The word arthritis refers to inflammation of the joint. The word comes from Greek arthron meaning joint, and Latin itis meaning inflammation. The plural is arthritides.
Arthritis is not a single disease. It is a term that covers scores of medical conditions. The most common is osteoarthritis. Other forms include rheumatoid arthritis, gout, septic arthritis and psoriatic arthritis, to name but a few of the many types.
What is a Joint and How does it Work?
A joint is an area of the body where two different bones meet, essentially where one bone moves on another bone. Ligaments hold the two bones together. The ligaments are somewhat like elastic bands, while they keep the bones in place the muscles relax or contract to make the joint move.
Cartilage covers the surface of the bone in order to stop the two bones rubbing directly against each other. This covering of cartilage, suitably lubricated, allows the joint to work smoothly and painlessly.
The joint is surrounded by a capsule. The space within the joint, the joint cavity, contains synovial fluid. This synovial fluid, produced by the synovium or synovial membrane lining the joint cavity, lubricates and nourishes the joint and cartilage.
Statistics on Arthritis
Arthritis sufferers include men, women and children. It is estimated that some 350 million people worldwide have arthritis. Osteoarthritis is by far the most common.
Figures from the Australian Bureau of Statistics (ABS) show that, of the total Australian population in 2004-05, 15% reported arthritis. Of those with arthritis, 51% reported having osteoarthritis and 16% reported having rheumatoid arthritis.
In general, arthritis affects women more than men. The age of onset varies with the different types of arthritis. The ABS report that, in 2004-05, in those people 65 years of age and older, 49% have arthritis.
Types of Arthritis
Most authors claim that there are over 100 types of arthritis. Only a select few of these will be covered in this newsletter, the purpose of which is to provide an overview of this common condition and to give guidance to prevention and management.
There are two groups of arthritis.
Primary forms of arthritis include:
Septic or Infectious arthritis
Food intolerance arthritis.
Arthritis secondary to other diseases include:
Multiple myeloma, hypertrophic osteoarthropathy and osteoporosis may mimic arthritis and should not be diagnosed as arthritis.
The Cause of Arthritis
If you have arthritis, something has gone wrong with the joint(s). What goes wrong depends on the type of arthritis. It could be a wearing away of the cartilage, a lack of fluid, autoimmunity, infection, or a combination of many factors. The specific causes will be referred to in the description of the different types of arthritis discussed below.
Symptoms of Arthritis
The symptoms of arthritis depend on the type of arthritis. However, the most common symptoms, irrespective of the type of arthritis, are:
· joint stiffness
· constant ache around the joint.
Pain is the major complaint by individuals who have arthritis. Pain is often a constant and daily feature of the condition.
Arthritic disorders like rheumatoid disease can also affect other organs of the body with a variety of symptoms and include:
· tiredness and fatigue
· weight loss
The Signs of Arthritis
The signs of arthritis are those of inflammation. The word inflammation comes from the Latin inflammare , meaning ‘to set on fire’. The five classic signs are:
· Dolor - pain
· Rubor - redness
· Calor - heat
· Tumor - swelling
· Functio laesa - loss of function.
The first four of these were described in the first century AD by the Roman medical writer Aulus Cornelius Celsus (30BC - 45AD). He wrote, referring to inflammation, “rubor et tumor cum calore et dolore” (redness and swelling with heat and pain).
Diagnosis of Arthritis
The first step is a detailed history. Important features are the speed and time of onset of the symptoms, the pattern of joint involvement, early morning stiffness, aggravating and relieving factors and other systemic symptoms. History relevant to past trauma, sporting activities, etc is an essential part of the history.
Physical examination, especially to examine the joints for signs of inflammation, deformity etc, is an essential part of the assessment.
Blood tests and X-rays of the affected joints are often performed to make the diagnosis.
As already mentioned, all types of arthritis feature pain. Pain patterns differ depending on the type of arthritis and the location. For example, rheumatoid arthritis is generally worse in the morning and is associated with stiffness.
TYPES OF ARTHRITIS
Some of the more common forms of arthritis are discussed as follows.
Osteoarthritis is the most common form of arthritis. It affects the larger joints of the body, the weight bearing joints, like the back, hips and knees. This disease is essentially one acquired from daily wear and tear of the joint. It begins in the cartilage which loses its elasticity, becoming stiff and easily damaged and its important role as a shock absorber is lost. The bone surfaces become less well protected and eventually the two opposing bones erode into each other.
The symptoms develop slowly and get worse as time goes by. There is pain in the joint, either during or after use, or after a period of inactivity. There is tenderness over the joint. There is stiffness, especially first thing in the morning. The joint loses its flexibility.
Osteoarthritis mainly affects people over the age of 45 years, but can develop in younger people.
Risk factors for osteoarthritis include:
· prior joint trauma
· repetitive joint use
· sedentary lifestyle.
