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Arthritis: There are Alternatives to NASD’s and Pain
Description
Arthritis is a disease of the joints characterized by pain, swelling, and redness, heat and, sometimes, structural changes. This condition is more common in women than in men. Arthritis may result from another condition, be associated with another condition, or simply develop on its own. The two most common forms of this disease are osteoarthritis and rheumatoid arthritis.
Osteoarthritis
A degenerative joint disease and the most common form of arthritis and joint disorders, is the gradual deterioration of cartilage, usually in the larger, weight-bearing joints such as the hips, knees, and spine. This wear and tear is a normal process predominantly found in people age 55 and older. Among those younger than 45, it occurs more often in men. After that age, women contract this disorder more often. By the eighth decade of life, approximately 90% of all people are affected by osteoarthritis. Since this is a natural part of aging, beyond a certain age most people will almost certainly contract the disease, even if the symptoms are not detected. Although the joints are not always inflamed, the articular cartilage may begin to flake and crack, due to overuse or injury. In severe cases the underlying bone becomes thickened and distorted. Scar tissue may then replace damaged cartilage. If movement becomes painful and restricted, lessened use of the associated muscles will lead to their atrophy.
Rheumatoid Arthritis
A chronic joint disease affecting one or more joints; the synovium gradually becomes inflamed and swollen. Inflammation may occur in other parts of the joints as well. Gradual weakening of the bones comprising the joint occurs in persistent cases of rheumatoid arthritis. Tissue destruction occurs in the most severe cases. The most commonly affected joints are those of the hands and feet, particularly those of the knuckle and toe joints. The wrists, knees, ankles, and neck are also frequently affected.
Rheumatoid arthritis may occur as a single mild attack, or as several episodes, which can leave the victim increasingly disabled. In extremely few persons, rheumatoid arthritis causes extensive deterioration of joint and bone tissues, producing deformities of the affected and surrounding areas. Damage to the lungs, heart, nerves and eyes can also occur, making it difficult to lead an active, normal life. This form of arthritis can affect people of any age, including juveniles, but predominantly affects those between the ages of 40 and 60. Slightly less than one-half of affected individuals have complete remission. Approximately one in ten individuals are severely disabled.
Management of Arthritis
A physician, who will not only take a careful history of the symptoms, but also do a proper physical examination to elicit the signs of arthritis and the functional status of the joints, makes diagnosis. Not infrequently, the physician will do certain laboratory tests to complete the study. The common ones are: a complete blood count, a urinalysis, a sedimentation rate (ESR), test for rheumatoid factor and antinuclear antibodies, synovianalysis (examination of the joint fluid) and X-rays of the affected joints. These tests are used both for the establishment of diagnosis and for the progress of therapy.
Prevention of arthritis (A Joint Protection Program)
Individuals who are genetically predisposed to getting arthritis (i.e.,” it runs in the family”) can fend off symptoms of severe arthritis by regulating their body weight, and by seeking physical or occupational therapy for newly affected joints.
Treatment
There are four primary objectives in the treatment of arthritis: reduction of inflammation and pain; preservation of the joint’s function prevention of deformity; and treatment of the cause (if known)
The best treatment is to remove weight from the joints. This may entail using a walking stick, going on a balanced weight reduction diet, sleeping on a bed, which properly conforms to the shape of the body, and getting frequent rest. Regular exercise, both active and passive, will keep the affected muscles from weakening. The individual may benefit from a hydrotherapy program under trained supervision. Heat and cold applications to the joint may induce muscle relaxation and an analgesic effect.
Aspirin is commonly used as a painkiller as well as other nonprescription pain relievers. However, because of individual sensitivity to side effects (aspirin, for example, can cause gastrointestinal bleeding), the physician may try several drugs to determine which has the least, or no deleterious effects: nonsteroidal anti-inflammatory drugs, such as Indomethacin; corticosteriods; and (in the case of rheumatoid arthritis) ant-malaria’s, gold salts, penicillamine, plus experimental cytotoxic drugs.
Surgical removal of badly inflamed joint synovium may be required. Common types of surgery are synovectomy (removal of the synovial membrane), arthroplasty (for realignment and reconstruction), repair of tendon rupture, arthrodesis (fusion of the joint). Some joints may be artificially replaced.
Alternative treatments exist which are not universally accepted: acupuncture; chiropractic; and nutritional, herbal or folk therapy.
Arthritis - Causes Osteoarthritis
Primary Factors
The primary cause of osteoarthritis is wear due to aging. There may be reduced bio-material properties due to normal processes or disturbances in cartilage metabolism from:
Diabetes
Acromegaly
Ochronosis
Predisposing Factors-Macrotrauma, especially common in athletes involved in contact sports
Microtrausia Inactivity
Rheumatoid arthritis
Primary Factors-The primary cause of rheumatoid arthritis is not known with any certainty. It is speculated an autoimnune process due to a viral infection may be involved.
