Organic Arthritis Blog

The Benefits of Exercise

Sun, 20 Nov 2022 21:13:17 GMT

We all know the importance of staying active and exercising. It is advice we have heard many times as we navigate the twists and turns known as life. Often it is easier said than done especially for those with arthropathy and joint pains. However, we must fight the battle and remain as mobile and dynamic as possible. Because data shows that our quality of life, overall health, and even life expectancy itself are greatly impacted by our patterns of activity.

We define physical activity as bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above the basal (baseline) level. Any type of physical activity can be included (occupational, household, leisure time, and transportation) and it is often categorized by level of intensity. The term "exercise" refers to a form of physical activity that is planned, structured, repetitive, and purposeful with a main objective of improvement or maintenance of one or more components of physical fitness.

A metabolic equivalents scor e (often called MET score) is often used by scientists to help quantify the energy expenditure of activities. A score of 1 represents the amount of energy used when a person is at rest. Using this as a baseline, scientists have given common activities MET scores. While MET scores have their limitations, they are useful starting points for discussing exercise .

Activities with a MET score of 1-4 are in the low-intensity category. They would not improve the cardiovascular fitness of most people, though they could be a good starting point for some. Activities with a MET score of 5-8 are classified as moderate and would be appropriate for those who are older or sedentary. Activities with a MET score over 8 are high intensity and are best for improving fitness as long as they can be done safely.

Here are some other common workouts and their MET scores:

Walking on a firm, level surface at a very brisk pace: 5.0
Running at the rate of a 10-minute mile: 9.8
Low-impact aerobics: 5.0
Swimming laps: 5.8

Everyday tasks also use energy and have their own MET scores, including:

Moving furniture: 5.8
Raking leaves: 3.8
Washing windows: 3.2
Walking the dog: 3.5

There is strong and consistent data that cardiorespiratory fitness (CRF) and exercise can greatly effect clinical outcomes. In this meta analysis by Kodama S et al - data from MEDLINE (1966 to December 31, 2008) and EMBASE (1980 to December 31, 2008) databases were evaluated. Participants were characterized based on estimated cardiorespiratory fitness (CRF) utilizing metabolic equivalent (MET) units. Participants were categorized as low fitness (< 7.9 METs), intermediate fitness (7.9-10.8 METs), or high fitness (> or = 10.9 METs). There was strong association with higher cardiorespiratory fitness levels and lower risk of all-cause mortality and cardiac events. Participants at 7.9 METs or more had substantially lower rates of all-cause mortality and cardiovascular events compared with those with a less than 7.9 METs.

Some of the potential benefits of exercise / movement?

Help control weight by burning calories
Help maintain bone mineral density - so bones don't get thin and break easily
Help with stress relief
Can help improve/control depression and anxiety
Can help with blood pressure control
Can control blood sugar levels in people with diabetes
Can lower the chance of dying from heart disease

How often should One exercise?

Doctors recommend that people exercise at least 30 minutes a day, on 5 or more days of the week . If you can't exercise for 30 minutes straight, try to exercise for 10 minutes at a time, 3 or 4 times a day. Even exercising for shorter amounts of time is good for you, especially if it means spending less time sitting.

What are the main types of exercise?

There are 3 main types of exercise. They are:

● Aerobic exercise – Aerobic exercise raises a person's heart rate. Examples of aerobic exercise are walking, running, dancing, riding a bike, or swimming.

● Resistance training – Resistance training helps make your muscles stronger. People can do this type of exercise using weights, exercise bands, or weight machines. You can also do this type of exercise using your own body weight, as with push-ups, or by lifting items in your home, like jugs of water.

● Stretching – Stretching exercises help your muscles and joints move more easily.

It's important to have all 3 types of exercise in your exercise program. That way, your body, muscles, and joints can be as healthy as possible.

What should I do when I exercise?

Each time you exercise, you should:

● Warm up – Warming up can help protect and keep you from hurting your muscles when you exercise. To warm up, do a light aerobic exercise (such as walking slowly) or stretch for 5 to 10 minutes.

● Work out – You should try to get a mix of aerobic exercise, resistance training, and stretching. During an aerobic workout, you can walk fast, swim, run, or use an exercise machine. Other activities, like dancing or playing tennis, are also forms of aerobic exercise. You should also take time to stretch all of your joints, including your neck, shoulders, back, hips, and knees. At least 2 times a week, you can do resistance training exercises as part of your workout.

● Cool down – Cooling down helps keep you from feeling dizzy after you exercise and helps prevent muscle cramps. To cool down, you can stretch or do a light aerobic exercise for 5 minutes.

The beauty of exercise regimens is the variability and potential adaptability of individual plans. One can exercise at home by themselves or in group activities or gyms. People can walk, jog, bike, or stretch. They can do resistance training with or without weights. They can find activities they enjoy such as basketball, tennis, or swimming. So keep battling and keep working on a personalized exercise regimen to help keep you active, healthy, and happy and everyone!

Glucosamine and Chondroitin: What Does the Data Show

Mon, 08 Aug 2022 01:09:55 GMT

Osteoarthritis is commonly referred to as the “wear and tear” degenerative joint disease. It typically results from the gradual loss of cartilage - the tough connective tissue that is within/between joints. In a way too simple analogy of this complex mechanism - this cartilage serves as essentially a shock absorber preventing direct shear force or “bone on bone” pressure. Once the shock absorber is weakened/gone – trauma will slowly lead to inflammation and erosion of the joint (PAIN!).

This leads to a pretty straightforward question - is there a way to repair or at the least slow down the decline of cartilage?

Enter Glucosamine - which is an amino sugar and precursor in the synthesis of glycosylated lipids and proteins. It is a natural compound that exists in our cartilage.

In supplement form, glucosamine is harvested from shells of shellfish or made in a lab. There are several forms of glucosamine, including glucosamine sulfate, glucosamine hydrochloride and N-acetyl glucosamine.

Generally it is taken as an oral supplement, oftentimes partnering with Chondroitin which is a chondrin derivative also naturally found in our cartilage.

So now we have some background info on the players (Glucosamine and Chondroitin) the question is - do they make a difference? Well that is a complex question that may best be answered with a maybe or even an outright no. Let us review some of the data:

In this meta analysis by Zhu et al - Twenty-six articles describing 30 trials met the inclusion criteria and were included in the analysis. The estimates between chondroitin and placebo showed that chondroitin could alleviate pain symptoms and improve function somewhat. Compared with placebo, glucosamine proved a mild significant effect only on stiffness improvement. However, the combination therapy did not have enough evidence to be superior to placebo.

In another meta-analysis by Reichenbach et al concluded after reviewing large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent. The authors final recommendation was the use of chondroitin in routine clinical practice should therefore be discouraged.

In another multicenter randomized control trial by Roman-Blas et al - 164 patients with moderate to severe knee osteoarthritis were treated with either chondroitin sulfate plus glucosamine or placebo. At six months' follow-up, the mean reduction in the global pain score was actually greater in the placebo group (33 percent) compared with the chondroitin sulfate plus glucosamine group (19 percent).

In general, there have been conflicting results from randomized trials evaluating the efficacy of glucosamine and chondroitin in knee osteoarthritis. Results from reviews with larger, methodologically sound studies found negligible effects of glucosamine hydrochloride on knee pain, while higher doses or higher-grade formulations of glucosamine sulfate (1500 mg/day) or chondroitin (800 mg/day) showed more favorable results and may have a statistically significant but small effect on symptoms compared with placebo.

Please refer to our blog for more potential information and therapy options for osteoarthritis. Sending good vibes and wishing everyone the absolute best. Feel free to reach out anytime with any questions. Stay healthy and stay active everyone!

Osteoarthritis: Clinical Manifestations

Mon, 31 Jan 2022 01:53:05 GMT

Osteoarthritis is one of the most common medical conditions in the world and is commonly referred to as “wear and tear” degenerative joint disease. It typically results from the gradual loss of cartilage within/between joints. This cartilage serves as a type of shock absorber preventing direct shear force and “bone on bone” pressure. Once the shock-absorber is gone it will slowly lead to inflammation and erosion of the joint.

US Centers for Disease Control data estimate approx 60 million people with doctor diagnosed arthritis – and remember many people live with joint aches/pain without seeing a physician or getting a formal diagnosis of OA. Sadly the symptoms of OA simply do not stop at the joint.

The Arthritis Foundation notes that individuals with OA are almost three times more likely to develop cardiovascular disease (CVD) or heart failure than those without OA. Also, people with osteoarthritis experience as much as 30 percent more falls and have a 20 percent greater risk of fracture than those without OA. These links are especially strong when arthritis is in certain weight bearing/balance joints, such as the knee/back/hip.

It makes sense – pain/weakness especially in our stabilizing joints such as knees/hips/spine will limit mobility and lead to risk factors such as weight gain, cardiovascular disease, diabetes coupled with stability issues. These patients would have difficulty following American Heart Association recommendation s that recommend increased physical activity and note that becoming more active can help lower blood pressure and also boost levels of good cholesterol. Without regular physical activity, the body slowly loses its strength, stamina and ability to function well - People who are physically active live about 7 years longer than those who are not active and are obese (American Heart Association). Studies have shown that adults who are inactive/minimally active more than 4 hours a day had a 46% increased risk of death from any cause and an 80% increased risk of death from cardiovascular disease!

So now let us focus on some of the clinical presentations of Osteoarthritis (OA). In general there is a marked variability of disease expression. Although most patients present with joint pain and functional limitations, the age of disease onset, sequence of joint involvement, and disease progression vary from person to person. OA ranges from an asymptomatic, incidental finding on clinical or radiologic examination to a progressive disabling disorder eventually culminating in "joint failure" with impaired mobility and quality of life.

The primary symptoms of osteoarthritis (OA) are joint pain, stiffness, and motor restriction. Symptoms usually present in just one or a few joints in a middle-aged or older person. Other manifestations in patients with OA include sequelae such as muscle weakness, poor balance, and associated conditions such as fibromyalgia (a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues).

Symptoms and signs — The following symptoms and signs may be observed in patients with OA:

● Pain – Pain is the most common symptom of those suffering with osteoarthritis. Pain in OA is typically worse with joint use (usage-related pain) and relieved by rest. A study by Hawker et all comments on the pain pattern of OA and it may progress through three stages:

•Stage 1 – Predictable, sharp pain usually brought on by a mechanical insult that eventually limits high-impact activities with relatively modest effect on function.

•Stage 2 – Pain becomes more constant and starts to affect daily activities. There may be unpredictable episodes of stiffness.

•Stage 3 – Constant dull/aching pain punctuated by episodes of often unpredictable, intense, exhausting pain that results in severe limitations in function.

