INTRODUCTION:

Osteoarthritis (OA) is a joint disorder characterized by destruction of articulate cartilage, change in sub-chondral bone and formation of Osteophyte. It is one of the common forms of joint disorders, which damages the joint, and painful in nature. Other symptoms are arecurring pain, stiffness, and swelling of affected joint, inability to move a joint. In general, there is two types of osteoarthritis i.e. Primary and Secondary Osteoarthritis. Primary Osteoarthritis is a chronic degenerative disorder while Secondary Osteoarthritis is caused by other causes [1][2]. In case of OA, the pain is usually localized with the absence of a history of inflammation, fever etc. The main cause of pain, in general, is due to the growth of osteophytes and widening of adjacent periosteum. The intensity of pain can be measured by using parameters like Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score” (KOOS).

Etiopathogenesis of OA brings about changes inside the cells of the cartilage resulting in loss of elasticity, in turn, lead to ruptures in the cartilages as well as inflammation of the synovial membrane. Joints of the whole body may get affected by Osteoarthritis mainly OA of the knee joint is most common. It can be diagnosed clinically by clinical and radiographic features. OA can be managed by both pharmacological and non-pharmacological approaches. Pharmacologically it can be managed by Non-Steroidal Anti-Inflammatory Drugs (NSAID),While non-pharmacologically it can be managed by using education for both healthcare professionals and patients, self-management, exercise for improving muscle condition especially quadriceps, physiotherapy, occupational therapy and protecting joints involved. The most common treatment option as per Osteoarthritis Research International (OARSI) guidelines is that OA can be treated by decreasing pain, stiffness, and disability of joints and educating the mass [3]. Research in Medical Science and due to advances in medical technology, now a day we can treat as well as prevent OA successfully. Few of them are using calcium supplements, steroid injection etc.

Nature takes care of us in its own way. Complementary and Alternative Systems of Medicine (CAM) contribute to the management of osteoarthritis by usage of oil massage, phytoestrogens, leech therapy, supplements like glucosamine and exercise.

Use of Supplements:

There is a mere necessity neutraceutical which iscost-effective, free from adverse events and freely available for the management of OA. The most commonly used diet and neutraceuticals are antioxidants like vitamin E and vitamin C which diminish the synovial inflammation in OA. There are many supplements available to maintain the health of the joints; one among them is Glucosamine and it can be used as dietary supplement as well as neutraceutical. It is a constituent of Hyaluronic Acid derived from chitin in crustacean shells. It may act as anti-oxidant and prevents the injury to chondrocytes by oxidative stress. Glucosamine can originate naturally in our body (6-carbon amino sugar) and body used in the case of maintenance of health of cartilage. It can be used as Dietary supplement alone or along with Glucosamine. It is of three types’ glucosamine sulfate and glucosamine hydrochloride, and N-acetylglucosamine, these glucosamines stimulates connective tissue, helps in the healing process. Glucosamine sulfate is available as a natural substance and maintains cartilage metabolism and also repairs the damaged one as it possesses anti-inflammatory property also. There is no significant difference observed in efficacy or adverse effect in both the forms of Glucosamine like glucosamine sulfate and glucosamine hydrochloride [4].

Hirudotherapy (Leech therapy):

There are various treatment modalities explained for OA, One among them is Hirudotherapy (bloodletting therapy by using medicinal leeches). Leeches are blood-sucking annelid worms and the most commonly used Leeches for the medical purpose are Hirudomedicinalis. These leeches are helpful in treating OA of theknee joint [5].Research shows that leech saliva contains many chemicals which are potent anticoagulants as well as ananalgesic in nature. These anti-coagulants are Hirudin, Hementin, Theromin, Haemadin, Hyaluronidase, Eglin, Gelin etc. give relief from pain [6].

Use of Oleation:

Oil can be used a food as well as medicine. Pharmaceutical science considers oil as a liquid dosage form, used for both oral and Systemic/topical application like epidural, intramuscular, transdermal etc. In medicine, oil is used as various dosage modalities like liniments, lotions, emulsions etc. There are many oils which alone or with other medicinal herbs possess pharmacological actions like analgesic, anti-inflammatory etc. So successfully they can be used in pain management of OA. Fish oil contains fatty acids like Omega-3 which eases degenerative and inflammatory features of chondrocyte metabolism. Clinical Pharmacology shows that absorption through the skin can be boosted by suspending the drug in an oily vehicle and massaging into the skin. Studies reveal further that fatty acids significantly decrease the levels of prostaglandins and leukotrienes and thus reduce the intensity of the pain [7][8].

Castor oil is used widely in Indian traditional system of medicine, Ayurveda. Detailed description and usage of castor oil are available in the Ayurvedic treatise. The analgesic activity of castor oil is mainly due to the presence of chemical constituent ricinoleic acid, constrains phospholipase, and leukotriene [9-11] Sesame oil is another oil used in traditional system of medicine in gulf countries as well as in India[12] . Sesame oil, in general, is known as Til oil, which contains unsaturated fatty acids like palmitic acid, oleic acid, and linoleic acids, and chemical constituents like sesamin all of which possess analgesic activity.

Use of Sudation:

Use of heat or sudation for the therapeutic purpose will be helpful in the management of pain and it also produces relaxation of muscle tissue [13].

