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arthritis

Overcoming Inflammation

Exercises to help hand osteoarthritis

November 21, 2017
Exercises to help hand osteoarthritis

Osteoarthritis is the most common joint disease.  Unlike rheumatoid arthritis, osteoarthritis is not an autoimmune disease.  Osteoarthritis mainly affects the fingers, knees, hips, as well as the spine.  Today, I would like to talk about hand osteoarthritis, which is much more common in women and particularly women above the age of 50.

We like to think of osteoarthritis as a wear-and-tear arthritis, however, this is somewhat adopting a limited view.  Osteoarthritis certainly has to do with wear-and-tear, however, there are several biochemical and genetic factors that play a crucial role in the pathogenesis of the condition.

Because osteoarthritis is not an autoimmune disease, medications that we use for rheumatoid arthritis that deal with the immune system like methotrexate, are generally not effective in either alleviating pain or stop progression.  Currently there are no disease modifying medications that significantly alter the progress of the disease.  Typically, treatment relies on analgesic medications, both topical and oral, splinting, steroid injections, and surgery.

Although there are no medications that alter the progress of osteoarthritis, hand exercises play a major role in improving function and alleviating pain.  The aim is to strengthen the muscle surrounding the joints to act as cushion to reduce the pressure on the joints.  This will have the effect of improving grip strength, range of motion, and help with pain.

Here’s some evidence.

Hand anatomy

First let’s refresh our anatomy.

First of all, here we have a picture that illustrates the various bones that make up your hand.

  • Carpals
  • Metacarpals
  • Proximal phalanges
  • Intermediate phalanges
  • Distal phalanges

Distal phalanges, intermediate phalanges, proximal phalanges, metacarpals, carpals

And then we have the joints that make up your hand.

  • Midcarpal joint
  • 1st carpometacarpal (CMC) joint
  • 1st interphalangeal (IP) joint
  • Metacarpophalangeal (MCP) joints
  • Proximal interphalangeal (PIP) joints
  • Distal interphalangeal (DIP) joints

DIP, PIP, MCP, IP, and CMC joints

Finally, your hand needs to adapt to do everyday tasks.  Below you will find a picture that demonstrates the arches of the hands.  Basically, these are the different ways your hand can move – range of motion.

Arches of the hand

Improved hand function, self-rated health and decreased activity limitations – results after two month hand osteoarthritis group intervention

A recent study aimed to study the effect of exercise and paraffin wax therapy on osteoarthritis.  They wanted to see if their intervention would improve hand function, activity limitation, and self-rated health in people suffering from hand osteoarthritis.[1]

This was a prospective cohort study which consecutively recruited people in a primary care clinic in Sweden.  They included people who were symptomatic or had radiographically verified and osteoarthritis.  Finally, they excluded people who had other types of hand diseases, like rheumatoid arthritis or had undergone hand surgery.

Intervention

The intervention consisted of both an educational and exercise component.  People received two group sessions lasting an 1 ½ each.  During the educational piece, they discussed osteoarthritis in general, as well as guides to treatment.  They also discussed why exercise is important for rehabilitation and how to perform exercise as well as how to modify exercise due to pain.

The exercise component started after two educational sessions.  They were held twice weekly over a six-week period.  These were spearheaded by occupational therapists.  Each session started with 20 minutes of paraffin wax therapy followed by 25 minutes of hand exercises.  Typically these included 14 different types of exercises performed at least five times during the 25 minute.

Assessment

Everyone who participated in the study saw one of three occupational therapists at baseline, after three months (after the end of the intervention), and after 12 months (long-term follow-up).  During each visit, the occupational therapist measured hand function, activity limitation, as well as self-rated health.

Hand function

  • Range of motion
  • Grip force
  • Hand pain
  • Grip ability

Activity limitations

Self-rated health

Results

A total of 49 people participated in the study: 5 were men and 44 were women.  There weren’t any significant differences between the participants who completed study versus those who dropped out, except that the people who dropped out were more likely to be working and the people who completed the study were more likely to be retired.

Hand function

  • Grip ability improved significantly from baseline to three months, p<0.001. There was no difference between three months and at 12 months.
  • Range of motion improved significantly from baseline to three months, p= 0.011. There was no difference between the results at three months and 12 months.
  • Grip force improved significantly from baseline to three months, p<0.001 in the right-hand as well as in the left-hand, p=0.008. The left-hand continued to improve between three months and 12 months but not the right hand.
  • Hand pain at rest also significantly reduced after 3 months, p<0.001. There was no difference between the results at three months versus 12 months.

