By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
What is Arthritis? The literal meaning of the word “arthritis” is joint inflammation. However, the term is used to refer to a group of over 100 diseases that can cause joint pain, stiffness, and/or swelling in the joints, and sometimes the ligaments, tendons, muscles, or bones. Over 40 million Americans are affected by some type of arthritis. Two of the most common forms of the disease are osteoarthritis and rheumatoid arthritis. Both of these diseases cause chronic pain that can last weeks, months, years, or a lifetime.
By far, the most common form of arthritis is osteoarthritis, which is sometimes called degenerative joint disease or degenerative arthritis. This condition afflicts approximately 33 million Americans. Although it most common among people over 65 years of age, arthritis can strike people of all ages (there is such a thing as juvenile arthritis). Rheumatoid arthritis, a chronic inflammatory disease troubling approximately 1.3 million Americans, is actually more disabling; in fact it is the most disabling type of arthritis (we will discuss rheumatoid arthritis later on in this article).
Osteoarthritis occurs when cartilage, which cushions the ends of bones, breaks down at the joint, the place where bones meet. The cartilage wears away, exposing the bones and allowing them to rub together. Sometimes the shape and makeup of the joint is affected in such a way that it no longer functions smoothly. When this happens, people often have trouble with movements that put additional stress on the joint, like walking or climbing stairs, and they may begin to limp.
Several additional problems can develop within joint components. For instance, osteophytes, also called spurs, can develop on the ends of bones and damage the surrounding tissues, causing pain to occur. The fluid inside the joint may also be affected; if the fluid doesn’t have enough of a substance called hyaluronan, the joint’s ability to absorb shock may be compromised. Also, fragments of bone or cartilage may float in joint fluid, leading to pain and irritation.
Common symptoms of osteoarthritis include pain and stiffness, especially first thing in the morning or after resting. Symptoms may vary based on the particular joints affected and the severity of the arthritis. Osteoarthritis which most often compromises the knees, feet, hips, and lower back, for example, creates difficulties walking and/or lifting objects. The neck is another commonly affected joint. Osteoarthritis in the finger and hand joints, including the base of the thumb, may cause the person to experience difficulty grasping or holding objects, such as a pen, and/or doing delicate tasks.
There is no one specific cause of osteoarthritis. Several factors – including genes, lifestyle, weight, injury, or overuse- may contribute to the development of osteoarthritis.
People can inherit a tendency towards osteoarthritis in several ways. One possibility is the genetic inheritance of traits that can lead to slight defects in the way the joints and bones fit together, so that cartilage wears away at a faster rate than normal. Double-jointedness (joint laxity), which allows joints to bend farther than they usually would, is another genetic predisposition. Keep in mind, though, that simply inheriting a gene that increases your risk for developing osteoarthritis does not necessarily sentence you to a life with this disease. Your eating, exercising, and sleeping habits, as well as whether or not you smoke, significantly impact your chances of becoming osteoarthritic.
Accordingly, being overweight or obese can elevate your risk for osteoarthritis, and it can also worsen arthritic symptoms. When you are overweight, you put extra pressure on the joints that bear the majority of your weight: the hips and knees. According to the Johns Hopkins Arthritic Center, even ten extra pounds can severely strain the joints. When you carry these extra pounds for many years, the cartilage that cushions your joints tend to break down.
Besides weight, another common cause of osteoarthritis is joint injury (such as a fracture) or overuse/repetitive movements. Athletes, for example, who repeatedly damage certain joints, ligaments, or tendons, may face increases in the rate at which their cartilage breaks down. Likewise, people engaged in professions requiring repetitive movements, such as landscapers who must constantly bend their knees, may experience overly-worn cartilage as a result.
Other factors that contribute to osteoarthritis include metabolic disorders such as hemochromatosis- where the body absorbs too much iron, or acromegaly- where the body produces too much growth hormone. Other bone and joint disorders, such as rheumatoid arthritis, impact osteoarthritic risk. Endocrine issues, such as hormonal changes caused by diabetes, hypothyroidism or obesity also can increase risk of osteoarthritis.
Rheumatoid arthritis is an autoimmune disease characterized by chronic inflammation of the joints. Such disorder occurs when the immune system mistakenly attacks the synovium, the thin membrane lining the joints. Resulting symptoms may include pain, inflammation, joint damage, loss of function, or disability. Although rheumatoid arthritis is a chronic condition, the symptoms can actually come and go, with periods of low disease activity followed by flare-up spells. Sometimes treatment can actually lead to the disease becoming inactive, with all symptoms disappearing completely.
Rheumatoid arthritis most often affects the feet, ankles, knees, hands, wrists, or elbows, and if one joint is affected, the same joint on the opposite side of the body is usually affected as well. As an inflammatory disease, rheumatoid arthritis can also affect the cardiovascular system, as well the skin.
Conservative non-surgical treatment which decreases pain and improves joint function is preferred over surgery to treat osteoarthritis. Non-surgical methods to treat may include patient education, nutritional supplementation, an exercise or physical therapy regime, pain medications, bracing, weight loss, acupuncture, massage, and chiropractic work, among other non-invasive modalities. However, if arthritis pain is unmanageable despite all non-surgical treatments, surgery may be the appropriate protocol.
