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Dr. Theo on Arthritis Continued


Rheumatoid arthritis (RA) is an autoimmune disease brought about when the body has, for unknown reasons, turned on itself. In RA, the immune system starts attacking body tissues as if they were foreign invaders. In its mildest form, rheumatoid arthritis is characterized by joint discomfort caused when the joint lining, especially the part that meets the cartilage, becomes inflamed. In its most serious form, RA can cause painfully deformed joints and harm organ system.

Some experts believe that RA is brought about by a bacterial infection in the joints, but it might also be triggered by a virus in those who are genetically susceptible. People with a family history of RA have a much higher risk of RA. A recent study suggests that the disease's origin may be related to the body's attack on a carbohydrate chain in the joint cartilage, not on proteins, as had been previously been theorized.

Over time, the chronic inflammation of RA makes the joint lining thick and overgrown. This overgrown lining may then start to invade the cartilage, other joint supporting tissues, and even the bone, causing small erosions in the bone and weakening the entire joint structure. Eventually, the weakened joint becomes more and more painful and less able to perform. Under pressure, it may even become dislocated and deformed.

Usually appearing in the same joint on both sides of the body (both hands, for example), RA hits suddenly. The joints become swollen, tender, and inflamed; there may also be fever, weight loss, and a general feeling of sickness, soreness, stiffness, and aching. The eyes and mouth may dry out if the tear and salivary glands become involved: People with RA generally have stiffness in their joints that lasts for an hour or more when they wake up in the morning. The pain and stiffness are often better after movement.

RA affects more than 2.5 million people in the United States, striking women three times as often as men. Onset is typically between the ages of 20 and 40, although older persons and children are also victims. Joint inflammation is chronic and can be mild to severe, with occasional attacks or "flares." The disease may get progressively worse over time and lead to severe deformities in the joints.

The treatment for RA is designed to alleviate pain, reduce inflammation, stop or slow joint damage, and improve overall body functioning. In the past, treatment was started with mostly mild drugs; the more potent (and potentially more hazardous) disease modifying drugs (or DMARDs) were reserved for the time when the disease started to cause joint destruction. The trend over the past few years, however, has been to start with more aggressive treatment immediately rather than wait for joint destruction to become apparent Some rheumatoid arthritis sufferers can have rapid progression of the disease. In just a year they can have such severe damage to one or two joints that they require joint replacement surgery. This is why it's critical to get a diagnosis of RA early, have a consultation with a rheumatologist, and start prescription medicine immediately.

Aspirin and NSAIDs are used to control pain in RA, but these drugs do not slow the progression of the joint destruction. Immunosuppressive medications such as methotrexate, sulfasalazine, leflunomide (Arava®) hydroxychloroquine, azothioprin (Imuran), and cyclosporin may help slow the joint destruction associated with RA. Three new biologic medicines known as tumor necrosis factor inhibitors have been approved for use in RA: etanercept (Enbrel), infliximab (Remicade) and adiliniumab (Humira). Another new medication called anakinra (Kineret®), which works by blocking the activity of a natural inflammatory agent in your body called interleukin-l, is now available. These medications have had a major impact on controlling pain, joint swelling, and joint destruction due to RA. Exercise and therapy can help reduce joint soreness and swelling, alleviate pain, and increase joint mobility. Surgery is an option in the case of severe damage to the hips or knees and sometimes the shoulder when it can make the difference between dependence and independence.

Unfortunately, there have not been any large, controlled studies on the use of glucosamine, chondroitin, or ASU on rheumatoid arthritis sufferers. From a theoretical standpoint, some of the mechanisms of action of these supplements would suggest that they should benefit The supplements can inhibit the enzymes that break down cartilage as well as the negative effects of IL-l, chemicals that are produced both in osteoarthritis and even more so in rheumatoid arthritis. Furthermore, many people with RA also have osteoarthritis and can benefit from the use of the supplements. Since every case of RA is different, it is important to discuss the use of these supplements with your rheumatologist.


Can arthritis be brought about by germs? Absolutely. Many forms of bacteria. viruses, and fungi can cause infectious arthritis, which is frequently characterized by loss of joint function, fever, and inflammation of one or more joints, and (occasionally) chills. The knee joint is most commonly involved (50 percent of the cases), followed by the hip, shoulder, wrist, and ankle. Infectious arthritis can generally be cured if caught early enough. In practice, any bacterium, virus, or fungus that produces disease can prompt this infectious form of arthritis, and there are many ways that the infecting agent can enter the body: trauma. surgery, inserting a needle into a joint, abscess or bone infection near the joint, animal bites, insect bites (see the discussion of Lyme disease that follows), and even thorns. Chronic alcoholics and drug abusers are at high risk for infectious arthritis, as are those suffering from diabetes, sickle cell anemia, kidney disease, and certain forms of cancer. A less obvious cause of joint infection is bacteria that travels through the bloodstream from a distant site in the body and settles in a joint. Infections almost anywhere in the body can move to the joints, including infections that begin in the lungs, urinary tract, and skin. Remember that any medical procedure involving a joint can lead to infection and infectious arthritis. Many joint infections are complications of surgery on the joints; very rarely does an injection into the joint space actually lead to an infection.

The body responds to the infection by mobilizing the immune system and engaging in a fierce battle with the infectious agent. The joint becomes the battleground. Like all battlegrounds, the joint suffers, becoming inflamed and painful as the body releases enzymes that inadvertently degrade the cartilage as they seek to destroy the invaders.

