Arthritis comes in various forms. But the most common type is osteoarthritis, which is a combination of wear and tear and inflammation. If you’re unlucky enough to get osteoarthritis, we need to know how to prevent progression or improve damage. Can osteoarthritis be reversed?

What is osteoarthritis?  

Osteoarthritis is a type of arthritis where the cartilage in the joint gradually erodes, leading to bone-on-bone rubbing. This rubbing causes joint pain and swelling.

Generally, osteoarthritis affects the hips, knees, and fingers, although any joint can be affected.

Can osteoarthritis be reversed? 

Generally, damage to the joint can’t be reversed once it happens. However, the good news is that you can halt the progression through lifestyle factors such as exercise and weight loss. Improvements in your diet can also help.

Recent studies suggest that getting a diagnosis of osteoarthritis does not necessarily mean you’re headed toward a joint replacement. For example, of those who develop knee osteoarthritis, only 30% required a knee replacement in their lifetime. Also, putting on weight means your chances of a knee replacement increase by 25%. So, making good choices now reduces your chances of future surgery.

Top tips to stop the progression of osteoarthritis

How do you make good choices to stop the progression of osteoarthritis?

Follow these basic guidelines:

Diet

A healthy diet that provides adequate vitamins, minerals, and antioxidants is good for joint health.

Recent studies suggest that plant-based foods with plenty of fruit, vegetables, and legumes reduce pain associated with osteoarthritis. Moreover, other studies suggest that certain nutrients, such as ginger, green tea, turmeric, and pomegranate, protect cartilage from further damage.

Weight loss

Obesity is a leading cause of the progression of osteoarthritis. Weight gain increases your risk of a knee replacement by at least 25%. However, losing even a small amount of weight can significantly reduce hip and knee osteoarthritis pain. Studies suggest that a 5% reduction in weight leads to an 18% reduction in pain. Moreover, a 10% reduction in weight leads to a massive 50% improvement in pain.

Can osteoarthritis be reversed through exercise therapy? 

squats after myositis ossificans

Generally, we recommend exercise in strength training and aerobic conditioning.

Symptom improvement occurs from lowering chronic inflammation in the body and weight loss and muscle strength gain. In addition, strengthening the muscles around the knee helps offload the knee and reduce pressure on the joint. Finally, studies suggest combining gym, Pilates, yoga, and Tai Chi is the most effective for improving pain and function.

Generally, exercise works best for the following:

  • Younger patients, although older patients, still benefit.
  • Knee arthritis. There are over 50 high-level studies showing exercise works in knee arthritis.
  • An exercise program that follows the American College of Sports Medicine guidelines. So, we combine aerobic, resistance training, and balance exercises with strength training progression. Generally, the stronger you get, the better. Also, a supervised program with a personal trainer works best.

Also, you may need to modify your existing exercise. For example, consider adjusting the impact activity and replacing it with non-impact or low-impact activities such as swimming, cycling, rowing, cross-country skiing, yoga, and Pilates. In addition, a recent study found that Tai Chi improves quadriceps strength in elderly patients.

Braces

Supportive devices can reduce the load on joints and help you stay active. Examples include knee braces, walkers, and shoe inserts.

A new shoe insert called APOS therapy has recently gained NICE recommendations for treating severe knee arthritis. These particular shoes have unique rounded pods fitted to the undersurface of the shoe. We think APOS therapy reduces knee pain by changing the forces on the foot and knee and correcting abnormal walking patterns. NICE highlighted that clinical evidence from a high-quality trial improves knee pain and function compared to a sham device. The cost for the footwear and associated treatment from trained professionals is estimated at £875 per person.

Supplements 

There is increasing evidence that some supplements may improve knee arthritis pain:

Boswellia Serrata is a herb extracted from the Indian frankincense tree. Boswellic acids inhibits the 5-lipoxygenase enzyme which has an anti-inflammatory effects. In some studies, Boswellia serrata reduces pain and stiffness in knee arthritis. We recommend 100-250mg daily for fours weeks.

Curcumin is obtained from the curcuma longa plant. Curcumin has anti-inflammatory effects through several pathways including inhibition inflammatory substances such as the COX-2 enzyme. Studies suggest Curcumin is effective for knee arthritis and should be taken for 12 weeks. 

