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           - William Pawluk, M.D. M.Sc.

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HEALTH TOPICS Arthritis

 

Arthritis

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Treatment Goals

Magnetic Field Treatment

Specific Devices

Nutrition

References

 

Pathophysiology

 

Pain, edema, joint stiffness, decreased mobility, decreased strength, thickening around joints, loss of cartilage, inflammation, osteophytes.

Two main forms of arthritis: degenerative and inflammatory.

 

Inflammatory causes, particularly autoimmune conditions, such as rheumatoid arthritis, psoriatic, lupus, etc. Are more complicated to manage and are often more damaging. These types are also more prone to wax and wane based on emotional, environmental, nutritional and infectious stresses. So, daily stress reduction is critical for repair and decreasing progression. They are also more likely to benefit from supplements supporting anti-oxidant functions.

 

Wear and tear (repetitive stress) or load causes joint stress and wears out the cartilage. The body tries to repair it by inducing inflammation and swelling with bone or calcium build up at the joint margins. This results in nodules in the joints - especially seen in the hands. This type is usually very slowly progressive. Injuries involving joints often years later will result in arthritis.

 

Allergies, infections or deposits of crystals cause other forms of arthritis, such as in gout.

 

Anatomy

 

All joints in the body can be involved. Depending on the cause, some joints are more likely than others to be affected.

 

 

Treatment Goals

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Clearly the cause should be addressed or progression may not be halted. The magnetic field treatments will then be competing for which cause will dominate. As with all magnetic therapy, appropriate basic treatment is still needed. The MF treatments will work at the energy level, on the acupuncture system and systemic levels as well as directly on the cells themselves.

 

The primary goals are to reduce

 

·      pain,

·      edema,

·      joint stiffness,

·      thickening around the joints,

·      loss of cartilage,

·      inflammation,

·      osteophytes and

·      increase mobility and

·      increase strength.  

 

 

The secondary goals are to assist with

·      sleep,

·      depression,

·      irritability and

·      stress.

 

As a result dependence on medications should be less and make the likelihood of surgery less.

 

The expected time interval for seeing these benefits will depend on the cause  and its removal, how much arthritis there is in the body, how deep it is, the severity and duration it was present and adherence to other good treatments.

 

Recall the layers of a disease or condition to get some sense of how it might take to get a benefit. Unrealistic expectations will lead to  a wrong conclusion of lack of benefit. The condition didn't get there over night and won't go away over night. Medications that give relief don't usually produce reversal of the arthritis. MFs, especially, PEMFs, that are strong enough to go all the way through a joint and, that stimulate tissue repair, have a chance of reversing the arthritis, in addition to giving symptom relief.

 

Remember, treatment is a long-term process. There are no magic bullets. Even joint replacements eventually fail and there is a limit to how many joints can be replaced. Starting magnetic treatments early in the course of arthritic change stands the best chance of stopping or slowing the arthritis. Slowing of progression or development has been demonstrated dramatically in research in dogs (Rogachefsky). Some research in humans indicates that early treatment can recover joints in some circumstances. The challenge in research has been lack of studies of long-term use. Short term randomized controlled studies in humans have shown signs of improvement in knee osteoarthritis (Pawluk).

 

Medications and supplements can and should be used together in a comprehensive treatment program. Other modalities such as acupuncture, massage, manipulation and physical therapy can be used concurrently. The magnetics would be used daily, whereas these other modalities are used less often and require visits to the practitioners.

 

 

Magnetic Field Treatment for Arthritis

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Local vs. systemic application

 

As long as the MFs are strong enough, most types of fields will deliver considerable benefits to the arthritis sufferer. I usually recommend systemic treatments since most people with arthritis have multiple joints involved. Individual joints should also be separately treated and selected based on pain or disability. Rotating treatments of individual joints would help if home treatments were done regularly.

