Coping With Arthritis

By RAJGOPAL NIDAMBOOR

Arthritis is a degenerative disorder of the joints, characterised by pain and inflammation.

The most common form of arthritic affection, osteoarthritis [OA], affects millions of people worldwide -- as a matter of fact, it seems to be more common than heart disease and diabetes.

Call it a paradox, or what you may, one major fact remains -- osteoarthritis is only going to expand in its intensity, and also get firmly rooted in one’s middle years, sooner than later.

Also -- if the problem affects millions of people in India today, including over 40 million Americans, experts estimate that over two million people visit their doctor for osteoarthritis, in the UK, every year.

Osteoarthritis is characterised by loss of cartilage and joint degeneration. It is a condition that is much more common in men at age 45; it becomes more predominant in women over age 45.

Osteoarthritis, to put it mildly, robs you of your basic ability to get fully engaged in day-to-day activity. When it escalates, it may confine you to your bed -- even for days at a stretch. In its early stages, it may affect one joint, or multiple joints; besides, it varies in its intensity, or severity. The result: one may experience mild pain and stiffness and/or crippling aches, not to speak of joint deformity.

Needless to say, osteoarthritis is one of man’s oldest afflictions.

By way of medical definition, OA is a chronic disease that involves the breakdown of joints and surrounding tissue. Its name is derived from Greek: “osteo,” refers to bones; “orthro,” to joints involved; and, “itis,” referring to the inflammatory process of the disease.

In simple terms, osteoarthritis is a typical progression of events affected by normal aging, physical injury, chronic joint stress, oxidative stress, and genetic anomalies.

It is estimated that Americans alone spend over $10 billion a year in an attempt to alleviate arthritis pain. Add to this, the expenditure on arthritis medicines worldwide, and you have a huge market, nay an industry, catering to patients’ needs.

NSAIDs: Damaging Effects

One of the most conventional modes of treatment to ease arthritis pain is the use of prescription drugs -- non-steroidal anti-inflammatory drugs [NSAID], which are quite expensive. Furthermore, the long-term use of these medications is known to lead to dangerous side-effects.

Reports estimate that thousands of patients suffer from gastrointestinal tract bleeding as a direct result, from 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 recent study, conducted in Norway, has found that OA patients taking indocin, a strong NSAID, had far more rapid destruction of the hip than the group not taking any NSAID.

“The Journal Of The American Medical Association,” to underline the point, reports severe liver damage caused by voltaren, a NSAID most frequently prescribed for arthritis in the US. The journal also reports that patients developed hepatitis within 4-6 weeks of taking the medication, and also possible liver damage, weeks after taking the drug.

Steroids Ain’t Good

Corticosteroids, like NSAIDs, are also used to control inflammation and suppress symptoms. They seem to have just as many bad effects as NSAIDs; perhaps, more.

According to the noted alternative physician, Dr Julian Whitaker, “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 10 mg per day, an individual will feel increased appetite. Salt and water will be retained. The individual will gain weight. And, the person will get sick more often. Research shows an increased susceptibility to infections in [rheumatoid] arthritis patients on corticosteroids…”

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. 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. Meantime, over one-half [57 per cent] of individuals on corticosteroids have depression, or other mental, or emotional disturbances. This is not surprising, considering the onslaught of side-effects overlaid on their original disease.”

What Next?

When NSAIDs and steroids stop to halt the progression of arthritis, down the line, patients are often asked to switch over to a third option -- 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 112 patients who were on such an aggressive drug therapy over a 20-year period, over 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 [rheumatoid] 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 anacin, aspirin, and acetaminophen [paracetamol] that can lead to serious, unfavourable effects. It is estimated that almost 15-20 per cent patients who take large doses of these non-prescription, or OTC, drugs are likely to develop serious gastric ulcers.

In the US alone, it is estimated that 10,000 of them die from 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.

The Big Question

Now, the big question -- what happens when drugs, like NSAIDs or steroids, no longer help you?

You are witness to the most likely scenario. Your doctor will hurl his 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.
• Artificial joint replacement, in the most severe cases, which is also the most expensive, and extremely profitable for the doctor performing the procedure. It is also the most painful of surgical procedures with protracted recovery time and recuperation.

It is reported that an estimated 50 per of joint replacement patients continue to have pain and restricted mobility following the operation. 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 to undergo the procedure again in 8-10 years. Add to this the cause of the joint problems having not been corrected, and you will probably come back with the disorder in other parts of the body. You will have nothing but only lament, thereafter.

Hence, the big question, again -- if existing drugs and medical procedures don’t work, is there anything else, which is useful and free from deleterious side-effects, the arthritis victim can resort to, for relief?

Nature Nurtures

Thank nature for big mercies! This is not all. New research is throwing fresh light on natural remedies and opening up new treatment avenues for relief from arthritic agony.

Let’s look at some of the natural arthritis remedies, or supplements, also called nutraceuticals, that natural physicians/therapists recommend the most. These remedies are all well-researched and have proven very effective in the treatment of arthritis.

Glucosamine Sulphate

The most widely used natural substance for arthritis, glucosamine offers a low-cost and safe alternative to arthritis drugs. Besides this, it provides, in most cases, better pain relief than prescription or over-the-counter [OTC] medication.

Several studies have found that by adding glucosamine, a naturally occurring substance in our body, back to the body in supplement form, leads to enhanced connective tissue healing and regeneration.

