PATIENT ENQUIRY

How to Treat Arthritis


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What Is?
What is Arthritis
How to Treat Arthritis
Natural Treatments for Arthritis

What is arthritis?

Arthritis is a chronic or recurrent inflammatory joint disorder caused by factors that trigger inflammation resulting in pain, swelling, joint effusion, restriction of movement, and culminating in cartilage destruction and joint deformity.

At least one hundred different forms of arthritis have been identified, the most common being osteoarthritis. Different types of arthritis have different symptoms, but in general a person with arthritis will feel pain and stiffness in the joints, muscles, or soft tissues surrounding the joints. As is the case with most medical conditions, early diagnosis and treatment is important. A person who seeks early medical advice for arthritis has a better chance of reduced joint damage, and will be able to control the symptoms of arthritis more successfully.

Common symptoms of arthritis:

  • Pain or tenderness in a joint
  • Joint stiffness, swelling, warmth, redness of the joint
  • Difficulty using or moving a joint normally

‘Rheumatism’ is a term people use to describe a number of problems affecting the joints, muscles or soft tissues of the body, rather than a specific disease. People often use ‘rheumatism’ to describe osteoarthritis, rheumatoid arthritis, bursitis, fibrositis, lumbago, sciatica or tendonitis.

Types of arthritis

Types of arthritis

More than 100 types of arthritis have been classified, but the two most common are osteoarthritis and rheumatoid arthritis. Gout, psoriatic arthritis, lupus, and septic arthritis are other arthritic conditions.

Osteoarthritis develops as part of the aging process and results from ‘wear and tear’ on joints. Obesity and injury, both acute and repetitive, contribute to early development of osteoarthritis, because joints are subjected to greater strain. Unlike rheumatoid arthritis and lupus, osteoarthritis does not affect other organs.

Cartilage is a tough, flexible tissue, without blood or nerve supply, composed mainly of water and collagen. The amount of water in cartilage decreases as a person ages, from 85% to approximately 70% in the elderly. Chondrocytes, the only cells found in cartilage, generate and preserve the cartilage matrix.

Bone joints contain a layer of articular cartilage at the end of each bone to cushion the joint and enable smooth sliding. Improper joint alignment, excess weight, overuse, or injury will cause articular cartilage to wear away.

In the initial stages, pain occurs in the joints during and after activity, but as the condition progresses pain may be experienced from minimal movement or during rest. A person with severe osteoarthritis can suffer complete loss of cartilage and the friction of bone rubbing on bone, which causes pain, stiffness, limited range of movement, and functional disability of the problem joint.

The symptoms of osteoarthritis vary from patient to patient and depend on which joints are affected. The amount of joint destruction on medical images doesn’t always directly correlate with the severity of symptoms. The most common symptom is pain in the joint after repetitive use, but can also involve swelling, creaking, redness, and warmth.

Osteoarthritis of the fingers can cuase bony enlargement of the joints, called nodes (Heberden’s and Bouchard’s nodes), which can limit the movement and strength of the hands. Osteoarthritis of the big toe my cause a bunion deformity and osteoarthritis of the knees can cause bowed legs.

Rheumatoid arthritis develops when the body’s immune system attacks bone joints, causing the synovial membrane that encloses the joint to become inflamed. Synovial fluid production then increases, which causes the capsule around the joint to swell. This causes further pain and leads to cartilage damage and erosion.

Rheumatoid arthritis most commonly affects the hand joints and can lead to deformities of the hands, and to a lesser extent the feet, shoulders and knees, and usually affects both sides of the body. The disease usually starts during 25 to 50 age bracket.

Juvenile idiopathic arthritis
(JIA) develops during childhood, from the age of six months to 16 years of age. Usually only a few joints are affected, commonly knees, ankles, wrists and fingers. JIA can also affect the skin, tendons, muscles, and eyes. In Australia, the likelihood of developing JIA is one in 1000. The immune system confuses normal bone joints with a foreign body and attacks the joints.