The goal in treating infectious arthritis is first to eliminate the infection, then handle the arthritis itself. Treatment depends upon what caused it in the first place: antibiotics are prescribed for bacterial causes, while NSAIDs are the medicine of choice for viral causes. If the cause is a bacterial infection, infected joints should be drained in order to limit destruction to the joint due to the active infection and inflammation. Physical therapy may then be used to build up muscle strength and relieve joint stiffness.


A bacterial illness caused by a spirochete, Lyme disease is spread by bites from infected deer ticks. The illness gets its name from Old Lyme, Connecticut, where the first cases were recognized in 1975. Today it is the most common tick-transmitted disease in the United States. It's most common in the northeastern region, but cases have been reported in every state and also in other countries.

Lyme disease usually, though not always, starts with a characteristic "bull's-eye" rash at the site of the tick bite. This is followed by flu-like symptoms, including fever, muscle and joint pain, and headaches. When Lyme disease patients are treated promptly with antibiotics, the illness usually goes away with no lasting effects. Unfortunately, because the bull's-eye rash isn't always present and because the other symptoms can sometimes be quite mild, some patients don't know they have the disease and go untreated. These people can end up with late-stage nerve and heart problems-and also with arthritis, usually in the knees. In fact, the first cases of Lyme disease were initially diagnosed as rheumatoid arthritis because the patients all suddenly had swollen, painful knee joints. It was only when doctors realized that a cluster of rheumatoid arthritis cases in one place at one time was unlikely that they realized there was an infection involved.

As with other forms of infectious arthritis, treatment for late-stage Lyme disease usually involves antibiotics to treat the infection; and NSAIDs and possibly surgery to treat the affected joints.


Characterized by widespread, sometimes incapacitating pain, fibromyalgia produces stiffness and weakness of the muscular areas of the lower back, hips, thighs, neck, shoulder, chest, or arms, accompanied by muscle spasms ("charley horses") in any of those areas. Patients often tell their doctors: "I hurt allover." The symptoms of fibromyalgia are quite similar to those of chronic fatigue syndrome (CFS), which explains why doctors have had a hard time distinguishing between the two. But in recent years, researchers have discovered that the diagnosis of fibromyalgia is based on pain or tenderness in at least 11 of 18 specific points of the body.

Formerly referred to as fibrosis, because it was thought to be an inflammation of the muscles, fibromyalgia literally means "muscle pain." Recent controlled studies, however, show no evidence of inflamed muscles in patients with fibromyalgia. Researchers now think that fibromyalgia is secondary to abnormal pain perception. In controlled studies, patients with fibromyalgia perceived stimuli as painful at lower levels than did controls. When the brain activity of patients with fibromyalgia was compared to that of controls, people with fibromyalgia had more brain activity in response to the same stimuli: In other words, someone with fibromyalgia is very sensitive to pain. Things that someone without fibromyalgia doesn't perceive as painful are definitely painful to people with fibromyalgia. Why this is so is still a mystery.

Women between the ages of 35 and 60 are the most likely victims of fibromyalgia, with the highest incidence occurring just before menopause. No specific cause has been pinpointed. Fibromyalgia is often misdiagnosed because most of its symptoms are similar to those found in other conditions.

Treatment of fibromyalgia includes alleviating chronic pain and sleep disturbances, as well as dealing with the depression that often accompanies a chronic disease. Water exercises, biofeedback, and relaxation techniques are all helpful. Although aspirin and NSAIDs are usually prescribed to relieve the pain, they don't always do the job. That's why muscle relaxants or local anesthetics are sometimes injected into the painful areas to quickly relax the muscle and alleviate pain. In addition, medications that act on the central nervous system, most notably the prescription drugs amitriptyline (Elavil®) and cyclobenzaprine (Flexeril®, have been shown to help sleep disturbance and improve pain. SSRI antidepressants such as fluoxetine (Prozac®) also seem to help with pain due to fibromyalgia, even if the patient isn't depressed. Fibromyalgia is a very difficult disease, both to have and to treat. The good news is that although the joints may be painful, the disease does not cause deformity or deterioration.


Psoriatic arthritis is an inherited disease that sometimes occurs in people with the skin condition called psoriasis. The red, scaly patches of psoriasis often appear on the neck. knees, and elbows; the nails may become pitted. People with psoriatic arthritis usually have stiffness in their joints in .the morning that lasts at least 30 minutes. Psoriatic arthritis often affects the back. It also often affects the end joints of the fingers or toes, causing them to become so swollen that they're often referred to as "sausage digits." Despite the swelling, affected joints tend to be less tender than with other arthritis conditions, so patients with psoriatic arthritis may develop joint deformity without a significant amount of pain.

Although swollen joints in the extremities are the most common symptom of psoriatic arthritis, the diagnosis can't be made unless the patient also has skin and nail involvement consistent with psoriasis. Sometimes, however, patients with psoriatic arthritis have only nail lesions or such mild skin lesions that they don't even know they have psoriasis.

Psoriatic arthritis usually appears when its victims are between the ages of 20 and 30, although it may occur at any age. It affects men and women .equally, and occurs in 5 to 8 percent of those who have psoriasis. Treatment regimens include NSAIDs to reduce the inflammation, exercises to improve joint mobility, and immunosuppressive drugs such as methotrexate or cyclosporin, which can slow the rate of joint destruction. The new biologic medications etanercept and infliximab have been approved for the treatment of psoriatic arthritis and can be very effective at both clearing up the skin lesions and treating the arthritis.

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90% of people who follow The Arthritis Cure treatment program don't need anti-inflammatories (like Aleve, Celebrex or Advil).
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