Osteoarthritis cannot be cured, so the aim must be to prevent or at least delay the condition worsening. Attaining and maintaining the ideal body weight (Body Mass Index in the region of 21) is an essential part of management and is the key to improving symptoms and preventing or delaying progression. Almost always, some weight loss is required. Physical therapy to strengthen muscles and joints is very helpful. Pain medications are generally necessary for individuals with osteoarthritis. When the disease is advanced and the pain is continuous, surgery may be an option.
Rheumatoid arthritis is an autoimmune disease that causes inflammation of the joints, usually in the hands, feet and knees. The synovial membrane is attacked by antibodies produced by the body’s own immune system. This results in the production of increased amounts of fluid in the joints causing swelling, pain and stiffness. The disease, which tends to be equal on both sides of the body, often leads to the joint becoming deformed and extremely painful. Women are some three times more likely to develop this form of arthritis than men. Symptoms are usually worst on waking in the morning.
As a systemic illness, other symptoms such as fatigue, tiredness and weight loss will be present. Rheumatoid arthritis occurs mostly in people aged 20 and above.
There is no cure for rheumatoid arthritis, but since it is an autoimmune disease, the immune protocol as described in my October 2008 newsletter Autoimmune Protocol – A Natural Approach to Autoimmune Disease should be an integral part of management. Drugs in the treatment of rheumatoid arthritis range from corticosteroids to monoclonal antibodies given intravenously. Appropriate medication for pain relief is given as necessary. (See below)
Gout occurs when the blood levels of uric acid are elevated.
Uric acid is a waste product produced by the body and is disposed of by dissolving in the blood. It is then filtered out by the kidneys and finally excreted in the urine. Uric acid is a breakdown product of purine, a substance found in many foods.
The reference (normal) range for uric acid is 3.6mg/dL to 8.3mg/dL or 214 m.mol/L to 494 m.mol/L.
The levels can be elevated either by excess production or reduced excretion of uric acid.
When the level is elevated, the uric acid cannot remain in solution and so precipitates out of the blood and is deposited as uric acid crystals in and around the joints. These crystals are very irritating, causing inflammation. In the early stages, the gouty arthritis usually occurs in one joint, often the big toe. In time it can occur in many joints and can be quite crippling. The treatment is to reduce the uric acid levels by a combination of diet and medication. Foods that should be avoided because they are high in purine include organ meats, game meats, anchovies, herring, dried beans and dried peas.
Infectious or Septic Arthritis
Infectious arthritis is also called septic arthritis. It is an infection in the synovial fluid and tissues of the joint, generally caused by bacteria, but can also be caused by viruses or by fungi. The patient will generally have a fever as well as the joint symptoms of inflammation. The most commonly affected joints are the knee, shoulder, elbow, wrist and finger. In the majority of cases, just one joint is affected. Infectious arthritis must be diagnosed rapidly and treated promptly with the appropriate antibiotic.
The most common form is juvenile rheumatoid arthritis. This means arthritis that affects a person aged 16 years or less. Thus the patient is a child. There is generally intermittent fevers which tend to peak in the evening. Some degree of loss of appetite with weight loss is common. Various joints are affected.
Psoriatic arthritis can be a severe arthritis. About 5% of people with psoriasis develop arthritis. The typical features are continuous joint pains, stiffness and swelling. A small percentage of people with psoriatic arthritis develop a severe and destructive form of arthritis which destroys the small joints of the hands and can lead to permanent disability. The management of psoriasis is set out in my July 2010 newsletter Psoriasis - A Non-Drug Approach to Management.
Food Intolerance Arthritis
One of the many ways that food intolerance can express itself is arthritis. While the food or foods that are responsible for the arthritic reaction continue to be consumed, the inflammatory reaction in the joints will be ongoing. By identifying the food(s) responsible, and then excluding them from the diet, the arthritis can be cured.
The way to do so is described in detail in my book How to Stop Feeling so Awful (see homepage). In essence, there are three steps:
i) The suspect foods are identified. These are the foods that are consumed regularly. Any food that is eaten twice or more frequently each week is a ‘suspect food’, meaning it could be a food to which there is an intolerance, and so the cause of the arthritis.
ii) Each of these suspect foods is to be excluded from the diet for a period of 10 days. The purpose of this exclusion is to achieve three essential things before the third step can be carried out successfully.
a) There has to be none of that food, or its residue after digestion, left in the body. Transit time (the time from eating to excretion) can be up to 72 hours and even longer.
b) Withdrawal symptoms have to be finished. The way intolerance comes about is by an addiction process. This is described in detail in my book How to Stop Felling so Awful.
c) Unmasking has to take place. When a food is consumed regularly, it is not possible to look at a food diary and identify the offending food due to the masking. This means that on some days when the food is eaten there may be no symptoms and on other days, without other changes in diet etc, the symptoms are present. It takes up to 10 days for unmasking to happen.
iii) The food is then reintroduced. It is eaten as a test meal, consumed by itself. This is a challenge test meal. Over the next four hours the person is monitored for symptoms (of any kind, not just joint symptoms). If there is no reaction, the food is considered to be safe, and can continue to be eaten. If there is a reaction, it is an ‘unsafe food’, and there has been a food intolerance reaction. This food should then be excluded from the diet.