Gout is a joint disorder caused by increased uric acid levels in the blood. Gout presents as a recurrent, acute inflammatory arthritis that causes a red, hot, swollen, painful joint. The first metatarsophalangeal joint (base of big toe) is the joint most commonly affected. Gout can also present as deposits of urate crystals in the joints, kidney stones, or acute uric acid nephropathy.

Systemic Lupus Erythematosus (SLE) or lupus is an autoimmune disease of unknown cause, which can affect the skin, joints, kidneys, brain, and other organs. While lupus can occur at any age, in either sex, in any race, women are more likely to be affected than men, and 15% of people develop lupus after 55 years of age.

Most people with lupus suffer with joint pain and swelling, usually the fingers, hands, wrists, and knees. Approximately half have a facial rash across the cheeks called a ‘butterfly rash’.

Psoriatic arthritis is an arthritic inflammation that occurs in about 15% of patients who have a skin rash called psoriasis. Any joint in the body can be affected and symptoms vary from person to person. As with other forms of arthritis, persistent inflammation from psoriatic arthritis can lead to joint damage, but fortunately effective treatments are available for most people.

Septic arthritis means infection of a joint from a bacterial, viral, or fungal infection that has spread from another part of the body. Symptoms include intense joint pain, redness and swelling, chills and fever, and an inability to move the sore joint.

What causes arthritis?

What causes arthritis?

Common causes of acute monoarticular arthritis:

  • Crystal arthritis – gout, pseudogout, calcific periarthritis – wherein deposition of crystals within the joint trigger an acute inflammatory reaction
  • Traumatic haemarthrosis – caused by traumatic bleeding into the joint and particularly common in patients with haemophilia or anticoagulation therapy
  • Septic arthritis – uncommon in modern society, though still common in undeveloped countries and following joint trauma
  • Immunological reactions – autoimmune disease and immune reactions following viral and bacterial infections, particularly Ross River virus, Barmah Forest virus, Yersinia enterocolitis, salmonella infections and with inflammatory bowel disease.

Common causes of acute polyarticular arthritis:

    • Rheumatoid arthritis
    • Systemic lupus erythematosus
    • Psoriatic arthritis and associated spondylarthropathies
    • Reactive arthritis – Reiter’s disease, rheumatic fever
    • Acute palindromic arthritis – associated with severe infectious disease
    • Post-viral arthritis – rubella, polio virus, hepatitis B

 
Osteoarthritis of the digits (fingers and the toes) may have a genetic basis and is found in many female members of certain families, with a familial disposition for osteoarthritis.

What are the risk factors for arthritis?

Researchers have identified certain factors that increase a person’s likelihood of developing arthritis. These factors include:

  • Family history
  • Genetic factors
  • Gender – women account for 60% of cases
  • Environmental triggers – being overweight or repeat joint injury

Arthritis Australia provides an online tool to enable a person to measure his or her risk of developing osteoarthritis at www.myjointpain.org.au

Australian facts and statistics for arthritis

During 2004 to 2005 in Australia, 15% of the population reported having some form of arthritis. Arthritis is more prevalent among the socially disadvantaged (16%) compared with people who are financially comfortable (12%).
Symptoms of osteoarthritis may include joint pain and progressive stiffness that develops gradually.

Chronic pain, joint inflammation

Chronic pain, joint inflammation

A doctor will clinically examine the sore joint to assess for swelling, redness, and range of movement. Blood tests will show whether a person has antibodies called rheumatoid factors or anti-CCP antibodies in their blood. The presence of anti-CCP antibodies can predict which patients will develop more severe rheumatoid arthritis.

Medical imaging, such as X-ray, CT, or MRI will provide information about loss of cartilage and joint destruction. Ultrasound is also used to assess hand joints for rheumatoid arthritis recurrence. An aspiration of joint fluid can be used to rule out infectious and other types of arthritis.