Arthritis - Nutritional Supplements
General Supplements-
Adult Child/Adolescent
Beta Carotene 10,000 IU’s 5,000 IU’s
DHEA 10-50 mgs
DLPA 500- 2,000 mgs 100-1,000 mgs
EP0 2-3grams 1-2 grams
Fish Oils 6 -10 grams 3-4 grams
Manganese 5 - 20 mgs 2-5 mgs
Selenium 100 - 300 mcgs 20-100 mcgs
Vitamin B-6 25 - 100 mgs 5-20 mgs
Vitamin E 400 - 1,200 IU’s 200-800 IU
Zinc 20 -100 mgs 10-30 mgs
Specialty Supplements-
Glucosamine Sulfate: 1,000-2,000 mg
PCOs: 25-100 mg
Bioflavonoids: 25-100 mg
NMC: 5,000-8,000 IU
Hyaluronidase: 400-800 mcg
Glossary
Bioflavonoids = Citrus Bioflavonoids
HCA = Garcinia Cambogia (Hydroxy Citric Acid)
NMC = Natural Mixed Carotenoids
Germanium (GE 132) = Organic Germanium Sesquioxide
(PCOs) Procyanidolic Oligomers = Pycnogenol, Grape Seed / Skin Extract
Vitamin E = d-Alpha Tocopherol Acid Succinate
Notes
There has been a virtual explosion of interest concerning the efficacy of antioxidants in arthritic conditions. Some combinations call for six, eight, or even more, such nutrients to be taken together.
This has extended the number of antioxidants commonly available, some of which are reputed to be many times more powerful than vitamin C.
The first list includes: manganese, selenium, zinc and vitamin E. To this list may now be added: vitamin 515, Niacinamide, vitamin C, bioflavonoids, Beta Carotene, pycnogenol, sulfur and superoxide dismutase.
Probably the most exciting development has been with glucosamine sulfate. This appears to be at least as effective as the ubiquitous NSAIDs without the side effects!
The hormone DHEA has been excitedly received in some quarters for reversing the aging process, part of which seems to be arthritic conditions.
For those who like to increase their consumption of natural plant foods, chlorella and wheat grass juice may prove to be beneficial.
Note:
All amounts are in addition to those supplements having a Recommended Dietary Allowance (RflA) . Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.
Arthritis - Herbal Approaches Combination of Choice
Contents
Alfalfa (Medicago sativa) Equal parts of the seed and leaf.
Celery Seed (Apium graveolens)
Burdock Root (Arctium lappa)
Chaparral (Larrea divaricata)
Sarsaparilla Root (Smilax aristolochi-aceafolia)
Comfrey (1/2 root, 1/2 leaf) (Symphytum officinale)
Kelp (Laminaria, Macrocystes, Ascophyllum)
Cayenne (Capsicum annuum)
Queen—of-the-Meadow Root (Eupatorium purpureum)
Measurement— A 440-490 mg. blend per capsule
Alternative Herbal Combination
Contents
Parsley (1/2 root, 1/2 leaf) (Petroselinum sativum)
Cornsilk (Stigmata maydis)
tlva Ursi Leaves (Arctostaphylos uva-ursi)
Cleavers (Galium aparine)
Buchu Leaves (Barosma crenata)
Juniper Berries (Juniperus communis)
Kelp (Laminaria, Macrocystis, Ascophyllum)
Cayenne (Capsicum annuum))
Queen-of-the-Meadow Root (Eupatorium purpureum)
Measurement— A 410-460 mg. blend per capsule
Fibromyalgia- Capsaicin has been recommended for this form of non-articular arthritis. It is used topically at a strength of 0.025%.
It should be used sparingly in affected areas, besides warming the area, it may inhibit the neurotransmitter (designated as substance P for pain) responsible for neurogenic inflammation. Of course it is also irritating to the eyes and other mucosal surfaces.
Note-: The misdirected use of some herbs can produce severely adverse effects, especially when it is taken with prescription drugs or other medications. This Herbal Preparation information is a summary of data from books and articles by various authors. It is not intended to replace the advice or attention of health care professionals.
Arthritis - Homeopathic Remedy
1.* Rhus Toxicodendron - 2000 to 1GM use chronically.
2.* Rhododendron - 6K to 300
3* Elaterium - 300 especially gouty arthritis and arthritic nodules.
4. Arbutus Andrachne - 3K to 300 better on larger joints.
5* Bryonia - 12K to 300 especially with swelling, knees, feet.
6.**Apocynum androsaemifolium - 200K to 2000 use when all joints hurt, swelling in feet, hot feet.