Activity Limitations

  • Activity limitations in all three activities improved significantly from baseline to three months, p=0.008, p=0.001, p=0.004. There was no change between three months and 12 months.
  • Activity limitations using the Quick-Dash improved significantly from baseline to three months, p=0.001.

Self-rated health

  • Self-rated health also improved significantly between baseline and three months, p=0.039, and the results remained stable at long-term follow-up.

Limitations

The study had multiple limitations:

  • Small sample size
  • Based on the study design, it was impossible to tell whether the improvement in activity and self-rated health leads to improve hand function or vice versa.
  • This was not a randomized control trial.
  • Unable to distinguish the results of the separate parts of the intervention.

Conclusion

People who suffer from osteoarthritis appeared to improve when it comes to hand function, activity limitations, as well as overall self-rated health when they combine education as well hand exercises.  The improvements were also sustained at 12 months!

In this study, the participants also started their exercise program with a paraffin wax bath.  The European league against rheumatism (EULAR) recommends local application of heat, light, paraffin wax therapy, for the treatment of osteoarthritis as a short-term treatment option to decrease pain and to support muscle strength.  There is ample evidence supporting that hand exercises independently improve pain and function in osteoarthritis.  That being said, it’s safe to say that the improvement seen during the course of this study were not solely caused by paraffin wax therapy.  Although, who would ever say no to a nice relaxing paraffin wax bath?

Hand osteoarthritis program

Now that we have evidence that exercise supporting the role of exercises to improve hand osteoarthritis, it’s time to start the healing process.  Now not all of us either has resources or the time to see an occupational therapist twice a week, but here are a few interventions that you can do in the comfort of your home.

Remember, hand exercises for osteoarthritis should include flexion and extension of the DIP, PIP, and MCP joints, opposition of the index and middle fingers, and well as an opening grip movement – like opening up a door handle.

Please leave your comments below!

References

[1] Bjurehed L, Brodin N, Nordenskiold U, Bjork M. Improved hand function, self-rated health and decreased activity limitations – results after a two month hand osteoarthritis group intervention. Arthritis Care Res (Hoboken). 2017 Oct 3. doi: 10.1002/acr.23431. [Epub ahead of print]

Scheme human hand bones, Mariana Ruiz Villarreal (LadyofHats); retouches by Nyks

Human-Hands-Front-Back, by Evan-Amos

Hand-arches, Drawn freely (OK, crappy) from Physiology of the Joints, I.A. Kapandij 1982, p. 169. Made in Inkscape. |Source={{own}} |Date=January 2013 |Author= [[User:Fama Clamosa|Fama Cl…

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

Overcoming Inflammation

How to boost joint wellness with turmeric

December 19, 2016
Turmeric capsules, supplementing with turmeric can help joint inflammation

A few years back, my mother-in-law brought me a grocery bag full of supplements.  You heard it, a GROCERY BAG of supplements.  To boot, this was her monthly supply.  Not lifetime, not yearly, her monthly supply.  Every month, she was ingesting a grocery bag full pills for various ailments.  That’s a lot pills.  This was very concerning to me.  First, this had to be very expensive and she had very little, if any knowledge of what she actually was taking.  What were some of the potential side effects?  Were any these interacting with each other?  Were these interacting with her prescribed medications for diabetes and thyroid disease?

Now, I don’t know about you but the world of supplements is downright daunting.  How do you know whether a supplement works for its intended purpose and is it safe?  There’s so much conflicting data out there.

Today, I’d like to show you how I approach assessing the efficacy and safety of any supplement, medication, or procedure.

I’m going to use turmeric, also known as Curcuma, as an example.  This is a supplement that is rapidly becoming an important player in the world of supplements.  It’s used to treat various conditions such as osteoarthritis.

Safety First!

First, here are a few safety tips.  The FDA regulates herbal supplements but they fall under a group called dietary supplements.  When it comes to dietary supplements, manufacturers don’t have to seek FDA approval to put their product on the market.  They don’t even need to prove that their product actually works.  Manufacturers must follow good manufacturing practices to make sure that the supplement is processed consistently and meets quality standards.

