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A Pain in the Joint

Perhaps it starts out as an inconvenience. One day, you get out of bed and feel a little stiffer than usual. Movements that you didn't notice before are suddenly very noticeable; you can feel the movements. You may be experiencing the first signs of one of the many forms of arthritis. Welcome to the club.

There are some 127 types of arthritis, and most, if not all, of them have something to do with inflammation of the joints. They have been with us, well, forever. The Museum of Natural History at the University of Kansas has a 100 million-year-old reptile skeleton that shows the effects of multiple arthritis. If you view the paintings of Peter Paul Reubens (1577-1640), you will find knobby fingers and swollen wrists, which are two of the telltale signs of rheumatoid arthritis.

Of the 127 forms, perhaps the most well-known are osteoarthritis and rheumatoid arthritis. The most common form is osteoarthritis, which is a pain and stiffness in the joints. Of greater concern is rheumatoid arthritis (RA), which is a systemic illness - a disease of the whole body. It brings many different symptoms_fever, chills, loss of appetite, sweating, fatigue_as well as painful joints. When it flares up, it is as dangerous as any illness; indeed, people with aggressive RA have long-term survival rates nearly on par with some types of leukemia or advanced coronary artery disease. And despite the "age" of these two forms of arthritis, we still do not know very much about how to alleviate them.

Osteoarthritis

Osteoarthritis, or OA, is generally limited to the fingers, knees, hips, neck, and lower back. It seems to first appear in people at around the age of 50, and symptoms include stiffness in the morning that wears off as the day progresses and the cracking and grinding of joints. It traditionally has been considered the "my body's worn out" arthritis and involves the breakdown of cartilage in a joint. What causes this is still a mystery. It probably results from a combination of genetic and joint deterioration. OA can "just happen" or be the result of an injury, joint infections, tissue damage, or calcium deposits.

OA is painful because the smooth cartilage covering the ends of bones softens, becomes pitted, and loses its elasticity. Spurs can form at the ends of bones, and in extreme cases sections of cartilage may be worn away completely, allowing the bones to rub together.

Rheumatoid Arthritis

Although rheumatoid arthritis can develop into a serious illness, it rarely does. Twenty percent of those who develop RA recover completely; they may suffer some joint pain, but have learned to live with the problem. This is because they sought diagnosis and treatment early.

RA is not a disease of the elderly; it generally affects people between 25 and 50 years old. It is an inflammation of the joint membrane, or synovitis. In RA, the synovium membrane, which lines the joint capsule and (along with cartilage) helps keep bones from grinding against each other, becomes inflamed. The body then releases enzymes to fight the inflammation. The enzymes can cause increased irritation and pain, and, if this process continues for years, the enzymes may attack the cartilage and bone, slowly eating it away. And because your immune system is involved, you feel sick all over.

Prevention

To prevent, or at least delay, both forms of arthritis the best thing you can do is practice general good health. Maintain the correct weight (too much weight puts more pressure on joints) and exercise regularly (but choose an activity appropriate for your current shape and age). Eat a healthy diet (more on this later). If you have arthritis and are taking medication, you should be aware that the medication can affect other body systems and possibly hurt you in other ways. Check for high blood pressure and high cholesterol levels regularly, and stop smoking and drinking. It is also very important to have RA diagnosed. If you catch it early, you can do much to make things better for yourself.

Treatment

Conventional treatment for arthritis centers around reducing inflammation, swelling, and pain. More recently, research is being done (especially in regards to OA) on cartilage regeneration. Conventional methods include drugs, rest, and exercise. Nonmedical treatments (that is, those that do not involve drugs or surgery) focus on exercise, rest, nutrition and diet, and a number of other ideas.

Traditional Drugs

Traditionally, nonsteroidal antiinflammatory drugs (NSAIDs) are used as first-line drugs for OA and RA and steroids as another first-line drug for RA. Disease-modifying antirheumatic drugs (DMADs) are a second-line drug for RA. The NSAIDs reduce inflammation and include aspirin, ibuprofen, and different prescription drugs. Steroids such as prednisone are used for RA, although they are not a first choice due to side effects. DMADs appear to bring on remission symptoms. They include gold salts, penicillamine, and plaqeuenil. However, these drugs are treating the symptoms, not the disease, and may even further impair the cartilage, making the long-term situation worse. If you feel you need to use some sort of drug for arthritis, you should always consult with a health professional. Many drugs do have side effects or work differently on some people. More and more, people are realizing that serious gastrointestinal effects may result from continued use of the traditional drugs.

