All About Arthritis

ARTHRITIS

The human body is a marvel of engineering. Its dexterity, strength, and stamina allow amazing feats of athleticism and, yes, survival in the worst adversity; but wear and tear takes its toll over time on just about everything with moving parts (even you). The resulting loss of work efficiency and mobility, bad enough in normal times, can decrease your chances to succeed after a major disaster.

The moving parts in our skeletal frame are known as joints. Each one has varying amounts of range of motion and strength. They are remarkably durable, but break down with time and strain. The longer lives of modern humans has, thus, caused a high prevalence of joint disease called “arthritis”.

It’s thought that 54 million Americans today suffer from some form of arthritis, and that the number will rise to 78 million by the year 2040.  Although you might consider arthritis a disease of the elderly, two-thirds of the cases occur in pre-retirement age individuals.

Risk factors for arthritis include:

Age: Many types of arthritis are more common as people get older

Sex: Women are more likely to get certain types, such as rheumatoid arthritis, while men are more prone to a form of arthritis known as “gout”.

Family history: Some types of arthritis seem to run in families.

Injuries: Increased strain can injure joints, which can eventually lead to arthritis. This is seen in athletes, but can occur from manual labor, after surgery, or an accident.

Obesity: Those who lead sedentary lifestyles and are obese suffer long-standing strain on the joints in the hips, knees, and back, which can lead to arthritis.

Symptoms of Arthritis

Symptoms of arthritis may include:

• Pain
• Swelling
• Joint stiffness and decreased range of motion
• Reluctance to use the affected joint due to discomfort
• Accumulation of fluid or other material (like uric acid in gout) in the joint space
• Muscle weakness (with chronic arthritis)
• Fever (if caused by an infection)

Types of Arthritis

Osteoarthritis

Osteoarthritis is the most common form of arthritis, especially in older individuals.  It can affect just about any joint in the body.  Hands, feet, back, hip, and knees are most commonly affected, but osteoarthritis can occur even in the spinal column.

Osteoarthritis is acquired by daily wear and tear on the joints, although it can also be a long term effect of a previous injury which accelerates degeneration. Obesity can increase stress on joints and lead to osteoarthritis, as well.

Warm compresses are useful to treat discomfort and stiffness.  Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin are helpful, as is Capsaicin cream or ointment.

The worst cases may require oral or injectable steroids.  Sometimes, a needle is placed to drain excess fluid from an affected joint to give relief. This is call “arthrocentesis”. This procedure may decrease pain, but could introduce infection into the joint if not performed with care.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is the most common auto-immune disease in the world today. In RA. the body’s immune system attacks its own tissues. The attack is not only directed at the joint but to other parts of the body.  Unlike some other joint diseases, rheumatoid arthritis tends to affect the same joint on both sides of the body. Women seem to be more susceptible than men.

Rheumatoid arthritis especially affects joints in the fingers and wrists, but is also common in knees and elbows. Over time, it can lead to severe deformities if not treated. Rheumatoid arthritis occurs in younger populations than osteoarthritis, even striking children on occasion.

Other symptoms associated with rheumatoid arthritis that you might not see with degenerative osteoarthritis:

• Dry mouth
• Dryness, Itching or burning in the eyes
• Insomnia
• Strange sensations in the hands or feet
• Nodules under the skin
• Chest pain when taking a breath

At present, there is no cure for rheumatoid arthritis. Treatments concentrate on easing the symptoms. Medical therapy includes strong anti-inflammatory medications such as oral steroids (example: Prednisone).

Another auto-immune disorder that can cause joint disease is known as Systemic Lupus Erythematosus (SLE). Although usually diagnosed by blood testing, Lupus can be differentiated from rheumatoid arthritis due to its one-sided nature. You will also see patients with SLE experience hair loss and body rashes. Lupus is often treated with long-term oral steroids.

Even though rheumatoid arthritis cannot be cured, it is thought to be possible to prevent the condition from worsening. Weight loss is one way to improve symptoms and prevent progression. Physical therapy to strengthen muscles and joints is also thought to be helpful.

Bacterial Arthritis

Bacterial arthritis (sometimes called “septic” arthritis) is often the result of some penetrating injury that allows organisms to invade the joint space. It can also occur from within, as when a blood infection (septicemia) or bone infection (osteomyelitis) has spread to a joint.

