Osteoarthritis (osteoarthritis, also known as degenerative arthritis, degenerative joint disease), is a condition in which low-grade inflammation results in pain in the joints, caused by abnormal wearing of the cartilage that covers and acts as a cushion inside joints and destruction or decrease of synovial fluid that lubricates those joints. As the bone surfaces become less well protected by cartilage,  pain is experienced upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and  ligaments may become more lax. Arthritis is considered an autoimmune disease, where the body attacks itself (i.e. allergies).

Osteoarthritis is the world's most common form of arthritis. In America alone, OA accounts for 7 million doctor's visits annually. More than 20 million Americans suffer from osteoarthritis, with half a million Americans having a total joint replacement each year.  The Centers for Disease Control (CDC) report that OA causes more physical limitations than lung disease, heart disease and diabetes mellitus. In fact, if you are over the age of 65 one in two people are inflicted with arthritis, with the knee being one of the most common joints involved. With so many people suffering from this condition worldwide there has been an extreme amount of interest in discovering ways to address the painful symptoms of this sometimes disabilitating disease.

In 2002 research conducted by the Arthritis Foundation surveyed over five thousand people discovering a whopping fifty-two percent of those people were unaware they were at risk for arthritis. Sixty-seven percent were reported as already at risk for the disease, and worse, fifty-three percent, more than half the total number of people surveyed, were already found to be exhibiting common symptoms of arthritis.

The same press release issued by the Arthritis Foundation stated arthritis is the nations leading cause of disability, and one out of every six Americans has some form of arthritis. They also predict that by the year 2020, the odds become one in five; roughly, 60 million people in the United States will suffer from arthritis in the future. 

Osteoarthritis Symptoms 

Mosby's Medical Encyclopedia lists one of the principal symptoms in Osteoarthritis as being a deep, painful aching in the joint, which may be exacerbated by exercise, activity, or weight-bearing movements. Additionally, a "grating" of the joint may occur. This may occur during ambulation or other movement, along with joint stiffness, especially in the morning.The main symptom is chronic pain, causing loss of mobility and often stiffness. "Pain" is generally described as a sharp ache, or a burning sensation in the associated muscles and tendons.

Osteoarthritis can also cause a crackling noise (called "crepitus") when the affected joint is moved or touched, and patients may experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with fluid.

Joints that ache in cold or humid weather, gait changes, and range-of-motion limitations may also be some other symptoms. Emotional or occupational stress, poor posture, and obesity can all aggravate the symptoms. Osteoarthritis is also the most common cause of water on the knee, an accumulation of excess fluid in or around the knee joint. 

Osteoarthritis may eventually lead to impaired functioning of the joint itself, especially weight-bearing joints, like the hips or knees. 

Osteoarthritis Treatment 

Arthritis is one of the most common chronic diseases in the world. Despite lot of research and effort, generally speaking, the process of osteoarthritis is irreversible, and typical treatment consists of medication or other interventions that can reduce the pain of osteoarthritis and thereby improve the function of the joint. Natural treatment options may include:

• Weight control. Excess weight puts extra stress on the joints and will increase pain and cause damage. 
• Appropriate rest. Most experts agree that rest is most prudent when a person is having a flare-up.
• Acupuncture.  A meta-analysis of randomized controlled trials of acupuncture for knee osteoarthritis concluded "clinically relevant benefits, some of which may be due to placebo or expectation effects"
  

	Acupuncture Acupuncture is a technique of inserting and manipulating fine filiform needles into specific points on the body with the aim of relieving pain and for therapeutic purposes.

• Heat. Heat can ease inflammation and swelling, and may improve circulation, which has a healing effect on the local area. Types of heat treatment may include: moist heat, paraffin dips for hands, etc.
• Cryotheraphy.  Cryotheraphy (or cryotherapy) is simply the therapeautic use of cold or freezing, used to treat a variety of minor conditions. Cryotherapy involves putting ice on the area for 5 minutes at a time. This will help reduce the pain. Do not continue to apply ice if a burning sensation is felt.

• Regular exercise.  Exercise needs to be part of the client's daily routine, just like good nutrition and proper usage of medication. Proper exercise brings nutrients to the joint; helps protect the joint by improving the stability through increased strength of the muscles (this ultimately reduces the load on the joint; improves range of motion, improve bone density, retard bone loss, and will assist with burning calories that may lead to weight loss that will decrease the load on the joint. Activities that place a heavy load on a joint are ill advised. Jogging on hard surfaces, full squats, overhead presses with heavy weights, biking with heavy resistance and even walking or water exercise without proper shoes can increase pain. Exercise should be in the form of walking or swimming, is encouraged.
• Massage therapy. While massage is contraindicated during the severe phases of osteoarthritis, many studies have found massage therapy beneficial when symptoms allow, such as when there is no inflammation, or acute pain.Massage offers osteoarthritis sufferers numerous benefits, including a reduction in muscle tension and increase in blood flow to the treated areas. Massage can also assist in alleviating pain associated with OA, by eliciting the parasympathetic response (the relaxation response) in the body.The American Massage Therapy Association reports that 74% of medical practitioners feel massage is usually or always effective as a conjunctive therapy.
• Bone Friendly Diet. Nutritional changes shown to aid in the treatment of osteoarthritis include decreasing saturated fat and using a low energy diet to decrease body fat. A low fat vegetarian diet can reduce arthritis symptoms. A macrobiotic diet has been known to reduce symptoms as well.
• Supplements.There have been several studies showing potential benefits of dietary supplements for treating osteoarthritis . Potential treatment options may include:

