Abstract
Osteoarthritis is one of the most commonly encountered disorders in daily clinical practice. It is a degenerative joint disease that predominantly affects the elderly population and is characterized by progressive degeneration of articular cartilage, making the term “wear and tear” appropriate in describing its pathology. This article provides a comprehensive overview of osteoarthritis, including its etiology, pathology, clinical features, and diagnostic considerations. Special emphasis is given to its management from a homoeopathic perspective. In homoeopathy, treatment is based on detailed case taking, thorough case analysis and evaluation, and an understanding of the patient’s miasmatic background. This article also presents a brief account of commonly indicated remedies that are frequently useful in day-to day clinical management of osteoarthritis.
Keywords
Osteoarthritis, wear and tear, degenerative disorder, Cartilage Breakdown, Subchondral Bone Remodelling, osteophytes, homoeopathic management.
Introduction
Osteoarthritis (OA) is the most common type of arthritis. It is second most prevalent musculoskeletal condition after back pain and utilizes a major part of healthcare resources. OA is no longer considered as a simple “wear and tear” or degenerative joint disease. It occurs in the synovial joints and results from genetic factors, overuse and injury. Osteoarthritis is thought to result from an imbalance between cartilage damage and the chondrocyte response, leading to structural issues in the joint. Risk factors include obesity, age, occupation, trauma, being female and family history. the term “osteoarthritis” was first used and popularized by John Kent Spender, an English physician, in the 19th century. Arthritis characterized by erosion of articular cartilage, either primary or secondary to trauma or other conditions, which become soft, frayed and thinned with calcification of subchondral bone and outgrowths of marginal osteophytes; pain and loss of function result mainly affects weight bearing joints.
Defination
Osteoarthritis (OA) is a chronic, non-inflammatory degenerative disorder of synovial joints characterized by progressive loss of articular cartilage with secondary changes in the underlying bone and surrounding soft tissue.
Epidemiology
Osteoarthritis commonly involves knee joint, hip joint, first metatarsophalangeal (MTP) joint, hand joints, and cervical and lumbar spine. The prevalence of radiographic OA is much more prevalent than symptomatic OA, latter is much more prevalent in women and prevalence increases significantly beyond 50 years of age. Knee and hand OA are much more prevalent than hip OA. A large epidemiological study in India reported an average prevalence of 4.2% and 6.25% for symptomatic knee and all-joint OA, respectively. Around 25% of OA patients will have symptomatic OA in multiple joints.
Classification of Osteoarthritis
Osteoarthritis is classified as primary (idiopathic) or secondary to some known cause.
Primary osteoarthritis may be localized to specific joints (eg, hands, knee, hip). If primary osteoarthritis involves multiple joints, it is classified as generalized osteoarthritis.
Secondary osteoarthritis results from conditions that change the microenvironment of the cartilage or joint structure. These conditions include significant trauma, congenital joint abnormalities, metabolic defects (eg, hemochromatosis, Wilson disease), infections (causing post-infectious arthritis), endocrine and neuropathic diseases, and disorders that alter the normal structure and function of hyaline cartilage (eg, rheumatoid arthritis, psoriatic arthritis, calcium crystal deposition disease).
Etiology And Risk Factor
Age: Age is the most significant non-modifiable risk factor for OA. Globally around 9% of males and 16% of females above 60 years of age have symptomatic OA.
Gender: Females as compared to men, are twice more likely to have symptomatic OA (especially knee and hands).
Genetics: though no single gene is responsible for OA, about 30–50% of OA risk is genetically determined, more so for hand and hip OA.
Joint injuries: Heavy duty jobs like farming, construction workers, etc., and frequent kneeling practices (e.g., squatting in India) are associated with higher risk of OA. A cruciate ligament or meniscal injury can predispose to early OA in 10–30% of patients over the next decade.
Obesity: Obesity is an important risk factor for incidence, progression, and severity of OA in both weight-bearing (hip, knee) and non-weight bearing joints (hand).