 

One of the most frustrating forms of arthritis is that involving the spine, especially spinal stenosis. There is virtually no treatment that will stop the progression of spinal stenosis. MFs are the only treatment I know of that will act at the spinal joints themselves. Other than pain medications and acupuncture, none can act deep enough to help at the level of the involved spinal joints. Assistance with pain relief is important but I always want to stop, reverse or slow progression.

 

Static or permanent magnets

 

The biggest challenges in using static magnets are having strong enough magnets to adequately treat the whole joint, getting systemic exposure, length of exposures and applying the magnets to and keeping them on the body. When single, smaller joints are involved, static magnets work very well. Magnetic wraps with multi-polar patterns or multiple individual magnets work very well. The wraps with individual magnets can be made with much stronger magnets. These are more likely to help superficial joints or tissues and reach deeper into the joint to help with joint repair. This is especially important for the larger joints – knees and hips.

 

If a magnet is not helping with joint pain, the first thing to do is to increase the field strength, since the magnet may not be getting a strong enough action at the place in the joint generating the pain. If this doesn’t work, increase the duration of use or try different placements. Sometimes it may be necessary to stimulate the joint/s and simultaneously to treat acupuncture points near the joint/s.  Eastern European doctors would often add magnets to the spinal part governing the joint/s involved. I will use a strong magnet over the neck for upper extremity joints and over the lower back for joints below that level.

 

PEMFs

 

The beauty of PEMFs is that it almost doesn’t matter how strong the field is to get a reasonable measure of relief. Treatment doesn’t need to be for extended periods. There are no special placement needs. Many different frequencies have been successfully used. Systems are available that will do both whole body and individual joints. For example, laying on one’s back on a Magnopro and using the pillow applicator over individual joints for 15-30 minutes, will accomplish the same thing as using multiple strong static magnets for possibly hours. Key is daily use and preferably at least 2 times a day.

 

Others

 

Other types of electromagnetic therapies such are hulpfull such as:

·      laser,

·      infrared,

·      electrical stimulation,

·      diathermy,

·      millimeter waves,

·      microwave resonance,

·      qui machines,

·      etc.

 

Most of these are best for more superficial applications. They are best for pain, edema and inflammation. For most of these the more limited depth of penetration is a consideration, especially for large joints. Also, they are typically used for individual joints and so whole body treatment is severely limited. Many are only available in doctors’ or therapists’ offices.

 

I will use some of them for more severe pain, swelling and joint stiffness, alongside the whole body PEMFs to get the best short-term help. The PEMFs then would continue to be used lifelong, for both treatment and prevention. Remember, whole body PEMFs also give the many additional advantages of supporting the rest of the body too and being useable for other organs, tissues, functions and problems.

 

Key is daily use – twice a day if you can. In the morning to wake up the cells. In the evening to clean out the effects of the day’s stresses on the body. You can still use the system mid-day if needed for any other given problem/s. The arthritis settings and pillow/pad placements as needed may be combined at any given treatment session with Health Maintenance settings.

 

Specific Devices

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I recommend PEMF devices over static magnetic devices, if a choice is available. These include: Quantron Resonance System (QRS) and the Magnopro System.

 

 

How to use PEMF devices for arthritis

   Magnopro System

   QRS System

 

 

Since the recommended devices can have complicated set-ups and treatment regimens and often do not come with explicit directions, consultation is the best way to get individually tailored protocols, specific to any given individual’s unique overall health issues or needs.  Otherwise, the manufacturer’s directions can be a starting place.

 

Always check for sensitivity when you start. If you think you may be sensitive, or know you are, “start low and go slow” in advancing the settings.

