What is it?
Arthritis literally means joint (arth) inflammation (itis).
It may be due to normal wear and tear or excessive wear after injury (osteoarthritis) or due to inflammation attacking one or more joints, as in gout and rheumatoid disease.
What it is not:
While fibromyalgia and chronic fatigue symptoms include joint pain, these are not diseases of bone but of muscles.
Bursitis is inflammation of the fluid sac that surrounds the joint.
Who gets it?
Osteoarthritis affects 90% people over age 60 across the world. Inflammatory arthritis in its various forms is less common, but affects up to 1% of the population at any age.
What are the Causes?
Osteoarthritis, often known as ‘wear and tear’ arthritis, is frequently due to simple aging, but excess weight is a major problem as it places extra wear on the back and lower limbs, and also makes rehabilitation more difficult. Previous injury predisposes the joint to both osteoarthritis and gout.
Inflammatory arthritis such as Rheumatoid and Lupus have a genetic predisposition, but often the cause is unknown. Some forms are associated with other disorders such as Psoriasis and Inflammatory bowel disease.
Gout is caused by deposition of uric acid crystals in joints due to high levels of the acid in the blood stream. This is largely from the breakdown of certain foods containing high levels of purine, so can be helped to a certain extent by avoiding these foods. Pseudogout is due to a build-up of calcium in the joints.
What is the usual Treatment ?
Drugs that reduce inflammation and pain, the commonest of which are called non-steroidal anti inflammatories (NSAIDs), are the mainstay of treatment, however some people cannot take these drugs due to side effects or allergy, so paracetamol, with or without additional codeine, is used.
In severe cases cortisone is used, both as tablets and by injection into a badly affected joint.
For inflammatory arthritis, disease modifying drugs such as Methotrexate , Salazopyrin and Novaquine are used early in the disease, to prevent damage. New drugs are continually being developed for these forms of arthritis.
Physiotherapy is an important treatment in all forms of arthritis, as it can help with pain relief, mobility and prevention of further damage by correcting poor posture, strengthening supporting muscles and mobilizing stiff joints.
As sleep is essential for well being, a low dose of antidepressant, far less than is used in treatment of depression, is often used to help sleep; this also raises the pain threshold, i.e. the level of pain which a person can manage.
What Other treatments are available?
In addition to pharmaceutical treatments, patients can help themselves by watching their weight, exercising regularly and becoming informed about their disease. Swimming and cycling are excellent ways of exercising without stressing the joints, and can also be relaxing. Yoga, thai chi and pilates are all helpful for both mobility and relaxation, -or simply walk the dog!
Chronic pain often leads to both depression and muscle tension, and it is important to recognize your limitations and reduce unnecessary stress. Addressing these can improve the quality of life for people suffering chronic pain, as well as improving mobility. Aroma therapy and massage are usually helpful in relaxing tense muscles and mind, which can make a huge difference to pain tolerance.
Sleep is important for wellbeing as well as for joint repair, and attention must be given to a comfortable mattress, pillows, and support of inflamed joints. A pillow between the knees at night helps support a sore hip or knee joint.
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Good posture is essential, and chronic pain can result in a tendency to stoop. The Alexander technique teaches good posture that allows you to use your body correctly. Teachers are available throughout the country.
Body Stress Release can help release muscle tension secondary to local pain, and again, practitioners are to be found in all major centres.
Acupuncture may be very effective for pain relief in many forms of arthritis.
Attention to diet as regards weight control is very important, but in some cases diet may have a more important effect, as in gout, where high purine containing foods* should be avoided.
Occasionally arthritis, and especially joint pain without evidence of damage, may be made worse by food allergy, especially to tomatoes, potatoes, peppers and eggplant. To find out, exclude these items for 2 weeks, then if the pain is relieved, reintroduce them 1 at a time, 1 week apart to see whether symptoms return.
Avoid hydrogenated fats, as in margarine etc, as they tend to increase inflammation. Stick to butter!
Omega 3 oils have a natural anti-inflammatory effect, and should be taken as 1000mg /day. It is wise to include oily fish in your diet at least twice a week.
Evening primrose oil is rich in gamma linoleic acid (GLA) and is also anti-inflammatory. Take approx 240mg daily.
*Avoid tea, sugar, coffee in excess.
Avoid refined carbohydrates such as white flour, sugars, white rice, etc which tend to be inflammatory to the body, so try to think brown and wholemeal instead of white.
It is wise to avoid Gluten-containing foods if you have inflammatory arthritis, as gluten can encourage inflammation. Gluten is found in wheat, barley, rye and oats, but is present in many processed foods from sauces and soups to chocolate. The best way to avoid it is to eat unprocessed foods, and read food labels.
A good multivitamin should be used to provide an antioxidant combination with Vitamins A, C, E and Selenium, Vit B5 (pantothenic acid )500mg daily, B vitamins and additional VitaminC 2000mg / day, or as much as is tolerated.
Eat plenty of onions, broccoli, citrus all of which are rich in Quercetin, a natural anti-inflammatory.
Vitamin D, calcium, magnesium, and boron all contribute to bone health.
Turmeric and Devils Claw are both naturally anti-inflammatory. Devils claw should not be used during pregnancy.
Cherries have been shown to relieve gout. Nettle and coriander are also helpful.
Glucosamine helps counter the joint damage done by anti-inflammatory drugs. Preparations containing MSM, a naturally occurring substance with a strong anti-inflammatory effect, are ideal and MSM is also available on its own.
Boswellia is useful especially in cream form over small joints.
Non-steroidal anti-inflammatories such as diclofenac are produced in ointment form which is also useful for small joints, and a rubbing ointment made from Grandpa’s powder (or soluble aspirin) and aqueous cream is a safe and cheap alternative.
DMSO used topically is anti-inflammatory and aids absorption of other locally applied medications.
Homeopathic treatments such as Rhus tox may help.
Tissue salts calc fluor, ferr phos, nat phos and nat sulph may help. There is also an ‘arthritis combin’.
Micro Current therapy is a fairly new pain reliving aid. Appliances are available which are worn over the affected area and reduce pain while worn, and for some time afterwards. They are also shown to have a healing affect on local tissues.
Copper bracelets are an age old remedy for arthritis, and copper is indeed anti-inflammatory.
Naltrexone (generic name) is a pharmacologically active opioid antagonist, conventionally used to treat drug- and alcohol addiction – normally at doses of 50mg to 300mg. Researchers have found that at very low dosages (3 to 4.5 mg), naltrexone has properties that may be able to successfully treat a wide range of diseases, including rheumatoid arthritis, multiple sclerosis (MS), Parkinson’s, fibromyalgia, and Crohn’s disease, just to name a few. Dr Kamffer can order it if you wish to try.
Knee pain in young teens may be due to Osgood Schlatter’s disease; this may be helped by 250 micrograms of selenium and 400 IU of vitamin E as mixed tocopherols.
What not to do.
Do not try out every special diet or cream that is a ‘miracle cure’. If such claims were to be true, then it would truly be a miracle, and this article would be pointless!
Long term complications
The long term problems of osteoarthritis involve increasing pain and disability. Modern techniques in joint replacement and pain control have improved the outlook for many sufferers.
Inflammatory arthritis also involves joint destruction, and the above applies to this as well. Various drugs are being developed to prevent the destruction instead of having to replace the damaged joint, which is why strong medications are given early on.
WHEN TO WORRY
If a joint suddenly becomes more painful, swollen or inflamed, especially if there is systemic illness i.e. a general feeling of unwellness or fever, medical help should be sought.