Medication

Overall, careful use of anti-inflammatory medication can improve symptoms. First, try simple NSAIDs such as ibuprofen. Studies suggest that Volaterol or Acoxia are the most effective tablets for arthritis. Topical ibuprofen cream is as effective as tablets. A review of topical NSAID creams found they were effective and safe in treating chronic musculoskeletal conditions for two weeks. Other creams, such as lidocaine patches or capsaicin cream, can be effective.

However, you need to be careful with NSAIDs because of potential side effects such as stomach ulcers, high blood pressure, heart disease, or kidney damage. Always ask your doctor whether you can use these medications frequently.

Injections

Platelet-rich plasma injections - alternative to cortisone injection in shoulder

Generally, we only use injections as an extra addition to other treatments. We use three different types of injections for osteoarthritis:

Cortisone 

Cortisone is a powerful anti-inflammatory drug that reduces inflammation and pain in osteoarthritis. Overall, studies suggest cortisone has a mild and short-lived effect on osteoarthritis. However, there are some concerns with cortisone. For example, one study found that frequent cortisone injections for knee arthritis reduced cartilage thickness. Also, other studies suggest that having a cortisone injection for knee arthritis could accelerate the time to knee joint replacement.

Hyaluronic acid 

Hyaluronic acid is a naturally occurring substance in joints, tendons, and ligaments. Injecting hyaluronic acid into joints reduces inflammation and acts as a lubricant.

Overall, studies show a moderate effect on pain of osteoarthritis that can last for up to 6 months. However, a particular type of hyaluronic acid with a high molecular weight and cross-linking is more effective for knee arthritis. Specific brands that are high molecular weight include Durolane and Synvisc-1. In addition, there are very few side effects apart from occasional allergic reactions. Also, recent studies suggest that hyaluronic acid may help delay the need for a total knee replacement for up to 3 1/2 years. 

All in all, hyaluronic acid is a reasonable option for mild to moderate knee arthritis.

Platelet-rich plasma

Platelet-rich plasma (PRP) is becoming more popular for treating arthritis and tendonitis.

We obtain PRP from whole blood. Then, we spin the blood to separate the plasma from red and white cells. Plasma contains a high concentration of platelets that are rich in growth factors. Finally, we inject the plasma into the joints.

Overall, 23 studies show a positive effect of PRP on knee osteoarthritis. Furthermore, comparing PRP to other injections, such as hyaluronic acid, reveals a better impact of PRP.

Finally, PRP with hyaluronic acid produces better results at 1, 6, and 12 months than PRP alone.

Arthrosamid injeciton for knee arthritis 

Arthrosamid is a unique hydrogel of water molecules attached to a polyacrylamide backbone. The injectable is non-degradable, meaning the body does not break it down.

It works by coating the lining of the synovium of the knee joint, reducing inflammation, and providing lubrication.

Recent studies show improvement in pain scores lasting for up to 2 years. In addition, compared to hyaluronic acid, it works better in younger and slimmer patients. However, we need more long-term data before recommending Arthrosamid as a first-line injection for knee arthritis. Currently, we suggest Arthrosamid after trying some of the other injectables first. 

Can osteoarthritis be reversed? Other frequently asked questions

Is glucosamine or chondroitin sulfate helpful for osteoarthritis? 

Contrary to popular opinion, studies show that neither supplement is helpful for osteoarthritis pain.

Do stem cell injections reverse cartilage damage in osteoarthritis?

No. No evidence that stem cells or other injections reverse cartilage damage. Therefore, it would be best to be careful about sourcing these injections for ‘cartilage reversal.’ Recent evidence in randomised trials suggests that stem cell injections are no different to cortisone injections.

How can I reverse osteoarthritis naturally? 

Although you can’t reverse the present damage, you can slow the progression by focusing on a healthy lifestyle, such as losing weight, gaining muscle, and controlling sugar and cholesterol levels.

Final word from Sportdoctorlondon: ‘Can osteoarthritis be reversed?’

We can’t reverse osteoarthritis changes. However, by changing your lifestyle and exercising regularly, you can stop the progression of this disease.

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