The above is a very brief overview of the way food intolerance can be identified. Full details of this fascinating subject are set out in the book, and a simple and practical way forward is in Chapter 15 Suspect, Exclude and Reintroduce.
Food intolerance causing arthritis is quite common, though rarely considered and looked for by the orthodox medical profession. Common foods causing arthritis include wheat (not necessarily the gluten component, but the wholegrain), members of the deadly nightshade family (potato, tomato, capsicum, egg plant), or any food eaten regularly.
Prevention of Arthritis
While the most common types of arthritis, namely osteoarthritis and rheumatoid arthritis, cannot be completely prevented, it is possible to reduce the risks by becoming physically active, participating in physical therapy, losing weight and eating healthily.
Food intolerance causing arthritis is being increasingly recognised and, by excluding the unsafe foods, it is possible to completely prevent the arthritic reaction.
All individuals who have pain in the joints should seek early diagnosis because the earlier the treatment is started, the better is the prognosis.
TREATMENT OF ARTHRITIS
Some of the treatment strategies have already been outlined above. The following are more generalised comments.
Earlier and accurate diagnosis can help prevent irreversible damage and disability. Properly guided programmes of exercise and rest, medications, lifestyle change, dietary supplements, physical therapy and surgery options can give the best long-term outcome for arthritic patients.
There are treatments available for various symptoms. Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage is slowed.
In general, studies have shown that physical exercise of the affected joint can have noticeable improvement in long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the whole person.
The Role of Medications in Treating Arthritis
Ideally, the initial drugs prescribed should have the fewest side effects. As the arthritis progresses, stronger medications may be needed.
The following are listed only. Details of the different brands, side effects etc can be obtained elsewhere, preferably from the prescribing physician, although “Pharmacy Advice” may be helpful.
· Non-steroidal anti-inflammatory drugs. These are usually the drugs of first choice. Many of these do not require a prescription. These drugs help decrease inflammation and reduce pain. While these drugs are effective, they are associated with a variety of side effects like abdominal pain, gastrointestinal bleeding, liver and kidney damage. These drugs should not be used for prolonged periods without proper physician supervision.
· Corticosteroids. These are potent drugs. They can help reduce inflammation and slow down joint damage. However they have potent side effects which range from ulcers, skin bruising, weight gain, cataracts, osteoporosis, diabetes and hypertension. They are usually given for a short time to help reduce acute symptoms.
· Disease-modifying antirheumatic drugs and immune suppressants. These can help slow down the progression of rheumatoid arthritis and joint damage. These are anticancer drugs. All of these have side effects which include liver damage and bone marrow suppression.
· Others include anti-malarial drugs, sulphasalazine, gout medications.
The Role of Physical and Occupational Therapy in Treating Arthritis
In arthritis, the joints become stiff and the range of movements is limited. Physical therapy can teach you how to relax the stiff joint and not damage the joint. Splints and braces can be made for the affected joints. There are also assistance devices that can help in driving, having a bath, dressing etc. Physical therapy also involves the use of ice and/or heating pads as well as ultrasound and guided massage therapy.
Occupational therapy can teach you how to reduce stress on the joint from daily living activities. It can also teach you how to modify your home and work environment so as to reduce movements that may worsen the arthritis.
The Role of Life Style Changes in Treating Arthritis
The treatment of arthritis begins at home, and all individuals with arthritis should make changes in lifestyle to adapt to the disease. As already indicated, exercise is highly recommended. The exercises should be gentle and help increase the range of motion and physical strength. Swimming is a good type of exercise for these purposes.
Relaxing is one of the best ways to cope with arthritis. Available techniques for relaxation include hypnotherapy, acupuncture or acupressure, yoga and Tai Chi. All these, once learned, can be carried out at home. More formal sessions of, for example, hypnotherapy, to assist in pain management can be beneficial.
The Role of Diet in Treating Arthritis
A good healthy diet is essential in the overall management of arthritis. Once foods to which there is an intolerance have been excluded, the diet should conform to the dietary guidelines as set out in my book How to Live to 100+ Years Free from Symptoms and Disease (see homepage). Weight loss to the ideal body mass index is also essential, and this can be achieved with the correct diet.
Although arthritis can make daily tasks more difficult and exhausting, there are many techniques and therapies, as set out above, which added together, can give a much better quality of life, compared to no therapy at all.
It is important that people with arthritis seek appropriate help and treatment. Although there is no cure for many of the types of arthritis, food intolerance arthritis being the exception, there is a lot that can be done to minimise the overall effects of the arthritis on everyday life.
*Copyright 2011: The Huntly Centre.
Disclaimer: All material in the huntlycentre.com.au website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.
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