 

In addition:

q     Always treat your day’s water ration on the system with you in the morning – preferably in a glass container without a metal lid.

q     Take your morning supplements before you get on the system. There are no supplements I know of no supplements that have to be avoided with these treatments.

q     Have a drink of water – at least 10-16 ounces before you get on the system.

q     Have your breakfast first to stimulate digestion. 

q     Let your body tell you what it needs in terms of settings, length of treatments and/or placements of applicators.

q     It doesn’t matter when supplements are taken relative to magnetic field therapy. In the ideal circumstance they should be taken about half an hour to one hour before the magnetics treatment.

q     Key is daily use – twice a day if you can. In the morning to wake up the cells. In the evening to clean out the effects of the day’s stresses on the body. You can still use the system mid-day if needed for any other given problem/s. Health Maintenance settings may be combined at any given treatment session with treatment settings and pillow/pad placements as needed.

q       In the morning:

o      If sensitive, start at the lowest setting and gradually- typically every 3-4 days -  increase the settings until the strongest setting is reached.

o      If not sensitive, typically start the mid-range and increase the settings, by one or two every day until the strongest setting is reached.

o      Once the highest setting is reached is reached, you can stay at that level or whatever level seems to produce the best results from then on, unless you have a reaction or your intuition tells you another setting is preferred.  

q       In the evening:

o      Always use the lowest setting for at least 20 minutes just before bedtime. This is always the last setting to use for the day. It is the “finishing” treatment – the “finishing” touch.

o     You can combine any other settings in a separate treatment session if you want just before ending the day with the finishing treatment.

 

How to use static magnets for arthritis

 

Static or permanent magnets can be useful for individual joints. They can be used as individual magnets if there are specific tender points around a joint. The small permanent magnets are more useful wrapped or taped to small joints near the skin surface, such as, hand or foot joints, the acromioclavicular joint, rib joints or TMJs.

 

Because magnetic field strength drops off so rapidly, permanent magnets work best on these small, near the surface (superficial) joints. Large joints, such as the knees or hips or deep joints like those in the spine, don’t lend themselves well to permanent magnets. Can these help, yes, they often do but they don’t accomplish my primary goal of getting the field deep into the joint to do its work. Wrapping a flexible material with many magnets woven or sewn into it may work to give better relief. When all the joint cartilage is gone, relief is a reasonable goal. Joint replacement may be a justifiable option at this point in the condition.

 

Do not wear the magnets all day every day. Give the body a break, a chance to rebalance itself every day. To prevent morning stiffness and gelling, use them at night. If symptoms are worse as the day wears on, with use or standing, put them on during the day.

 

Remember, relief is what you can get from typical conventional medications. They just don’t stop, slow or reverse the arthritis process at a structural level. Deep acting magnets and PEMFs are most likely to not only give relief, but also to have a chance to stop, slow or reverse the arthritis process at a structural level. PEMF treatments can be used for up to 1-2 hours per day if needed, depending on the system being used. Daily use is probably going to be the most useful, especially to stop, slow or reverse the arthritis process.

 

Pain relief and improvement of sleep or anxiety, is usually seen within hours to days. Stiffness, strength and range of motion often require several weeks to significantly improve.  A sense of improvement will be the greatest in the first few weeks and then progress may seem to stop or slow a lot.. You need to have faith that continuous improvement will happen, even though more slowly, over months, if not years. This depends on how badly the joints have been affected. I remind people, they didn’t get to their current state overnight, so they won’t recover overnight.  People are amazed at how much progress is made, when they look back a year later.

 

I am reminded of a somewhat crusty, older gentleman who saw me for his spinal arthritis. I treated him with a back magnetic pad. When he came back 2 weeks later, I asked him how he was. He said “no better.” I then asked, “well then, how’s your back?” He replied, “Oh that’s better, but I’m no better!” The progress people make with magnetic fields, doesn’t always make everything else better too. But … miracles do happen.

 

 

Nutrition

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Most conventional day-to-day treatments for arthritis, e.g., the anti-inflammatories and “pain killers” are simply helping with symptoms. They may even long-term worsen the arthritis, because of the basic underlying actions. Their anti-inflammatory actions also have important immune suppressant effects – for example, significantly reducing the body’s levels of vitamin C, among others.  Some supplements are more than symptom modifiers. They are structure modifiers – as are magnetic fields. This means nutritional supplements are likely in the long term to actually improve the joints, without causing long term joint deterioration. The combination of these agents and magnetic fields would be even better.

