Ayurveda Treatment for Osteoarthritis

Do you know what this medical term means? Osteo means your bones and arthritis means painful inflammation of joints. Basically, a degenerative joint disease, this condition is often nick-named Wear and tear arthritis affecting joints in the hands, knees, and more weight-bearing hip and spine too. If you are female, you are more likely to encounter this disease in your lifetime. If you are nearing the stoppage of periods aka menopause, you can get this, like seriously. After all, your bone becomes brittle as age advances, right?

Symptoms of Osteoarthritis 

Swelling on joints, pain in joints, stiffness in joints, tenderness, crepitus, muscle weakness, joint pain which worsens later in the day, and even pain after long periods of inactivity are seen as symptoms often when you have this condition OA of knees occur due to excess upper body weight, injury or joint surgery.

About Osteoarthritis and its prevalence

Osteoarthritis is a joint disease, which is common all over the world. In our country, the prevalence is 22 to 39 percent. It is more common in women than in men. 

45 percent of women after the age of 65 are dealing with the symptoms of osteoarthritis today, while about 70per cent are showing clearer radiological evidence of the disease. 

Over the world, 9.6 percent of men and 18 percent of women have systemic symptoms of osteoarthritis. This disease restricts the movement of 80 percent of patients and 25 percent of them complained of an inability to carry on their daily activities. 

Osteoarthritis affects more than 30 million in the United States of America. Internationally, osteoarthritis is the most popular articular disease. The prevalence varies all over the world, locations, and ages.

When and how does osteoarthritis happen?

• Osteoarthritis was primarily thought to be a disease that degenerates the articular cartilage. That results in the chemical breakdown of the hyaline cartilage of the synovial joints. But it is a disease of the whole joint organ, the synovium, and also the subchondral bone in the joint. 
• It was also assumed to be inflicted by wear and tear previously. Which are contributed by inflammation and abnormal mechanical stress. Some invasive procedures that are previously performed also end up in osteoarthritis after a while. That is why osteoarthritis is no longer called a degenerative disease. 
• Osteoarthritis is divided into two forms, a primary and a secondary form. Although the classification is artificial. 
• The primary form of osteoarthritis or an idiopathic form is not affected by any enticing agents or triggers or underlying causes. The definition of primary osteoarthritis is nebulous. It is less clear to put in words. 
• It is more of an aging process seen in older individuals after 50 years. It starts purely as an idiopathic phenomenon, with no specific initiating factor but affects the already healthy and intact joints that have been so for years. 
• Osteoarthritis of digits, fingers, joints at the base of the thumb, and joints in the hands are categorized under primary osteoarthritis. Though, some physicians also include hip, pelvis, spine, knee, etc flexible joint articulations as well in the same. 
• Whereas the secondary form of osteoarthritis is stimulated by a reaction to tears, injuries, trauma, and previous surgeries. It is induced by predisposing factors. Although the form is only deduced by physical examination, patient medical history, and conditions. 
• Some investigators believe that primary osteoarthritis of the hip joint can be affected by subtle, unrecognizable, and congenital developmental defects of an individual and not always by aging. That is why it is figured out in adults as young as 18 years onwards with the severely low bone density of hip bone.

Subtypes of primary Osteoarthritis:

1. Primary generalized osteoarthritis 

• Often referred to as degenerative osteoarthritis. Primary generalized osteoarthritis is idiopathic, not a sure ground. Its description makes sense to elderly patients but the younger ones.
• But familial osteoarthritis is correlated with aging and developmental defects like premature development of Heberden’s and Bouchard’s nodes. Congenital defects are also stated in the list. The bone mass density of the bones has nothing to do with the cause of osteoarthritis. 
• In recent research done on the relationship between bone mass density and primary generalized osteoarthritis, it is seen that the bone mass density of the hip joint is higher than normal in primary generalized osteoarthritis. So no trial of the bone mass density of the patient would help in finding the cause of the disease. But yes, the density of bone remains can be sorted out.
• Familial osteoarthritis is associated with the degeneration of the cartilage. Even a radiographic image of the disease on familial grounds is distinguishable from the nonfamilial. 
• The joints of hands and fingers, metacarpal joints, pelvic or hip joint flexion like knee joints, and spinal articulations are the areas of the primary generalized osteoarthritis. It can also affect multiple joints at once as in polyarthritis. 
• Specifically, articular lesions can enhance the rapid progression of the disease. The cartilage tissue located on the articular joints erodes completely, crippling the function of the patients. 

