Dr. Theo on Arthritis
Arthritis and related conditions are actually made up of about 100
When the word "arthritis" is used as a general term, it is meant
to refer to problems that are specific to or include the joints.
There are over 230 different joints in the human body. A joint is
the union of two or more bones, surrounded by various other tissues such as:
- Joint capsule (fibrous tissue which encloses the joint in a watertight and airtight environment)
- Muscles (which allow for movement around the joint)
- Tendons (which connect muscles to bones)
- Ligaments (which connect bone to other bones)
- Cartilage (which lines the ends of the bones and acts as both a shock absorbers and a slippery surface that allows the bones to move easily over one another)
Arthritis is a Greek word that translates literally into ?joint
inflammation.? The symptoms of arthritis usually include joint pain, stiffness,
and sometimes swelling or warmth.
Some people might have advanced arthritis and not have any
symptoms of pain. That's because cartilage on the end of the bones does not
have the nerve endings. Sometimes, even with significant degeneration of the
cartilage, people are unaware of their condition.
In many cases, people might notice stiffness without pain as their
predominant symptom of arthritis.
As will see below, it's extremely important to have a physician
accurately diagnose the cause of your symptoms. There are many different forms
of arthritis that result in the same symptoms. Despite the overlap in symptoms,
however, the treatment intervention might vary considerably depending on which
form of arthritis is finally diagnosed. Getting the wrong kind of treatment for
a particular condition can be detrimental. In some cases, the treatment might
make the disease worse, even if there is temporary pain relief at the beginning
of the treatment.
How many people are affected?
According to the CDC, arthritis causes symptoms and problems in
nearly 70 million Americans, or about one in every three adults. As the
population ages, develops more obesity, diabetes, and joint injuries, this
number is expected to rise, perhaps even double by 2020.
Despite the fact that most people associate arthritis with the
elderly, a full two thirds of the cases are in those younger than age 65.
Arthritis is by far the number one cause of pain and disability in
Americans. Fortunately, we know more about treatment and prevention than ever
before. The past 10 years have provided us with tremendous breakthroughs in the
diagnosis and treatment of many of the forms of arthritis.
Specific diseases categorized as arthritis
It's easy to confuse osteoarthritis and rheumatoid arthritis, two
very different rheumatologic diseases with similar names. And it gets even more
confusing when you learn that there are about 100 different types of rheumatic
diseases, many causing different forms of arthritis. Depending upon the type of
arthritis, the associated inflammation may flare up in one joint or many, may
limit itself to the joint only, or it might spread to the muscles, tendons,
ligaments, internal organs, and even the skin. Different types of arthritis
have different causes, courses, and cures.
Naturally, your arthritis cannot be effectively treated until the
type has been diagnosed. Your doctor will make the diagnosis, which may very
well be one of the common forms listed here.
Half or more of the total cases of arthritis are attributed to
osteoarthritis, often abbreviated as OA.
OA is a condition which often starts in those in their teens or
20s and become symptomatic tend to 30 years later.
The hallmark of OA is a slow loss of cartilage on the end of the
bones, along with characteristic changes to the bones that include: bone spur
formation, tiny fractures called microfractures, and an increase in the
pressure inside the bone marrow cavity.
Though osteoarthritis can occur in almost any joint, 55% of the
pain and disability is due to osteoarthritis of the knees. The other joints
commonly affected include the hips, neck and low back, fingers and thumb
It is believed that there are about 20 different causes of
osteoarthritis including: injury or trauma, family history, metabolic disorders
such as thyroid problems, diabetes, obesity and an overload of iron; alignment
problems in the joints (which may be acquired or have been present since birth), as well
as a whole host of other factors.
Risk factors for developing osteoarthritis include: obesity,
diabetes, low levels of Vitamin D, decreased muscle strength around the joints,
and overuse syndromes through work or sporting activities.
The vast majority of people who have osteoarthritis are unaware of
it. In fact, a recent study looking at patients 55 years and older who had no
symptoms of joint problems revealed that 96% of them showed signs of
osteoarthritis on x-ray.
Unfortunately, the vast majority of those treating osteoarthritis
relied on pain relievers and anti-inflammatory medications including
over-the-counter and prescription drugs. Tylenol, Advil, Aleve as well as
prescription drugs such as Celebrex and Vioxx were often given as the first
line therapy for those who have symptomatic osteoarthritis.
We now know that the use of these medications is not without
significant chance of harm, and that the medications themselves might lead to
worsening of the disease process itself, even in those who experience some pain
The hallmark of the book The Arthritis Cure- Revised Edition is to
explain all of the causes and interventions of osteoarthritis in an
easy-to-read manner. The book details the nine step program for prevention and
treatment of this debilitating disease.