Joint anatomy: A dysplastic or misaligned joint is more at risk for developing OA. Varus malalignment of knees is a significant risk factor for OA progression independent of obesity.
Pathophysiology
Cartilage Breakdown: Due to an imbalance in synthesis and degradation of extracellular matrix, primarily by enzymes like matrix metalloproteinases. Subchondral Bone Remodelling: Thickening and cyst formation occur as part of an adaptive response.
Inflammation of Synovium: Low-grade chronic inflammation contributes to further joint damage via cytokines like IL-1β and TNF-α.
Formation of Osteophytes: Bony projections that limit joint movement and cause pain.
Loss of Joint Space: A classic radiological feature indicating cartilage erosion.
Pathology
Macroscopic Changes: Cartilage becomes yellowish, thinned, and pitted, while bony growths (osteophytes) are evident.
Histological Features: Include fibrillation of cartilage, proliferation of chondrocytes, and increased bone density in affected regions.
Presentation & Examination
Osteoarthritis presents with joint pain and stiffness. The pain and stiffness tend to worsen with activity and at the end of the day. This is the reverse of the pattern in inflammatory arthritis, where symptoms are worse in the morning and improve with activity. Osteoarthritis leads to deformity, instability and reduced function of the joint.
General signs of osteoarthritis: Bulky, bony enlargement of the joint; Restricted range of motion; Crepitus on movement; Effusions (fluid) around the joint.
On examination:
1] Tenderness of joint on palpation (+/- osteophyte).
2] Joint effusion.
3] Crepitation of knees.
Diagnosis
Physical Evaluation: Detects tenderness, restricted motion, and joint deformities. Radiographic Imaging: X-ray changes as LOSS.
✔ L – Loss of joint space.
✔ O – Osteophytes (bone spurs).
✔ S – Subarticular sclerosis (increased density of the bone along the joint line). ✔ S – Subchondral cysts (fluid-filled holes in the bone).
Advanced Imaging: MRI or ultrasound may be used for better visualization of soft tissues.
Lab Investigations: Usually normal, but may help rule out autoimmune conditions like rheumatoid arthritis.
Management
Non medicinal management: Avoiding excessive joint loading should be a key strategy in patients with hip and knee OA. This could be achieved by altering daily activities (e.g., replace running with fast walking, avoid squatting, using western commodes rather than Indian toilets, avoid sitting on floor or lower level seats, etc.), use of assistive devices, correcting malalignment, and promoting weight loss strategies.
Homoeopathic Therapeutics:
1) Arnica montana: After traumatic injuries, overuse of any organ, strains. Sore, lame, bruised feeling. Great fear of being touched or approached. Rheumatism begins low down and works up (ledum). Want strength in the knee, with failing of the joint when walking. Tension in the knee, as from contraction of the tendons. Pale swelling in the knee.
Modalities: Worse, least touch; motion; rest; wine; damp cold. Better, lying down, or with head low.
2) Ruta Graveolans: Weakness, trembling, and paralytic heaviness of knees and legs, which prevent standing firmly, fatigue and heaviness of legs after walking. Sensation of contraction in tendons of knee (as if they were shortened, and weakness in them, esp. on descending).
Modalities: Worse, lying down, from cold, wet weather.
3) Bryonia Alba: The general character of the pain here is stitchin\, tearing; worse by motion, better rest. Dropsical effusions into synovial and serous membranes. Knees stiff and painful. Hot swelling of feet. Joints red, swollen, hot, with stitches and tearing; worse on least movement. Every spot is painful on pressure. Sharp pains in the knees, extending to the tibia.
Modalities: Worse, warmth, any motion, morning, eating, hot weather, exertion, touch. Cannot sit up; gets faint and sick. Better, lying on the painful side, pressure, rest, cold things.
4) Phytolaca Decandra: Aching, soreness, restlessness, prostration, are general symptoms guiding to Phytolacca. Syphilitic bone pains; chronic rheumatism. Rheumatism pains; worse in morning. Pains fly like electric
shocks, shooting, lancinating, shifting rapidly (Puls; Kali bich). Rheumatic pains in lower extremities, < damp weather.
