Osteoarthritis-a burden to the society-homoeopathic therapeutics

Dr Geoffrey Bhakupar Marbaniang

ABSTRACT:
Osteoarthritis is a joint disorder mainly affecting the cartilage of a joint and it causes reduced range of motion (ROM) due to reduced joint space. Hence, it creates an impact in day to day living of an individual and due to this condition, the daily living is disrupted.. Patients usually present with stiffness of joint, tenderness and reduced ROM. In this article, we will witness the various Homoeopathic remedies to combat the problem.

KEYWORDS: Osteoarthritis, Range of Motion, Multifactorial, Chondrocyte, Extra cartilaginous, Intra-articular hyaluronic acid.

INTRODUCTION:
Osteoarthritis is multifactorial degenerative diseases. It is several factors involving osteoarthritis mainly systemic factors were age, sex, genes and local factors were muscle weakness, joint deformity and specific aetiological factors are still unknown, but may cause mechanical overloading, failure of the chondrocyte controlled internal remodelling system and extra cartilaginous factors.¹

It is involves joint lining, cartilage, ligaments and bone, and symptomatic treatment by analgesics, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), opioids, chondroitin sulphate, glucosamine, intra-articular corticosteroids, intra-articular hyaluronic acid.²

Knee arthritis is the one of the greater reported site of musculoskeletal pain.³

This disease is associated with varying degree of pain, functional limitation and reduced activities of daily living and is accountable for more trouble with climbing stairs and walking than any other disorder. A holistic approach to care considers the global needs of an individual, considering social and psychological factors that influence their ability to carry out activities of daily living.⁴

Homoeopathy is a system of medicine where we can treat the individual based symptom similarity and hence, a homoeopathic medicine similar to the disease condition can be given and treatment can be achieved accordingly.

OSTEOARTHRITIS – REVIEW OF LITERATURE:
Increase in overall life expectancy around the globe has led towards increase in age related disease burden. With ageing, many organs loose active functionality, imposing limitations for day to day activities. Most of the age related diseases are chronic in nature and along with time severity of such diseases may lead to the disability, if they remain untreated. Burden of age related disease is expected to grow significantly in future among developing countries.⁵

Osteoarthritis (OA) is one of the major diseases, which often starts during ageing and affects significant proportion of geriatric around the globe. With worldwide ageing of population, OA is one of the emerging health issues. Especially in Asian countries in coming two to three decades with huge geriatric concentration in population, OA will be among the top diseases. Osteoarthritis is common most form of musculoskeletal disease currently fourth most common predictor of health problem in women and eighth common predictor among men worldwide.⁶

Homoeopathic concept:
The basis of cure is the fundamental law of similars. The law of similars is the fundamental law also in the palliation of incurable states. The administration of narcotics and sedatives suppresses symptoms and destroys the power of elimination by locking up the secretions in all states so completely that we cannot get a true picture of the condition of the vital force and energy upon which we must evaluate our symptomatology. The result of palliative treatment by the use of narcotics demands the continual increase of the drugging, for as soon as the effect seems to be subsiding, more drug must be administered. It becomes a vicious circle from which there is no escape except to be sent to the ultimate end in a confused and half-deadened condition, instead of being helped to live out as many years as possible in the easiest, quietest and most gentle manner.⁷ Therefore, law of palliation can be applied for treating such a condition.

• Commonly seen in weight bearing joints such as hip and knee.
• Also seen in spine and hands.
• Both males and females are affected.
• More common in elderly women i.e., above 50 years, particularly in postmenopausal age.⁸

 RISK FACTORS⁸

• Obesity especially OA knee.
• Abnormal mechanical loading example: meniscectomy, instability.
• Inherited type II collagen defects in premature polyarticular OA.
• Inheritance in nodal OA.
• Occupation ex. farmers.
• Infection: non-gonococcal septic arthritis.
• Ageing process in joint cartilage.
• Defective lubricating mechanism.
• Incompletely treated congenital dislocation of hip.

PRIMARY OA⁸

• More common than secondary OA
• CAUSE – unknown
• Common in elders where there is no previous pathology.
• It is mainly due to wear and tear changes occuring in old ages mainly in weight bearing joints.

SECONDARY  OA⁸

It is due to predisposing cause such as –

• Injury to the joint
• Previous infection
• Rheumatoid arthritis
• Congenital dislocation of hip
• Deformity
• Obesity
• Hyperthyroidism

PATHOLOGY⁸

OA affects the following :

• Articular cartilage
• Bone
• Synovial membrane
• Capsule
• Ligament
• Muscle

1. Articular cartilages

• Osteoarthritis primarily affects the articular cartilage.
• Increase in water content and depletion of the proteoglycans from the cartilaginous matrix.
• Repeated weight bearing on such cartilages leads to its fibrillation.
• The cartilage gets abraded by the grinding mechanism at work at the points of contacts between the opposing articular surfaces.

2. Bone (Eburnation)

• With further rubbing the subchondral bone becomes hard and glossy.
• Meanwhile, the bone at the margins of the joint hypertrophies to form a rim of projecting spurs known as osteophytes.
• Formation of subchondral cysts and sclerosis.

3. Synovial membrane and capsule

• Synovial membrane undergoes hypertrophy and becomes oedematous.
• Reduction of synovial fluid secretion results in loss of nutrition and lubricating action of articular cartilage.
• The loose flakes of cartilage incite synovial inflammation and thickening of the capsule, leading to deformity and stiffness of the joint.

