signs associated with osteoarthritis.

Chondroitin sulfate (CS) is found in the lining of the joints, and clinical evidence in double-blind studies shows that supplementation with CS reduces pain and inflammation and increases joint mobility. In the veterinary field, Anderson (1999) and Canapp (1999) showed that there was significant reduction in pain and improved mobility as reported by survey veterinarians.

Fatty acids: In a double-blind study of people with rheumatoid arthritis, Joe (1993) showed that a number of people had significant benefits from the addition of evening primrose oil (EPO). Kremer (1995) has shown that fish oil helps to reduce inflammation in people with arthritis.

Botanical Cox2 inhibitors: Botanical Cox2 inhibitors have been shown to have antioxidative and antiinflammatory effects. Botanical Cox 2 inhibitors reduce inflammation without the inherent side effects of Cox2 medications.

Vitamin C: Vitamin C has been studied clinically in animals. Brown (1994), Berg (1990), and Newman (1995) reported on the benefits of vitamin C in the treatment of degenerative joint disease and movement in dogs and horses. Belfield reported on the beneficial effects of vitamin C in treating and preventing hip dys-plasia in dogs.

Chinese herbal medicine / acupuncture

General considerations / rationale

Practitioners of traditional Chinese medicine consider arthritis to be a combination of Wind, Damp, and Cold. The Kidney, which has the function of controlling the bones, is the main organ that is involved. Wind is a traveling pathogen, according to traditional Chinese medicine (traditional Chinese medicine). It refers to the tendency of arthritis to manifest in various joints on different days. Wind also refers to motion. Some animals with arthritis may have twitching of the muscles, spasms, or trembling in the affected area. Cold causes stiffness, as many practitioners note. Animals tend to have more trouble getting up and mobilizing on colder days. Cold also causes pain. The animals often prefer warm areas on cold days. People know from experience that a heating pad helps decrease the pain associated with arthritis. Damp refers to swelling in the joint, i.e., the accumulation of fluids in the joint.

In addition to treating the signs of arthritis, it is important to address the underlying cause, such as rickettsial diseases, bacterial infections, and excess weight. Immune-mediated arthritis must be treated differently than degenerative arthritis.

Appropriate Chinese herbs

Aconite (Fu zi): Effectively decreases joint inflammation and has analgesic properties.

Angelica (Bai zhi): Has antiinflammatory and analgesic properties. It contains scopoletin, an effective muscle relaxant.

Atractylodes (Bai zhu): Has been shown to decrease pain related to chronic back and leg arthritis in humans.

Bupleurum (Chai hu): Contains saikosaponin, which has analgesic properties.

Cinnamon twigs (Gui zhi): Have analgesic effects. Licorice contains two compounds, glycyrrhizin and glycrrhetinic acid, which have shown efficacy in treating arthritis.

Ginger (Sheng jiang): Has been shown to be effective in decreasing arthritis pain in several studies.

Notopterygium (Qiang huo): Has been shown to relieve muscular pain in mice.

Pubescent angelica root (Du huo): Has demonstrated antiinflammatory and analgesic effects.

White peony (Bai shao): Contains paeoniflorin, which is a strong antiinflammatory. It is an effective pain reliever, and in combination with gan cao is excellent for muscle spasms.

Acupuncture

Musculoskeletal disease is one of the most common reasons for seeking acupuncture treatment in this country. Acupuncture has been used extensively and effectively in all types of arthritic conditions. There are generalized points one can choose for acupuncture. For example, bai hua is a good choice for treating generalized weakness associated with muscle atrophy. In addition to being a good point to increase the body’s energy, it also serves as a local point for the hip joint, lumbar spine, and hind legs.

Local points also may be chosen. The following is a list of specific areas and possible point choices according to the author’s experience:

Neck: SI16, LI18, BL10

Shoulders: SI9, SI10, TH14

Elbow: LI11, Qiang Feng.

Carpus: PC6, TH5

Back: Hua tuo jia ji (points just lateral to each vertebrae chosen according to the location of the pain)

Hip: BL54, GB28, GB29

Stifle: GB34, ST35

Hock: BL60, KI3

Homotoxicology

General considerations / rationale

Osteoarthritis, a degenerative, nonautoimmune form of arthritis, represents homotoxicoses in the Inflammation, Deposition, and Degenerative phases, and is a common entity in veterinary medicine. Therapy is aimed at reducing homotoxin levels, improving circulation and lymphatic flows, reducing inflammatory pain, and improving mobility. Proper diet, adequate exercise, and weight management are critical to the success of any program designed to assist the osteoarthritis patient. Agents should be chosen initially that have minimal risk to the patient. An initial treatment period of 5 to 8 weeks is needed to properly assess response. Biological agents frequently require a longer window to demonstrate their effects, and clients should be advised of this fact at the initiation of therapy.

Homotoxicology has many biological agents that assist in managing arthritis with a minimum of harmful side effects, and consumers appreciate this immensely. Many clinicians take their first steps toward biological therapy in pursuit of better methods of pain management and rehabilitation for their patients, as well as for themselves. Some evidence for the effectiveness of antihomotoxic pain medications is discussed in the homotoxicology chapter of this text.