How can arthritis be prevented?

How can arthritis be prevented?

Arthritis is a term used broadly for more than 100 conditions, disorders and diseases, so a simple ‘cure all’ isn’t possible. However, some important guiding principles will enable a person at risk for osteoarthritis to delay or prevent disability.

Improving your knowledge about the causes of pain for the type of arthritis that affects you will enable you to better manage your symptoms. Find out more about the arthritis medication your doctor has prescribed and find practical solutions to enable you to continue with everyday activities.

Keep physically active to reduce joint pain and stiffness and try to stay motivated. Maintaining an ideal weight means less stress on joints. If a person with arthritis is overweight, losing weight can significantly reduce symptoms.

Daily exercise helps to keep joints mobile, reduces weight, and improves general well being. Walking is easy to do and offers many benefits. Take time to properly warm up before exercise and gently stretch the leg muscles afterwards.

Because repetitive joint injury can worsen arthritis, adopt sensible strategies for gardening and housework to minimise joint trauma, for example when lifting something ‘bend with you knees, not your back’. When dusting, reaching overhead, cleaning walls and windows, and lifting object try to keep the arms close to the body to minimise strain. Try not to kneel on both knees at once. If you must then wear kneepads or place a towel under the knees to reduce the pressure on knee joints.

Conventional medical treatments doctors use to treat arthritis

While no cure for arthritis is available, a number of medical treatments can help to manage symptoms and slow disease progress. As with most medical disorders, the best chance for stopping or slowing joint cartilage damage is through early diagnosis, early treatment, and good management.

Three key characteristics of osteoarthritis:

  • Mild inflammation of the tissues in and around joints
  • Damage to cartilage, the smooth surface that lines the bones and enables joints to move without friction
  • Bony spurs that develop around the edges joints.

Treatment depends on which joint is affected and involves medication and exercise. Analgesics minimise joint pain, and non-steroidal anti-inflammatory medication and corticosteroids help reduce joint inflammation.

If a person is overweight or obese weight loss through a reduction in calorific intake will improve osteoarthritis symptoms.

In severe cases, if movement is very restricted and the joint misaligned, joint replacement surgery may be necessary.

New medical research into cartilage replacement could replace surgical joint replacement in the future. Osteochondral grafting, autologous chondrocyte implantation, and mesenchymal stem cell regeneration are three newly developed techniques that aim to restore articular cartilage.

Osteochrondral grafting involves harvesting a plug of bone and cartilage from a healthy joint and then transplanting the plug to the joint crippled by arthritis. This technique is currently used to treat knee injuries.

Autologous chondrocyte implantation can be used to improved arthritic knees or after knee injury. The treatment involves harvesting healthy cartilage cells that are cultivated and then implanted at the knee joint.

Mesenchymal stem cell regeneration is an experimental treatment that harvests bone marrow, which is implanted to create new cartilage to cover the joint affected by arthritis.

Medications prescribed to treat arthritis

Medications prescribed to treat arthritis

Over-the-counter and prescription medications can help a person manage osteoarthritis and other types of arthritis and control symptoms

Paracetamol is an analgesic and antipyretic drug that can provide simple pain relief by reducing the production of prostaglandins, which are responsible for the mediation of pain and fever. Tylenol is another type of paracetamol.

Non-steroidal anti-inflammatory drugs (NSAIDs) safely reduce inflammation without the use of steroid medication.

Some NSAIDs used to treat osteoarthritis and rheumatoid arthritis:

  • Celebrex
  • Feldene
  • Mobic
  • Naprosyn
  • Voltaren – for short-term use in acute pain

Kenacort-A is a corticosteroid that may be given as an injection into an arthritic joint as a short-term treatment for osteroarthritis, rheumatoid arthritis, or gout. Or Kenacort-A may be infected into the skin to treat discoid lupus and psoriasis.