2. Erosive osteoarthritis

• Primary Osteoarthritis that has degradation along with the ongoing inflammation is erosive arthritis. It is found in women after menopause. It can be hereditary and is also reported in men, but scarcely compared to women. 
• The signature symptom is this gull fig appearance of the phalangeal joints. Central erosions of the cartilage. 
• Osseous fusion and soft tissue swelling are the other symptoms. There is also a close-knit similarity between rheumatoid arthritis for erosive osteoarthritis. 
• Diagnosis also involves evaluating the autoimmune, metabolic, and hormonal values. No lab findings or sedimentation evaluations vary much in this disease. 
• The stage of the disease is found by a biopsy. Inflammation in this disease is so huge, and the articular joints degrade so fast that their erosive abnormalities arise in no time. 
• Occurs in the joints of the hands and fingers in between the phalanges and the last joint of the fingers. In rare instances, it can cause inflammation of the first carpel, even of feet. 
• Hand functioning and gripping get restricted, as the disease progresses. Holding things and lifting them becomes hard.
• Physical therapy, painkillers like prednisone, and NSAIDs are prescribed and also other treatment strategies are required.

3. Patellofemoral pain syndrome

• Patellofemoral pain is commonly complained by anterior knee pain in youth and adults under 50 years of age. Yearly 23 percent prevalence is reported for this syndrome. 
• Higher weight and higher BMI are found to be the add ons for the grievance. 
• Symptoms apart from pain implicate the clicking sound in movement, pain in the knees on sitting, stretching, standing, the tenderness in the patella facet. 
• This is inflicted by the imbalance in controlling the patellar compression while bending the knees, and being overweight on the knees increases mechanical stress on the joints. 
• This happens through continuous stress through or behind the knees, weight-bearing activities, running, jogging, squatting, stair ambulation, jumping, etc. 
• Generally, when knee pain is being complained of there is always a priority for the tibiofemoral joints, but the patellofemoral pain is as much as associated with osteoarthritis. The evaluation does not need a radiograph immediately. 
• A clear note of chronicity of the pain, the location, examination of the knee bone and the surrounding structures, and previous treatments are taken. 
• Physical therapy is just sufficient for treating patellofemoral pain syndrome. Strengthening exercises of the hip, flexion, knee, and trunk muscle groups along with a short course of non-steroidal anti-inflammatory drugs are prescribed, with surgery being the last resort. 
• Radiographs are recommended for the elderly above 50 years of age, for differential diagnosis from other types of arthritis, and diseases.

4. Post-traumatic osteoarthritis:

Post-traumatic osteoarthritis develops lately after a joint injury. Those that have had a tear or injury to the anterior cruciate ligament have greater risks of this disease.

The incidence of an anterior cruciate ligament tear progressing into post-traumatic osteoarthritis is high. That is why remodeling of the anterior cruciate ligament, possible mechanisms to stop the advancement, interventions, and therapeutic actions to combat the disease, are highly necessary.

As the start of post-traumatic osteoarthritis is much clearer, early detection and intervention can work efficiently for the prevention. Standardized assessment techniques, non-surgical treatments, and exercises can alleviate the pain to a great extent in post-traumatic osteoarthritis.

5. Progression of osteoarthritis:

• The progression of osteoarthritis happens slowly. It advances over the years and decades of the disease. 
• The patient gets a little more sedentary day by day also with the developing morbidities and complications of the same. 
• Weight gain that comes with potential inactivity can also bring in unwanted complications.  
• At the beginning of the disease, joint pain is the only potential morbidity experienced. And also the joints look normal even with pain. 
• Antalgic gait issues can be noticed in patients with weight-bearing joints involved in osteoarthritis. The posture, standing, sitting everything gets influenced  
• They happen to limp or walk abnormally. 
• The pain in osteoarthritis is a deep achy pain that radiates from deep within, as deep as the joints and muscles over them. 
• Restricted motion of the bones and joints makes life hard each day.
• Also the inability to move increases day by day with popping, crackling, and tickling of the joints when moved. Crepitus is harmless and not painful at all. But it is also present along with immobility. 
• The primary symptom is pain, it can be exacerbated with extensive use. In the initial days of the disease, rest can ease the pain, with also the use of simple analgesics. As the disease progresses, the stiffness of the joints increases with the rest taken. 
• The decrease in motion and a prominent increase in pain happen with the progress of the disease. Morning stiffness of the joints can last up to half an hour after waking up. 
• The pain later becomes unyielding to the medications and also rest in the latter days. Sedentary life becomes a habit.

