Biomedical and TCM Study of Osterarthritis
ATD I
AOMA Fall 2013
One out of every three Americans suffer from some type of joint pain (J. Wu & F. Yip, 2004). According to The Global Burden of Disease: 2004, Osteoarthritis (OA) causes moderate to severe disability for 43.4 million people globally (WHO, 2004). In 2011 the US saw close to a million hospitalizations for OA (A. Pfuntner et al, 2011). Currently there are no measures being taken to control OA prevalence, lifestyle modifications are shown to provide some slowing in degeneration, but there are no known cures.
There are many different types and causes for arthritis ranging from auto-immune to overwork. Osteoarthritis is one of the most common types of arthritis, it is also known as degenerative arthritis or wear-and-tear arthritis. OA differers from other types of arthritis because it is affects specific joints that are repetitively damaged from mechanical stress with insufficient self repair (J. Wu & F. Yip, 2004 ). Primary OA is found to have a genetic component, though a single factor has not be shown to be a sufficient cause. Primary OA is also correlated to a history of joint injury, obesity and change in the sex-hormones of post-menopausal women. Secondary OA is caused by other factors but the resulting pathology remains the same as primary (WHO, 2004).
In TCM Osteoarthritis and Rheumatoid arthritis are both categorized as simply arthritis. The etiology of arthritis in TCM involves the invasion of the external pathogens: wind, cold and dampness. The combination of all three external pathogenetic factors is what makes arthritis more complex to treat. It can also be caused by irregular diet, specifically food allergies leading to damp-heat. Lastly, it can be caused by repetitive physical work and strain throughout life. The TCM mechanism of arthritis is local Qi and blood stagnation with general weakness. In the case of OA, it is considered to be in the Qi stage because it has a more functional etiology (J. WU & F. Yip, 2004).
The signs and symptoms of osteoarthritis are mainly pain, loss of ability and often stiffness. Pain is usually described as sharp, aching and burning (J. Wu & F. Yip, 2004). OA usually affects the hands, feet, spine and large weight bearing joints like the knees and hips (J. Ezzo et al, 2001). Sometimes crackling noises called crepitus can be heard when the affected joint is touched or moved. Hard boney enlargements may form on the smaller joints, called Heberden’s nodes when on the distal interphalangeal joints and/or Bouchard’s nodes when on the proximal interphalangeal joints. The biomedical method for diagnosis involves clinical examinations and can be made with reasonable certainty based on patient history. X-rays can confirms the diagnosis if needed. The X-ray will show joint space narrowing, osteophytes, increased bone formation around the joint and subchondral cyst formation.
In TCM the etiology of OA is the combination of wind, cold and dampness, so in order to diagnosis and treat the patients their other symptoms must be looked at to learn if there is more cold, damp or wind involved. If it is more due to a wind invasion the pain will be wandering and will be located more of the upper part of the body. There will be other common wind invasion symptoms like aversion to wind and a slight fever. If the OA is more due to a cold invasion the pain will be more sever and stabbing and can be alleviated by warmth. There will also be general cold symptoms like cold extremities, aversion to cold, profuse clear urine and a superficial & tight or deep & slow pulse. If there is more dampness involved the arthritis will mainly be on the lower limbs due to damp sinking. The pain will be dull with a sensation of heaviness. In the local area there will be swelling and there may be edema and numbness. There will also be general damp symptoms including general heaviness, nausea, decreased appetite, vomiting, profuse vaginal discharge, loose stools with sticky pieces, gas and bloating. The tongue will show dampness with swelling and teeth marks (J. Wu & F. Yip, 2004).
Biomedical treatments are limited and more about management. Weight lose is important for obese patients, and a prescription for acetaminophen is very common (J. Flood, 2004). Moderate exercise is recommended for reduction of pain and increase in function (J. Wu & F.Yip, 2004). If these management options are ineffective and disability is significant, joint replacement surgery can be performed. For TCM treatments, a combination of acupuncture and Tui-na is considered the most effective (J. Wu & F. Yip, 2004). Though research has shown that acupuncture can provide pain relief, because OA is a disorder of the tendo-muscular meridians, massage and Tui-na address the type of pain much better (J. Ezzo et al, 2001). Warming therapies and exercise are also recommended (J. Wu & F. Yip, 2004).
Acupuncture points should be chosen based on the differentiation: if more wind, use common wind points like BL12 and 13, GB20 and SJ17, if more cold, use common cold points like GB20, LU7, LI4 with moxa. If there is more dampness, use common damp points like SJ5, Sp9, St40, Sp6. It is important to pair cold, wind and/or damp points with local points according to the location of the arthritis (J. Wu & F. Yip, 2004). There are some herbal formulas which can be used in conjunction with Tui-na and acupuncture. If cold is prominent use Chuan Wu Tang (J. Wu & F. Yip, 2004). In a 2004 study on the effectiveness of Duhuo Jisheng Wan compared to the commonly used Diclofenac it was found that they have clinically comparable effects after four weeks of treatment (S. Teekachunhatean et al, 2004).
Osteoarthritis is a complex, multi-layered disease and it’s management can be difficult whether it’s being treated by biomedical or TCM techniques.
Arthritis/bi syndrome (guan jie yan). In (2004). J. Wu & F. Yip (Eds.), Acupuncture treatment of disease: Student study guide
Ezzo, J., Hadhazy, V., Birch, S., Lao, L., Kaplan, G., Hochberg, M., & Berman, B. (2001). Acupuncture for osteoarthritis of the knee: A systematic review.Arthritis & Rheumatism, 44(4), 819-825. doi: 10.1002/1529-0131(200104)44:4<819::AID-ANR138>3.0.CO;2-P
Flood, J. (2010). The role of acetaminophen in the treatment of osteoarthritis. The American journal of managed care, 48-54. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20297877
Pfuntner A., Wier L.M., Stocks C. Most Frequent Conditions in U.S. Hospitals, 2011. HCUP Statistical Brief #162. September 2013. Agency for Healthcare Research and Quality, Rockville, MD.
Teekachunhatean, S., Kunanusorn, P., Rojanasthien, N., Sananpanich, K., Pojchamarnwiputh, S., Lhieochaiphunt, S., & Pruksakorn, S. (2004). Chinese herbal recipe versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial . BMC Complementary and Alternative Medicine, 4(19), doi: 10.1186/1472-6882-4-19
World Health Organization. (2004). The global burden of disease:2004 update . Geneva, Switzerland: World Health Organization Press. Retrieved from http://books.google.com/books?id=xrYYZ6Jcfv0C&pg=PA35
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