However, not all patients go through such distinct stages, and pain progression may be arrested at any stage, and even go away (especially with hand OA). OA pain is generally worse in the late afternoon and early evening particularly with heavy/repetitive joint use; however, there are reports of OA morning pain soon after waking up. There may also be night pain in severe OA that can interfere with sleep - sometimes referred to as painsomnia - you can read our blog on painsomnia and OA. In some people, the pain has a burning (neuropathic) quality, is widespread around the joint, and is associated with paresthesia (a burning or prickling sensation often times called pins and needles). Such features also suggest co-morbid fibromyalgia.

● Limitation of motion – Reduced range of motion (equal for both active and passive movement) mainly results from pain/inflammation

● Tenderness – Tender upon touching/palpation. Joint-line tenderness suggests articular pathology directly at the affected cartilage site while tenderness away from the joint line suggests periarticular soft-tissue pathology or effusion.

● Bony swelling – Bony swelling reflects remodeling of the bone and cartilage on either side of the joint and may be evident in small joints (such as the fingers) and large joints (such as the knee).

● Joint deformity – Deformity is a sign of advanced joint damage

● Instability – Giving way or buckling is a common symptom in knee OA. Occasionally people may stumble and fall, but usually it is a feeling of apprehension and lack of confidence to weight-bear rather than literally "giving way." It is predominantly a sign of muscle weakness with subsequent altered patellar tracking (with lateral patellar subluxation) but may also be associated with true joint instability

OA can be categorized into localized or generalized forms of the disease typically by the type of joint involvement. There can also be single joint or multiple joint disease. The most common site of OA include:

Knees
Lower Back (Lumbar spine)
Neck (Cervical spine)
Hips
Finger interphalangeal joints (Hands)

OA less commonly affects the elbow, wrist, shoulder (ie, the glenohumeral joint), and ankle.

This blog entry focuses on some of the clinical manifestations of arthritis. We do have more information on specific disease types and potential therapy strategies in our OA blog . Please also feel free to visit our site and learn more about our product - Herbal Joint Supplement by Organic Arthritis. It has been utilized for an extended time and has shown to be a well-tolerated supplement for individuals with joint pains. All ingredients are herbal/organic and have been used for generations in holistic medicine. Clinical study data exists for active ingredients showing anti-inflammatory action at extracted dosages. We have been getting great personal feedback from users ( please read our fantastic Amazon reviews here ) . We also conducted an observational analysis of users who were clinically recommended to stop NSAIDS and did not have adequate relief on Acetaminophen who then began using Organic Arthritis - over 90% of those surveyed noted improved, efficacious relief of inflammatory symptoms using only Organic Arthritis alone at recommended dosages. There can be a safe, effective, and natural solution! Thank your for the time - stay healthy, active, and safe everyone!

Osteoarthritis - a Complex (Metabolic) System

Wed, 24 Nov 2021 17:14:05 GMT

Osteoarthritis is oftentimes characterized in simple terms - typically referred to as a “wear and tear” injury to a specific joint. This usually involves the weight bearing joints of the body such as the lower back (lumbar spine), the hips, or the knees but can also include common repetitive use joints such as the fingers/toes and also the ankle (especially if historical trauma/injury is noted).

In actuality - osteoarthritis is a complex system with many mediators that can affect degradation of joints/cartilage. There are multiple mechanisms that can help trigger erosive joint disease - including several metabolic triggers. In this excellent review by Wang/Hunter et a l from Osteoarthritis and Cartilage - they have an interesting info graphic highlighting potential metabolic contributors to OA (shared below).

Metabolic osteoarthritis refers to triggered inflammation and subsequent joint erosion associated with metabolic risk factors. Let us go through some of these potential metabolic triggers for osteoarthritis:

Metabolic Syndrome - a group of five conditions that can lead to heart disease , diabetes , stroke and other health problems (including Osteoarthritis). Metabolic syndrome is diagnosed when someone has three or more of these risk factors:

High blood glucose (sugar)
Low levels of HDL (“good”) cholesterol in the blood
High levels of triglycerides in the blood
Large waist circumference or “apple-shaped” body
High blood pressure

2. Elevated body mass index (BMI) - The CDC lists general guidelines for adult body mass indexes. BMI is a person’s weight in kilograms divided by the square of height in meters. A high BMI can indicate high body fat levels (but not in all instances)

If your BMI is less than 18.5, it falls within the underweight range.
If your BMI is 18.5 to <25, it falls within the healthy weight range.
If your BMI is 25.0 to <30, it falls within the overweight range.
If your BMI is 30.0 or higher, it falls within the obesity range.

Obesity is frequently subdivided into categories:

Class 1: BMI of 30 to < 35
Class 2: BMI of 35 to < 40
Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “severe” obesity.

People who have obesity, compared to those with a normal or healthy weight, are at increased risk for many serious diseases and health conditions , including the following:

All-causes of death (mortality)
High blood pressure (Hypertension)
High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
Type 2 diabetes
Coronary heart disease
Stroke
Gallbladder disease
Osteoarthritis (a breakdown of cartilage and bone within a joint)
Sleep apnea and breathing problems
Many types of cancer - such as gastric, endometrial, kidney, liver ca, and many more
Low quality of life scores
Mental illness such as clinical depression, anxiety, and other mental disorders
Body pain and difficulty with physical functioning

Our focus in this blog is on the body pain component - particularly arthropathy associated with elevated BMI. Being overweight/obese is a clear risk factor for developing OA. Population-based studies have consistently shown a link between overweight or obesity and knee OA. Estimating prevalence across populations is difficult since definitions for obesity and knee OA vary among investigators. Data from the first National Health and Nutrition Examination Survey (HANES I) indicated that women with a BMI over 30 had nearly 4 times the risk of knee OA as compared with non-obese women; for obese men, the risk was nearly 5 times greater.

3. Elevated Waist Circumference - there is a long standing association between waist circumference and various disease risks. In a long term 13 year follow up study by Larsson et al - there were strong associations between an elevated waist to hip circumference ratio with occurrence of stroke (p = 0.002) and ischemic heart disease (p = 0.04). There also is strong data between waist circumference and elevated risks of diabetes mellitus. There is even strong correlation dat a between waist circumference and overall mortality (death) risks. In this study by Batsis et al - they evaluated physical effects of waist circumference and noted higher waist circumferences are associated with lower quality of life, a decline in physical function, and a slightly higher risk of disability over time with higher general arthritis rates.

4. Adipose (fatty tissue) derived inflammation (cytokine up-regulation) - Data also shows that it is not weight and sheer force impact on the joints itself that is the root cause of degradation of a joint space. There is a complex inflammatory environment that adipose tissue seems to help facilitate. In an article by Wang et al - they noted obese individuals and study animals showed a higher level of serum tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL)-1β and IL-6, all of which are produced by macrophages derived from adipose tissue. These are commonly known pro-inflammatory cytokines that data shows are typically elevated in the synovial fluid, synovial membrane, subchondral bone and cartilage of osteoarthritis patients -confirming their important roles in OA pathogenesis.

5. Glucose (sugar) issues - data has long shown a correlation with elevated blood glucose levels (diabetes) and risk of arthritis. In this study by Schett et al - Rates of arthroplasty (95% CI) were 17.7 per 1,000 person-years in patients with type 2 diabetes and 5.3 per 1,000 person-years in those without ( P < 0.001). Type 2 diabetes emerged as an independent risk predictor for arthroplasty( P < 0.001) in an unadjusted analysis and 2.1( P = 0.023) after adjustment for age, BMI, and other risk factors for OA.

6. Hormonal changes - as individuals age - there are multiple hormonal changes that occur. Estrogen levels typically decrease in females and testosterone levels decrease in males which can potentially contribute to a plethora of clinical symptoms. There has been varying data on hormonal effects on joint disease and also whether hormonal therapy can impact symptoms of osteoarthritis.

So an interesting review here on arthritis and the complex factors that may be contributing to progression. Sending good vibes and wishing everyone the absolute best. Feel free to reach out anytime with any questions. Stay healthy, stay active, and stay safe everyone!

Falls - Let us discuss risk factors and also fall prevention strategies

Mon, 20 Sep 2021 21:39:17 GMT

Falls are a major issue especially in our elderly population and falls are the leading cause of injury, both fatal and nonfatal, among older adults in the United States . I can not even count the number of lives that were significantly (and often times permanently) changed after a fall through my decades of practice as a Nephrologist and Internist.

I will share one story of a long term patient (who became a long time friend along with his family) - I can not share his name for medical legal reasons. This was a pleasant gentleman who had moved to the DMV region from the Midwest. He was approximately 93 years young when he moved to the area and had stage 5 chronic kidney disease with less than 10 ml/min (approximately 10 percent) kidney function when he came to our CKD clinic. He was sharp as could be and would even drive to clinic visits (often accompanied by his daughter). He initially said he would only pursue medical management with pills and clinic visits and would not pursue machine-based modalities such as hemodialysis even if acutely indicated.

Approximately 2 years after establishing with us - with further progression of his kidney disease we had major issues controlling his volume despite maximal oral diuretic (fluid pills) therapy and he had several hospital admissions over a short time for IV diuretics to control his fluid status and congestive heart failure. At this time he had approximately 7 ml/min (approximately 7%) kidney function and we had a big family meeting on his overall goals of care. He still was sharp and self sufficient (but was starting to have some fatigue/energy issues likely from toxin build up due to his severe kidney disease). The options were likely moving to hospice/comfort measures vs a trial of hemodialysis (a machine that filters the blood to help simulate kidney function/clearance).

My now 95 year old friend decided to try hemodialysis to help control his volume status and remove toxins from the bloodstream. He responded well to therapy and immediately noted improved energy/appetite with toxin removal. We were able to control his fluid status with the dialysis sessions and he did well. He remained on dialysis with no hospital admissions until the age of 99. I had seen him regularly at the dialysis unit and we had great conversations for years. He would often tell me stories about his life experiences - even details of World War 2. He remained sharp with a good quality of life - until he had an accidental fall in the shower at age 99.

With the fall - my friend unfortunately suffered a right femoral head fracture. After surgery - he had constant issues with pain management coupled with decreased mobility and was unable to care for himself for the first time in his adult life. He would need a nursing home at this point and struggled gaining mobility despite attempting rehab with his usual zeal and positive attitude. He developed wounds/ulcers in his bottom region and was in constant pain. We had another family meeting and he decided to stop dialysis and focus on hospice/comfort measures. He soon passed away after a long and distinguished life. I will always remember him and this was just one example how a fall can change everything unexpectedly.

In 2018, according to the CDC Behavioral Risk Factor Surveillance System - 27.5 percent of adults aged ≥65 years reported at least one fall in the past year (35.6 million falls), and 10.2 percent reported a fall-related injury (8.4 million fall-related injuries). The percent of falls increases to about 34 percent in those 85 years and older, and falls and fall injuries were reported more commonly by women than by men.