Modalities: Worse, sensitive to electric changes. Effects of wetting, when it rains, exposure to damp, cold weather, night exposure, motion, right side. Better, warmth, dry weather, rest.
5) Rhus Toxicodendron: Rhus affects fibrous tissue markedly-joints, tendons, sheaths-aponeurosis, etc, producing pains and stiffness. Rheumatic pains spread over a large surface at the nape850/ of neck, loins, and extremities; better motion (Agaric). Tenderness about knee-joint. Stretching causes cracking in knees. Best adapted to patient with rheumatic diathesis.
Modalities: Worse, during sleep, cold, wet rainy weather and after rain; at night, during rest, drenching, when lying on back or right side. Better, warm, dry weather, motion; walking, change of position, rubbing, warm applications, from stretching out limbs.
6) Medorrhinum: Mater kent says, for gonorrhoeal rheumatism, Medorrhinum is most important (kent). It controls the rheumatic symptoms and restores the disease. (kent). During heavy thunderstorm very sharp pains in knees start upwards; pains < by stretching. Trembling in legs from knees down (< l.), burning in feet.
Modalities: Worse, when thinking of ailment, from daylight to sunset, heat, inland. Better, at the seashore, lying on stomach, damp weather (Caust).
7) Calcarea Flourica: Chronic synovitis of knee-joint. Cracking in joints. Useful in cases with degenerative changes and nodules.
Modalities: Worse, during rest, changes of weather. Better, heat, warm applications.
8) Kali Iodatum: Periosteum thickened, especially tibia; sensitive to touch (Kali b; Asaf). Rheumatism; pains at night and in damp weather. Contraction of joints. Rheumatism of knees with effusion. Tearing twitching in r. knee. Housemaid’s knee. Tearing in knees at night. Tearing in periosteum of left knee at night when sitting with a swelling. Modalities: Worse, warm clothing, warm room, at night, damp weather. Better, motion, open air.
9) Colchicum autumnale: Affects markedly the muscular tissues, periosteum, and synovial membranes of joints. Pain worse in evening and warm weather. Joints stiff and feverish; shifting rheumatism; pains worse at night. Knees strike together, can hardly walk.
Modalities: Worse, sundown to sunrise; motion, loss of sleep, smell of food in evening, mental exertion. Better, stooping.
Conclusion
Osteoarthritis is a common degenerative joint disorder that places a considerable burden on the ageing population and significantly affects daily functioning. Homoeopathy can play a positive role in the management of osteoarthritis through an individualized approach based on detailed case taking and evaluation of the patient’s overall symptom picture. Rather than relying on a single remedy for all cases, treatment is tailored to the individual, leading to gradual improvement and symptomatic relief. When combined with appropriate exercise, homoeopathic management may contribute to better functional outcomes and improved quality of life in patients with osteoarthritis.
References
1.Boericke W. Pocket Manual of Homeopathic Materia Medica & Repertory. New Delhi, India: B. Jain; 2007.
2.Dr. Thomas Watchman. Zero To Finals Medicine. 2019.
3. Gupta Y.,Sharma J., Sharma S., Homoeopathic Management in Osteoarthritis. TUJ. Homo & Medi. Sci. 2021;4(1):61-67.
4.John Henry Clarke. Dictionary of practical materia medica. New Delhi: B. Jain; 2015.
5.share.google [Internet]. Share.google. 2025 [cited 2025 Dec 31]. Available from: http://share.google/z06FvgPjSzdp4guXA
6.Subrata Kumar Banerjea. Synoptic memorizer of materia medica. New Delhi: Jain; 1995.
7.TA NA, Aggarwal A. Soothing the ageing joints: A homeopathic approach to osteoarthritis. International Journal of Homoeopathic Sciences. 2025 Jul 1;9(3):1527–8.
8.Yash Pal Munjal. API textbook of medicine. 12th ed. Kamath SA, editor. Mumbai: Association Of Physicians Of India; 2022.
