Joint [In]action

Words: Dr Rajgopal NIDAMBOOR

Osteoarthritis [OA] is a degenerative disorder. It affects millions of people worldwide — it’s seemingly more common than heart disease and diabetes. Call it a paradox, or what you may, one major fact remains — OA is only going to expand in its intensity and also get firmly rooted in one’s middle years, sooner rather than later. Studies estimate that it may afflict over 250 million worldwide in the next fifteen years. While OA affects millions in India, studies approximate that over three million people visit their doctor for OA, in the UK, every year. There is no easy answer, much less a complete cure for OA.

OA is a chronic disorder; its name is derived from the Greek, ‘osteo,’ for bones; ‘orthro,’ to the joints involved; and, ‘itis,’ to the inflammatory process of the disorder. It is estimated that Americans alone spend over US$15 billion a year in an attempt to alleviate arthritis pain. Add to this, the expenditure on arthritis drugs worldwide, and you have a huge market, nay an industry, catering to ‘joint’ patients’ needs.

Causes

Age. The risk of osteoarthritis increases with age. However, after the age of 65-70, the risk drops down, for the most part due to a decline in heavy physical activity.

Gender. After the age of 55-60, women may have a higher incidence of osteoarthritis of the knee than men. Some studies suggest that the decline in native oestrogen, the female hormone, after menopause may play a role in amplified OA risk in women. Women with generalised osteoarthritis [hands, spine, knees and/or hips] appear to have a marginally increased risk of premature death too.

Obesity. Studies suggest that the risk of osteoarthritis of the knee joint in women increases by 40 per cent for each 10-pound weight gain. A body of medical opinion insists that if obesity were eliminated, the incidence of osteoarthritis of the knee joint in men and women would fall by 25-50 per cent.

Previous injury. Joint injury, such as a tear in the knee, increases the risk of osteoarthritis. OA occurs more swiftly in older adults with joint injuries than in younger people. Individuals who hold jobs requiring intense physical labour repeatedly ‘endure’ chronic joint damage. This often leads to osteoarthritis.

Muscle weakness. Studies have shown that some weakness in the quadriceps muscle [the muscle that runs from the front of the thigh across the knee, and down to the shin] is associated with osteoarthritis of the knee joint in people over age 65. Besides, a decline in the strength of the knee, brought on by aging, also leads to increased risk of osteoarthritis.

Congenital abnormalities. A structural abnormality, like congenital hip dysplasia [a childhood condition caused by abnormal development of the hip joint], can lead to osteoarthritis in later life, principally due to changes in the shape of the joint.

Joint infections. Though this is uncommon, joints can be infected by bacteria, viruses, fungi and mycobacteria [organisms that cause tuberculosis]. They can infiltrate the joint spaces. The outcome: acute and chronic damage, in the long run, and impending osteoarthritis. Some of the most infamous microbes that infect the joints also include the bacteria that cause Lyme disease and gonorrhoea.

Metabolic and hormonal disturbances. A host of disorders characterises osteoarthritis as a complication. They include Paget’s disease [where the bones are remodelled inappropriately], acromegaly [a slow progressive disease characterised by excessive circulating growth hormone], and haemochromatosis [iron storage disease].

Diet. Inappropriate diet and faulty lifestyle, or lack of exercise, may be yet another cause of OA. Recent studies have shown that high levels of vitamin C and vitamin D in the diet may be beneficial in osteoarthritis. In one study, evidence of continuing joint damage was reduced three-fold in people with the highest dietary intake of vitamins C and D. Most important: a bad gut is yet another likely cause of OA.

Symptoms

  • Pain, commonly in the hand, knee and hip joints; sometimes in the spine
  • Pain often related to any activity of the joint; pain, generally worse at the end of the day and/or after periods of activity [As the disease advances in its intensity, pain is often present during rest]
  • Stiffness, following long periods of inactivity, especially in the morning, after a goodnight’s sleep and/or after sitting for a long time
  • Restricted movement of the joint
  • Tenderness [sensitivity] and occasional swelling
  • ‘Crackling’ of the joints, accompanied by pain [This may also occur in a normal joint, not affected by osteoarthritis. It is usually painless]
  • Deformity of the joints — most notably seen when the disorder progresses to its crescendo.

Treatment

One of the foremost conventional modes of treatment to ease arthritis pain is the use of prescription drugs — non-steroidal anti-inflammatory drugs [NSAIDs] — which are quite expensive. Furthermore, the long-term use of such medications is known to lead to dangerous side-effects. Reports estimate that thousands of patients suffer from gastro-intestinal bleeding as a direct result of NSAID use, every year.

Ironically, though these drugs are used for arthritis pain relief, they are known to actually hasten the destruction of cartilage itself. One study, conducted in Europe, found that OA patients taking Indocin, an NSAID, had far more rapid destruction of the hip than the group not taking any NSAID. The Journal of the American Medical Association [JAMA], to underline the point, reports of severe liver damage caused by Voltaren, an NSAID most frequently prescribed for arthritis in the US. The journal reports that patients developed hepatitis within 4-6 weeks of taking the medication, and possible liver damage too, some weeks after taking the drug.

