Alternative Treatments for Arthritis

Leading Cause of Disability in the United States

Did you know that arthritis is the leading cause of disability in America? An estimated 50 million Americans suffer from arthritis or arthritis-related symptoms - that's 1 in 5 people struggling with arthritis pain. There are over 100 different forms of arthritis. Osteoarthritis, lupus, rheumatoid arthritis, gout, and fibromyalgia all qualify as arthritic diseases.

Initial Symptoms

The first symptoms of arthritis may come on like gangbusters with swelling of tissues causing extreme skin sensitivity, stabbing, knife-like pain and a deep aching in the joints, thus inhibiting movement.

The Role of Synovial Fluid

The swollen tissues are caused by inflammation of the synovial membranes.

Synovial fluid is a viscous, Non-Newtonian_fluid" found in the cavities of synovial joints. With its yolk-like consistency ("synovial" partially derives from ovum, Latin for egg), the principal role of synovial fluid is to reduce friction between thearticular cartilage of synovial joints during movement.

The inner membrane of synovial joints is called the synovial membrane and secretes synovial fluid into the joint cavity. The fluid contains hyaluronic acid secreted by fibroblast-like cells in the synovial membrane and interstitial fluid filtered from the blood plasma. This fluid forms a thin layer (roughly 50 μm) at the surface of cartilage and also seeps into microcavities and irregularities in the articular cartilage surface, filling all empty space. The fluid in articular cartilage effectively serves as a synovial fluid reserve. During movement, the synovial fluid held in the cartilage is squeezed out mechanically to maintain a layer of fluid on the cartilage surface (so-called weeping lubrication). The functions of the synovial fluid include:

• reduction of friction - synovial fluid lubricates the articulating joints
• shock absorption - as a dilatant fluid, synovial fluid is characterized by the rare quality of becoming more viscous under applied pressure; the synovial fluid in diarthrotic joints becomes thick the moment shear is applied in order to protect the joint and subsequently thins to normal viscosity instantaneously to resume its lubricating function between shocks
• nutrient and waste transportation - the fluid supplies oxygen and nutrients and removes carbon dioxide and metabolic wastes from the chondrocytes within the surrounding cartilag

Areas of the body commonly affected include the hands/fingers, knees, hips, feet/toes, and shoulders.

Treating the Symptoms

Many people diagnosed with arthritis take ibuprofen, Tylenol, or aspirin for relief of the pain associated with arthritis. Although there are times when this is necessary due to the excruciating pain caused by arthritis, these drugs treat the symptoms, rather than treating the cause.

Ibuprofen and aspirin treat the symptoms of arthritis by blocking the release of prostaglandins. They are termed COX-1 and COX-2 inhibitors.

The Role of Prostaglandins

Prostaglandins are found in most tissues and organs. They are produced by all nucleated cells except lymphocytes.

They are autocrine and paracrine lipid mediators that act upon platelets, endothelium, uterineand mast cells. They are synthesized in the cell from the essential fatty acids[5] (EFAs).

Prostaglandins are produced following the sequential oxidation of AA, DGLA or EPA by cyclooxygenases (COX-1 and COX-2) and terminal prostaglandin synthases. The classic dogma is as follows:

• COX-1 is responsible for the baseline levels of prostaglandins.
• COX-2 produces prostaglandins through stimulation.

However, while COX-1 and COX-2 are both located in the blood vessels, stomach and the kidneys, prostaglandin levels are increased by COX-2 in scenarios of inflammation. A third form of COX, termed COX-3 is thought to exist in the brain and may be associated with relief of Headaches when on NSAID therapy.

There are currently ten known prostaglandin receptors on various cell types. Prostaglandins ligate a sub-family of cell surface seven-transmembrane receptors, G-protein-coupled receptors. These receptors are termed DP1-2, EP1-4, FP, IP1-2, and TP, corresponding to the receptor that ligates the corresponding prostaglandin (e.g., DP1-2 receptors bind to PGD2).

The diversity of receptors means that prostaglandins act on an array of cells and have a wide variety of effects such as:

• cause constriction or dilation in vascular smooth muscle cells
• cause aggregation or disaggregation of platelets
• sensitize spinal neurons to pain
• decrease intraocular pressure
• regulate inflammatory mediation
• regulate calcium movement
• control hormone regulation
• control cell growth
• acts on thermoregulatory center of hypothalamus to produce fever
• acts on mesangial cells in the glomerulus of the kidney to increase Glomerular filtration rate

Side Effects of Long Term Use of NSAIDS

Long term use of NSAIDS, such as Ibuprofen and aspirin have been linked to gastrointestinal problems,including bleeding, and perforation of the stomach and intestine. Additionally, these may cause an increased risk of hypertension, serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.

As anyone who has ever suffered from the pain of arthritis knows, at the time you are having pain, the risk of causing damage is negated by the pain you are feeling at the moment. And, so we swallow the pills.