Treatment Schedule
Doses cited are to be administered on a 3K daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.
Legend
K = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
K or C underlined means it is most useful potency
Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one
remedy — if so, use all of them.
References
Boericke, D.E., 1988. Homeopathic Materia Medics.
Coulter, CR., 1986. Portraits of Homeopathic Medicines.
Kent, J.T., 1989. Repertory of the Homeopathic Materia Medics.
Koehler, G., 1989. Handbook of Homeopathy.
Shingale, J.N. , 1992. Bedside Prescriber.
Smith, Trevor, 1989. Homeopathic Medicine.
Ullman, Dana, 1991. The One Minute (or so) Healer.
Arthritis - Current Abstracts
Allergic Synovitis
Nine patients were evaluated who stated they had arthritis sometimes triggered by certain foods. All had a history of atopy. Food allergy appeared to be the mechanism in 3 patients and a 4th had synovitis with effusion in the knee triggered by drinking milk a few hours beforehand. Three case studies are described. The first is a 19 year old female with recurrent knee pain which was aggravated by aspirin sensitivity.
She had inhalant allergies and she had an attack (knee pain) precipitated by contact with the primula plant, and from her own experience, milk, dairy products and gluten precipitated symptoms as well as a sore throat. She had eosinophilia.
The second case was a 49 year old female with swelling and pain in the wrist and small joints of the fingers since having a hysterectomy. It appeared her symptoms could be precipitated by dairy foods.
She provoked the symptoms by drinking milk a few hours before an office visit and this resulted in the knee having to be aspirated because of a significant amount of fluid. The next case was a 34 year old woman who had knee pain, leg cramps, swelling and itching around these areas. She was strongly reactive to grass, pollens, house dust and cat fur. Antihistamines at the beginning of the onset of the attack could bring dramatic relief of symptoms. The authors acknowledge allergies may be an occasional cause of rheumatic pain or synovitis in certain atopic individuals.
“Is There an Allergic Synovitis?”, Golding, D.N. , Journal of The Royal Society of Medicine, May 1990;83:312-314. (Address: D.N. Golding, MD, Rheumatology Unit, Princess Alexandria Hospital, Hamstel Road, Harlow, Essex CN2O 1QX, United Kingdom)
Boron
In a double blind trial comparing 6 mg/d of boron with placebo in the treatment of arthritis, of the 10 patients on boron, five improved while only one of ten in the placebo group improved. The boron had significant benefit in severe osteoarthritis. The 6 mg of boron was in two tablets containing 25 ag of borax (sodium tetraborate decahydrate) . The experiment was carried over an eight week period. There were no side effects noted.
“Boron and Arthritis: The Results of a Double-Blind Pilot Study”, Travers, Richard L. , MD, et al, Journal of Nutritional Medicine, 1990:1:127-132. (Address: Rex E. Newnham, Ph.D., Cracoe House Cottage, Cracoc Near Skipton, North Yorkshire 5023 6LB, United Kingdom)
Diet
This is a review article on the role of diet in arthritis. Elimination diets have proven to be of benefit in some rheumatoid arthritic patients. A sample elimination diet includes going on a limited number of foods such as fish, pears, carrots, mineral water and then reintroducing foods one at a time to provoke the symptoms. A case report in 10 rheumatoid arthritis patients placed on elimination diets revealed 13 doing well without drug treatment on five year follow-up. Foods most often culpable include cereal grains, dairy products, tea, coffee, red meats and citrus fruits. Gluten may cause immunologic reactions in the gut allowing for the absorption of immune complexes and other sensitizing antigens. Omega-3 fatty acids are mentioned because of their ability to decrease inflammatory prostaglandin’s and leukotrienes, and they have shown benefit in rheumatoid arthritic patients. Evening Primrose Oil may alter prostaglandin synthesis away from the 2 to 1 series.
Therapy should be for at least six months. Infectious agents may also effect arthritic conditions. Disturbances in gut flora due to antibiotic therapy may promote abnormal types of bacteria which can irritate the gut wall leading to toxin release and increased intestinal permeability. This subsequently can lead to undigested macromolecules passing through the gut and triggering immunologic reactions such as exorphins. The possibility of candidiasis in the gut is debatable but he encourages further research in this area. In conclusion he states that there may be a disturbance in the gut from an infectious organism, or a yeast related illness that results in increased inflammation resulting in a secondary increase in intestinal permeability, subsequently foods such as gluten and milk may act as immuno-sensitizing antigens.
