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INTRODUCTION

A placebo-controlled, double-blind study carried out by the same researchers previously demonstrated the benefits of treatment with a topical cream consisting of a blend of CFA (Celadrin) on OA knees. Thus the purpose of this study was to extend the findings of previous research to provide further support for the use of CFA with the addition of menthol in the treatment for arthritis of the knees and also the wrists and elbows.

METHODS AND MATERIALS
28 individuals (26 women and 2 men) diagnosed with arthritis by a physician were assigned to one of three experimental groups based on the anatomic location of pain (i.e. knee, elbow, or wrist). Each individual applied the cream to the affected area twice per day, every working day for one week and subsequently returned to the laboratory for post study functional performance testing.

Individuals were assessed for functional performance before and after the 7-day experimental period. For individuals with knee arthritis, the selection of assessments and the sequence performed were (a) the timed “up-and-go” test, (b) the stair-climbing test, (c) the unilateral anterior reach test, and (d) the medial step-down test.

For individuals with elbow and wrist arthritis, the selection of assessments and sequence performed were (a) grip strength, (b) peak isometric force of the elbow flexors at 90 degrees, (c) 1 repetition maximum of the elbow flexors, (d) isometric local muscular endurance of elbow flexors at 90 degrees, and (e) number of repetitions performed for the arm curl with a standard resistance.

The topical cream used was a proprietary blend of cetylated fatty acid oil (cetyl myristoleate, cetyl myristate, cetyl palmitoleate, cetyl laureate, cetyl palmitate, and cetyl oleate), PEG-100, stearate, benzyl alcohol, lecithin, carbomer, potassium hydroxide, tocopheryl acetate, menthol, and olive oil (Celadrint, Imagenetix, Inc., San Diego, CA).

Individuals were instructed to apply a standardized amount of cream to the affected area. In addition, individuals were not taking additional arthritis medications, did not initiate any exercise programs, and were not permitted to practice the performance tests to prevent any training effects during the 1-week experimental period.

RESULTS AND CONCLUSIONS
For individuals with knee OA, there were significant reductions in the times to complete the up-and-go and stair climbing tests and unilateral anterior reach performance increased significantly.

The range of motion of the knee improved significantly in the knee flexion test, as well as in the full extension test for the left leg.

For individuals with elbow and wrists arthritis, significant improvements were observed in the local muscular endurance assessments (i.e., isometric endurance test and repetitions of the arm curl).

The findings this study support those of previous researchers, indication a topical cream consisting of a blend of cetylated fatty acids is effective for (a) improving knee range of motion; (b) improving ability to climb stairs, rise from a chair, and walk; and (c) improving balance, strength, and endurance in patients with knee OA.

Unique to the present investigation were the findings that this topical cream also enhances dynamic and isometric local muscular endurance and reduces pain in individuals with severe pain of the elbow and wrist (e.g., OA or rheumatoid arthritis).

The average pain reductions reported with the use of NSAIDs is 30%. In the present study it was reported that there was approximately 43% reduction in pain in individuals with arthritis of the wrist and elbow after only 1 week.

PRACTICAL APPLICATIONS
Although effective, side effects may occur with the chronic use of analgesics and NSAIDs. Thus, the development of topical treatments that produce no or minimal side effects is warranted.

The results provide further support for the use of a topical cream consisting of a blend of CFA and menthol in the treatment of individuals with arthritis of the knee, elbow, and wrist. In the present investigation, significant improvements in stair climbing ability, “up-and-go” performance, balance, and range of motion; reductions in pain for knees, elbows and wrists; and significant improvements in dynamic and isometric local muscular endurance were reported. The use of such topical treatments may allow individuals to better exercise, thereby helping them improve their health and fitness. Strength and conditioning professionals who work with such populations may find it enhances workout capabilities.

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