The Trumpet Medical Advisor |
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Patricia Naeder, RN, BS.
October, 2010 Edition ew3 |
~~~~ OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS ~~~~ |
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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 “itis” means “inflammation of.” 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. 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
Heberdon’s and Bouchard’s nodes. Heberdon’s nodes are usually seen in
the first digit close to the finger tip. Bouchard’s 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. Heberdon’s
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 don’t 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 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 joint’s 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.
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.
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.
-
T cell
modulators
-
Interleukin 1 inhibitor (Il1)
-
Interleukin 6 inhibitor (Il6) and a
-
Targeted
B cell therapy 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.
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 it’s the only blood thinning
agent you’re 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 it’s in your multivitamin. It is the body’s 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 nature’s 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 body’s 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 athlete’s 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 don’t.
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 it’s hot, cool it
with a Cool Pak.
-
If your muscles are
fatigued, stop.
-
Don’t ruin your joints
with abusive activities.
-
Moderation is really
best!
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Good Health to You! |
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Medical Advisor |
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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 |
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