According to an article in the Journals of Gerontology - Fall-related injuries are associated with significant subsequent morbidity: decline in functional status, increased likelihood of nursing home placement, and greater use of medical services.

In another article in the American Journal of Epidemiology - Compared with hospitalization due to other conditions, hospitalizations from falls resulting in hip fracture or other injuries lead to worse outcomes and a greater chance of nursing home admissions. Research also shows that among community-living older adults who sustain hip fractures, 25 to 75 percent do not recover pre-injury functional status.

So we all recognize that falls have major consequences - now let us focus on potential risk factors that may increase the chances of a fall. There are hundreds of studies on falls and potential risk factors leading to them. Some reviews such as this one in the Journal of the American Medical Association - attempt to identify several characteristics that may increase the chances of falls. These include:

●Past history of a fall

●Lower-extremity weakness

●Age

●Female sex

●Cognitive impairment

●Balance problems

●Psychotropic drug use

●Arthritis

●History of stroke

●Orthostatic hypotension

●Dizziness

●Anemia

So now that we have identified some risk factors that may increase the chance of a fall - we can discuss some potential interventions to help decrease falls. In actuality fall prevention should be a comprehensive and multi disciplinary process that focuses on risk factor identification and optimization. The review includes:

Working to optimize blood pressure and volume status ( avoid Hypotension (Low Blood Pressure) and Orthostasis (low blood pressure when rising)

Minimizing medications - particularly those associated with fall risks

Vision evaluation ( and potential treatment such as for cataracts)

Heart rate and rhythm evaluation (avoid bradycardia (low heart rate) and also identify heart arrhythmias (such as atrial fibrillation )

Vitamin D supplementation and repletion to goal levels - there is growing data (debatable though) that vitamin D deficiency does increase chances of falls

Physical therapy evaluation to assess gait/balance and potentially the need for assist devices (such as canes/walkers)

Manage foot and footwear issues (may even need a Podiatry evaluation if impairments noted)

Modify the home environment in ways to limit fall risks (such as less need to climb or descend stairs)

Provide education and social support if needed

Data shows balance and or mobility issues can significantly increase risks for falls. Arthritis itself - particularly of the knee/hip/back - also elevated risks. Arthritis also may limit participation in core strengthening and balance exercises that themselves may prevent/limit falls. An anti inflammatory - particularly safe, natural solutions with limited side effect profiles (such as Organic Arthritis!) can be used prior to exercise to help participation.

There are potential benefits in particularly core strengthening and balance exercises to help prevent falls. Below are some good exercise resources:

Again sending good vibes and wishing everyone the absolute best. Feel free to reach out anytime with any questions. Stay healthy, stay active, and stay safe everyone!

Yoga and Arthritis

Sun, 05 Sep 2021 18:28:19 GMT

Cultures around the world, originally in eastern philosophy, have utilized mind body movement exercises for generations for various potential mental and physical benefits. These practices have increased in popularity and scope and are now truly global disciplines such as yoga and tai chi .

Yoga likely was founded in Indi a and entails discipline in physical, mental, and spiritual realms with originally strong followings in the hindu and buddhist doctrines. It has morphed from being tied to a single country and also bypassed religious connotations. The term "yoga" in the Western world often denotes a modern form of hatha yoga and posture-based physical fitness, stress-relief, and relaxation techniques sometimes accompanied with breathing exercises

The focus of yoga in this modern sense is to blend posture based positions/poses to help facilitate exercise for the body and potentially mind. There are many different disciplines/variations of Yoga with significant fluctuations in their physical demands. Many researchers/physicians attempt to quantify the strenuousness of exercises by their energy cost of exercise commonly measured in metabolic equivalent of task (MET). Less than 3 METs counts as light exercise; 3 to 6 METs is moderate; 6 or over is vigorous. American College of Sports Medicine and American Heart Association guidelines count periods of at least 10 minutes of moderate MET level activity towards their recommended daily amounts of exercise. For healthy adults aged 18 to 65, the guidelines recommend moderate exercise for 30 minutes five days a week, or vigorous aerobic exercis e for 20 minutes three days a week. Treated as a form of exercise, a complete yoga session with asanas (body posture) and pranayama (focusing on breath) discipline provides 3.3 ± 1.6 METs which would be classified as an average/moderate workout in strenuousness.

There have been several hundred published articles/scientific trials on Yoga and its potential health benefits. Let us focus on some of the data for arthropathy.

In one randomized control trial by Deepeshwar et al - Sixty-six individual diagnosed with with knee osteoarthritis (ages between 30 and 75 yo) were randomized into two groups. One group would then participate in yoga for 1 week at a yoga center ( n = 31) and then a control ( n = 35) group who did not participate in any yoga activities. Multiple functional tests were performed on day 1 and then at day 7 - including the Falls Efficacy Scale (FES), Handgrip Strength test (left hand LHGS and right hand RHGS), Timed Up and Go Test (TUG), Sit-to-Stand (STS), and right & left extension and flexion. Results indicated a significant reduction in TUG ( p < 0.001), Right ( p < 0.001), and Left Flexion ( p < 0.001) whereas significant improvements in LHGS ( p < 0.01), and right extension ( p < 0.05) & left extension ( p < 0.001) from baseline was found in the yoga group. This would suggest improved muscular strength, flexibility, and functional mobility in the yoga group.

This was a small study that also was completed over a short time frame (1 week) but did show marked functional improvements. Let us look at more data via a large review by Haaz et a l . Researchers combed through peer-reviewed clinical trials (published from 1980-2010) that used yoga as an intervention for arthritis patients and reported quantitative findings. Eleven studies were identified, including four randomized control trials and four non randomized trials. The trials reviewed data is below in the table.

All trials were small and control groups varied in demographics. Evidence was strongest for reduction in disease symptoms (tender/swollen joints, pain) and disability, as well as improved self-efficacy and mental health. No adverse events were reported in yoga participants and attrition was comparable or better than typical for exercise interventions. The study finding table is below.

So we have some data now that yoga can be beneficial for individuals suffering from various types arthropathy (knee, back, hand) - now let us share some resources on yoga and joint disease:

The Johns Hopkins Arthritis Center has some great resources and more information on yoga for arthritis including some instructional videos

The Arthritis Foundation has some information (and videos) on arthritis-friendly yoga poses

Healthline has some information on several yoga poses to help with osteoarthritis symptoms

Spine-Health has some information on several beginner yoga poses for lower back relief

Remember if the arthritis pain itself is limiting - you can try an anti-inflammatory (such as Organic Arthritis! ) to potentially help you participate in activities such as yoga. As always - thank you for taking the time out to read our blog. Feel free to leave any comments/insights below. Stay healthy, active, and safe everyone!

Dietary Patterns and Progression of Knee Osteoarthritis: Data from the Osteoarthritis Initiative

Sun, 22 Aug 2021 15:22:59 GMT

Let us review an interesting study from the Harvard medical system published in the American Journal of Clinical Nutritio n and also Osteoarthritis and Cartilage Journal by Xu et all dealing with the potential impacts of dietary intake patterns and progression of Knee osteoarthritis.

There is an age old saying - "You are what you eat" and there has been past data on certain foods/nutrients linked with outcome effects on knee arthritis such as (click the links below for reference articles):

Soft drink consumption (potential increased risk of OA progression)
Milk consumption (potential decreased risk of OA progression particularly in women)
Dietary fat intake (potential increased risk of OA progression)
Strawberrie s (potential decreased risk of OA progression particularly in obese adults)
Fiber intake (potential decreased risk of OA progression)

We also know of many herbs that have varying arthritis control data (some very convincing) and our own Organic Arthritis Herbal Supplement is composed of strong data driven herbs for arthropathy control. There have been past study links between a general Mediterranean diet having a relative lower risk of and improved overall symptom control of knee OA. This study focuses more on overall diet classes and effects on osteoarthritis. This study compares two diet classes based on the Scree test via individual diet questionnaires:

Western Diet - composed of high intakes of red and/or processed meats, refined grains, and french fries

Prudent Diet - composed of high intakes of vegetables, fruit, fish, whole grains, and legumes

Researchers utilized the Osteoarthritis Initiative (OAI) - launched by the NIH in 2004 that includes 4796 individuals aged 45-79 all with established symptomatic knee osteoarthritis or significant risk factors for developing knee OA. Clinical testing centers were located in Maryland, Ohio, Pennsylvania, and Rhode Island. Of this population - 2757 participants were selected with existing knee osteoarthritis (mean age 62 y). Below is an study graphic highlighting the selection/inclusion process.

These individuals then had their diet evaluated at baseline and also via regular questionnaires for up to 72 months. They were then categorized as having Prudent or Western dietary patterns on a scale/score base.

These individuals' overall arthritis progression was then assessed using 2 seperate radiographic measures:

Kellgren–Lawrence (KL) grade increase

Loss in joint space width (JSW)

Also individuals were assessed for symptomatic progression of their knee osteoarthritis via Western Ontario and McMaster Universities Arthritis Index (WOMAC) scoring.

The results noted a clear difference in outcomes based on dietary pattern. Individuals with higher Western diet patterns had risk for worsened KL grades (compared with quartile 1, HR for quartile 4: 1.30; 95% CI: 1.05, 1.61; P-trend < 0.01). Also individuals with higher Western diet pattern scores also had increased odds of having progressively higher WOMAC symptomatic progression scores (compared with quartile 1, OR for quartile 4: 1.39; 95% CI: 1.18, 1.63; P-trend < 0.01). There was no significant change in joint space width imaging loss even as Western Diet pattern scores rose.

Increasing Prudent dietary pattern scores were associated with decreased KL-worsening risk (compared with quartile 1, HR for quartile 4: 0.79; 95% CI: 0.64, 0.98; P-trend = 0.02). Individuals with higher Prudent pattern scores also had decreased odds of higher WOMAC progression (compared with quartile 1, OR for quartile 4 0.73; 95% CI: 0.62, 0.86; P-trend < 0.01). Rising Prudent diet pattern scores were also associated with decreased joint space width imaging loss (quartile 1: 0.46 mm; quartile 4: 0.38 mm; Ptrend < 0.01).

So very interesting data here - following a more Western dietary pattern composed of high intakes of red and/or processed meats, refined grains, and french fries was strongly associated with increased radiographic (via KL but not JSW scoring) and symptomatic knee osteoarthritis progression. On the other hand - following a more Prudent dietary pattern composed of high intakes of vegetables, fruit, fish, whole grains, and legumes was associated with both reduced knee osteoarthritis radiographic progression (both via KL and JSW scoring) and symptomatic progression (via WOMAC scoring).

So as always - stay healthy (healthy diet also!), safe, and active everyone!

