Treatment

Evidence/ Studies

Cost(HI,M,L)

Major Findings

Safety Concerns

Severity Effects

Glucosamine

Beaumont et al.2007

Wang et al. 2007

Bruyere et al. 2003

Approx $20-$30 for 120-150 tablets.

Glucosamine may help protect bones from the high rates of turnover associated with OA.  Partial analgesic properties.

Possible but unlikely shellfish allergy.  Diabetics should monitor their blood sugar while using.  Pregnant women should not use.  

Most effective when taken at the onset of symptoms. Graduated effects when taken later.   

Acupuncture

Self et al.2008

Berman et al.2004

Sangdee et al.2002

Witt et al.2005

Yurtkurgfan et al.1999.  

Initial visits vary from $50-$85 per session.

Follow ups approx $60. 

Studies show reduced subjective pain and increased functioning in patients. 

None, some patients report mild warmness or redness, but not the extent to discontinue treatment. 

None, patients included in each study were based solely on the fact that they exhibited the symptoms of OA regardless of severity. 

Bromelain

Brien. 2006

Klein.2000,

Singer et al.2001

Tilwe et al. 2001

Approx $10-$15 for 60-80 tablets

Inconclusive: studies find both positive and negative outcomes for bromelain usage.  Larger studies needed for validation. 

Mild nausea and other stomach upset was the major side of effects of use.  Most were mild and well tolerated by subjects.

Homogeny of study results.  Definitive results are still uncertain. 

Resistance Training

Jan et al.2008

Hughes et al.2006

Etinger et al. 1997

Rogind et al 1998.

A personal trainer cost $60-$70 per session. Without a trainer, materials for exercise cost anything between $40 and $50.  

Reduction in lower extremity stiffness and marginal reduction in pain by participants. 

Always consult a doctor before starting an exercise regimen.  Only minimal discomfort accompanied any cited studies.

Patients included only if level 3 on the Kellgren/Laurence scale of OA

Insoles/ Orthotics

Franz et al. 2008

Hinman et al. 2008.

Kuroyanagi. 2007

$15-$30 per set depending on size and shape. 

Very effective when used with discretion. Only full length laterally wedged insoles decreased temporary pressure on knees.

No patients in either study complained of pain or adverse events during the study. However, caution should be taken to find the correct orthotic for each patient. 

Participants were at least grade 2 on the Kellgren/Laurence scale of OA.  

Yoga

Kolasinski. 2005.pdf

Approx $10-$20 per session.

Statistically significant reduction in pain and stiffness.  Larger studies needed.

No adverse events reported.  Participants must be healthy enough for physical activity. 

Only participants with significant confounding diseases were excluded. 

Tai Chi

Lee et al. 2008

Brismee et al. 2007

Fransen et al. 2007

Approx. $20 per session.  Recommended 2-3 classes per week.  

Tai chi has been show to help with stiffness, pain, and physical functioning associated with OA. 

Patients must be healthy enough for physical activity. Always consult a doctor before starting a

None; only participants with other confounding diseases were excluded.

Massage

Perlman et al. 2006

Depending on the area approx $ 65/hr per session.

Study is not confirmed by another large controlled experiment.  However, statistically significant.

No adverse events reported.  No age or disability considerations. 

None, no participants were excluded from the test group.

Water Aerobics

Silva et al.2007

Cochrane et al.2005

Cost per annum totaled $225 or approx. $19 per month.

Study suggests that results show decrease in pain, but further evaluation is needed.  No difference between land and water treatment groups.  

Two patients in the exercise group (Cochrane et al) slipped poolside and sustained minor bruising.

None reported with the studies included.  

Spa Therapy/ Balneotherapy

Yurtkuran et al. 2006

Karagulle et al. 2007

*(Tubergen et all. 2002)

For similar spa therapy packages mean cost totaled $335 per month for 10 months.

Study found significant paid reductions, but the mechanism is still uncertain.  Effects of heat are still possible.

None, no adverse events were reported and attrition was a minimal from the study.

None.  Participants were only excluded if preexisting conditions warrant.