The Trumpet Medical Advisor

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patPatricia Naeder, RN, BS.

pat@billbaur.com/public

    

October, 2010 Edition ew3


~~~~ OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS ~~~~

    

One in three people in America suffer from arthritis of some type.  It occurs in both genders, but somewhat more prevalent in women.

It is a painful, limiting malady.  Arthro means joint, and ďitisĒ means ďinflammation of.Ē

 OSTEOARTHRITIS

WHAT IT IS:

The protective cartilage on the ends of the bones begins to wear away and degenerate, producing bone on bone irritation and pain. Then there is degeneration of the adjacent anatomical structures such as the membrane lining of the joint which produces the protective synovial fluid to keep the joint moving smoothly.

This synovial fluid can seep out, or reduce in production due to the  inflammation and degeneration of the joint.

This process causes inflammation, pain, swelling, stiffness, and limitation of movement of the joint as further degeneration, and scaring of the joint continues.

 SYMPTOMS:

Because of the wearing away of the cartilage and the wear and tear from over-demand on the joints, not only is there deterioration of the joint but there can be painful nodes, calcifications and bone spurs in the hands and feet.

These are called Heberdonís and Bouchardís nodes. Heberdonís nodes are usually seen in the first digit close to the finger tip. Bouchardís nodes are seen in the middle of the fingers and toes. 

CAUSES:

1-   Osteoarthritis can run in families, with a predisposing genetic component.

2-   It can be triggered in athletes by over stressing and abusing the joint over the years with repeated and over-demanding, or twisting activities. This causes the joint to become inflamed and degenerate.

3-   Dancers also place constant over-demand on their joints.

4-   Manual laborers who pound with tools, or lift heavy objects are subject to triggering inflammation.

5-   Constant use of a computer board and the repeated trauma to the joints, and especially the dominant index finger, can trigger it also. Heberdonís nodes are commonly seen on index fingers.

TREATMENTS:

1-   There are many options for you and your physician to use to treat osteoarthritis. Use a multi-pronged approach for the best results.

2-   Treat the symptoms with over the counter anti-inflammatory, pain medications that you would use for a headache. Be aware of the particular side effects of the product that you choose. Some can irritate the stomach lining, which would irritate ulcers.

Others, like Aspirin, can thin your blood, so that if you are on Plavix, or Coumadin/Warfarin, you would not want to choose aspirin for your pain relief.

3-   There are prescription Cox 2 inhibitors that you can speak to your physician about.

4-   You can use Cool Paks to calm the joint and shrink the swelling for instant relief.

5-   Speak to your physician about an anti-inflammatory diet to reduce inflammation and swelling, which reduces pressure on the nerves that transmit the pain message. See list below.

6-   There are many Anti-inflammatory diets out there. Basically use The Mediterranean style diet which is hi in vegetables, fruit, salmon and cold water fish, and olive oil. Avoid hi fat foods like bacon, butter, cold cuts, cream, and sausage.

7-   Some Anti-inflammatory foods are:

a.     Ginger.

b.    Pineapple.

c.     Curcumin.

d.    Turmeric.

e.     Fish.

f.      Green tea. If you donít like the taste, put another tea bag in with it.

8-   Anti-inflammatory supplements such as Omega 3 fish oil (low mercury) and a multivitamin with minerals, will work well.

   

 RHEUMATOID ARTHRITIS

Rheumatoid Arthritis is an auto-immune condition. The immune system begins act against the joints and adjacent structures such as the lining and supportive structures around the joints, which then become swollen, inflamed, and can become damaged.

Rheumatoid arthritis can be found in any joint, but is commonly seen in the hands, wrists, and knees, not usually in the spine, as in osteoarthritis.

The inflammation can be moderate to pervasive and can affect the cartilage, bone, nerves, skin, and sometimes other organs. If it is diagnosed and treated early, the damage to the jointís anatomy can be slowed.