Corticosteroids, like NSAIDs, are used to control inflammation and stifle symptoms. They seem to have just as many bad effects as NSAIDs; perhaps, more. According to Dr Julian Whitaker, MD, “These agents [corticosteroids] are so powerful that, even at lower doses, a handful of side-effects are not just possible, they are expected. On less than 10mg per day, an individual will feel increased appetite. Salt and water will be retained. The individual will gain weight. And, will get sick more often. Research shows an increased susceptibility to infections in arthritis patients on corticosteroids.”

Dr Whitaker elaborates, “If the dose is stepped up, a whole cascade of problems can emerge. There are cosmetic problems, such as acne and increasing facial hair in women. Some individuals may begin to feel muscle cramps and weakness. The individual’s skin may thin and weaken. Peptic ulcers may develop. Blood pressure may rise, with its attendant risks. Diabetes can develop. So can osteoporosis. Susceptibility to blood clot formation increases. It is suggested that over one half [57 per cent] of individuals on corticosteroids have depression, or other emotional disturbances. This is not surprising, considering the onslaught of side-effects overlaid on their original disease.”

To augment the exemplar. When NSAIDs and steroids stop to ‘halt’ the progression of arthritis, patients are often asked to switch over to a third option, down the line — this drug therapy consists of methotrexate, cyclophosphamide, penicillamine, hydroxychloroquine, azathioprine, and gold therapy. They are, in essence, toxic disease-modifying drugs, which are administered concurrently with NSAIDs and corticosteroids.

According to a study published in The Lancet, which looked at a group of patients who were on such aggressive drug therapy over a 20-year period, one-third [35 per cent] had died and another fifth [19 per cent] were severely disabled. Most of the mortality and morbidity, the study pointed out, was directly related to arthritis and its treatment. Interestingly, the study observed that only 18 per cent of patients were able to lead normal lives.

Wait a moment. There are, in addition, anti-inflammatories such as aspirin and acetaminophen [paracetamol] that can lead to serious, unfavourable effects. It is estimated that almost 15-20 per cent of individuals or patients who take large doses of these non-prescription, or over the counter [OTC], drugs are likely to develop serious gastric ulcers. In the US alone, it is estimated that 15,000 of them die from gastro-intestinal haemorrhages, every year. It is also said that kidney failure is another possible side-effect of NSAIDs, especially in individuals whose blood flow is inadequate, owing to age and/or on account of medications.

Now, the big question — what happens when drugs, like NSAIDs or steroids, no longer help? You are witness to the most likely scenario. Your doctor will hurl their hands up in the air, with a touch of disgust, and say, “There’s nothing much we can do for you, apart from surgery.” So, you move on to the next step — with hope and also apprehension.

Arthritis surgery often consists of one or more of the following procedures: synovectomy, or removal of badly inflamed joint synovium; anthroplasty, or joint realignment and reconstruction; joint fusion, or tendon repair; and, artificial joint replacement, which is the most expensive, but also the most effective in ‘advanced’ cases, when nothing provides tangible relief.

Yet, on the downside, it is estimated that 50 per of joint replacement patients continue to have pain and restricted mobility following the procedure. Many also experience extreme discomfort than before the surgery. Patients, who manage to get through, tend to often have problems with the operated joint 3-4 years later and may require undergoing the procedure again in 8-10 years. Add to this the cause of joint problems not having been corrected fully, and you will probably come back with the disorder in a different form.

Natural Treatment

Now, the big question — if existing drugs don’t really work, in certain instances, is there anything else, which is useful in the long-term and free of deleterious side-effects the arthritis sufferer can resort to for subjective and objective relief? There are no easy answers, nor solutions. The best thing to achieve, or aim at, is prevention, as some physicians and clinicians suggest and incorporate an integrated approach which synthesises the best of the two worlds — modern medicine with natural approaches, such as certain herbs, like boswellia [Indian frankincense], or dietary supplements, such as glucosamine, chondrotin, fish oil, multi-vitamin-mineral supplements and methylsulphonylmethane [MSM], that have it in them to offer a ‘palpable’ degree of relief in ‘medically preventable, or treatable’ cases — although this is sometimes easier said than done, or achieved.

All the same, the caveat is natural products, though relatively safe and useful, are not ‘quick-fixes’ or ‘swift’ cures. You’d first need to realise that inflammation must be stopped and the tissue ‘rebuilt’ before OA pain can come to a standstill. Also, the elder or older the person is, the longer the rebuilding process. However, while some individuals notice results after using natural remedies, it should be borne in mind that the damage to the joints didn’t happen suddenly. It was a slow process. Hence, its repair, perforce, will take equal or more time.

Homeopathy 

  • In a study, published in The American Journal of Pain Management, OA patients were split into two groups. They were either given a homoeopathic remedy, or acetaminophen, a commonly prescribed conventional drug for pain relief in OA. The study’s researchers found that homeopathy provided a level of pain relief that was superior to acetaminophen, yet with no adverse reactions, or side-effects.
  • In a clinical study carried out at the Glasgow Homeopathic Hospital, UK, a group of people suffering from OA were treated with coated aspirin and another group suffering from the same condition were treated with individualised homeopathic treatment. The results of the two forms of therapy were compared at the end of the study. It was found that OA subjects on homeopathic treatment did considerably better than subjects on aspirin. In addition, more than 40 per cent of subjects taking aspirin during the study experienced side-effects, while individuals taking homeopathic treatment experienced no side-effects.
Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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