The cause and development of osteoarthritis happen in three progressive stages. 

What happens in a joint affected by osteoarthritis?

• Our body responds with a repair for every damage and breakdown it faces. In the synovial joints, when osteoporosis starts, a biochemical breakdown occurs. 
• To balance this out, a repair of tissues has to begin. But the imbalance between these two processes results in osteoarthritis. 

Stage one:

A  proteolytic breakdown happens in the collagen matrix of the joint. The chondrocytes metabolism which is affected produces the enzymes that are proteases, collagen, stromelysin, etc. Which causes further destruction to the collagen matrix. Besides this, the chondrocytes also produce protease inhibitors including the tissue mallet proteases TIMP1 and TIMP2. But their deficiency can not counteract the proteolysis effect of melting away the collagen. 

Stage two: 

The cartilage surface on the synovial joints gradually deteriorates. The chondrocytes fail to bind to the fibronectin. Fibrillation and erosion of the cartilage follow. The fragments of the collagen and the proteases fall into the synovium now.

Stage three:

All the products of the cartilage breakdown start to induce the inflammatory effect in the synovium. A chronic inflammatory response begins with cytokines, tumor necrosis factor, cytokines like interleukins 1, and macrophages like the metalloproteases of the synovium. All of these can flow back up to cartilage only to cause additional inflammation to it. 

• By the progression of the third stage, the architecture of the joint alters. A bone overgrowth can be seen to compensate for the same. Once the cartilage disappears, the bones rub one with another. This leads to gait, immobility, more mechanical stress, and more inflammatory stress. And the disease progresses unchecked in no time.

Grading of the osteoarthritis

• The focal cartilage degradation is measured into grades by a worldwide accepted system called the kellgren Lawrence grading system. It is based on the radiographic findings of osteoarthritis. 
• As the diseases from cracking of the cartilage to its complete loss, the radiographic findings show a clearer demarcation of the joints, thinning of the cartilage, joint space narrowing, etc. 
• To classify this system uses four features of the joints: joint space narrowing, osteophytes, subchondral sclerosis, and subchondral cysts. 
• The grading is from 0 to 5. Where 0 is no osteoarthritis and 5 is severe arthritis. In grade 0 the articular cartilage is normal, in grade II it starts to soften and swell, in stage III it starts to fragment and fissure to less than 0.5 inches and if it is more than 0.5 inches it is grade IV and if the fragments and cartilage dissolves to the subchondral bone, then it is the severe grade V

Rehabilitation options for osteoarthritis:

• Therapeutic approach: therapeutic exercises are the best non-pharmacological methods available to treat osteoarthritis. The stress is placed on the types of exercises, duration of the exercise, exercise intensity, duration, resistance equipment, and supervision. 
• The different types of therapeutic exercises are concentric which shortens muscle length, eccentric which lengthens the muscles, isometric exercises which contract the muscle fibers, and kinetics exercise which acts on the muscles at a constant tension and constant speed. 
• Aerobic exercising, and also low impact exercises for knee joints, are proven to cause considerable relief from pain.
• Walking for longer times like 30mins or 45 mins on a treadmill increases the knee pain, whereas the same walk for shorter times like 15 mins and at intervals are said to ease the pain.
• Both weight-bearing and non-weight-bearing exercises have been in use for osteoarthritis. Whereas the weight-bearing exercises have demonstrated improvement, in posture to pain. 
• Home exercises that are of low impact and for at least three days a week yield a good result after 12 sessions.
• Occupational therapy: this includes protection for the joints, which includes cradling objects that ease the use or strain of holding, and assistive devices that improve function and decrease the joint strain such as neoprene and thermoplastic splints. Although occupational therapy is alone sufficient to improve the quality of life, it together with therapeutic exercises works the best.