SYMPTOMS:

1-   Fingers wrists and feet inflamed, and may be swollen.

2-   Pain in joints.

3-   Can be damage to lining of joints and the adjacent structures.

4-   Cartilage, tendon and ligament damage can turn the anatomy into abnormal positions due to instability of the structures.

5-   Joints feel hot.

6-   Can affect other organs which would show up on blood work

7-   Fatigue.

8-   Loss of appetite.

9-   Low grade fever.

Patients with Rheumatoid Arthritis do not have uniform symptoms. There is a spectrum. They can be unpredictable, with periods of remission and exacerbation.

Some patients may have little damage on their imaging, and yet have severe pain. Others may have severe damage and mild pain.

The course of symptoms is not predictable, depending upon the state of the immune system and the therapy used.

MAKING THE DIAGNOSIS:

1-   History and physical.

2-   X-Rays for bone structure pictures.

3-   Imaging studies, like MRI to see how much of the joint is involved.

4-   Blood work:

Blood Work for Rheumatoid Arthritis focuses on inflammatory blood markers after baseline studies are done:

1-   Routine Sedimentation Rate reveals the level of damage in the body.

2-   C Reactive Protein indicates inflammation levels in the body.

3-   Test for Rheumatoid Factor, (IgMRF) ( 80% of Rheumatoid Arthritis patients are positive for it. 20% are not) This is more specific. There can be false positives. Repeat all positive tests.

 4-   Anti-CCP  (Anti cyclic citrullenated peptide antibody). This is a newer antibody test to help determine the TYPE of Rheumatoid Arthritis present.

If this comes back with a High result, it can suggest that there is a higher chance of attack on the anatomy of the joint. This helps the physician in their choice of therapies.

TREATMENTS:

The goal of therapy is to manage the symptoms by reducing inflammation, controlling pain, decreasing anatomy damage, preventing disability, and supporting health and regeneration of anatomical structures.

1-   Manage pain and inflammation in cooperation with your Rheumatologist.

2-   There are many pain and anti- inflammatory medications to choose from. Discuss with your physician.

3-   Summary of drug categories used in treatment of Rheumatoid Arthritis, aimed at the mechanism of cause:

      a.  In the 1980s a class of drugs was frequently being used to target the activity of the immune system. They are called DMARD class of drugs; Disease Modifying Anti-heumatic drugs.

      b.  In the 1990s the new biologic form of DMARD class of drug started to be used to target TNF, tumor necrosis factor.

      c.  Today, with the advent of biologically based Research and Development in Medications we are enjoying an ever expanding group of new therapeutic drugs that target the causes of the auto-immune problem by aiming at the segments of the Immune System.

4-   We are enjoying the use of newer types of Biologic Drugs that target different parts of the Immune System. This is a very exciting time because we now have agents such as:

      -         T cell modulators

      -         Interleukin 1 inhibitor (Il1)

      -         Interleukin 6 inhibitor (Il6) and a

      -         Targeted B cell therapy

 These advances in treatment should give everyone hope, that we are finally treating the cause of our disorders instead of the symptoms. So have faith and hope for your future. Medical Research is working for you.

 NATURAL SOLUTIONS TO ADD TO YOUR REGIMEN (Please discuss the following with your physician before integrating into your regimen. There may be interactions with your medications. Also, allergies need to be considered.)

Living an Anti-inflammatory life is good for everyone. I am listing some optional Lifestyle changes that you can add to your life to keep your health at an optimum level.

 Keep in mind that many people are allergic to different foods and supplements. So test first. Also, remember that supplements interact with your medications. Discuss with your doctor.

1-   Walk 20 minutes a day 5 days a week, if you are able. It brings circulation, which carries nutrients and oxygen with it. Also walking strengthens muscles and bones.

2-   Eat an anti-inflammatory diet like the Mediterranean diet: Fruit, veggies, fish, olive oil, nuts, and occasionally lean beef. Eat the foods that rank high on the ORAC antioxidant scale.