Bethamethasone (Celestone) is another corticosteroid that may be injected into an joint to treat the inflammation, swelling, and pain of arthritis.

Types of arthritis

Types of arthritis

Self-help measures for a person with arthritis
A person with arthritis should aim to stay active and keep joints healthy to maintain daily activities and social connections, and live independently for as long as possible.

A doctor or physiotherapist can develop an appropriate exercise program to strengthen muscles, which will in turn take the strain off joints and prevent injury. The worst thing a person with arthritis can do is nothing.

When pain is too severe to participate in daily activities, such as walking, gardening, or golf consult a doctor about pain treatment options.

A few simple measures to alleviate arthritic pain:

  • Insert orthotics into shoes to correct gait and protect knees and hips by acting as shock absorbers when walking
  • Wear a knee brace, which can improve knee joint stability
  • Apply ice to the joint to reduce swelling, pain, and improve joint movement
  • Topical analgesics, in the form of cream or gel, can relieve painful joints, and
  • Over-the-counter or prescription medications can help relieve pain and stiffness.

Applying ice to a joint to reduce inflammation usually increases stiffness to the local tissues. So, apply heat early in the day to the muscles around the joints, then apply ice at the end of the day, after activity has caused symptoms to flare up, in order to minimise the resulting inflammation. Always wrap ice in a thin cloth before applying to skin to prevent ice from burning the skin. The object of an ice pack is to cool the muscle without damaging the skin.

Nutritional medicine treatment for arthritis

Arthritis is a general term for conditions that joint pain and inflammation as the principle symptom. Typical treatment involves pain-reducing medication and anti-inflammatory drugs. There is growing scientific rationale for the use of dietary supplements as adjuncts in the treatment of inflammatory discorders, such as arthritis.

In the past, many doctors believed that diet modification would not help symptoms and they told arthritis patients that dietary changes would not benefit them. However, this conclusion was based on older research with diets that included many of the products that researchers now believe contribute to inflammation, such as dairy products, alcohol, poultry, or meat.

While there is no definitive arthritis diet, increasing anti-inflammatory foods and limiting foods that may trigger joint pain will reduce symptoms and improve well being. At least for some people, a healthier diet is the answer to less pain and stiffness.

The generation of free radicals within the body is an important factor in the development and on-going condition of arthritis. Oxidation occurs when oxygen reacts with certain molecules to form free radicals, which are highly chemically reactive towards other substances.

While many free radicals are necessary for human health, such are killing bacteria, some free radicals participate in unwanted side reactions that can damage important cellular components, and cause cell injury and death. Excessive free radicals are thought to play a role in cancer, stoke, heart attack, diabetes, and inflammatory disorders such as arthritis.

To counter the effects of free radicals, dietary antioxidants play a key role in minimising cell damage and repairing damaged cells. Vitamins A, C, and E, glutathione, selenium, bioflavonoids (quercetin and anthocyanidins), tocopherols, and polyphenols are all antioxidants. Insufficient levels of antioxidants can lead to oxidative stress, when cells are damaged and can’t function adequately, and eventually chronic inflammation.

Quescetin is found in onions, kale, leeks, cherry tomatoes, broccoli, blueberries, black currants, elderberries, cocoa powder, apricots and apples. While anthocyanidins are found in blackberries, black currants, blueberries, eggplant, elderberries, raspberries, cherries, boysenberries, grapes, strawberries and plums.

Glutathione is the primary antioxidant produced within the body, and keeps the dietary antioxidants (vitamins A, C, and E) in their active forms.

The Omega-3 fatty acids (ALA, DHA, EPA) are polyunsaturated fatty acids that are essential to normal growth and play an important role in reducing inflammation. The body can’t produce this substance, so we can only derive omega-3 fatty acids from what we eat and drink. However, mammals can use ALA to derive EPA, and to a lesser extent DHA.