Arthritis - More than Physical Discomfort - Let’s Talk About Social Interaction

Fri, 06 Aug 2021 13:33:21 GMT

Arthritis is one of the most common medical conditions diagnosed in the United States and world-wide. CDC US data notes there are approximately 60 million individuals battling arthropathy with that estimate rapidly growing to an estimated 78 million (26%) US adults aged 18 years or older projected to have doctor-diagnosed arthritis by 2040 .

Some reviews state this CDC data is underestimating the future prevalence of arthropathy as individuals generally live longer coupled with rising average population body mass indexes (BMI) – which leads to more shear stress on weight bearing joints like the lumbar spine / hips / knees. Either way we look at this – this is an enormous disease burden that is accelerating in incidence yearly and more than 1 out of every 4 US adults will have diagnosed arthropathy in the near future.

The issue here is that arthropathy simply does not lead to pain/discomfort. There are other tremendous downstream affects of chronic joint pains. This blog post will focus on the mental impacts of arthropathy. There is growing data that individuals with arthritis have a markedly increased risk of social isolation (when adults become lonely) and diagnosed depression.

In a study published in the Journal of the American Geriatrics Society – researchers combed the EPOSA Study and examined the relationship between osteoarthritis and social interactions. This study pool included 2,942 adults between 65-85 years of age living in Germany, Italy, the Netherlands, Spain, Sweden, and the UK which led to 1,967 active participants. Researchers used questionnaires that logged how often and how many times the participants connected socially with friends and family members. They also learned how often the participants volunteered or participated in social activities.

Study results indicated approximately 20 percent of individuals were classified as having social isolation at the baseline (start) of the study with a 13% additional incident diagnosis of social isolation found 12 to 18 months after baseline. The study concluded that OA independently increases the risk of incident social isolation onset. People with hip and/or knee OA particularly are at increased risk of social isolation in a community cohort. The presence of cognitive impairment and worse walking times in both sexes and depression in the females also increased the risk of becoming socially isolated during the follow-up period. Osteoarthritis also remained an independent predictor of worse outcomes in the multivariate analyses, even after adjusting for functional limitations and pain scoring.

Social isolation is not a benign condition and can increase multiple health risks for individuals. Below is a chart highlighting four variables that proved significant in analysis: clinical OA, cognitive impairment, depression, and walking time.

A report based on the United States population from the National Academies of Sciences, Engineering, and Medicine (NASEM ) points out approximately 40% of adults over age 45 having limited social interactions overall with nearly one-fourth of adults aged 65 and older considered to be overtly socially isolated (lonely). This report highlighted glaring potential health impacts for those with social isolation including:

Social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity

Social isolation was associated with about a 50% percent increased risk of dementia

Poor social relationships (characterized by social isolation or loneliness) was associated with a 29% increased risk of heart disease and a 32% increased risk of stroke

Loneliness was associated with higher rates of depression, anxiety, and suicide

Loneliness among heart failure patients was associated with a nearly 4 times increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits

So we know a few things from these reviews – that arthropathy increases rates of social isolation and that social isolation itself has a plethora of physical and mental health complications that go as far as to increase mortality risks (death). We as physicians/clinicians need to understand and own these facts and regularly discuss and screen for impaired social interactions and overt depression in our patient cohorts. We need to implement active treatment plans to help those in need and potentially improve our overall patient outcomes and quality of life.

If yourself or someone you know is suffering from impaired social interactions or overt social isolation (loneliness). Here are some suggestions to get active again:

See your Primary Care, Geriatrician, or Mental Health expert to assess social interaction/depression screening and potential therapy options

Arthropathy management – can focus on anti inflammatory agents (such as Organic Arthritis) or physical therapy to help control root cause symptoms that often times lead to decreased activity, mobility, and social interaction. You can learn more about potential therapy options on our OA Blog

AARP —Provides helpful information to seniors to help improve quality of life and provides access to Community Connection Tools.

Area Agencies on Aging (AAA)—A network of over 620 organizations across America that provides information and assistance with programs including nutrition and meal programs (counseling and home-delivered or group meals), caregiver support, and more. The website can help you find your local AAA, which may provide classes in Tai Chi and diabetes self-management.

Eldercare Locator —A free national service that helps find local resources for seniors such as financial support, caregiving services, and transportation. It includes a brochure that shows how volunteering can help keep you socially connected.

National Council on Aging —Works with nonprofit organizations, governments, and businesses to provide community programs and services. This is the place to find what senior programs are available to assist with healthy aging and financial security, including the Aging Mastery Program® that is shown to increase social connectedness and healthy eating habits.

National Institute on Aging (NIA) – Provides materials on social isolation and loneliness for older adults, caregivers, and health care providers. Materials include health information, a print publication available to view or order no-cost paper copies, a health care provider flyer, and social media graphics and posts.

Sending good vibes and wishing everyone the absolute best. Feel free to reach out anytime with any questions. Stay healthy and stay active everyone!

Painsomnia - sleep issues caused by pain

Mon, 12 Jul 2021 20:23:47 GMT

Many of us have heard of the medical term INSOMNIA . It refers to a medical condition in which individuals have difficulty falling, staying, or getting back to sleep. There can be short term sleep issues lasting nights or weeks, termed acute insomnia , or long term sleep disturbances ranging months to years, termed chronic insomnia . This can lead to a multitude of general health ramifications.

The first question - how much sleep is recommended daily?

According to United States Centers for Disease control recommendations - adults should generally have 7 or more hours of sleep nightly to help ensure optimal functional status. This CDC table below helps show National Sleep Foundation and American Academy of Sleep Medicine recommendations:

In addition to overall hours of sleep in quantity - several other factors help determine the overall effectiveness of bedtime such as one's sleep quality. Adequate sleep quality is generally defined by the Sleep Foundation as the following attributes:

Fall asleep soon after getting into bed, within 30 minutes or less.
You typically sleep straight through the night, waking up no more than once per night.
You’re able to sleep the recommended amount of hours for your age group.
You fall back asleep within 20 minutes if you do wake up.
You feel rested, restored, and energized upon waking up in the morning

Now that we have an idea on general sleep recommendations - now let's talk in more detail about insomnia.

United States Centers for Disease Control data notes that nearly one third of all US adults report getting less than the recommended hours of sleep nightly. This figure below shows the age-adjusted percentage of adults who reported short sleep duration (less than 7 hours of sleep per 24-hour period), by state in the United States from 2014 census data

One of the most commonly reported reasons for impaired sleep duration or quality is pain at night particularly in those with arthritis.

Up to 80 percent of people with arthritis report some difficulty sleeping - with joint pains at night being cited as the most likely culprit. National Health Interview Survey Data from the NIH has indicated the adjusted prevalence of diagnosed insomnia was higher among adults with arthritis than those without arthritis. Joint pain and limitation due to pain mediated the association between arthritis and insomnia among those surveyed.

There is data showing improved sleep quantity and quality is associated with reduced daily arthritis pains - so let us discuss some potential options to help you get a good night's sleep!

1) Practicing good overall sleep habits - often called sleep hygiene - some recommendations include:

Regular bedtime/Rise time - consistent bedtime and rise time leads to more regular sleep schedules and avoids periods of sleep deprivation or periods of extended wakefulness during the night

Avoid Napping - especially naps over 1 hr in duration and naps later in the day

Limit caffeine - void caffeine after lunch. The time between lunch and bedtime represents approximately 2 half-lives for caffeine, and this time window allows for most caffeine to be metabolized before bedtime

Limit Alcohol - limit/ avoid alcohol near bedtime. Alcohol is initially sedating, but activating as it is metabolized. Alcohol also negatively impacts sleep architecture

Avoid Nicotine - Nicotine is a stimulant and should be avoided near bedtime and at night

Exercise regularly - Daytime physical activity is encouraged, in particular, 4 to 6 hours before bedtime, as this may facilitate sleep onset. Rigorous exercise within 2 hours of bedtime is discouraged

Keep the sleep environment quiet and dark - Noise and light exposure during the night can disrupt sleep. White noise or ear plugs are often recommended to reduce noise. Using blackout shades or an eye mask is commonly recommended to reduce light.

Avoiding exposure to television or technology near bedtime, as this can have an impact on circadian rhythms by shifting sleep timing later

Don’t watch the clock - Avoid checking the time at night. This includes alarm clocks and other time pieces (eg, watches and smart phones). Checking the time increases cognitive arousal and prolongs wakefulness

Avoid late meals - Avoid a large meal near bedtime, but don't go to bed hungry. Eat a healthy and filling meal in the evening and avoid late-night snacks

2) Make a pre-bed routine that focuses on quiet and calm - find a passtime such as light reading or soothing sounds prior to bedtime to help facilitate sleep

3) In most patients with chronic insomnia - experts suggest cognitive behavioral therapy for insomnia (CBT-I) as first-line therapy. It is a multicomponent treatment typically conducted by expert sleep therapists over four to eight sessions focusing on sleep education, sleep restriction therapy, sleep compression, stimulus control therapy, sleep hygiene, cognitive therapy, and counter-arousal measures including relaxation

4) Herbal te a could be potential options that have had varying degree

5) Melatonin (over the counter) has been used as a sleep aid with varying effectiveness. It is often referred to as the sleep hormone and is a central part of the body’s sleep-wake cycle. Its production increases with evening darkness, promoting healthy sleep and helping to orient our circadian rhythm

6) Attempt to control the physical pain/arthropathy. There a multitude of options that could be attempted such as:

Hot or Cold therapy - warm baths or warmed blankets can help calm sore joints prior to bed with some people preferring ice to swollen areas

Anti- inflammatory - an anti inflammatory prior to bedtime may be an effective solution to take the edge off the pains/aches to help facilitate a good night's sleep

Common anti-inflammatory agents include NSAIDs or Acetaminophen. We would clearly recommend Organic Arthritis as a safe, effective, and natural solution for your needs with a much improved and limited side effect profile. As always - stay healthy, active, and safe everyone!

Knee Arthritis - a review on exercise, weight loss, and physical therapy!

Sun, 13 Jun 2021 17:16:17 GMT

We did a detailed blog and topic overview on knee pain/arthritis in the past – let's switch gears a bit. This post will focus on exercise and physical therapy as potential therapeutic options for knee osteoarthritis (referred to as OA).

To recap – knee osteoarthritis is commonly referred to as a “wear and tear” injury that occurs over time as our cartilage which typically serves as a sort of shock absorber between the bones of the knee joint erodes. Subsequent bone on bone pressure leads to inflammation. Data now shows a much more complex ecosystem leading to inflammation than simple “wear and tear” that is a mix of inflammatory mediators, biomechanical factors such as shear stress or ligament damage, and protease involvement. Regardless the cause – once knee osteoarthritis is diagnosed clinically and on imaging – there are limited tools to help alleviate symptoms.