Medications for osteoarthritis: 

• Acetophenone is administered to the patients. It is given in combinations of non-steroidal anti-inflammatory drugs and intra articular corticosteroids in case of higher dosages.
• Nutritional supplements are given as a part of the treatment plan. 
• For the elderly with chronic kidney diseases, topical NSAIDs are suggested. For those with no history of gastrointestinal bleeding for at least a year a combination of oral NSAIDs can be given along with a Proton pump inhibitor. 
• Biologic injections, steroid injections, stem cell therapies, ibuprofen on lesser aspirin, hyaluronic acid injections, opioid analgesics, platelet-rich plasma injections, disease-modifying therapies, using orthoses like footwear and cushioning devices are utilized in treating osteoarthritis. 
• Intra Articular steroid injections provide pain relief and are believed to significantly reduce the inflammatory effects on the knee. Their benefits last for six weeks on a stretch. The platelet-rich plasma injections are commonly used and derived from the patient’s blood itself. Biologics are derived medications from cultured cells, infliximab is one such injection.
• Acupuncture, massage therapy, physiotherapy, and stimulation therapies like transcutaneous electrical nerve stimulation and pulsed electromagnetic simulations are other treatment options. There is no data enough to establish the potential of massage therapy and acupuncture. But many patients to date said that they’re able to get back to their normal life after the massage therapy. 

Surgical interventions for osteoarthritis

• Apart from all these, surgical interventions are most often seen in patients with severe osteoarthritis. Depending on the location, degree of involvement, damage, and joint, various interventions are taken into consideration. 
• For knees, arthroscopic lavages, joint realignments, joint fusions, and joint replacements aka arthroplasty. These unicompartmental arthroplasties are used for the knees, often because of the speed recovery rate, and better motion after the operation. 
• For the hip, the replacements of the joints are two types, hemiarthroplasty or total hip arthroplasty which replaces the femoral sides of the hip with or without the acetabulum. Even for the hip joint, joint realignment or osteotomy, and joint fusion called arthrodesis are available surgical interventions. 
• The prognosis is great for patients who get their osteoarthritis joints replaced. They get back to their normal life in less than six months after surgery. The success rate also is as high as 80 percent. The prosthesis should be revised 10-15 days after installation. 

Ayurvedic take on Osteoarthritis 

Known as Sandhi Gata Vata in Ayurvedic classics, this condition is caused due to incompatible food, insufficient intake of food, consumption of dry, cold, or stale food, irregular sleeping habits, exposure to severe cold, and dry weather, suppression of natural urges and excessive physical exhaustion. 

Ayurveda considers pain as the primary symptom associated with any Vata imbalance in the body. Joints are also vital locations of wind energy in your body. Obviously, the imbalance disturbs the lubrication of the joint and its smooth movements making it weak and brittle eventually. 

Ayurveda treatment for osteoarthritis

Ayurvedic treatment for osteoarthritis help in preventing further progression of disease or detonation in the joints and heals the damaged cartilages.

Herbs widely used in the treatment are

1. Guduchi or Giloy ( Tinospora cordifolia), 
2. Guggulu (Commiphora guggul), 
3. Rasna (Alpinia galanga), 
4. Shigru (Moringa oleifera) 
5. Earanda (Ricinus communis)
6. Nirgundi (Vitex negundo)
7. Shunti (Zingiber officinale) 

Choice of herbs also is based upon factors like the involvement of doshas, dhatus, and the chronicity of your condition. Even your Prakriti, the physical and mental constitution, and your place of residing in the Desha are taken into account.

Commonly used Ayurvedic medicines for Osteoarthritis

The following compound ayurvedic formulations are commonly used to treat osteoarthritis. They may be used for internal administration or for external applications.

1.  Yoga raja Guggulu
2. Ashwagandha churna
3. Kseera bala Taila
4. Murivenna
5. Pinda Taila
6. Maha Narayana Taila
7. Prabhanjana vimardana Taila
8. Kottamchukkadi choorna
9. Rasnadi choorna
10. Jadamayadi choorna
11. Grihadhumadi choorna 

Above are suggested by classical texts like Sahasra yoga helping to treat Sandhigatavata. 

Nowadays, patent medicinal forms like capsules and liniments are also found in Ayurvedic rheumatology medicines. If you need a handy, easy-to-use Ayurvedic medicine, you may opt for these medicinal forms also. 