“Dietary Treatment of Rheumatoid Arthritis”, Ramsey, Norman et al .,” The Practitioner”, May 8,
1990:234:456-460. (Address: Gail Darlington MD/Norman Ramsey, Ph.D., Rheumatology Unit, Epsom District Hospital, Epsom, Surrey, United Kingdom)
Food Induced
Sixteen patients (ages 18-65) with inflammatory arthritis who had the disease starting after 16 years of age were evaluated because of their alleged food induced arthritis. A wide parameter of immunologic studies were done include circulating immune complexes, complement and immunoglobulin levels. All 16 patients underwent double-blind controlled food challenges and it was found that three demonstrated subjective and objective rheumatic symptoms after double-blind encapsulated food challenge. The three were asymptomatic after receiving elemental nutrition or just avoiding the foods. The three antigens were milk, shrimp and nitrate.
The milk sensitive patient had increased IgG4 anti-alpha-lactalbumin, IgG milk complexes and delayed skin and cellular reactivity to milk. The delayed synovitis from shrimp resulted in increased Igo anti—shrimp antibodies and a COO nurse experienced rheumatic symptoms after exposure to nitrates. Other parameters were not different than controls. The authors suggest most patients alleging food induced symptoms do not show this on blinded challenge and that probably no more than 5% of rheumatic disease patients have immunologic sensitivity to foods. These observations suggest a role for food allergy in some patients with rheumatic disease. 8696
“Food Induced (”Allergic”) Arthritis: Clinical and Serological Studies”, Panush, Richard S., Journal of Rheumatology, 1990;17(3) :291-294. (Address: Dr. R. Panush, Department of Medicine, St. Barnabas Medical Center, Livingston, NJ 07039, USA)
Gut Integrity and Antigen Uptake
Gut lesions and articular disease have been found in bypass syndrome, reactive arthritis, celiac, Whipple’s and inflammatory bowel diseases. IgA immune complexes can be formed intraluminally and pass into the circulation through a defective mucosal barrier.
Arthritic lesions can result from the release of immunologic mediators triggered by infectious organisms such as chlamydia and yersinia. In celiac disease it is theorized there is immunologically mediated mucosal injury, increasing intestinal permeability allowing for provoking antigens to penetrate into the general circulation. Symptoms of arthritis can improve on a gluten free diet but gluten challenge does not necessarily provoke the arthritis. A flare-up in inflammatory bowel disease may be predicted by achy joints which can be reduced with therapy directed towards the bowel. HI..A antigens may also play a role in the expression of inflammation.
Non-steroidal anti-inflammatory agents increase intestinal permeability in patients with rheumatoid arthritis and osteoarthritis. One half to two thirds of patients with NSAIDs have evidence of subclinical small intestine inflammation. In conclusion, there is strong evidence suggesting a relationship between gastrointestinal mucosa integrity and articular disease. Current evidence supports the hypothesis that abnormal absorption of antigens, or a disturbed local defense, can induce immunologic mechanisms responsible for “extra intestinal disease”.
“Articular Diseases and The Gut: Evidence For a Strong Relationship Between Spondylarthropathy and Inflammation of The Gut in Man”, De Vos, M., ACTA Clinics Belgica, 1990;45(1):20-24. (Address: N. De Vos, University Hospital of Ghent, Department of Gastroenterology, De Pintelsan, 185 - B - 9000, Ghent, Belgium)
Osteoarthritis and Boron
Six mgs/d of Boron (2 tablets of 25 mg Borax Sodium Tetraborate Decahydrate) was evaluated in
10 patients with radiographically proven osteoarthritis while 10 patients received placebos.
Out of the 10 patients taking boron 5 improved while only 1 improved in the placebo group.
There were no apparent side effects and the author suggests this limited trial should
encourage further investigation.
“Clinical Trial — Boron on Arthritis”, Travers, Richard L. , Townsend Letter For Doctors, June 1990360-362. (Address: Dr. Richard L. Travers, Department of Medicine, Royal Melbourne Hospital, Parkville 3050, Australia)
Zinc Monoglycerolate
In a rat model zinc repletion by parenteral administration of zinc monoglycerolate and other lipophilic zinc complexes suppressed the development of adjuvant-induced polyarthritis in rats. The zinc was not effective orally, only parenterally. It had less local irritation than other zinc salts when injected subcutaneously. It could also be applied as a dry powder for rubbing into the skin and this route was found to have antiarthritic activity as well. Zinc monoglycerate showed consistent antiarthritic activity in rats under conditions in which two drugs, aurothiomalate and auranofin, had variable effects. It is still questionable whether oral zinc may have benefit in rheumatoid arthritis.
“Zinc Nonoglycerolate: A Slow-Release Source of Zinc With Anti-Arthritic Activity in Rats”, Whitehouse, MW., et al, Agents and Actions, 1990;31:47-58. (Address: Dr. MW. Whitehouse, Department of Pathology, University of Adelaide, GPO Box 498, Adelaide, SA. 5001, Australia)
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