Unfortunately – an estimated fourteen million people in the United States have symptomatic knee O A , with more than half of those being younger than 65 years of age. United States data from 2007 to 2008 report 7 percent of adults over 25 as having symptomatic knee OA – which is just a massive. Sadly - the disease burden of knee osteoarthritis is accelerating in prevalence with some study data estimating the lifetime risk of developing symptomatic knee OA at approximately 40 percent in men and 47 percent in women - with the highest risk in individuals with a body mass index over 30.

The potential therapies for knee osteoarthritis include anti-inflammatory medications or herbals supplements ( Hello Organic Arthritis! ), injections, or eventual surgical joint replacement. However, a mainstay of management often gets overlooked - simple exercise/therapy/weight loss regimens to strengthen structures around the joint and alleviate further pressure/force on the joint.

A Cochrane review that included 54 total trials - 19 of which were considered as "low risk of bias" - concluded there is moderate-to high-quality evidence suggesting that land-based exercise improves knee pain and function. Also, among people with knee osteoarthritis, land-based therapeutic exercise provides short-term benefit that is sustained for at least 2-6 months after cessation of formal treatment exercise regimens.

Another large review artic le noted the magnitude of effect with formal exercise/therapy is comparable to that reported for oral nonsteroidal antiinflammatory drugs (NSAIDs) and much better than Acetaminophen Arthritis (Tylenol Arthritis).

An article in the Journal of the American Medical Association on the IDEA trial randomized 454 overweight and obese adults with knee OA into one of three groups: diet plus exercise, diet alone, or exercise alone. Participants in the diet plus exercise group had the highest percentage of weight lost (11.4 percent of body weight) and improvement in pain after 18 months, achieving a decrease in pain scores of approximately 50 percent, with 38 percent of patients reporting no or little pain at the end of the trial. Moreover, a dose-response relationship between the extent of percentage change in body weight and improvement in joint symptoms has been demonstrated, with more robust effects achieved when at least a 10 percent reduction in body weight is attained. Meta-analysis review s may hint that a reasonable initial target is a 5 to 10 percent weight reduction within a six-month period with the initial goals being updated periodically and individually for each individual.

Combination of low-impact aerobic fitness training (eg, walking, cycling, rowing, and deep-water running) and lower-limb strengthening exercises, which addresses the full spectrum of impairments in most patients with knee OA. Exercise choice should be tailored based on an individuals mobility, specific impairments (eg, strength, range of motion, aerobic fitness, and balance), and preferences. Exercises involving high impact on the joints such as running or jumping are usually discouraged in order to avoid further joint damage, especially in cases of more advanced OA, although research evidence demonstrating an association between running and progression of knee OA is scarce

For those patients who already run or jog for exercise and develop mild symptoms of OA but wish to continue running - consider a load management approach with a focus on rest days, running surfaces, distance and speed, and footwear, as well as building up muscle strength. Stretching or flexibility exercises, particularly of the hamstrings to avoid or minimize flexion contracture of the knee, can also be part of the exercise program to increase knee range of motion

Aquatic exercise also have a potential clinically relevant effect on knee pain, function, and stiffness. Per this Cochrane Revie w the benefits may be small when compared with non-treatment controls. Still aquatic training may be particularly useful for patients with severe pain and/or poor physical function due to its better tolerance and lower potential to cause adverse events (less shear force on the joints)

Tai Chi can be considered as an exercise option for knee OA. Despite a limited number of large trials investigating the long-term effects of Tai Chi - study data has shown Tai Chi could potential produce benefits similar to those of a standard course of physical therapy in the treatment of knee osteoarthritis per this Randomized Control Trial highlighted in the Annals of Internal Medicin e . Also per this meta analysis - Tai Chi has been shown to be as effective as a standard exercise program after 12 weeks in terms of knee pain, physical function, and reduction in analgesic use as well as improves balance and is associated with a reduced falls risk in older patients with knee OA

Dedicated physical therapy and muscle strengthening can also add potential additional benefits. This graphic below from Veritas Health highlights the potential benefit if knee exercises on the actual knee joint itself.

Now we always advocate an evaluation by trained and experienced licensed physical therapists particularly those who specialize on the knee joint/lower extremities; however, here are some great resources on exercises that can typically be done at home to strengthen muscles around the joint. (Click on the link to open the webpages):

6 Exercises for Knee OA Pain from the Arthritis Foundation

Knee Osteoarthritis Exercises from WebMd

Easy Exercises for Knee Arthritis from Healthline

Knee Exercises to Ease Arthritis Pain : How Exercise Helps Your Knees, and 7 Daily Exercises to Try from CreakyJoints

Knee Strengthening Exercises from Arthritis-health

Thanks for taking time out to join us on this journey! We sincerely hope Organic Arthritis assists you in staying active and on your path to healthy and meaningful living!

NSAIDs use in Chronic Kidney Disease - a growing problem!

Fri, 11 Jun 2021 22:54:03 GMT

There is a strong chance all of us are aware of or have used non-steroidal anti-inflammatory drugs (commonly referred to as NSAIDs) in our lifetimes. There also is a good chance many have been told by their medical providers to avoid using NSAIDs especially long term given the risk factors for particular those with chronic kidney disease, congestive heart failure, resistant hypertension, gastritis/stomach ulcers, or even those with electrolyte concerns such as hyperkalemia (high potassium) or hyponatremia (low sodium).

Despite these risks – NSAIDs are simply the most recommended/prescribed anti-inflammatory medications in the world today. This class of medications includes such commonplace names as (click underlined links below for more info):

1) Advil

2) Aleve

3) Ibuprofen

4) Motrin

5) Naprosyn/Naproxen

6) Diclofenac/Voltaren

7) Celebrex/Celecoxib

8) Mobic (Meloxicam)

9) Indomethacin/Indocin

Though often times effective for inflammatory control - there are several noted risks to NSAIDs particularly in those with chronic kidney disease. NSAIDs provide their analgesic, anti-inflammatory, and antipyretic actions through inhibition of cyclooxygenase (COX) enzymes – which convert arichidonic acid (released from cell membranes) to prostaglandins and thromboxanes. This graphic in the American Journal of Kidney Disease highlights this COX cascade pathway affects:

Via the inhibition of the COX1/2 cascades - NSAIDs can potentially lead to decreased perfusion of blood flow entering our kidneys filtration system which can negatively affect kidney function along with other potential adverse effects such as sodium retention (swelling + blood pressure elevation), Congestive heart failure exacerbations, elevated potassium levels (referred to as hyperkalemia), and decreased sodium levels (referred to as hyponatremia) in the blood stream.

These adverse risks the largest societies on kidney care guidelines recommend to limit use of NSAIDs in the chronic kidney disease patient populations.

1) Kidney Disease Improving Global Outcomes (KDIGO) – guidelines from Kidney International - recommend to avoid prolonged use of NSAIDS in stage 3 chronic kidney disease and to completely avoid use in stages 4 and 5 CKD

2) KDOQI US-guidelines by the National Kidney Foundation also recommend to avoid prolonged use of NSAIDS in stage 3 chronic kidney disease and to completely avoid use in stages 4 and 5 CKD

3) Treatment of pain in patients with renal insufficiency: the World Health Organization three-step ladder approach also recommend to avoid NSAIDS entirely in stage 3/4/5 CKD

So now we know that NSAIDs in general should be cautioned/avoided in those with Chronic Kidney Disease – but there remains an issue – many individuals with CKD continue to regularly take NSAIDs. The reason is that there are few western alternatives for arthritis/pain control. Tylenol Arthritis (Acetaminophen) has weak data overall with several studies and analysis of trial data noting it has an effect only slightly better than placebo and much weaker than NSAIDs. Opioid data is even worse – with studies noting the tolerability of opioids is low and efficacy is not clinically relevant in controlled studies for osteoarthritis pain. The side effect profile of opioids is worse and many have died from these medications as this CDC graph shows:

In this cohort study in the Journal of Internal Medicine via the Center for Kidney Research, Education, and Hope (CURE-CKD) registry, more than 2.6 million adults and children had chronic kidney disease or were evaluated. Unfortunately – NSAID usage remains fairly regular and actually rising over the most recently evaluated years in the CKD population - look at this graphic below:

We had to dig deep and look for alternative options for our patients in need of solutions. Several herbs have been used in holistic medicine for generations for inflammation control such as curcumin, capsaicin extracts, ginger, willow bark, cloves, fenugreek, or nigella sativa. There is a multitude of bench data as well as clinical trial data (including several randomized control trials) for several of these herbs/extracts. We began looking into herbal/holistic substances and we parsed basic science/bench as well as clinical research databases. Our ingredients have shown to suppress the inflammatory cascade with the caveat of no known issues with kidney function / Sodium retention / Blood Pressure elevation / stomach lining erosion that plague chronic NSAID use. In 2014 after some testing and adjustments - we solidified a powder based regimen and would at times suggest patients seeking alternative/additional relief try it. We did not commercially sell it but would just suggest individuals obtain and try the ingredients on their own.

The response was tremendous and more often than not this became their go to relief agent. The only consistent suggestion (and complaint) was the taste of the powders and the need for a tablet to ease delivery/use. We adjusted the extract ratios/concentrations and were able to manufacture (made in the USA at an FDA registered and GMP certified facility) a coated (should be tasteless) tablet also scored to decrease size to help ease use. The feedback and reviews have been phenomenal (click here to see our Amazon reviews ) . We sincerely hope Organic Arthritis assists you in staying active and on your path to healthy and meaningful living. Thanks for taking time out to join me on this journey!

About Organic Arthritis

Mon, 15 Feb 2021 18:52:21 GMT

Our founders are dual board-certified in Internal Medicine and Nephrology by the American Board of Internal Medicine and have been practicing in the DC Metropolitan area with over 40 years of clinical experience.

Common practice in Nephrology and Internal Medicine is to advise any patient with a diagnosis of Chronic Kidney Disease, Resistant Hypertension, Congestive Heart Failure, or Gastritis/Stomach ulcers to avoid all common anti-inflammatory agents in the NSAIDs category. This includes popular over-the- counter medications such as Advil / Motrin / Aleve / Naproxen / Ibuprofen along with several prescription-strength NSAIDs such as Diclofenac / Voltaren / Celebrex / Indomethacin / Meloxicam.

The only regular recommended alternative is Tylenol (Acetaminophen) Extra Strength/Arthritis at recommended dosages to control aches/pains/inflammation. The issue: Acetaminophen has weak data on arthritis/inflammation control and more often than not our patients come back to us saying they are not achieving adequate management without NSAIDs.

Opioids are sadly another commonly used option for chronic arthropathy pain but have potentially severe side effects and addictive properties resulting in over an estimated 130 deaths per day according to the US Department of Health and Human Services (2019 Data).

We had to research this field to find a safe and effective alternative for our patients!