Appropriate homotoxicology formulas

Homeopathic strategies vary depending upon the anatomical location of the osteoarthritis as well as the presence or absence of other aggravating factors (cold, damp, skin rashes, etc (also see Autoimmune Arthritis in site). The following remedies have proven themselves in hundreds of cases in the authors’ clinics:

Aconitum homaccord: Treats polyarthrtis, particularly when combined with Rbododendroneel S and Bryaconeel.

Aesculus compositum: Is primarily a peripheral circulatory agent, but contains Rhus tox, Ruta graviolens, and Arnica, which are all excellent arthritis remedies.

Atropinum compositum: Treats painful muscle spasms associated with arthropathy.

BHI-Arthritis: Used for swollen, painful joints and muscle stiffness. Particularly useful for patients that are more affected in cold, wet weather.

BHI-Back: Treats back pain, muscle spasm, arthropathy.

Bryaconeel: Treats polyarthritis, particularly when combined with Rbododendroneel S and Aconitum homaccord.

Calcoheel: Used for disordered calcium metabolism.

Cimicifuga homaccord: Treats neck pain and chronic luxations of pedal joints.

Colnadul: Used for arthritis that worsens with wet weather. It is particularly suited to knee problems, e.g. chronic dislocations. The authors use this in stifle issues.

Colocynthis homaccord: Used as an initial therapeutic agent, particularly for acutely painful conditions involving the lower back and hips. Initially use it every 15 to 30 minutes, until relief is noted.

Cruroheel: Used particularly for afflictions of the hind limbs.

Discus compositum: Treats spinal arthropathy.

Dulcamara homaccord: Used for arthritis worsened by wet weather.

Ferrum homaccord: Treats shoulder pain and shoulder-hand syndromes.

Gelsemium homaccord: Treats head and neck pain and lower limb weakness.

Graphites homaccord: Used for deforming arthropathies.

Lithiumeel: Treats osteoarthritis of the hip joints, and is useful in conjunction with Graphites homaccord in hipdysplasia-induced osteoarthritis.

Osteoheel: Treats ankle pain.

Psorinoheel: Indicated in chronic polyarthritis. There is some evidence for microbial causes of arthritides, e.g., mycoplasmas, and this remedy may have applicability for therapy.

Rheuma-Heel: Treats left-sided arthritis of the shoulder or knee.

Rhododendroneel S: Treats polyarthritis, particularly when combined with Bryaconeel and Aconitum homaccord.

Traumeel S: Useful in the form of vials, drops, tablets, ointment, and gel in many applications in osteo-arthritis cases, particularly in the early phases for control of acute pain. This formula has more scientific research than any other homeopathic remedy and is listed in the Physician’s Desk Reference as a nonsteroidal antiinflammatory agent (see the homotoxicology chapter for references).

Zeel: Useful in the form of ampules, tablets, ointment, and gel as the main long-term remedy for osteoarthritis. Revitalizes tissues through Catilago suis, Funiculus umbilicus, and Placenta suis. It includes a number of homeopathic botanicals that are useful in arthritis (Rhus tox, Arnica, Solanum dulcamara, Symphytum officinale, and Sanguinaria). It also has agents that assist in metabolism (Sulphur, Nicotinamide adenine dinucleotide [NAD], Coenzyme A, alpha-lipoic acid, and sodium oxalacetate). It is useful for arthritic pathology in any location, but it is best for stifle arthritis. Combine with other agents to target specific anatomical areas (See the homotoxicology chapter references).

Authors’ suggested protocols

Nutrition

Cartilage / ligament / muscle / skeletal support formula: 1 tablet for every 25 pounds of body weight BID.

Eskimo fish oil: One-half to 1 teaspoon per meal for cats. 1 teaspoon for every 35 pounds of body weight for dogs.

Evening primrose oil: 1 capsule (500 mgs) for every 25 pounds of body weight daily.

Zyflamend: One-half dropper for every 25 pounds of body weight BID.

Chinese herbal medicine / acupuncture

JointGuard: 1 capsule per 10 to 20 pounds twice daily. This supplement has analgesic, antiinflammatory, and antipyretic effects. In addition to the herbs mentioned above, JointGuard also contains amenarrhena (Zhi mu), allium (Cong bai), siler (Fang feng), cnidium (Chuan xiong), platycodon (Jie geng), bitter orange (Zhi ke), peu-cedanum (Qian hu), poria (Fu ling), and jujube fruit (Da Zao).

Homotoxicology

Initial therapy: Traumeel S drops BID and Zeel tablets twice daily; recheck in 3 weeks. Injection therapy, bio-puncture, or autosanguis with these agents can be very useful and can be repeated every 2 weeks to speed up response. Select other agents to target specific locations or symptoms.

Product sources

Nutrition

Cartilage / ligament / muscle / skeletal support formula:

Animal Nutrition Technologies. Alternatives: Cosequin — Nutramax Labs; Glycoflex — Vetri Science; Musculoskeletal support — Standard Process Veterinary Formulas; Nutriflex — Vet Rx Vitamins for Pets; Arthragen — Thorne Veterinary Products.

Evening primrose oil: Jarrow Formulas.

Eskimo fish oil: Tyler Encapsulations.

Zyflamend: New Chapter. Alternative: Botanical Treasures — Natura Health Products.

Chinese herbal medicine

HI and H95: Natural Solutions, Inc.

Homotoxicology

BHI / Heel Corporation