Arthritis alternatives to surgery

It causes pain, stiffness and immobility.

When you have osteoarthritis, every single step can be a struggle. There are invasive surgeries and drugs with a long list of side effects that most patients try to avoid.

As a youth orchestra conductor, Dorothy Kitchen was used to being on her feet all day. But then knee arthritis struck.

"I sit now, instead of stand, when I conduct,” she said.

Kitchen is determined not to have surgery and only takes meds if she's really in pain. “I'm not a pill-taker,” she said.

Instead, she has found that a massage is a great solution. “I feel more alive, my legs feel mobile,” she said.

Doctor Adam Perlman of Duke University launched a pilot study on massage for knee osteoarthritis. Patients who had massages twice a week for a month and then once a week for another month, had less pain, better range of motion and faster walking speeds.

“That improvement actually persisted eight weeks after massage was finished,” Dr. Perlman said.

He said another alternative for arthritis is acupuncture. “There is very interesting data suggesting that acupuncture can be effective particularly for arthritis of the knee.”

In one study, 25 percent of arthritis patients who were scheduled for knee surgery cancelled their procedures after acupuncture. Then there's glucosamine.

"These studies are conflicting about glucosamine,” Dr. Perlman warns.

Most studies show glucosamine sulfate at 15-hundred milligrams a day can help but glucosamine hydrochloride is most commonly sold in the u-s and does not.

Arthritis sufferers can also fight pain by losing weight. Every pound you lose means four pounds less pressure on your knees.

Kitchen said taking daily walks worked for her. "It’s wonderful! I feel good all afternoon,” she said.

Dr. Perlman is now enrolling patients in the massage study, which will take place at three centers. One at Duke, one at Yale and another in New Jersey.
BACKGROUND: Osteoarthritis affects about 27 million Americans. It is characterized by the breakdown of cartilage, which is the part of a joint that cushions the ends of the bones and allows easy movement. Bones begin to rub against each other once cartilage deteriorates. This bone on bone contact can cause stiffness and pain. Osteoarthritis can also damage ligaments, mensci, and muscles. It occurs most often in the knees, hips, hands and shoulders. Typically, joints ache or become painful or stiff first thing in the morning or during and after use. They may also become stiff after periods of inactivity. There are two types of osteoarthritis: primary and secondary. Primary osteoarthritis is associated with aging. Secondary osteoarthritis tends to develop relatively early in life after a specific cause such as an injury or obesity. (SOURCE:

STANDARD TREATMENTS: There is no cure for osteoarthritis, but treatments can help relieve the pain. Oral and injectable corticosteroids can control inflammation, but they aren't recommended for frequent or long-term use. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain, swelling and inflammation, but they can cause stomach distress and ulcers. These drugs may also increase the risk of heart attack in some patients. Surgery, including joint replacement, may be an option for very damaged joints. (SOURCE:

ALTERNATIVES: There are several alternative therapies that may help patients with arthritis. These include:
* Massage: The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, is currently spending $2.7 million on massage research. This is up from $1.5 million in 2002. A study published in the Archives of Internal Medicine in 2006 showed full-body Swedish massage greatly improved symptoms of knee osteoarthritis. Now, researchers at Duke University are enrolling for a second clinical trial that will look at the effects of massage. (SOURCE: Wall Street Journal)
* Acupuncture: Typical acupuncture treatments for arthritis last from five to 30 minutes with the patient being treated one or two times a week. A study at the University of Maryland showed that elderly arthritis patients with knee pain due to arthritis improved significantly when acupuncture was added to their treatment regimen. Those who did not receive acupuncture showed no significant change. (SOURCE:
* Lifestyle: Losing weight and exercising may be two more ways to relieve arthritis pain. Some patients will see their symptoms disappear if they lose 10-20 pounds. Experts used to believe exercise made arthritis worse, but now they believe the opposite is true. Swedish researchers looked at exercise, including jogging, in patients at risk for arthritis. After imaging the joints of the participants, they found that the biochemistry of cartilage actually appeared to improve in those who jogged. Some believe that exercise can stimulate cartilage to repair minor damage. (SOURCES: MSN Health, NPR)
* Supplements: Many patients have heard about glucosamine supplements for arthritis pain. While studies have offered conflicting results, most experts agree it's the type of glucosamine that matters. Some studies show glucosamine sulfate is beneficial, but glucosamine hydrochloride is not. However, most of the products sold in the United States are glucosamine hydrochloride. (SOURCE: MSN Health)

For More Information, Contact:

Mary Jane Gore
Sr. Media Relations Specialist
Duke Medicine News and Communications

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