Our specific formula has been utilized for an extended time in our clinics and has shown to be a well-tolerated solution for individuals with joint pains. All ingredients are herbal/organic and have been used for generations in holistic medicine. Clinical study data exists for active ingredients showing anti-inflammatory action at extracted dosages.

We knew Organic Arthritis worked well from all of the personal feedback we had been getting from users but we decided to test the effectiveness further. In an observational analysis of patients who were clinically recommended to stop NSAIDS and did not have adequate relief on Acetaminophen who then began using Organic Arthritis - over 90% of patients surveyed noted efficacious relief of inflammatory symptoms using only Organic Arthritis alone at recommended dosages.

There can be a safe, effective, and natural solution for your inflammation/pain!

Organic Arthritis - Customer Feedback

Sat, 26 Dec 2020 02:30:18 GMT

Organic Arthritis - Customer Feedback

I have had the pleasure of working as a dual board certified Internal Medicine and Nephrology physician (via the American Board of Internal Medicine ) for over 30 years. It has been a tremendous honor connecting with so many patients and helping guide them through a plethora of issues most commonly advanced kidney disease, dialysis modalities, and kidney transplantation.

It is common for patients with chronic kidney disease , congestive heart failure , gastritis/ulcerations , or resistant hypertension to be told by medical providers and pharmacists to avoid using NSAIDs (such as Advil/Motrin/Aleve/Naproxen/Ibuprofen) for their aches/pains and use Acetaminophen/Tylenol. Unfortunately - Acetaminophen (even arthritis strength) has questionable data on its effectiveness in arthropathy .

I can not count the number of times our practice had a patient who was told to avoid NSAIDS who then came to the office with suboptimal relief on Tylenol/Acetaminophen. Came with issues walking/exercising. Issues in the quality of their lives. I generally do not prescribe opioids - especially in the chronic kidney disease population which impairs the body's ability to clear many opioids and can increase the risk of overdose/toxicity. I had to ask them to seek orthopedic specialists to help control their symptoms - but procedural intervention can often times be inconvenient and difficult particularly in patients with multiple medical issues.

Study data on one of our key ingredients exhibited a dose-dependent anti-inflammatory effect in bench data comparable to the reference drug Indomethacin ( a very potent prescription strength NSAID) (Mutabagani A - Pharm J 1997; 5: 110-113). Another study on one of our key ingredients noted significant decrease in induced proinflammatory cytokines such as interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α), metalloproteinase-13 (MMP-13), COX-2, and prostaglandin E2 in an in vitro model (Vaillancourt et al - J Cell Biochem 2011; 112: 107-117).

Also in a multi database meta analysis including several human randomized controlled trials (RCTs) - one of our key ingredients showed marked reduction in documented pain visual analogue score (PVAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores vs placebo (P < .00001) and there was no significant mean difference in PVAS between our ingredient and pain medicine (typically NSAIDs) in a meta-analysis of five studies (Daily J et al - J Med Food. 2016;19(8):717-729)

In 2014 after some testing and adjustments - we solidified a powder based regimen and would at times suggest patients seeking alternative/additional relief try it. We did not commercially sell it but would just suggest one could obtain and try the ingredients on their own. The response was tremendous and more often than not this became their go to relief agent. The only consistent suggestion (and complaint) was the taste of the powders and the need for a tablet to ease delivery/use.

We went to work and adjusted the extract ratios/concentrations and were able to manufacture (made in the USA at an FDA registered and GMP certified facility) a coated (should be tasteless) tablet that can be scored in half to help ease of use. We launched Organic Arthritis.

We have been blessed to have tremendous support and the feedback to date has been stellar both in our clinic and online with essentially every review coming back at 5 stars. We wanted to gather more concrete data in an observational study format which led us to conducting an observational analysis of patients who were clinically recommended to stop NSAIDS + did not have adequate relief on Acetaminophen who then began using Organic Arthritis with survey follow up at 30 and 60 days. Over 90% of patients surveyed (28/30) noted a degree of efficacious relief of inflammatory symptoms utilizing only Organic Arthritis at recommended dosages. Over 90% of patients reordered our product on their own accord to continue use after the study period ended! This was truly an amazing response and we sincerely hope that our product can safely help many in need of joint/muscle relief!

Organic Arthritis - Why use it?

Mon, 13 Jul 2020 20:01:39 GMT

Organic Arthritis - Why use it?

Because we need another alternative for patients particularly with Chronic Kidney Disease / Congestive Heart Failure / Uncontrolled Hypertension / Stomach Gastritis or Ulcerations

Before I get into some details on Organic Arthritis - I want to provide some background on my medical experience and share some insights on a common recurrent issue I kept unfortunately encountering with my patients. I am a dual board certified Internal Medicine and Nephrology physician (via the American Board of Internal Medicine (https://www.abim.org/). Nephrology is a unique field in medicine and I have had the immense pleasure navigating it for over 30 years. It has been a tremendous honor connecting with so many patients and helping guide them through a plethora of issues such as: (can click the text/links below for more information)

- Chronic Kidney Disease (commonly referred to as CKD)

- Dialysis - either Hemodialysis or Peritoneal Dialysis

- Kidney Transplant care

- Resistant Hypertension

- Electrolyte disorders - such as sodium / potassium / calcium issues

- Acid/Base disorders

- Diuretic/Volume management

Nephrology is a field that typically results in a consistent connection with patients most commonly as they navigate chronic kidney disease and/or dialysis/kidney transplantation. The goal for every patient with CKD (chronic kidney disease) is to work on slowing down their decline in kidney function (usually gauged by their serum Creatinine - which is used to calculate their estimated GFR (Glomerular filtration rate) . This graphic from the national kidney foundation shows the stages of CKD:

The most common risk factors for progressive CKD include:

- Diabetes

- Hypertension

- Proteinuria

- Cardiovascular disease / Congestive Heart Failure

- Medications that could induce kidney damage / Decrease renal perfusion

- Intrinsic kidney disease

- Structural collecting system issues

- Liver disease

We work with our patients to help optimize their diabetic control and hypertension control along with a multitude of other risk factors. We strongly advise our patients to avoid medications that have associations with progression of kidney disease. In all my years of practice - by far the most common medications kidney specialists generally ask patients to avoid/stop are NSAIDs. Below is a list of common NSAIDS (click the text/link to see their websites (and you can parse through the caution/avoid use sections!):

- Advil / Ibuprofen

- Motrin

- Aleve / Naproxen

- Voltaren / Diclofenac

- Celebrex / Celecoxib

- Mobic / Meloxicam

- Aspirin (Arthritis strength)

We in nephrology are not alone in our recommended avoidance of NSAIDS. Most Gastroenterologists I know advise their patients with stomach ulcers/gastritis to avoid all NSAIDS (stomach mucosal irritation/ulceration is a known issue with NSAIDs). Most Cardiologists I know also will tell their patients to avoid NSAID use - NSAIDs have been shown to accelerate Hypertension and could lead to fluid retention/congestive heart failure exacerbations/progressions.

This mantra of NSAID avoidance by many internists/specialists leads to a major issue in our patient populations. NSAIDS are generally the best anti inflammatory agents for joint/muscle issues and without it we are left with:

1) Tylenol/Acetaminophen/Paracetamol (Arthritis strength or Extra Strength) - The issue is study data is mixed on Acetaminophen and may show it is not very effective at controlling joint inflammation.

2) Opioids (such as Morphine / Percocet / Vicodin / Dilaudid / Fentanyl) or Opioid like medications (such as Tramadol) - The issues is Opioids are dangerous medications that can be addictive in nature and can lead to bad outcomes (this link will lead to the US Department of Health and Human Services epidemic information site

I can not count the number of times our practice had a patient we told to avoid NSAIDS in our clinic who then came to the office with suboptimal relief on Tylenol/Acetaminophen. Came with issues walking/exercising. Issues in the quality of their lives. I generally do not prescribe opioids - especially in the chronic kidney disease population which impairs the body's ability to clear many opioids and can increase the risk of overdose/toxicity. I had to ask them to seek orthopedic specialists to help control their symptoms - but procedural intervention can often times be inconvenient and difficult particularly in patients with multiple medical issues.

I can not stress the importance of mobility/exercise - there is a lot of data from organizations such as the American Heart Association noting the benefits of regular activity/exercise . I felt stuck - I started searching with my partners for a potential remedy for joint/muscle inflammation that our patient population could try.

We began looking into herbal/holistic substances that have been utilized for generations in inflammatory relief across the world. We parsed basic science/bench as well as clinical research databases. Our ingredients have shown COX or IL37 suppression or urine prostaglandin decrease indicating effectiveness in suppressing the inflammatory cascade with the caveat of no known issues with stomach lining or kidney function / Sodium retention / Blood Pressure elevation. In 2014 after some testing and adjustments - we solidified a powder based regimen and would at times suggest patients seeking alternative/additional relief try it. We did not commercially sell it but would just suggest they obtain and try the ingredients on their own.

The response was tremendous and more often than not this became their go to relief agent. The only consistent suggestion (and complaint) was the taste of the powders and the need for a tablet to ease delivery/use. We adjusted the extract ratios/concentrations and were able to manufacture (made in the USA at an FDA registered and GMP certified facility) a coated (should be tasteless) tablet to help ease use. We sincerely hope Organic Arthritis assists you on your path to healthy and meaningful living. Thanks for taking time out to join me on this journey!

What is Osteoarthritis?

Thu, 11 Jun 2020 23:57:18 GMT

In a previous blog post we defined the overall category of arthritis and discussed some of the metrics showing the marked public health burden (and rapid growing prevalence) it encompasses. Now let us start breaking down some of the entities under the umbrella of arthritis. By far the most common issue is osteoarthritis.

Osteoarthritis is commonly referred to as the “wear and tear” degenerative joint disease. It is so common medical docs simply refer to it as OA. It typically results from the gradual loss of cartilage within/between joints. This cartilage serves as essentially a shock absorber preventing direct shear force or “bone on bone” pressure. Once the shock absorber is gone – trauma will slowly lead to inflammation and erosion of the joint.

Risk factors for degenerative joint disease include:

- Age - risk for OA rises as an individual (and the individual’s joints/cartilage/muscles) age

- Joint overuse - repetitive force placed on particular joint

- Joint trauma – fracture or cartilage damage or tear

- Obesity - Extra weight will increase force/stress on joints + fat cells promote inflammation

- Muscle injury/weakness – Joints can have force/stress if muscles do not provide support

- Gender – women typically have a slightly increased chance to develop OA

- Genetics – there is a potential genetic risk association

The most common locations of osteoarthritis are the weight bearing joints of the knees, hips, lower back, lower neck, and small joints of the fingers/toes. This inflammation can manifest clinically as:

- Pain/Ache

- Swelling/Inflammation of joint

- Stiffness / Decreased range of motion (or flexibility)

- Muscle Weakness (typically around the joint)

- Balance/Gait instability/Falls – depending on the joints affected

2015 US Centers for Disease Control data noted approx 30 million people with Osteoarthritis – and remember many people live with joint aches/pain without seeing a physician or getting a formal diagnosis of OA. Sadly the symptoms of OA simply do not stop at the joint.