 

·      Glucosamine sulphate (not hydrochloride) 500 mg three times daily.

·      Chondroitin 400 mg three times daily (alone or in combination with Glucosamine).

·      SAMe 400 to 1600 mg once daily.

·      MSM 1000 to 3000 mg three times daily.

·      Capsaicin cream (Zostrix) - thin film of cream (0.025%, 0.075%) to the joint/s four times a day.

·      Omega 3 Fish oil – 2000-6000 mg combine EPA/DHA per day.

·      Turmeric - 400 mg (containing 95% curcumin) 3 times a day between meals.

·      Boswellia -  210 to 240 mg of boswellic acids three times a day

·      For inflammatory arthritis: add Vitamin C Complex extended release 1000mg tablets – 2000-3000 mg twice a day.

 

 
Recommended Nutrition
   Glucosamine sulphate

   Chondroitin

   SAM-e

   MSM

   Capsaicin cream

   Omega 3 Fish oil

   Turmeric

   Boswellia

   Vitamin C

 

 

 

References

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·      Bulow PM, Jensen H, Danneskiold-Samsoe B. Low power Ga-Al-As laser treatment of painful osteoarthritis of the knee. A double-blind placebo-controlled study. Scand J Rehabil Med 1994 Sep;26(3):155-9.

·      Ciombor DM, Aaron RK, Wang S, Simon B. Modification of osteoarthritis by pulsed electromagnetic field--a morphological study. Osteoarthritis Cartilage. 2003 Jun;11(6):455-62.

·      Collacott EA, Zimmerman JT, White DW, Rindone JP. Bipolar permanent magnets for the treatment of chronic low back pain: a pilot study. JAMA 2000 Mar 8;283(10):1322-5.

·      De Mattei M, Pasello M, Pellati A, Stabellini G, Massari L, Gemmati D, Caruso A. Effects of electromagnetic fields on proteoglycan metabolism of bovine articular cartilage explants.  Connect Tissue Res. 2003;44(3-4):154-9.

·      Fargas-Babjak A, Rooney P, Gerecz E. Randomized trial of Codetron for pain control in osteoarthritis of the hip/knee. Clin J Pain 1989 Jun;5(2):137-41.

·      Foley-Nolan D, Barry C, Coughlan RJ, O'Connor P, Roden D. Pulsed high frequency (27MHz) electromagnetic therapy for persistent neck pain. A double blind, placebo-controlled study of 20 patients. Orthopedics. 1990 Apr;13(4):445-51.

·      Gordon A, Merenstein JH, D'Amico F, Hudgens D. The effects of therapeutic touch on patients with osteoarthritis of the knee. J Fam Pract 1998 Oct;47(4):271-7.

·       Hinman MR, Ford J, Heyl H. Effects of static magnets on chronic knee pain and physical function: a double-blind study. Altern Ther Health Med. 2002 Jul-Aug;8(4):50-5.

·       Jacobson JI, Gorman R, Yamanashi WS, Saxena BB, Clayton L. Low-amplitude, extremely low frequency magnetic fields for the treatment of osteoarthritic knees: a double-blind clinical study. Altern Ther Health Med. 2001 Sep-Oct;7(5):54-64, 66-9.

·      Johnson MT, Waite LR, Nindl G. Noninvasive treatment of inflammation using electromagnetic fields: current and emerging therapeutic potential. Biomed Sci Instrum. 2004;40:469-74.

·      Mazieres B, Combe B, Phan Van A, Tondut J, Grynfeltt M. Chondroitin sulfate in osteoarthritis of the knee: a prospective, double blind, placebo controlled multicenter clinical study. J Rheumatol 2001 Jan;28(1):173-81.