1. Glucosamine. Supplemental glucosamine may improve symptoms of osteoarthritis and delay its progression. The jury is still out as there are studies that show the benefit, while other studies conclude that glucosamine hydrochloride is not effective and that the effect of glucosamine sulfate is uncertain.
2. Chondroitin sulfate . Along with glucosamine, chondroitin sulfate has become a widely used dietary supplement for treatment of osteoarthritis. The Osteoarthritis Research Society International is in support of the use of chondroitin sulfate for osteoarthritis, however there have been studies which have found no benefit from chondroitin.
3. Vitamin D. Vitamin D deficiency has been reported in patients with osteoarthritis, and supplementation with Vitamin D3 is recommended for pain relief.
4. Hydrolyzed collagen (hydrolysate). Hydrolized collage (a gelatin product) may also prove beneficial in the relief of osteoarthritis symptoms, as substantiated in a German study by Beuker F. et al. and Seeligmuller et al. In their 6-month placebo-controlled study of 100 elderly patients, the verum group showed significant improvement in joint mobility.
5. Omega-3 fatty acid, a vitamin supplement comprised of important oils derived from fish has shown to benefit bone health. In fact, recent studies have shown that plant-based omega-3 polyunsaturated fatty acids (PUFA) contained in such foods as flaxseed and walnuts may have a protective effect on bone health, according to a team of Penn State researchers who carried out the first controlled diet study of these fatty acids.
6. Antioxidants, including Vitamins C and E in both foods and supplements, has shown in studies to provide pain relief from osteoarthritis.
7. Pycnogenol.  A new study to be published in the April 2008 edition (Volume 22, issue No 4) of the journal of Phytotherapy Research shows Pycnogenol (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree, was shown to reduce all osteoarthritis symptoms by 56 percent. The study revealed a particularly high efficacy of Pycnogenol for lowering joint pain by 55 percent. Moreover, patients required dramatically less standard pain medication (-58 percent), which greatly improved the gastrointestinal complications resulting from the pain medication by 63 percent. In addition to the osteoarthritis results, 76 percent of the patients in the Pycnogenol group and 79 percent in the placebo group showed visible ankle and foot edema at inclusion of the study.  After the three months, edema decreased in 79 percent of the Pycnogenol patients and only one percent in placebo-treated patients. A even larger more detailed study on osteoarthritis  carried out at the University of Arizona Tucson (published in Nutrition Research) prior to this study had discovered that Pycnogenol was effective for improving pain and joint function. After three months in the Pycnogenol group, there was a reduction of 43 percent in pain, 35 percent in stiffness, 52 percent in physical function subscales, respectively. The placebo group showed no significant scores throughout the entire study. Based on the studies the benefits of Pycnogenol for arthritic joints are suggested to result predominantly from the anti-inflammatory potency of Pycnogenol. There are more breakthrough studies on Pycnogenol and osteoarthritis expected to be published next year allowing for development of innovative, natural formulas for joint health.
8. Boswellia.  Boswellia is an herbal supplement in Ayurvedic medicine also know as Indian frankincense, salai guggal, and boswellin. The proper botanic label for boswellia is Boswellia serrata. It is derived from the resin of the bark of the Boswellia tree. While it grows in other parts of Southeast Asia, it is found abundantly found in the Indian subcontinent. The condition for which boaswellia has had the most supporting evidence for a beneficial effect is arthritis. The most convincing study was published in 2003 (Phytomedicine. 2003 Jan;10(1):3-7) when a research study examined  patients with osteoarthritis of the knee. Half of the patients received daily supplementation with 333 mgs of Boswellia. The other half received placebo. After the first intervention, washout was given and then the groups were crossed over to receive the opposite intervention for eight weeks. All patients receiving boswellia reported decrease in knee pain, increased knee flexion and increased walking distance. The frequency of swelling in the knee joint was decreased. Radiologically there was no change. The observed differences between drug treated and placebo being statistically significant, are clinically relevant. The conclusions of the study  were: “Boswellia serrata extract is recommended in the patients of osteoarthritis of the knee with possible therapeutic use in other arthritis.” Other studies have demonstrated anti-inflammatory and analgesic properties. Diseases that have been studied where good results have been reported include rheumatoid arthritis, osteoarthritis, inflammatory bowel disease, and bursitis.
9. Ginger (rhizome) extract. Ginger has shown in some studies to improve knee osteoarthritis symptoms moderately.
10. Selenium.  Selenium deficiency has been correlated with a higher risk and severity of osteoarthritis.
11. Vitamins B9 (folate) and B12 (cobalamin). Both taken in large doses significantly reduced osteoarthritis hand pain, presumably by reducing systemic inflammation.