The Arthritis Foundation notes that individuals with OA are almost three times more likely to develop cardiovascular disease (CVD) or heart failure than those without OA, studies show. Also, people with osteoarthritis experience as much as 30 percent more falls and have a 20 percent greater risk of facture than those without OA. These links are especially strong when arthritis is in certain joints, such as the knee/back/hip.

It makes sense – pain/weakness especially in our stabilizing joints such as knees/hips/spine will limit mobility and lead to risk factors such as weight gain, cardiovascular disease, diabetes coupled with stability issues. These patients would have difficulty following American Heart Association recommendations stating that increasing physical activity and becoming more active can help lower your blood pressure and also boost levels of good cholesterol. Without regular physical activity, the body slowly loses its strength, stamina and ability to function well. People who are physically active live about 7 years longer than those who are not active and are obese (American Heart Association). Studies have shown that adults who are inactive/minimally active more than 4 hours a day had a 46% increased risk of death from any cause and an 80% increased risk of death from cardiovascular disease!

Also certain medications classically used to help control symptoms of OA are not risk free. The initial algorithm to help maintain symptoms usually follow 3 routes:

1) Nondrug/Non surgical Therapies:

a. Physical therapy/Exercise - strengthen/stabilize muscles around the affected joint

b. Weight Loss – Alleviate pressure from the weight bearing joints (Spine/hip/knees)

2) Medications - used to control inflammation/pain:

a. NSAIDs – Non Steroidal Anti-inflammatory Drugs – one of the most commonly used medications in the world. Advil / Aspirin / Motrin / Aleve / Naproxen / Ibuprofen / Motrin / Diclofenac are all examples of NSAIDs. The issue is they are to be Cautioned/Avoided in individuals with multiple medical issues such as Chronic Kidney Diseae / Congestive Heart Failure / Gastritis or Stomach ulcers / Resistant hypertension.

b. Acetaminophen – commonly recommended when physicians ask patients to avoid NSAIDs. Ex: Tylenol Arthritis – the problem is multiple past studies (and decades of our clinical patient encounters) have shown minimal (if any) anti-inflammatory effectiveness

c. Opioids – Controlled narcotics pain medication that is classified as an unfortunate epidemic in the USA. These medications bind to opioid receptors in the brain/spinal cord and blunt to pain signals. The issue is they have dangerous side effect profile (can be fatal) and also patients develop tolerance and are in need of larger dosages which can lead to a potential addiction or overdose

3) Surgical Options

a. Joint injection – commonly performed by orthopedic surgeons or rheumatologists – typically are either a corticosteroid injection to suppress inflammation locally or a hyaluronic acid injection to provide some degree of joint cushion. The issue is both are short term solutions that typically lead to recurrent issues

b. Joint Surgery – commonly performed by an orthopedic surgeon. Such as a total hip arthoplasty (THA) or total knee arthroplasty (TKA) or spinal laminectomy and/or fusion procedure. The issue is these are invasive surgeries that carry risk of anesthesia/cardiac events/infections/blood clots and may be difficult especially in the elderly population

Above is a detailed overview of this complex but sadly common issue that is rising across our country and in our world. As a practicing Nephrologist (Kidney Doctor) - I generally never get consulted to manage osteoarthritis but end up playing a large role in the symptom control of my patients.

The most common reason for a patient to see a Nephrologist is for a diagnosis of chronic kidney disease . Our goal is to help slow the progression of this CKD by optimizing risk factors that historically damage kidneys and attempt to avoid progression to a need for renal replacement therapy (dialysis or kidney transplant). Every Nephrologist I know would immediately ask a patient to stop all NSAIDs such as Advil / Motrin / Alleve / Naproxen / Ibuprofen along with several prescription strength NSAIDs such as Diclofenac / Voltaren / Celebrex / Indomethacin / Meloxicam. The only regular recommended alternative is Tylenol (Acetaminophen) Extra Strength or Arthritis at recommended dosages to control aches/pains/inflammation. The issue: Acetaminophen has weak data on arthritis/inflammation control

More often than not our patients come back to us saying they are not achieving adequate management without NSAIDs. Opioids are almost never the right answer for osteoarthritis related pain management (they do not suppress joint inflammation and have a very unfavorable risk profile). Injections/surgeries are invasive and have their drawbacks especially in patients with more advanced chronic kidney disease. We had to research this field to find a safe and effective alternative for our patients!

After years of research - we created vegetarian custom compound that consist of all natural extracts such as Nigella Sativa / Curcumin / Fenugreek / Ginger. All ingredients are herbal and have been used for generations in holistic medicine. Clinical study data exists for active ingredients showing affecting anti-inflammatory action at extracted dosages along with a very favorable/minimal adverse reaction profile without any known common detriments to kidney function / blood pressure / cardiac function / stomach lining. Initially we would informally list out some of these ingredients for our patients to try via powder at their own discretion. The results were very good but the taste/difficulty mixing was cumbersome for most. Our solution is a tablet format called Organic Arthritis. I sincerely hope our OA (Organic Arthritis) works to help mitigate the symptoms of OA (Osteoarthritis) and improve the quality of life for many! Thank you for sharing your time with me on this blog!

What is Arthritis?

Mon, 08 Jun 2020 18:29:17 GMT

The dreaded term - Arthritis - like many medical terms it comes from latin origin characterizing inflammation of a joint or joints. The inflammation typically manifests as joint pain and/or stiffness and can lead to swelling/warmth/decreased range of motion. Let's take an initial dive into the concept!

Arthritis itself is not a diagnostic entity. There are a multitude of categories that fall under the umbrella that is arthritis. The types of arthritis include:

- Osteoarthritis (most common by far)

- Rheumatoid Arthritis

- Gout / Pseudo-gout

- Fibromyalgia related Arthropathy

- Autoimmune Arthropathy (usually secondary from immune mediated disease such as Lupus/Sjogren’s disease /Psoriasis)

- Septic Arthritis

- Many more rarer entities (over 100 disease entities have potential association with arthropathy)

The United States Centers for Disease Control and Prevention noted 2015 census data showing an estimated 54.4 million US adults (22.7%) annually had been told by a doctor that they had some form of osteoarthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. By 2040, an estimated 78 million (26%) US adults aged 18 years or older are projected to have doctor-diagnosed arthritis.

The above graph indicated the rising public health demand caused by arthritis in general. Further 2015 census data breakdowns noted age being a corollary with risk:

- 7.1% Aged 18 to 44 years reported doctor-diagnosed arthritis.

- 29.3% Aged 45 to 64 years reported doctor-diagnosed arthritis

- 49.6% Aged 65 years or older reported doctor-diagnosed arthritis

To add fuel to the fire – the above CDC data is likely a marked under representation of total arthritis/joint burden. Many individuals have low back pain or hip pain or knee pain or hand pains without seeking medical professional care or carrying a formal diagnosis.

For example - data from the Cleveland Clinic show 85-90% of United States residents experience joint pain at some time during their lives. Back pain is the second most common reason people visit their family doctors and often times is a result of chronic arthropathy of the spine. Cleveland Clinic data noted that on any given day - almost 2% of the entire US work force is disabled by back pain. It is also not entirely a problem of the elderly - In people under 40 years of age, back pain is the most common reason for the inability to perform daily tasks.

The chronicity of back pain is highlighted by the American Association of Family Physician who note most patients experience activity-limiting low back pain will go on to have recurrent episodes. Chronic continued low back pain affects up to 23% of the population worldwide, with an estimated 24% to 80% of patients having a recurrence at one year.

The American Chiropractic Association data echoes the marked morbidity of joint disease noting that World Health data highlights back pain as the single leading cause of disability, preventing many people from engaging in work as well as other everyday activities. One-half of all working Americans admit to having back pain symptoms each year. Back pain accounts for more than 264 million lost work days in one year—that’s two work days for every full-time worker in the country. Experts estimate that up to 80% of the population will experience back/joint pain at some time in their lives.

This is alarming data coupled with the fact that arthritis itself is not simply an isolated pain issue - but can lead to worsening overall mobility/functional status which affects overall health outcomes. A multitude of medical studies and data across countries/cultures/age groups/specialties have correlated activity with overall population health outcome data. The American Heart Association indicates that increasing physical activity and becoming more active can help lower your blood pressure and also boost your levels of good cholesterol. Without regular physical activity, the body slowly loses its strength, stamina and ability to function well. People who are physically active live about 7 years longer than those who are not active and are obese (American Heart Association). Studies have shown that adults who are inactive/minimally active more than 4 hours a day had a 46% increased risk of death from any cause and an 80% increased risk of death from cardiovascular disease!

So what data shows and we all kind of already realize through common sense – we have to stay active despite what our body is signaling us. This blog will provide some personal insight on this growingly cumbersome problem and give some useful information to help mitigate the morbidity of arthritis/joint disease and give ourselves the best chance of healthy, meaningful living! Thanks for taking time out to join me on this journey!

Back Pain - A general overview for a very common issue

Mon, 08 Jun 2020 18:29:17 GMT

Back pain is commonly cited as the most common medical complaint (and reason to see a doctor) in America. Mayo Clinic data noted approximately 80% of the population will at some point experience back pain that will limit functional status. It is also the most common complaint for lost job time - with an estimated $100-$200 Billion dollars of annual cost to the US economy (likely due to lost wages and productivity). The American Association of Neurological Surgeons echo support these estimates and note 75 to 85 percent of Americans will experience back pain in their lifetime. Of those, 50 percent will have more than one episode within a year. Let's take a deeper dive into this complex but sadly common issue

Let's take a deeper dive in this issue!

