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Osteoarthritis and Rheumatoid Arthritis
The information presented here on osteoarthritis, is contained in these pages on acupuncture. This material (and all the other acupuncture pages) are concerned with Traditional acupuncture (as part of Traditional Chinese Medicine). As an acupuncture practitioner, my registration with Acupuncture NZ, is as a traditional acupuncturist.
Of course, I am also an Osteopath, and as such take an interest in joint health, musculoskeletal medicine and biomechanics, which is my field of training as an Osteopath.
There are different forms of arthritis, but two main types are: Osteoarthritis and Rheumatoid Arthritis.
Osteoarthritis is known as degenerative arthritis or degenerative joint disease or osteoarthrosis. Osteoarthritis involves the degeneration or degradation of joints including the articular cartilage and subchondral bone. The symptoms of Osteoarthritis include joint pain and sometimes swelling or effusion (the presence of increased inter-articular fluid, that can affect any joint, but most commonly the knee). Osteoarthritis can sometimes cause a cracking noise (called 'crepitus'). Osteoarthritis most commonly affects the hands, feet, spine, and the large weight bearing joints (knees and hips), but any joint can be affected. There are various causes of osteoarthritis, including hereditary predisposition to this condition, as well as developmental, metabolic and mechanical deficits.
The development of osteoarthritis often correlates with a history of previous joint injury, and also obesity (especially affecting the knees). However, as the correlation between arthritis and obesity is also present for non-weight bearing joints (not just knees), and the loss of body-fat is related to symptom-relief (not just loss of body weight) there may be a metabolic link to body fat (as opposed to just mechanical load bearing). As osteoarthritis develops there is a loss of cartilage, and as bone surfaces become less well protected by cartilage, bone may become more exposed and damaged. As a result of pain and less mobility and decreased movement, the muscles surrounding the joints may weaken, atrophy, become shortened and hypertonic (increased tone) and the ligaments crossing the joint may become more lax.
Acupuncture and osteopathy may not be able to treat arthritis directly — but may reduce inflammation, and help muscles near the affected joint, and so help reduce the pain from arthritis.
Arthritis affects large numbers of New Zealanders. Although the arthritis and wear in joints cannot be reversed and acupuncture and osteopathy cannot treat arthritis directly and reverse this joint damage it is however possible that acupuncture might be able to alleviate the pain and stiffness associated with arthritis by working on the connective tissues and muscles crossing the affected joint.
Please see below for research that suggests an anti-inflammatory effect of acupuncture: The Acupuncture Evidence Project: A Comparative Literature Review, 2017.
In other words, acupuncture works on the muscles surrounding (above and or below) the affected joint, as these muscles can also become stiff. Acupuncture does not treat the joint itself, or the arthritis in the joint. Acupuncture can treat the surrounding area — and this may help ease the pain. So I am not making any claim here that acupuncture or osteopathy can treat or benefit arthritis directly. Although some research and evidence base (e.g. The Acupuncture Evidence Project, 2017) does suggest this.
Having said this some studies have found that "the acupuncture group experienced statistically significant pain reduction in comparison with the control group. One of these studies also found that the reduction in pain was significantly greater for the acupuncture group versus the drug treatment (diclofenac) group." (see the reference above for this). All I would suggest here is that acupuncture (or osteopathy) might be able to alleviate the muscle pain in the muscles near joints affected with arthritis.
Recently The Acupuncture Evidence Project: A Comparative Literature Review (2017) was published. This report (a literature review of acupuncture research) is primarily concerned with conditions that may be treated with acupuncture. However, this report also mentions (in section 3) research into the mechanisms of acupuncture, and the anti-inflammatory and pain relieving effects: "The anti-inflammatory effects of acupuncture have particular relevance to allergic rhinitis, irritable bowel syndrome, post-surgical recovery, migraine, osteoarthritis and inflammatory aspects of a range of musculoskeletal conditions."
The research suggests that acupuncture (and electroacupuncture) can have an anti-inflammatory effect — and that this may have relevance to certain conditions. The Acupuncture Evidence Project: A Comparative Literature Review (2017) mentions osteoarthritis (above) as one of these conditions. Perhaps it would be fair to say that acupuncture does not treat arthritis directly (after all joint damage and degeneration is irreversible) yet may be able to treat inflammation associated with osteoarthritis (according to the evidence from this research).
For practical purposes, acupuncture (or osteopathy) may be able to treat the muscles crossing the joint, or surrounding the joint, to help normalize any changes in muscle tone or tissue quality (muscles crossing a joint will have the same nerve supply as the joint itself). So although acupuncture (or osteopathy) do not treat the arthritis directly, acupuncture or osteopathy or physical therapy may be able to help with the joint pain associated with osteoarthritis, and may perhaps be able to help reduce inflammation and swelling (as research into acupuncture suggests) as well as benefiting the muscles surrounding the affected joint. This explanation would be in accordance with the research findings above.
Exercise can also be helpful (possibly also involving stretches to the muscles surrounding the affected joint). Gentle exercise can often alleviate the symptoms of osteoarthritis, but prolonged or excessive use may aggravate them. Weight loss (and exercise to facilitate this) could be beneficial for arthritis of the knees, ankles, and hips.
If pain becomes debilitating, and the range of movement of the joint becomes severely restricted, then joint replacement surgery may be considered. The most common joints for joint replacement surgery for osteoarthritis are the knees and hips.
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