Ayurvedic therapies for Osteoarthritis

Ayurvedic therapeutic procedures like  Snehana, Swedana, Mridu virechana, Matra Vasti, Jalaukavacharana, Fomentation therapy with Nirgundi Patra (Vitex negundo), Niruha Basti are useful to reduce the symptoms of Sandhigata vata and improve the health of joints as well as facilitate joint movements.

Purificatory procedures (panchakarma treatments) are needed when the disease is chronic, But it will be decided by the doctor. 

Treatments in detail can include these choices as per the condition of your joints. 

• Oral administration of ghee or any unctuous oil like  Guggulu tiktaka Ghrta, Tiktaka Ghrta, Indukanta Ghrta, Bala tailam; Dhara, Nasya, Shastika shali pinda Sweda, Janu Vasti and application of medicated pastes like Saindhavadi Lepa, Dashanga Lepa, etc. are beneficial.
• Nitya virechana with Gandharva hastadi Kashaya, Gandharva hasta eranda Taila like medications also can be given. 
• Asthapana Vasti is suitable to be given with Eranda muladi Kashaya, Dasha Mula kwatha like decoctions. 
• Rasa oushadhas that can be given are – Nava Jivana rasa, Godanti Bhasma, Pravala pishti , Sameer Pannaga ras , Vata vidhwamsa rasa 

How to prevent the progression of osteoarthritis?

Doing suitable changes in diet and lifestyle will help to prevent further deterioration of osteoarthritis.

Osteoarthritis Ayurvedic Diet

A conducive diet or Pathya includes lentils, pulses,  green gram cereals, wheat, oats, rice, millets, and ghee in sufficient quantity which aids digestion and is light in nature. 

Intake of sweet, sour, salt, and unctuous food is beneficial when used in a moderate way.

Onion, garlic, ginger, gooseberry, snake gourd, and cucumber can be taken among vegetables, and the buttermilk is added with a little bit of turmeric, ginger,  pepper, and rock salt also is good for daily use. 

Vata when out of balance induces dryness and constipation-prone situations in your body. Take care of your bowels also while you are in this condition. Remembering Triphala, right? Well, there are other bowel-friendly medicines also in Ayurveda. 

Ask your physician for a suitable one if you also experience constipation related to Vata imbalance and more dryness in the skin. 

Maintaining a healthy weight is beneficial.

Do exercise regularly.

 What to avoid in Osteoarthritis?

Say a big no to dry, too hot or cold food, fried, junk food, carbonated drinks, and more caffeinated beverages. These can make your body metabolic toxin-laden in the long term. 

Avoid awakening at night, excess fasting, and heavy food.

Suppression of natural urges.

Avoid joint injuries and improper postures.

Big yes to relaxing techniques 

If you have pain in your body, that’s fine. But what about mental stress? The moment you have a physical ache, your mind also gets disturbed. Go and practice some mind relaxing techniques and control your breath. This will be good for you; this will also improve the blood and air circulation in your whole body. 

Pranayama techniques like Sheetali and simple breathing exercises are suggested by many of the experts in this field. Heal yourself through meditation and music pieces like that Tibetan bells and natural sounds. 

Some more tips 

Stay warm and avoid excessive exposure to cold wind, water, and general surroundings. Keep warm water bottles handy while traveling, also preferably dry ginger water if you have related complaints like gas trouble, indigestion, etc…

Ginger water has got all the digestive, and carminative properties and is able to help you get rid of your accumulated metabolic toxin Ama. During your Ayurveda treatment sessions also, dry ginger water will be provided to you. 

Key to your recovery 

The key is your own care. Make yourself the priority and adopt a diet and lifestyle helping you to overcome Vata imbalance. Apply medicated oils like Dhanvanataram Taila before bath and massage well. Add castor leaves boiled water in your bathing tub and do this medicated bath at least once a week. 

The pain will be reduced to a great extent indeed by these simple tips. Keep your mind motivated and streamlined to achieve your life goals. Let the wind energy Vata in your body remain nourished and flow freely in your body providing an uninterrupted supply of vital energy. 

As the ancient Indian philosophy says, Sarve bhavanthu sukhinaha , Sarve Santhu niraamayaaha – let all remain pleasant and without disease always. Ayurveda, the age-old wisdom also is advocating the same. You care for your mind and body well and Ayurveda will help you achieve this effortlessly.