Risk Factors for Developing Back Pain include:

Age - the first acute episodes typically occur between ages 30-50 with more frequency and/or chronicity of symptoms as individuals age. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae with loss of cartilage. They can also have weakening of bone strength from osteoporosis which can lead to inflammation and even fractures. The risk of spinal stenosis also increases with age which can impinge on the spinal cord and lead to muscle and sensory weakness
Muscle or Ligament Strain / Injury
Overuse - heavy lifting, bending, pulling, pushing can increase strain particularly on the lower spine
Immune mediated Arthropathy - such as ankylosing spondylitis - a form of arthritis that involves fusion of the spinal joints leading to some immobility of the spine. ( This is a more detailed overview from WebMd )
Overweight/Obese - can increase strain particularly on the lower spine

Symptoms of back pain include:

General Aches/Pains locally to the damaged region
Nerve Root irritation - shooting and stabbing pain/sensations
Sciatica - pain that radiates typically down the leg
Muscle weakness
Impaired Mobility
If severe spinal stenosis - impingement of the spinal cord can occur with marked weakness of muscles (typically lower extremities)

Causes of back pain include:

Degenerative Joint Disease of spine/vertebrae - Osteoarthritis usually due to combination of aging and wear/tear is the most likely etiology
Muscle/Ligament Strain - tissue injury typically as a result of awkward movement or repeat heavy lifting/stress
Disc Herniation/Bulging - the gelatinous material inside a disc can weaken/inflame which can lead to nerve root irritation/pain
Osteoporosis - vertebral bone weakness can lead to brittle bones and eventual compression fractures of the spine
Immune mediated Arthropathy - such as ankylosing spondylitis - a form of arthritis that involves fusion of the spinal joints leading to some immobility of the spine. ( This is a more detailed overview from WebMd)

Therapy options for Back Pain

Acute Back Pain: The silver lining is most back pain statistically is acute in nature and the majority of these cases recover with:

Rest
Anti inflammatory medications and/or muscle relaxants
Time (usually in 1-2 weeks from initial presentation/injury)

Sadly National Institute of Health data does note that 20 percent of individuals with acute back pain develop chronic low back pain with persistent symptoms at one year. The overall prevalence of chronic back pain is estimated at over 20 million Americans - just a staggering number!

Chronic Back Pain Therapy options consist of usually an algorithm based treatment plan to help alleviate/maintain symptoms:

1) Nondrug/Non surgical Therapies:

a. Physical therapy/Exercise - strengthen/stabilize muscles around the affected joint/area

b. Weight Loss – Alleviate pressure from particularly the weight bearing vertabrae

2) Medications - used to control inflammation/pain:

a. NSAIDs – Non Steroidal Anti-inflammatory Drugs – one of the most commonly used medications in the world. Advil / Aspirin / Motrin / Aleve / Naproxen / Ibuprofen / Motrin / Diclofenac are all examples of NSAIDs. The issue is they are to be Cautioned/Avoided in individuals with multiple medical issues such as Chronic Kidney Diseae / Congestive Heart Failure / Gastritis or Stomach ulcers / Resistant hypertension.

b. Acetaminophen – commonly recommended when physicians ask patients to avoid NSAIDs. Ex: Tylenol Arthritis – the problem is multiple past studies (and decades of our clinical patient encounters) have shown minimal (if any) anti-inflammatory effectiveness

c. Opioids – Controlled narcotics pain medication that is classified as an unfortunate epidemic in the USA. These medications bind to opioid receptors in the brain/spinal cord and blunt to pain signals. The issue is they have dangerous side effect profile (can be fatal) and also patients develop tolerance and are in need of larger dosages which can lead to a potential addiction or overdose

3) Surgical Options

a. Joint injection – commonly performed by orthopedic surgeons or rheumatologists – typically are either a corticosteroid injection to suppress inflammation locally or a hyaluronic acid injection to provide some degree of joint cushion. The issue is both are short term solutions that typically lead to recurrent issues

b. Joint Surgery – commonly performed by an orthopedic surgeon. Such as a spinal laminectomy and/or fusion procedure. The issue is these are invasive surgeries that carry risk of anesthesia/cardiac events/infections/blood clots and may be difficult especially in the elderly population

Several herbs have been used in holistic medicine for generations for inflammation control such as curcumin, capsaicin extracts, ginger, willow bark, cloves, fenugreek, or nigella sativa. There is a multitude of bench data as well as clinical trial data (including several randomized control trials) for several of these herbs/extracts. We began looking into herbal/holistic substances and we parsed basic science/bench as well as clinical research databases. Our ingredients have shown to suppress the inflammatory cascade with the caveat of no known issues with kidney function / Sodium retention or swelling / Blood Pressure elevation / stomach lining erosion that plague chronic NSAID use. In 2014 after some testing and adjustments - we solidified a powder based regimen and would at times suggest patients seeking alternative/additional relief try it. We did not commercially sell it but would just suggest individuals obtain and try the ingredients on their own.

been phenomenal (click here to see our Amazo n reviews ). We sincerely hope Organic Arthritis assists you in staying active and on your path to healthy and meaningful living. Thanks for taking time out to join me on this journey! Thank you for sharing your time with me on this blog!

Knee Pain - a topic overview and general discussion

Mon, 08 Jun 2020 18:29:17 GMT

The knee joint’s purpose is to join the bones of the lower leg (the Tibia (shin bone) and fibula) with the Femur (thigh bone). It has the largest articulating surface of any joint in our bodies. This connection enables us to partake in activities such as standing, walking, and running. As a result of the tremendous and variable pressure/force this apparatus takes on - it is particularly susceptible to injury. Let's take a deep dive into some of the common ailments of our knees.

Knee pain can broadly be broken down into 2 encompassing categories - Acute pain (typically less than 8 weeks) and Chronic pain (typically greater than 12 weeks). The knee joint has classically been susceptible to many acute injuries from trauma ranging from bruises to ligament strains to more severe structural damage such as a basketball player tearing an ACL ligament. Chronic pain is likely due to the long term stress/shear force placed on the knee - studies have estimated that chronic pain at the knee affects approximately 25 percent of adults . Sadly - By 2025, the prevalence of knee OA is expected to increase by 40% , largely due to an aging population and the obesity epidemic.

Risk Factors for Developing Knee pain include:

- Past trauma/injury - past knee injury increases risk for chronic knee issues/pain as individuals age

- Overweight/Obese - increases pressure on knee joints which can increase the breakdown of cartilage and subsequent arthropathy of the knee

- Overuse - repetitive stress on the knees from jogging or basketball or certain occupations can increase the risks for joint degradation/cartilage erosion

- Muscle weakness/stiffness - A lack of support muscle strength and flexibility can increase the risk of knee injuries. Strong muscles help to stabilize and protect your joints, and muscle flexibility can help you achieve full range of motion.

Symptoms of knee pain include:

General Aches/Pains locally to the damaged region

Muscle weakness

Impaired Mobility

Inability to straighten the knee

Stability issues/falls

Causes of knee pain include:

Degenerative Joint Disease - Osteoarthritis usually due to combination of aging and wear/tear is the most likely etiology of chronic knee pain

Fractures - Bones of the knee/kneecap can break due to trauma especially if osteoporosis (weakening of the bony structure) is present

Meniscus damage - sheer stress can tear the meniscus (a cartilage based structure that acts as a shock absorber between the thighbone and shinbone)

Ligament Strain or tear- tissue injury typically as a result of awkward movement or shear stress

Bursitis of the knee - the bursae can get inflamed and painful (it is a small fluid filled sac that cushions the outside of the knee joint and allows ligaments and tendons to glide smoothly over the joint)

Patellar Tendinitis - this tendon attaches the quadriceps muscle on the front of the thigh to the shinbone and can get inflamed/damaged (particularly in heavy use/stress via running/cycling/skiing)

Immune mediated Arthropathy - such as Rheumatoid Arthritis of the knee (and many other joints of the body can be affected by RA) - a form of arthritis that involves the body's own immune system attacking its own joints. WebMD provided a more detailed overview of RA on the knee

Kneecap damage / dislocation - the patella (bone that covers the front of the knee) can slip out of place

Iliotibial Band Syndrome - tough band of tissue that extends from the lateral aspect of the hip to the lateral aspect of the knee. It can tighten typically from repetitive use (like distance running or cycling) and can apply pressure on the outer portion of the femur

Gout - can have uric acid crystal deposition and subsequent inflammation and tenderness of the knee joint (not as common of a gout joint as the toe)

Septic Arthritis - a typical bacterial infection of the knee joint leading to inflammation/tenderness and even systemic symptoms such as fever/chills

Therapy options for Knee Pain

Acute Knee Pain ( more information from Heathline here ):

1) Associated with high force trauma (motor vehicle crash or fall from height)

-Likely need acute evaluation (such as Emergency Room) with Xray to ensure no fracture and a potential MRI to assess for more intricate structural damage

2) Associated with Low force trauma

- Likely need non emergent but formal evaluation to assess for structural damage and may need imaging to assess structure (such as an MRI)

If no structural issue is noted on examination or imaging - the good news is most acute knee pain issues will improved with a combination of:

Rest

Anti inflammatory medications and/or muscle relaxants

Time (usually in 1-2 weeks from initial presentation/injury to slightly longer if it is a wear/tear injury such as patellar tendinitis or Iliotibial Band Syndrome)

Unfortunately - as WebMd notes here - data has shown that acute structural knee injuries does significantly increase the risk for chronic knee issues as one ages.

Chronic Back Pain Therapy options consist of usually an algorithm based treatment plan to help alleviate/maintain symptoms (a good reference here from the Mayo Clinic ):

1) Nondrug/Non surgical Therapies:

a. Physical therapy/Exercise - strengthen/stabilize muscles around the affected joint/area

b. Weight Loss – Alleviate pressure and shear force on the knee joint

2) Medications - used to control inflammation/pain:

3) Surgical Options

B. Platelet-rich Plasma (PRP) - commonly performed by a sports medicine or orthopedic doctor - PRP contains many growth factors that may potentially reduce inflammation and promote healing (study data is mixed though on the long term effectiveness though).

b. Joint Surgery – commonly performed by an orthopedic surgeon. Such as a total knee arthroplasty . The issue is these are invasive surgeries that carry risk of anesthesia/cardiac events/infections/blood clots and may be difficult especially in the elderly population

Organic Arthritis Blog

The Benefits of Exercise

Glucosamine and Chondroitin: What Does the Data Show

Osteoarthritis: Clinical Manifestations

Osteoarthritis - a Complex (Metabolic) System

Falls - Let us discuss risk factors and also fall prevention strategies

Yoga and Arthritis

Dietary Patterns and Progression of Knee Osteoarthritis: Data from the Osteoarthritis Initiative

Arthritis - More than Physical Discomfort - Let’s Talk About Social Interaction

Painsomnia - sleep issues caused by pain

Knee Arthritis - a review on exercise, weight loss, and physical therapy!

NSAIDs use in Chronic Kidney Disease - a growing problem!

About Organic Arthritis

Organic Arthritis - Customer Feedback

Organic Arthritis - Customer Feedback

Organic Arthritis - Why use it?

Organic Arthritis - Why use it? Because we need another alternative for patients particularly with Chronic Kidney Disease / Congestive Heart Failure / Uncontrolled Hypertension / Stomach Gastritis or Ulcerations

What is Osteoarthritis?

What is Arthritis?

Back Pain - A general overview for a very common issue

Knee Pain - a topic overview and general discussion

Organic Arthritis - Why use it?

Because we need another alternative for patients particularly with Chronic Kidney Disease / Congestive Heart Failure / Uncontrolled Hypertension / Stomach Gastritis or Ulcerations