For example, they aren’t allowed to cut their product with pesticides and heavy metals.  In the event that they do, the FDA can take action against the manufacturer or distributor and have the product recalled.  Basically the FDA has to make sure dietary supplements aren’t harming anyone.

High risk situations

High risk situations include: you’re pregnant or breast-feeding, you’re about to have surgery, you’re younger than 18 or older than 65, or you’re already taking other medications.  Herbal supplements may interact with your other medications and these interactions could be harmful or life-threatening.

The following are items that should always be made available on the labels of all herbal supplements:

  • The name of the supplement
  • The name and address of the manufacturer or distributor
  • A complete list of ingredients
  • Serving size, amount, and the active ingredient

 

When in doubt, ask your doctor or your pharmacist.  I argue that, you should ALWAYS ask your doctor or pharmacist.

Anything you put in your mouth, whether it be FDA approved, regulated, or not, in a way is a medication and has the potential to cause good but also cause harm.

Of note, the FDA regulates American manufacturers and distributors.  If the supplement comes from anywhere else, all bets are off.  Many countries don’t screen for or regulate their manufacturers so it’s impossible to know whether they contain any unwanted and potentially dangerous components.  I’ve included a few websites in the reference section, to help you with your research.

The Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Osteoarthritis is super common.  It affects about a quarter of the worldwide population.  There are no known cures.  Well maybe joint replacement but that’s kind of extreme and even then, it’s not a magic bullet.  Turmeric is a spice used in cooking for a really long time.  Millenia…  This spice has different bioactive components, the most important one being curcuma.

Curcuma is actually really interesting.  It modulates a completely different inflammatory pathway as compared to standard arthritis medications like naproxen, ibuprofen, or celecoxib.  It modifies something called NF-κβ signaling.  This pathway helps maintain normal immunity, but it also is linked to cancer and other diseases such as heart disease, asthma, inflammatory bowel disease, and osteoarthritis.  Don’t get me wrong, abnormal NF-κβ activity DOES NOT cause cancer or osteoarthritis.  It simply appears to be active when these diseases are present.

Methods

That really long header you just read, is the title of a recent study that sought to look at all prospective randomized clinical studies using turmeric for arthritis.  This type of study is a meta-analysis.  The researchers found eight studies: 4 high quality studies and 4 moderate quality studies.  The researchers used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess arthritis severity.  This is how bad the arthritis is general, how it limits your quality of life.  They then measured pain with the pain visual analogue score (PVAS).  Thankfully the dose of turmeric was similar across the studies: about 1 gram/day without pain killers and about 500 mg/day with pain killers.

Results

What the researchers found was that people receiving turmeric had lower WOMAC scores compared to placebo.  People receiving turmeric reported improved morning stiffness and overall ability to move.  Moreover, the improvement seen in the turmeric groups were similar to those achieved in ibuprofen and diclofenac groups.  These are standard arthritis medications.  The problem with them is that they can cause stomach problems, they can affect the liver and kidneys, and they should not be used when someone has coronary artery disease or is on blood thinners.  The nice thing about turmeric is that it is not associated with any of these nasty side effects.  At high doses it can cause some diarrhea and it has NOT been studied in pregnant or lactating women.

So basically, the study concluded that turmeric or Curcuma more specifically, at dose of 1000 mg per day can help the decrease arthritis symptoms.  They also mentioned that the sample size (i.e., number of people) of the various studies they included were rather small and some of the studies weren’t top notch quality.

“Therefore, turmeric extracts and curcumin can be cautiously recommended for alleviating the symptoms of arthritis, especially osteoarthritis.”

A few words of caution:

  • Always carefully read the packaging.
  • More is not necessarily better. 8 -12 grams of curcumin can cause diarrhea and can cause anemia.
  • Notify your doctor when you decide to start a new supplement.

Are there other natural supplements that block NF-κβ?

So the question is, are there other natural supplements that block NF-κβ?  The answer is yes.  Researchers are actively looking into these potential supplements: green tea, rosehip, and resveratrol.  Whether theory translates into clinical efficacy?  Please stay tuned for more!

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

References

NIH Dietary Supplement Label Database: https://dsld.nlm.nih.gov/dsld/

National Center for Complementary and Integrative Health: https://nccih.nih.gov/

Office of Dietary Supplements: https://ods.od.nih.gov/

Pubmed: https://www.ncbi.nlm.nih.gov/pubmed

Daily JM, Yang M, Park S. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. J Med Food. 2016 Aug;19(8):717-29.

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