Total joint replacement surgery (arthroplasty) is the most invasive surgical option for severe joint pain. Total hip replacement surgery (THR) is the treatment physicians commonly suggest for patients with severe pain in their hips, akin to total knee replacement surgery (TKR) for severely arthritic knees. At this point in time, totally replaced joints tend to last less than a few decades because of prosthetic joints tend to loosen or wear out. However, as technology evolves, the need for second or third surgeries may be avoided. Possible alternatives to, or means of delaying, total joint replacement surgeries include resurfacing, osteotomy, and arthroscopy. Most candidates for these procedures do not suffer from advanced osteoarthritis that has resulted in significant bone loss.
While osteotomy entails reshaping bones to improve alignment and relieve injured parts of joints, arthroscopy involves inserting a tiny telescope into the joint space to facilitate operation on damaged cartilage or ligaments with miniature instruments. Both procedures can help restore function and reduce pain in milder cases of osteoarthritis. Hip resurfacing is an emerging procedural alternative for patients young enough to potentially need hip replacement surgery more than once on the same hip. Less invasive than THR, resurfacing can replace the need for the first hip replacement, although long term success of this relatively recent procedure has not yet been proven.
During hip resurfacing, a surgeon will shave and reshape the top of the femur, then attach a cap over it with a metal ball that fits into the replacement socket. This procedure spares removal and replacement of the entire top of the femur, including the ball at the top that fits into the socket in your pelvis to form the hip joint, which is the case with THR. Resurfacing is like shaving down a tooth and placing a crown on it, rather than removing it and replacing it with a prosthetic tooth.
Another cutting edge procedure involves using the patient’s own stem cells and blood growth factors to grow new bone, cartilage, and muscle tissues. While this procedure is still too new to assess long-term success, patients have reported short-term results such as reduced pain and increased function of affected joint.
If you are overweight and suffering with arthritic joint pain, losing weight can significantly ameliorate your condition, especially with regard to hip and knee problems. A strong nutritional approach is also key. In fact, you can potentially delay the need for surgery by taking certain important nutritional supplements daily such as white willow bark up to 500 mg, glucosamine up to 2500 mg, chondroitin sulfate up to 2000 mg, methylsulfonylmethane (MSM) up to 4 grams, cat’s claw up to 200 mg and boswellian up to 1000 mg. Also helpful is are 2 potent NF-Kappa B inhibitors (strong markers of inflammation) such as curcumin up to 1000 mg daily and red kelp seaweed (Seanol) up to 2 grams daily.
Ingesting Omega-3 essential fatty acids may be one of the best ways of preserving your cartilage. Omega-3’s have been found to help stop or slow down inflammation, which can cause cartilage cells to break down. Omega-3s can be helpful in both rheumatoid arthritis and osteoarthritis cases by helping to relieve pain and stiffness. Found in fish, especially salmon, omega-3’s can also be obtained via fish oil supplements. To be effective against inflammation, up to 2-3 grams of fish oil per day may be necessary.
In summary, the following daily doses of nutritional supplements can be helpful in treating your arthritis:
- White willow bark 500 mg
- Glucosamine up to 2,500 mg
- Chondroitin up to 2,000 mg
- Methylsulfonylmethane (MSM) up to 4 grams
- Cat’s claw up to 200 mg
- Boswellian up to 1000 mg
- Curcumin up to 1000 mg
- Red kelp seaweed (Seanol) up to 2 grams
- Fish oil up to 2-3 grams (especially important!)
Treatment of Rheumatoid arthritis, an inflammatory condition, revolves around reducing inflammation through lifestyle changes, supplementation, and possibly medication. Patients and doctors should ultimately work together to choose the best treatment option(s) for individual patients.
Regular exercise, such as swimming which doesn’t put too much weight on joints, can strengthen muscles surrounding the joints as well as help fight fatigue. Adopting an anti-inflammatory diet rich with fruits, vegetables, and healthy proteins and fats, supplementing appropriately, and reducing emotional stress are also key to an anti-inflammatory lifestyle. Applying heat or cold, via hot water bottles and baths, or ice packs, respectively may lessen inflammation as well.
Over-the-counter and/or prescription medications which reduce inflammation, pain, and/or joint damage or drugs which target the autoimmune component of the disease may be of use depending on the severity of the disease. Surgeries such as total joint replacement, replacement of the joint lining, or tendon repair are last resort options for damaged joints.
Remember that a healthy lifestyle is an important defense against arthritis, whether you undergo surgery or not. Be sure to explore lifestyle changes such as diet, exercise, and supplementation as treatment options with your doctor, as being on medications for life can be a tough pill to swallow.
References and Resources:
- American Academy of Orthopedic Surgeons
- The Arthritis Foundation web site: Arthritis Today; available at http://www.arthritistoday.org/#5
- Curtis CL, Hughes CE, Flannery CR, et al. n-3 Fatty Acids Specifically Modulate Catabolic Factors Involved in Articular Cartilage Degradation. J Biol Chem. 2000; 275(2):721-724.
- Curtis CL, Rees SG, Cramp J, et al. Effects of n-3 Fatty Acids on Cartilage Metabolism. Proc Nutr Soc. 2002; 61(3): 381-389.
- John Hopkins Arthritis Center
- Mayo Clinic Web site
© 2010 HeartMD Institute. All rights reserved.