Omega-3 and omega-6 fatty acids compete for the same metabolic enzymes. This means that while eating omega-3-rich foods reduces inflammation, eating too much omega-6 can negate the benefits. The metabolites of omega-6 are more inflammatory than those from omega-3. Elevated omega-6 intake is associated with an increase in all inflammatory diseases. Decreasing the omega-6/omega-3 ratio protects against chronic, degenerative disesases.

A typical Western diet provides an omega-6/omega-3 ratio of 10:1 to 25:1. Most nutritional experts agree that the omega-6/omega-3 ratio should range from 1:1 to 5:1. (Mel to check). As a general rule avoid highly processed, highly refined, and highly oxidised oils used in processed foods, such as corn oil, canola oil, soy oil, hydrogenated fats, margarine, and shortening.

Ratios for various vegetable oils are:
Flaxseed oil 1:3 – an important source of omega-3
Cold pressed, extra virgin olive oil 3:1
Canola oil 4:1
Soybean 7:1
Corn oil 46:1

Peanut, grape seed, safflower, sesame, coconut, and sunflower oils contain no omega-3 fatty acids.

Omega-3 fatty acid is found in:
Seafood – salmon, herring, mackerel, sturgeon, green lipped mussels, halibut, flounker, hoki, oysters
Nuts and seeds – sunflower seeds, walnuts, flaxseed, pecan nuts, hazel nuts, chia seeds, sesame seeds, pumpkin seeds, almonds
Vegetables – spinach, broccoli, alfalfa sprouts, rocket, capers, pumpkin, cauliflower kale, parsley, watercress
Fruits – kiwi fruit, walnuts, avocado, grape leaves, strawberry
Herbs – basil, oregano, tarragon, mint, spinach, mint
Oils – extra virgin olive oil, flaxseed oil, avocado oil,

Pro-inflammatory effects of omegy-6 fatty acids. Modifying the ratio of omega-3 to omega-6 fatty acids to include more of the former and less of the latter may reduce pain and stiffness.

A toxin called advanced glycation end product AGE can damage proteins and incite the release of inflammatory messengers called cytokines, which speed up oxidative damage to cells and can lead to inflammatory conditions such as arthritis and other degenerative diseases.

AGEs are abundant in Western diets, because these days so much of the food we eat is reheated, pasteurised, dried, smoked, fried, or grilled. AGEs form during glycation, the chemical reaction when a carbohydrate binds to a protein without the help of an enzyme. Glycation makes cells less pliable and more prone damage and premature aging. Glycation takes place within the body after the ingestion of sugar-rich foods and during food preparation, when foods are processed, heated, and fried. Researchers believe that the daily AGE intake for many people eating a typical Western diet is at least three times higher than what the body can handle.

Not all sugars cause cell-damaging glycation. Glucose is the main sugar humans metabolise for energy. The two sugars that have a high likelihood of forming AGEs are fructose and galactose.

Fructose is a fruit sugar derived from sugar cane, sugar beet, and maize. Food manufacturers add fructose to foods and drinks to sweeten and enhance the flavour and to improve browning in baked goods. Lactose is found in milk and milk products and galactose forms when the body breaks down lactose into glucose and galactose. Dairy products, sugar beets, and gums also contain galactose.

Therefore, the amount of oxidative and perioxidative stress experienced by a person in good health is proportional to the amount of sugar-rich and processed foods he or she eats. To reduce exposure to AGEs, reduce your intake of sugar-rich foods and poach, stew, bake, steam, or bake at a low temperature instead of frying, boiling, grilling, or baking at a high temperature.

Because dairy products contain lactose and galactose, foods such as milk, cheese, and yoghurt may contribute to arthritis pain. For some people lactose can irritate the tissues around joints.

A gluten-free vegan diet, which contains no animal products or gluten at all, has reduced the level of pain and joint stiffness in some sufferers of arthritis. A raw, vegan diet is rich in antioxidants and fibre, high in omega-3 fatty acids and contains no saturated fat (omega-6 fatty acid). When people switch to a vegan diet they often lose weight as a result, which reduces the stress on damaged joints.

