I thought I would share today the latest developments in the treatment of osteoarthritis in the NHS and then compare it with my own experience of treating osteoarthritis.
The National Institute for Health and Clinical Excellence (NICE) have recently published their
draft guidelines for treatment http://www.nice.org.uk/nicemedia/live/13505/64904/64904.pdf. For many years it has been standard practice to recommend paracetamol, or anti-inflammatory medication and steroid injections into the affected joint if paracetamol does not work.
2008 guidelines suggest trying paracetamol and topical anti-inflammatory medication first, followed by oral non-steroidal anti inflammatories (NSAIDs) and COX-2 inhibitor, a relatively new anti-inflammatory, or opioid drugs such as codeine. Exercise is recommended as a key strategy for treatment.
The 2013 NICE draft review of osteoarthritis has been been in sync Arthritis Research UK. They were commissioned to do a systematic review of treatment for arthritis, January 2013 http://www.arthritisresearchuk.org/policy-and-public-affairs/reports-and-resources/reports.aspx (osteoarthritis in general practice report). It concluded that 8.75 million people have sought treatment for arthritis in the UK. It stands as the 4th reason for people becoming disabled in the UK.
They also reviewed osteoarthritis and complementary therapy.
www.arthritisresearchuk.org/~/media/.../Arthritis.../CAT-report-2013.
The sad thing for me is that the literature states that a third of people with arthritis go on the have chronic arthritis which leads to joint replacements, costing the NHS 100's of thousands of pounds.
From a naturopathic point of view, most of the documents above are working from the basis that there is no cure for arthritis. There is no mention of diet or prescribing complementary therapies within NHS guidelines currently. I am impressed however that NICE have looked at wider possible treatments for osteoarthritis, including glucosamine, chondroitin and acupuncture. However, they came to the conclusion that there was not enough evidence to show that they worked significantly enough for the NHS to pay for them. It is very difficult for acupuncture research to replicate the double blind trials that drug research favours. Giving acupuncture as a placebo is very difficult. It is difficult to pretend to needle someone! Therefore real needling and 'pretend' or sham acupuncture is not seen as having significant enough difference with regards to results. There are hundreds of Chinese research favouring acupuncture for arthritic pain, but these trials are deemed poor quality. It is very frustrating for us acupuncturists!
NICE draft guidelines did supported the use of exercise. The way the joint works, it needs pressure through the joint to stimulate the synovial fluid in order to protect and lubricate the joint, keeping it mobile and healthy.
My own experience is that the risks associated with NSAIDs are too great for any long term use. They are well known to cause gastric ulcers and kill 15 people per 100,000 due to gastric bleeds. The new COX-2 inhibitors (celecoxib) have been linked to an increase risk of heart disease, so again, long term use is not recommended. Doctors will tell you that the use of omeprezole and other proton pump inhibitors will protect you from gastric ulcers, but new research shows that the damage from the NSAIDs continues right through to the colon (large bowel) because the proton pump inhibitors only protects far down as the stomach and small bowel, contributing to the increase in diverticulitis and inflammatory bowel disorders.
It is my view that a more natural cure can be found. A lot of my customers come and see me for acupuncture years after their arthritis has been diagnosed. This makes treatment more tricky, but acupuncture can certainly stop arthritis from getting worse.
If however I had someone come and see me at the initial diagnosis of their arthritis, I can recommend a number of solutions. Ignoring a joint that hurts is a mistake. People say, 'I have arthritis in my right knee', but actually, they have arthritis in more than one joint, it is just not painful yet. Arthritic change can happen and we can have no pain. Once we start to have arthritis, we have it as a systemic problem. Joints that can hurt are ones that we have previously fractured, or often the ones which we have 'over-used'. Obesity is linked with knee arthritis for obvious reasons; more weight being put through that joint.
A third of people will experience pain and the arthritis will resolve itself. A third will develop systemic, but moderate pain and arthritic changes to the joints. The last third will develop chronic pain and progressive disease, resulting in joint replacement surgery.
If someone comes to see me with early arthritis I may recommend:
- Acupuncture
- supplements
- An alkaline diet
- Detoxification
- Tai Chi exercise
In the pdf article above, Arthritis Research UK did a very useful review of all the complementary therapies and their effective use in arthritis. Acupuncture and Tai Chi exercise came out top of the review results. Very impressive. These modalities reduce pain. However, I would also advocate that I could go one step further and stop the continued destruction of the joints. By addressing wider health issues and changing my clients diet, I can often reduce the inflammation and progression of arthritis. Prevention of the progression of disease has to be better than living with pain, misery and pain killers.