3-   Eat a low fat diet. No cold cuts, bacon, butter, heavy cream. Fat increases inflammation, and weakens your immune system.

4-   Eat low sugar diet. Eat fruit for dessert instead of cake or cookies.

5-   Ginger is an anti-inflammatory and aids digestion. It can be found in Chinese food. Or buy a knuckle of it in the produce aisle, and grate in on your chicken and other food.

6-   Eat pineapple. It contains bromelain which is an anti-inflammatory. It also thins blood slightly, which is good if itís the only blood thinning agent youíre taking.

7-   Take a Multivitamin with minerals, daily.

8-   Omega 3 is an anti-inflammatory, and speeds healing.

9-   GLA is Gamma Linoleic acid. Said to raise prostaglandin E1, that suppresses inflammation. Works well with Omega 3.

10- Vit E. Make sure that itís in your multivitamin. It is the bodyís principal fat soluable antioxidant, anti-inflammatory nutrient. It has been used in rheumatoid arthritis.

11-    Vitamin C is a powerful antioxidant that helps rebuild injured tissue. It also enhances collagen, which is a protein forming substance. A deficiency in Vit C can cause rheumatic symptom and bruising. If your multivitamin only has 60 to 100mg of Vitamin C, ask you doctor if you can take a 500mg Vit C daily.

12-    B-Complex pill a few times a week enhances normal nerve function and helps relieve pain. Eating lean beef is an alternative here.

13-    Flavonoids are among natureís best anti-inflammatory nutrients! They are found in fruit and vegetables; especially the dark green leafy, red and orange colorful ones.

14-    Grape seed extract. A very powerful anti-oxidant which scavenges up damaging free radicals harming your cells.

15-    Pycnogenol (Ginger pine bark extract) A strong anti-oxidant. Watch for allergies to trees here.

16-    Resveratrol, from skins of red grapes is great anti-oxidant.

17-    Glucosamine has been studied for cartilage repair. The studies are still being done over and over. The results are changing all of the time. Check for allergic reaction.

18-    MSM is a sulfur-rich substance and a cousin to DMSO. Sulfur is necessary to build disulfide bonds which hold tissue together, including cartilage, muscle and skin. Discuss with your physician.

19-    Sam-e supplement is a by-product of protein that contributes sulfur to many of the bodyís chemical reactions. It is a methyl donor. Therefore it contributes to molecules that are involved with calming inflammation, and pain. It is also said to contribute to tissue repair and growth. Some of these molecules help to form cartilage, tendons, and ligaments, and keep athleteís anatomy in repair.

20-    Chondroitin is the most abundant glycosamino glycan found in cartilage. It is said to act by preventing enzymes from destroying cartilage. Check for allergy reaction. Some people have had allergic reaction to glucosamine/chondroitin combinations, but most people donít.

Resources for you:

1-   Arthritis Foundations Drug Guide.

2-   American Academy of Orthopaedic Surgeons.

3-   American College of Rheumatology.

4-   American Pain Foundation.

5-   Arthritis Foundation.

6-   Association of Rheumatology Health Professionals.

7-   Hospital for Special Surgery.

8-   Johns Hopkins Arthritis Center.

9-   National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Listen to your body when exercising:

      -         If it hurts, stop.

      -         If it burns, stop.

      -         If itís hot, cool it with a Cool Pak.

      -         If your muscles are fatigued, stop.

      -         Donít ruin your joints with abusive activities.

      -         Moderation is really best!

 Remember, when youíre feeling low, hang on, because thereís no way but up!

 

Good Health to You!

 

Patricia Naeder, RN, BS

Medical Advisor

 

This column is for informational purposes only, and represents the opinion, and reporting of the author only. Any discussions with the Author should be presented to your own personal Physician for his/her Professional opinion. It is not meant to substitute for seeing one's own Medical Doctor, Psychiatrist, or Psychologist for Professional care.

This article is copywrited by the Autho