Glycosaminoglycans

Another avenue currently being explored by the medical community for treatment of OA uses substances derived from glycosaminoglycans. One substance, glucosamine sulfate, is derived from shellfish and acts to stimulate the synthesis of glycosaminoglycans, which in turn may aid in cartilage regeneration. A number of studies have shown encouraging results. Other glycosaminoglycan-related substances include N-acetyglucosamine and hyaluronic acid.

Exercise and Attitude

Exercise can improve muscles, build endurance, and give you more joint mobility with less pain and swelling. In one study, people who participated in a supervised walking program had less pain, used less medication, and were more mobile than a nonwalking group (Annals of Internal Medicine, April 1, 1992). Most doctors recommend exercise, and there are numerous books available on exercising with arthritis. The one caution should be to those with RA; exercise can make inflammation worse, and you should find the proper balance between rest and exercise.

Healthy Attitude

A healthy attitude is also important. To quote Shakespeare in Hamlet "There is nothing either good or bad but thinking it so." This may be hard to swallow when your joints are aching, but it is true. Studies have shown that a "feel good" attitude helps.

Diet and Nutrition

Much has been said about diet, nutrition, and arthritis. Some swear by it and say it is "a" factor, if not "the" factor. Others, notably those in the traditional medical profession, call many of the nutritional claims quackery.

One possible link between diet, nutrition, and arthritis is food sensitivities. A variety of studies have sought to link food allergies with arthritis. They have shown that, for some people, arthritis flares up due to milk, shrimp, and nitrates (a common food preservative) and eliminating these from your diet decreases, if not eliminates, arthritic symptoms. Other diets have eliminated red meat, additives, preservatives, dairy products, and alcohol, with mixed results. A 1991 study from the British medical journal, the Lancet, reported generally positive findings on the effect of fasting and a vegetarian diet.

Other health professionals recommend foods that contain natural anti-inflammatories and supplements. Dr. Julian Whitaker mentions the anti-inflammatory properties of both barley grass juice and omega-3 fatty acids in the summer 1994 issue of Health News & Review, and fish oil is featured in an article in the March 1994 issue of Prevention. Fatty acids are also mentioned in the previously mentioned Lancet article.

Non-Medical Treatments

Research also continues to seek alternative methods to treatment of arthritis. Recently, David W. Puett, MD and Marie R. Griffen, MD, MPH, reviewed all non-medical treatments (treatments not using drugs or surgery, excluding nutrition) for OA that turned up in a computer search of English-language reports from 1966 through 1993. Among the findings was, as we know, that exercise can be beneficial. Another promising finding was topical use of capsaicin. This is derived from the active ingredients in chili peppers and is sold over the counter. Capsaicin may, Dr. Puett and Dr. Griffen theorize, "interfere with the production of substance P, a chemical mediator of pain and local sensory terminals to the central nervous system." The burning sensation of the cream either decreased or disappeared with continued use for nearly half of those involved in the study.

If you are unfortunate to have some form of arthritis, what you do about it is up to you. You should, however, have it diagnosed; as mentioned, a late diagnosis, especially with RA, can result in serious problems down the road. There is a good deal of information available on arthritis, both conventional and alternative. We suggest finding a bookstore or library and doing a lot of browsing.

Books

Fried, F. James. 1990. Arthritis, A comprehensive guide to understanding your arthritis.
Addison-Wesley: Reading, MA. (Conventional approach)

Keough, Carol. 1983. Natural relief for arthritis
. Rodale Press: Emmaus, PA. (Alternate approaches)

Moyer, Ellen. 1993. Arthritis, questions you have _ answers you need.
People's Medical Society: Allentown, PA. (Conventional and alternative approaches)

There are numerous books available dealing with arthritis, diet, nutrition, and exercise.

Periodicals

"Green barley grass may help arthritics."
In Better Nutrition for Today's Living, July 1995.

"Gills in pills: more evidence backs fish oil for arthritis."
In Prevention, March 1994.

"Homeopathic remedies often help arthritis."
In Better Nutrition for Today's Living, May, 1994.

"Glucosamine,"
by A.S. Gissen. In the Vitamin and Research Products, Inc. Newsletter, July/August 1994.

"Nonmedical treatment for arthritis: a review."
In HealthFacts, August 1994, v19, n183.

"What you don't know about arthritis can hurt you: a nutritional approach."
In Health News & Review, Spring 1993.

"Glycosaminoglycan chondroprotection: pharmacological vistas,"
by Paroli, E. In the Int J Clin Pharmacol Res 1993; 3.

"Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis,"
by Dr. Jens Kjeldsen-Kragh, et. al. In the Lancet, 12/10/91.

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