4. Ligaments and muscles

• Ligament Undergoes fibrinous degeneration
• There is low grade chronic inflammatory changes due to which joint becomes contracted or elongated.
• Muscles undergo atrophy which results in limited movements and functions of joint.

SIGNS AND SYMPTOMS⁸

• Disease usually occurs in elderly people, mostly bilaterally in the major joints of lower limbs.
• Knee is involved more commonly in a population with Asian living habits i.e., the habit of squatting and sitting crossed legged.
• Pain is the earliest symptom.
• Coarse crepitus.
• Swelling of the joint is the late feature and is due to the effusion caused by inflammation of the synovial tissues.
• Stiffness is due to pain and muscle spasm.
• Restricted movement and deformity
• Muscle weakness or wasting
• Capsular contracture and incongruity of the joint surface contribute to it.

ON EXAMINATION⁸

• TENDERNESS on the joint line.
• CREPITUS on moving the joint.
• IRREGULAR ENLARGED looking joint due to formation of peripheral osteophytes.
• DEFORMITY – VARUS of the knee, flexion-adduction-external rotation of the hip.
• Effusion rare.
• STIFFNESS of joint movement.
• SUBLUXATION detected on ligament testing.

INVESTIGATIONS⁸

There are no pathognomonic laboratory findings for OA.

Laboratory analysis is performed for differential diagnosis.

RADIOLOGIC FINDINGS OF OA⁸

• Narrowing of joint space
• (due to loss of cartilage)
• Osteophytes
• Subchondral (paraarticular) sclerosis
• Bone cysts

RADIOLOGIC GRADE OF OA⁸

Grade I – Squaring of tibial margin.

Grade II – Flattening of femoral condyle, squaring and sclerosis of tibial margin. Grade III – Joint space narrowing, hypertrophic changes, or both.

Grade IV – 75% Joint space narrowing with the secondary feature.

PRIMARY PREVENTION⁸

• Regular exercises
• Weight control
• Prevention of trauma

TREATMENT OF OA⁸

• Symptomatic treatment
• Structure modifying treatment
• Surgical treatment

SYMPTOMATIC TREATMENT⁹

• Decrease of joint loading

– Weight control

• Exercises

– Swimming

– Walking

– Strengthening

• Patient education

HOMOEOPATHIC THERAPEUTICS:

KALMIA LATIFOLIA:
Deltoid rheumatism especially right. Pains from hips to knees and feet. Pains affect a large part of a limb, or several joints, and pass through quickly. Weakness, numbness, pricking, and sense of coldness in limbs and index finger. Joints red, hot, swollen. Tingling and numbness of left arm.¹⁰

LEDUM PALUSTRE:
Small joints. Swollen, hot, pale. Throbbing in right shoulder. Pressure in shoulder, worse motion. Cracking in joints; worse, warmth of bed. Ball of great to swollen. Rheumatism begins in lower limbs and ascends (Kalmia opposite). Ankles swollen. Soles painful, can hardly step on them. Easy spraining of ankle.¹⁰

APIS MELIFICA:
Oedematous. Synovitis. Knee swollen, shiny, sensitive, sore, with stinging pain. Feet swollen and stiff. Feel too large. Rheumatic pain in back and limbs; Tired, bruised feeling. Numbness of hands and tips of fingers. Hives with intolerable itching. oedematous swellings.¹⁰

STICTA PULMONARIA:
Rheumatic pain in right shoulder joint, deltoid, and biceps. Swelling, heat, redness of joints. Spot of inflammation and redness over affected joint. Pain severe and drawing. Chorea-like spasms; legs feel floating in air. Housemaid’s knee. Shooting pains in knees. Joints and neighbouring muscles red, swollen, painful. Rheumatic pains precede catarrhal symptoms.¹⁰

LITHIUM CARB:
Paralytic stiffness all over. Itching about joints. Rheumatic pains throughout shoulder-joint, arm, and fingers and small joints generally. Pain in hollow of foot, extending to knee. Swelling and tenderness of finger and toe joints; better, hot water. Nodular swellings in joints. Ankles pain when walking.¹⁰

SALICYLICUM ACIDUM:

The symptoms point to its use in rheumatism. Extremities: Knees swollen and painful. Acute articular rheumatism; worse, touch and motion. Limbs: Heat, redness, soreness, and swelling about joints; < in knees, with acute, piercing pains; < on motion; >from dry heat.¹⁰

Indicated rubrics for Osteo arthritis:

1. Extremities – Pain – Knees – Hollow of – Walking – Agg. – Caust., Nit-ac., Nux-v., Phyt., Rhus-t.¹¹
2. Extremities – Stiffness – Knees – Morning – Rhus-t., Lyc., Nat-m., Stry., Aesc.¹¹
3. Extremities – Stiffness – knees – Rhus-t., Caust., Lyc., Nit-ac., Nux-v.¹²
4. Extremities – Pain – Knee – Ascending stairs, on – Rhus-t., Caust., Lyc., Nit-ac., Nux-v.¹³

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Dr. Geoffrey Bhakupar Marbaniang
PG Scholar, Department Of Homoeopathic Materia Medica
Under the guidance of Dr. ARUN VARGHESE Assistant Professor,
Father Muller Homoeopathic Medical College
Deralakatte, Mangalore – 575018
E-mail ID: geoffmarbaniang@gmail.com