Foods to avoid with arthritis

Foods to avoid with arthritis

Foods known to contribute to arthritis pain:

  • Fruits – citrus fruits, bananas, peaches, tomatoes
  • Vegetables – potato
  • Dairy products – milk, cheese, yoghurt

  • Corn

  • Meats – beef, pork, chicken, turkey, fish
  • Wheat, oats, rye
  • Nuts
  • Coffee

Foods known to never contribute to arthritis pain:

  • Brown rice
  • Fruits – cherries, cranberries, pears, prunes (choose sulphite-free dried fruits)
  • Cooked green, yellow, and orange vegetables – artichokes, asparagus, broccoli, chard, collards, lettuce, spinach, string beans, summer or winter squash, sweet potatoes, tapioca, and taro
  • Modest amounts of salt, maple syrup, and vanilla extract are usually well tolerated.

Gout diet – what’s allowed and what’s not
Gout is a painful form of arthritis that has long been associated with food intake, particularly the overindulgence in meat, seafood, and alcohol. Gout develops because of too much uric acid, which is a byproduct of purine metabolism. Purines meats, anchovies, herring, asparagus, certain alcohol, and mushrooms.

Diet recommendations for the treatment of gout resemble a healthy-eating plan, which also controls the production and elimination of uric acid.

Animal proteins are high in purine so limit the amount of red meat, organ meats, organ meats, herring, anchovies, and mackerel. Because all meat, poultry, and fish contain purines limit your intake to 113 to 170 grams each day.

Saturated fat lowers uric acid elimination. Reduce the amount of saturated fats you eat by choosing plant-based protein, such as beans and legumes, and low-fat or fat-free dairy products. Obesity is linked to gout, so lowering weight to an ideal BMI will reduce a person’s risk of getting gout.

Alcohol restricts uric acid elimination, especially beer. During a gout flare up, a person should avoid all alcohol.

Fructose increases the amount of uric acid, so avoid products sweetened with high-fructose corn syrup, such as soft drinks or juice drinks.

Drink plenty of water, to ensure the body eliminates uric acid successfully.

Celery seed is mildly diuretic and helps the kidneys eliminate waste products, such as uric acid.

Devil’s claw, an analgesic and anti-inflammatory, helps relieve gout symptoms of pain, inflammation, joint tightness, and reinstate joint flexibility.

A 500mg dose of vitamin C every day for at least two months has been shown for reduce the risk of gout recurring.

Cutting back on fried and processed foods, while increasing the amount of fruit and vegetables in the diet, will reduce inflammation and help restorea person’s immune system, regardless of age of health status.

Glossary

Advanced glycation end product – pro-inflammatory toxin found in heated, grilled, fried or pasteurised foods.
anthocyanidins ?
Bowel dysbiosis – an imbalance in the intestinal microbiome
Candidiasis – fungal infection from the yeast genus Candida. Candida albicans is the most common agent of candidiasis in humans.
Endothelial vasculitis – inflammation of the endothelial layer of blood vessels
DHEA – didehydroepiandrosterone is an important endogenous steroid hormone
Hypochlorhydria – when the stomach gastric juices are low or absent
Granulomata – pleural of granuloma, a collection of macrophages formed when the body walls-off a foreign substance
Histo compatibility complex – set of cell surface molecules encoded by a large gene family in all vertebrates
Myositis – muscle inflammation
Periarticular – around the joint
Phytonutrients – chemical compounds that occur naturally in plants
Polyarthritis – any type of arthritis that affects five joint or more
Quercetin – a flavonoid (plant pigment) found in fruits, vegetables, leaves, and grains
Superoxide dismutases (SOD) – important antioxidant defence in nearly all cells exposed to oxygen
Tendonitis – inflammation of a tendon
Tenosynovitis – inflammation of the fluid-filled sheath that surrounds a tendon