·      Pawluk W. Treatment of Osteoarthritis with A New Broadband PEMF Signal (QRS Salut1 ), Paper presented and abstract published in the Proceedings abstracts, 24th Annual Conference, Bioelectromagnetics Society , Quebec City, PQ, Canada , June 2002.

·      Peroz I , Chun YH, Karageorgi G, Schwerin C, Bernhardt O, Roulet JF, Freesmeyer WB, Meyer G and Lange KP.  A multicenter clinical trial on the use of pulsed electromagnetic fields in the treatment of temporomandibular disorders The Journal of Prosthetic Dentistry, Volume 91, Issue 2, February 2004, Pages 180-187.

·      Prato FS, Carson JJ, Ossenkopp KP, Kavaliers M. Possible mechanisms by which extremely low frequency magnetic fields affect opioid function. FASEB J 1995 Jun;9(9):807-14.

·      Quittan M, Schuhfried O, Wiesinger GF, Fialka-Moser V. Clinical effectiveness of magnetic field therapy--a review of the literature. Acta Med Austriaca 2000;27(3):61-8.

 

·      Rindone JP, Hiller D, Collacott E, Nordhaugen N, Arriola G. Randomized, controlled trial of glucosamine for treating osteoarthritis of the knee. West J Med 2000 Feb;172(2):91-4.

·      Rogachefsky RA, Altman RD , Markov MS, Cheung HS. Use of a permanent magnetic field to inhibit the development of canine osteoarthritis. Bioelectromagnetics. 2004 May;25(4):260-70.

·      Schmid B, Ludtke R, Selbmann HK, Kotter I, Tschirdewahn B, Schaffner W, Heide L. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized placebo-controlled, double blind clinical trial. Phytother Res 2001 Jun;15(4):344-50.

·      Schmidt-Rohlfing B, Ihme N, Silny J. Electrical fields in the knee joint induced by external magnetic fields: results of an experimental study.  Z Orthop Ihre Grenzgeb. 2002 Sep-Oct;140(5):538-43.

·      Segal NA, Toda Y, Huston J, Saeki Y, Shimizu M, Fuchs H, Shimaoka Y, Holcomb R, McLean MJ. Two configurations of static magnetic fields for treating rheumatoid arthritis of the knee: a double-blind clinical trial. Arch Phys Med Rehabil 2001 Oct;82(10):1453-60.

·      Singer, F.; Schieler, K. Effect of pulsating electromagnetic energy and conventional short-wave diathermy in the conservative therapy of osteoarthritis. Wien Med Wochenschr 128(1):49-51, 1978.

·      Takeda W, Wessel J. Arthritis Care Res 1994 Sep;7(3):118-22. Acupuncture for the treatment of pain of osteoarthritic knees.

·      Trock DH, Bollet AJ, Dyer RH Jr, Fielding LP, Miner WK, Markoll R. A double-blind trial of the clinical effects of pulsed electromagnetic fields in osteoarthritis. J Rheumatol 1993 Mar;20(3):456-60.

·      Trock DH, Bollet AJ, Markoll R. The effect of pulsed electromagnetic fields in the treatment of osteoarthritis of the knee and cervical spine. Report of randomized, double blind, placebo controlled trials. J Rheumatol 1994 Oct;21(10):1903-11.

·      Usichenko TI, Ivashkivsky OI, Gizhko VV. Treatment of rheumatoid arthritis with electromagnetic millimeter waves applied to acupuncture points--a randomized double blind clinical study. Acupunct Electrother Res. 2003;28(1-2):11-8.

·      Vallbona C, Richards T. Evolution of magnetic therapy from alternative to traditional medicine.  Phys Med Rehabil Clin N Am. 1999 Aug;10(3):729-54.

·      Wang W, Wang Z, Zhang G, Clark CC, Brighton CT , Smith RL. Up-regulation of chondrocyte matrix genes and products by electric fields. Clin Orthop. 2004 Oct(427 Suppl):S163-73.

 

 

 

 

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