NSAIDS Stop the Healing Process

Another side effect that is not often mentioned, but discovered when a family member underwent rotor cuff surgery is what NSAIDS do to your joints over the long term.

The family member was prohibited from taking aspirin, tylenol, or ibuprofen after his surgery and instructed to take oxycontin for pain instead. When the doctor was questioned as to the reason for this, he replied, "NSAIDS inhibit inflammation. We want the shoulder to be inflamed, as this helps to heal the tissue and the joint. These drugs stop the healing process."

Long term that means that the very drugs arthritis sufferers are taking to relieve pain could end up causing more destruction in the joints, resulting in even more arthritic pain.

NSAIDs inhibit bone healing by blocking a natural substance in the body, prostaglandin, which supports the activity of bone-building cells, called osteoblasts. Without it, osteoblasts can still make new bone, "but not as robustly,'' said Dr. Thomas Einhorn, chairman of orthopedic surgery at the Boston University School of Medicine.

High-quality human studies are scarce, but animal studies, including work in Einhorn's lab, clearly demonstrate that NSAIDs inhibit healing. The good news, he said, is that once NSAIDs are discontinued, bone healing resumes.

The Role of Diet and Exercise

Asian and Indian cultures where the diet consists mainly of fish, organic fruits, vegetables, nuts, and herbs, and meat, rather than refined white sugar, flour, processed foods, and meat injected with steroid, antibiotics, and hormones, have relatively low rates of arthritis.

The reason for this? Naturopathic doctors theorize that toxins build up in the digestive system and eventually cause permeation through the intestines. These toxins then filter into our joints through the blood stream causing arthritis.

Some of the worst inflammatory agents are believed to be sugar, caffeine, and red meat. Also, vegetables in the nightshade family, such as tomatoes and eggplant have been noted by some as worsening arthritis.

It is also believed that food allergies to dairy, gluten, etc. can cause arthritic-like symptoms.

The only way to see if diet will help is to incorporate foods thought to be good for arthritis, while eliminating those thought to be inflammatory. Keep a food journal and see if you notice a difference.

Food Groups that arthritis sufferers have had good luck with include the following:

Fruits (high in Vitamin C)
Vegetables (high in Vitamin A)
Fish (rich in Omega-3 essential fatty acids--EFA-- and high in Vitamin E)
Unsalted Nuts and Seeds
Pulses and Grains

Anti-Inflammatory Foods

Tumeric
Ginger
Apples
Garlic
Apple Cider Vinegar

Herbs for Arthritis

There are so many different herbs out there that to list ones that are good for arthritis would take another article. As a cautionary note--many herbs may interfere with prescription medicines. If on prescription medicines it is best to consult with a naturopathic doctor/herbalist for advice on herbs. (Two that I take are bosweilla and rosehips)

During World War II, the people of Britain were encouraged through letters to The Times newspaper, articles in the British Medical Journal, and pamphlets produced by Claire Loewenfeld, a dietitian working for Great Ormond Street Hospital for Sick Children, to gather wild-grown rose hips and to make a vitamin C syrup for children. This was because German submarines were sinking many commercial ships: citrus fruits from the tropics were very difficult to import.

Rose hips also contain some vitamin A and B, essential fatty acids and antioxidant flavonoids. A study of a rose-hip preparation for treating rheumatoid arthritis concluded that there was a benefit, apparently due to both anti-inflammatory and anti-oxidant effects.

Many times doctors caution their patients not to take herbs.

However, in Asian and Indian cultures, where herbs, spices, and essential oils are used in medicine, the populace tends to be healthier than western cultures that depend on pharmaceutical drugs.

Exercise

Those who subscribe to the "no pain, no gain" exercise theory may be shocked to learn that very vigorous or prolonged exercise can cause further damage to your joints. It is only common sense. The best exercises for arthritis are those that do not cause trauma to the joints. These would include yoga, tai chi, swimming, and rebound exercise--that is jumping on a trampoline--and recumbant biking.

Exercise strengthens the muscles, ligaments, and tendons supporting the joints. Exercise helps the body to eliminate toxins through sweat glands. It also increases the secretion of certain "feel good" chemicals, such as serotonin, and dopamine.

Exercise is an essential part of slowing the progression of arthritis. Just take it slow.

Sources:

Bosweilla, Memorial Sloan Kettering Cancer Center

Judy Foreman, Boston Globe, NSAIDS inhibit bone healing, June 22, 2009

Prostaglandin, Wikipedia

RA-Food Allergies, Arthritis Today

Rose Hip, Wikipedia

Brian Cox, Spicy Foods will improve your health, Chinese Anti-Aging Secrets

Translating Science into Cures, Unfortunately, Aspirin will never be the cure for arthritis, Arthritis National Research Foundation

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