Common skin bacteria, such as Streptococcus and Staphylococcus, are the usual suspects; certain sexually transmitted diseases, like gonorrhea can also be the cause, although viruses and even fungi may be involved.

Typical symptoms of a bacterial arthritis are the same as osteoarthritis, except that the patient may have a fever and may exhibit redness or warmth over the affected joint. In addition to treatment for pain, arthrocentesis (removal of fluid with a needle) and intravenous antibiotics in the Keflex family (cephalosporins) or others may be helpful if the cause is bacterial.

Psoriatic Arthritis

Psoriasis is a relatively common skin condition that causes the formation of multiple red, scaly patches. This leads to itching and may be considered by some unsightly, but 30 per cent of sufferers also develop inflammation of the joints known as “psoriatic arthritis”.

Psoriatic arthritis victims may be differentiated from degenerative arthritis by nail changes that look like fungal infections, redness in the eyes, excessive fatigue, and swollen fingers and toes (the areas most commonly affected). The condition is most commonly treated with NSAIDs like ibuprofen for pain, steroids, and anti-psoriasis pharmaceuticals. Early treatment may lead to less severe damage to joints.

Gout

Gout is another condition that destroys joints over time. Inflammation is caused by deposition of uric acid crystals in the joint.  Some people simply produce too much uric acid or don’t eliminate it well.  Obesity is a major risk factor, as is diabetes. This illness occurs primarily in men; a history of certain types of kidney stones may be associated with episodes of gout.

The presentation of gout will appear as:

• Inflammation in one or two joints. The big toe is the classic example, but knees and ankles may also be affected.
• Warm, red, painful joints. The pain is throbbing and often severe. Even laying a sheet over it may cause pain.
• Fever.
• Episodic repeat attacks (50% of cases).

After multiple episodes, permanent damage occurs and the joint loses its range of motion. Chronic sufferers may also develop lumps composed of uric acid crystals called “tophi”.  Tophi are lumps below the skin, mostly around joints like the big toe. They may drain chalky material from time to time.

Specialized prescription drugs are available for gout, such as Colchicine and Allopurinol.  If you have a family member with gout, encourage them to stockpile extra medications; they won’t be found in your standard medic’s storage.

Lifestyle and dietary changes may be helpful in improving the quality of life of individuals with gouty arthritis. Consider:

• Avoiding alcohol
• Reducing how many uric acid elevating foods you eat. These include: Liver, red meat, herring, sardines, anchovies, kidney, beans, peas, mushrooms, asparagus, and cauliflower. .
• Avoiding fatty foods
• Eat enough carbohydrates

Natural Options For Arthritis

From an alternative standpoint, there are various treatments for joint pain caused by arthritis.  Glucosamine supplements are popular. It should be noted that glucosamine sulfate preparations have more evidence for their effectiveness than glucosamine hydrochloride. Take 1,500 milligrams once a day on a regular basis.

Glucosamine, when paired with chondroitin sulfate 800-1,200 milligrams a day, has been shown to possibly slow progression of some arthritic conditions.

Two teaspoons of lemon juice or apple cider vinegar mixed with a teaspoon of honey twice a day is a time-honored treatment.  Other oral supplements reported to be effective against joint pain are:

• Turmeric powder
• Soybean Oil
• Avocado Oil
• Rose hips
• Fish Oil (no more than 3 grams per day)
• Selenium
• Bathua leaf juice
• Alfalfa tea

For external use, warm and cold compresses are useful. Warmth increases blood flow to the joint, while cold decreases inflammation and swelling. Other options include:

• Capsaicin ointment or cream
• Use Arnica essential oil on affected areas (good for muscle aches as well)
• Apply warm vinegar to aching joints.
• Mix powdered sandalwood into a paste; it has a cooling effect when rubbed on a joint.

A number of other modalities may alleviate the pain of arthritis and improve range of motion. Acupuncture, massage therapy, and physical therapy may alleviate muscle spasms. Electricity delivered by a device known as a TENS (Transcutaneous Electrical Nerve Stimulation) unit may be helpful. Other suggest magnets applied to injured joint. These are just a few of the many alternative remedies available. Do your own research and make your own conclusions.

Joe Alton MD

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