Phytoestrogens:

Nowadays because of modern lifestyle, females hardly could give importance or concentrate on their health and this leads to the improper usage of essential vitamins, minerals, and balanced diet. Improper absorption of calcium leads to osteoporosis and finally may result in osteoarthritis, especially during the Post-menopausal age. But a few years back Boll and et al published a brainstorming article in British Medical Journal entitled, “Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis”, which deals with the role of calcium supplements and its role on the vascular system, especially on Tunica intima. We must know our daily food substances contain calcium precursor in the form of phytoestrogens. Thus Phytoestrogens chemically, structurally and functionally are correlated with ovarian as well as placental estrogens.

Phytoestrogens are commonly found in dietary items like cow’s milk, fruits, green vegetables, and red meat etc. Phytoestrogens are of various type one among is Lignans, which is commonly present in the fruits, vegetablegrains, and nuts.

DISCUSSION:

We are in the era of Noncommunicabledisorders. People are using CAM along with mainstream medicine. The advanced medical civilization and Shift in healthcare practices advocating Integrated, Multidisciplinary, Holistic management in controlling OA. It is observed that CAM definitely had its own role in the management of OA. The most commonly used unconventional methods are Dietary and neutraceuticals supplements like glucosamine, phytoestrogens, use of oil application, sudation therapy, leech therapy etc. This is the right time to use innovative analytical methods to address OA. So it is our responsibility to look towards better management options to deliver better health care in OA.Their concepts in the in the management of OA in contemporary science is very linear .using same linear methods are used in this paper to make understand nonlinear methods of CAM. This paper is a confirmed association between treatment approaches and contribution from nature of the healing process. We have to educate and motivate the people in the prevention of OA by natural means.

CONCLUSION:

OA is a progressively increasing noncommunicable disease. It is one of the most common forms of arthritis. We have to develop strategies which prevent the damage of joint. There are many other factors like obesity, osteoporosis which also contribute toincreasing osteoarthritis. At present therapeutic approach to osteoarthritis are mainly emphases on symptomatic relief. Relief can also be provided to some extent by controlling body weight, exercise. Exercises may cause improvement in joint lubrication, Strengthen the quadriceps muscle, helps in good circulation in affected joints. Clinical research reveals the role of glucosamine, Antioxidants like vitamin C and E, We have to work on to evaluate the efficacy of the data available.

CONFLICT OF INTEREST:

None declared.

REFERENCES:

1. Woolf, A. D., and Pfleger, B. The burden of major musculoskeletal conditions. Bulletin of the World Health Organization, 2003; 81(9), 646–-656.

2. March, L. M., and Bagga, H. Epidemiology of osteoarthritis in Australia. The Medical Journal ofAustralia, 2004; 180(5 Suppl), S6–-10.

3. Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., and Tugwell, P. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and cartilage, 2008;16 (2), 137–-162.

4. Rindone, J. P., Hiller, D., Collacott, E., Nordhaugen, N., andArriola, G. Randomized, controlled trial of glucosamine for treating osteoarthritis of the knee. Western Journal of Medicine, 2000; 172(2), 91.

5. Yang, Y., Fujita, J., Tokuda, M., Bandoh, S., Ishida, T., Murota, M., .and Nishioka, M. Clinical features of several connective tissue diseases with anti-Golgi antibody. Annals of the rheumatic diseases, 2001; 60(10), 986–-987.

6. Scott, K. Is hirudin a potential therapeutic agent for arthritis?. Annals of the rheumatic diseases, 61(6), 561–-562.

7. Carvalho, R. H. R., Galvão, E. L., Barros, J. A. C., Conceição, M. M., and Sousa, E. M. B. D. (2012). Extraction, fatty acid profile and antioxidant activity of sesame extract (SesamumIndicum L.). Brazilian Journal of Chemical Engineering, 2002; 29(2), 409-420.

8. Déciga-Campos, M., Montiel-Ruiz, R. M., Navarrete-Vázquez, G., andLópez-Muñoz, F. J. Palmitic acid analogues exhibiting antinociceptive activity in mice. In Proceedings of the Western Pharmacology Society 2006; 50, 75–-77.

9. Gaginella, T. S., Haddad, A. C., Go, V. L., and Phillips, S. F. Cytotoxicity of ricinoleic acid (castor oil) and other intestinal secretagogues on isolated intestinal epithelial cells. Journal of Pharmacology and Experimental Therapeutics, 1977; 201(1), 259–-266.

10. Beubler, E., and Juan, H. Effect of ricinoleic acid and other laxatives on net water flux and prostaglandin E release by the rat colon†. Journal of Pharmacy and Pharmacology, 1979; 31(1), 681–-685.

11. Racusen, L. C., and Binder, H. J. Ricinoleic acid stimulation of active anion secretion in colonic mucosa of the rat. Journal of Clinical Investigation, 1979; 63(4), 743.

12. Sadeghi, N., Oveisi, M. R., Hajimahmoodi, M., Jannat, B., Mazaheri, M., and Mansouri, S. The contents of sesamol in Iranian sesame seeds. Iranian Journal of Pharmaceutical Research, 2010; 101–-105.

13. Lehman JF, Brunner GD, Stow RW. Pain threshold measurement after therapeutic application of ultrasound, microwaves, and infrared. Arch Phys Med Rehabil.1958; 39,560–565.

Received on 04.08.2019 Modified on 19.10.2019

Research J. Pharm. and Tech. 2020; 13(10):5009-5011.

DOI: 10.5958/0974-360X.2020.00877.X