When someone mentions gout, we usually think of the hugebellied,
gluttonous King Henry VIII swilling port wine and chewing on a leg of mutton,
his bandaged foot resting on a stool. Gout was once called the "rich man's
disease" because it was associated with being overweight, overeating
(especially meat), and overindulging in drink. Today we know that gout is a
metabolic disorder, but a poor diet can make the condition worse.
In gout, uric acid, a waste product in the urea (urine) cycle, is
either overproduced, under excreted, or both. When a person has too much uric
acid in his or her system, some of it forms uric acid crystals. These crystals
(think of them as sharp pieces of glass inside your body) can be deposited into
the joint space, rather than being cleared by the kidneys. These "glass
shards" often find their way to the "bunion joint" of the big
toe, although gout is also found in the other joints of the feet, as well as
those of the fingers, wrists, elbows, knees, and ankles. The afflicted joint
suddenly becomes hot, painfully swollen, and stiff; fever and chills sometimes
follow. The skin of the affected area can appear shiny red or purple. The pain
from an acute attack of gout can be excruciating. In some cases, the joint is
so tender that even the light brush of a bed sheet can cause howls of pain.
Gout affects about two million Americans, most of them male (80
percent). Risk factors for getting the disease include a family history of
gout, drinking alcohol, high blood pressure, taking certain medications, being
overweight, or gaining weight unchecked. Aside from the severe pain of a gout
attack, the disease can be hazardous to your long-term health. The uric acid
crystals may eventually be deposited in soft tissue, cartilage, joints,
tendons, or elsewhere, forming painful lumps, and the crystals can also damage
The good news is that gout can often be completely controlled with
proper treatment, which usually includes the use of non-steroidal
anti-inflammatory drugs (NSAIDs) for pain and inflammation, abstinence from
alcohol, dietary restrictions (avoiding foods such as organ meats), and
possibly -medications to reduce the amount of uric acid production or increase
its excretion in the urine.
It is very important to treat gout and prevent gouty attacks
because recurrent attacks can lead to joint destruction, deformities, and
arthritis in the affected joint. Gout is a common secondary risk factor for
osteoarthritis. Treating the gout, and preventing uric acid crystals from
getting into the joint are the most important ways to prevent secondary
The name makes it sound as if it's a fake, but the pain and other
symptoms of pseudogout are real. Often striking the knee joint, then the wrists
and ankles, pseudogout attacks suddenly, causing pain and swelling in the joint
and possibly destroying cartilage. An attack may go on for days or even weeks,
with the acute phase lasting 12 to 36 hours. Sometimes the pain may flare up in
several joints at a time, though when that happens pseudogout is usually less
severe and more chronic. Sometimes the pain increases after activity; sometimes
it doesn't. These symptoms often disappear without treatment.
Also known as calcium pyrophosphate crystal deposition disease,
pseudogout is a form of inflammatory arthritis. As is the case with gout, the
pain is caused by crystals deposited in the joint spaces, but in pseudogout the
crystals are formed from calcium pyrophosphate rather than uric acid. The
calcium crystals can also be deposited into the cartilage, causing a condition
called chondrocalcinosis (Latin for "calcium in the cartilage").
Pseudogout is uncommon before the age of 65 and it seems to affect
men and women equally. The disease can be brought on by surgery, trauma, or
stress (because stress causes excessive parathyroid hormone production, which
affects the calcium balance in your body). Unlike gout, it's not caused or
affected by diet. Even though the crystals contain calcium, drinking milk or
eating high calcium foods doesn't seem to make a difference.
Treatment includes joint aspiration to remove the fluid containing
the crystals and NSAIDs to manage pain and inflammation. Exercise helps to
build muscle strength and restore full motion of the joints after an acute
attack. In rare instances, surgery may be used to replace a joint that has been
badly damaged, is extremely painful, or is unstable.
Perhaps the most dramatic responses to glucosamine, chondroitin and
ASU I have ever seen occurred in people suffering from pseudogout. Some cases
were patients who had little response to NSAIDs or even cortisone injections and
who were contemplating radical surgeries to scrape down the cartilage and
calcium deposits. After a few weeks on the supplements, their recovery was
dramatic. Some were completely cured of their pain and swelling, even years
later, and even after they took up running again.
Glucosamine has an "antireactive" effect that helps keep
the calcium crystals from irritating the cartilage. This is why I believe that
the research on the supplements, which generally just includes people with
primary osteoarthritis, underestimates the real-world value of treating people
with joint pain from other types of arthritis.
Continuing reading Dr. Theo on arthritis...