Glucosamine has been a boon for anyone suffering from diseases related to cartilage destruction. It may also be further said that glucosamine treats the root cause of the problem rather than just suppressing the symptoms as do standard drug therapies. In addition, glucosamine, unlike NSAIDs, is considered quite safe and non-toxic. The best part -- it can be used for extended periods of time without any hazard.

Chondroitin Sulphate

When glucosamine is combined with chondroitin sulphate, another naturally-occuring substance in the body, it has been found to be extremely effective in treating oseoarthritis. Several research studies also evidence the effectiveness of this combination as a safe and effective arthritis treatment plan. Glucosamine and chondroitin, which are both popular supplements of choice today, work together synergistically to initiate the production of new cartilage. At the same time, they protect the existing cartilage tissue, and prevent damage to it.

Glucosamine and Chondroitin have received wide acceptance after the mid-1990s, following the publication of the best-selling book, “The Arthritis Cure.”

In addition, the following natural substances, according to the latest research, have also been shown to reduce the symptoms/pain of arthritis.

Cetyl Myristoleate [CMO]

CMO is a natural immuno-modulator. It is believed to help regulate and normalise a faulty immune system, and reduce or impede the arthritic process itself. It works on nature’s own premise -- that once joint deterioration stops, and pain and inflammation are relieved, the body can heal itself from within and return to normalcy.

First discovered by Harry W Diehl, while working alone in his home laboratory, CMO is essentially an oil. It has sure come a long way…

While a host of published research reports commend its positive value in relieving joint pain, many studies have also corroborated its use to “modulate the inflammatory process” -- the hub of your arthritic agony.

Here’s testimony:

• In a double blind study, which included sixty-four patients, with chronic osteoarthritis [OA] of the knee joint, half of the patients received a CMO complex; the other half received a placebo, or dummy pill. Measurements included physician review, assessment of knee joint function, and the Lequesne Index -- a research tool used to measure the severity of OA symptoms. The result? Patients in the CMO group showed significant improvement, while patients in the placebo group showed little or no improvement. Researchers in the study concluded that CMO “may be an alternative to the use of non-steroidal anti-inflammatory drugs [NSAIDs] for the treatment of OA.” – “Journal Of The Rheumatology.”
• In another study that included 1,814 arthritis patients, results showed that over 87 per cent of the subjects had greater than 50 per cent recovery, and over 65 per cent showed 75 per cent to 100 per cent recovery, following a 16-day treatment on CMO. -- Advanced Medical Systems & Design, Ltd.,

This is not all. Says Dr Douglas Hunt, who was one among the first medical pioneers to research and study the long- and short-term effects of Cetyl myristoleate: “CMO does its job! Many who have taken CMO have been free of joint and muscle pain for as long as nine years.”

Studies have also found that when CMO is combined with Sea Cucumber -- a natural anti-inflammatory agent -- the “shared” formula is rendered more effective and potent to relieve arthritic pain from its roots.

Sea Cucumber, which has a long history of medicinal use in the Orient, encompasses a nerve-blocking agent -- holothurin. Holothurin has been stated to relieve joint pain and stiffness -- naturally. Besides, research also confirms the fact that Sea Cucumber is useful for many inflammatory conditions -- not just osteoarthritis and rheumatoid arthritis, but also ankylosing spondylitis, and so on.

Sea Cucumber, studies further report, has the ability to balance prostaglandins, which regulate the inflammatory process. Besides, it contains both chondroitin and mucopolysaccharides, which are “undersupplied” in arthritic patients. When the two elements are incorporated in your medicinal/treatment regimen, they not only reduce inflammation, but also help in tissue repair and lubrication of your joints.

MSM [Methylsulfonylmethane]

MSM, a natural form of organic sulphur, is found in all living organisms, including human body fluids and tissues.

Robert Herschler and Dr Stanley Jacob of the University of Oregon Medical School isolated it, in the early 1980s. The duo’s research showed that MSM is a natural sulphur compound, and also one of the most important compounds found in our body, and just as vital as water and sodium. Further studies also demonstrated that the sulphur present in MSM, called sulphonyl, was safe, and as essential as vitamin C in our diet. However this may be, MSM, a member of the sulphur family, should not be confused with sulpha drugs, which some people are allergic to.

A fragrance-free, water-soluble, white crystalline material that supplies a bioavailable form of dietary sulphur, MSM originates in the ocean and reaches the human food chain through rainfall. MSM is also found in many common foods, including raw milk, meat, fish, and a variety of fruits, vegetables, and grains. However, it is normally lost from our food by heating, storage, processing, drying, cooking, preserving, and even washing. While the substance has been shown to add elasticity to cell walls by allowing fluids to pass through the tissue more easily, it has also been found that it can increase tissue pliability and promote the repair of damaged skin.

Our MSM levels reduce with age. This results in symptoms of fatigue, tissue and organ malfunction, and increased susceptibility to disease.

In one preliminary study, to cull just a case in point, ten osteoarthritis patients taking MSM were compared with six who took a placebo. Results indicated almost 80 per cent control of pain within the first six weeks in them, while only two patients showed minimal improvement [less than 20 per cent] on placebo.

MSM has also been favoured to be a natural remedy for osteoarthritis, tendonitis and bursitis, muscular soreness and athletic injuries, carpal tunnel syndrome [which is caused by the compression of the median nerve in the wrist -- usually the result of repetitive motion of the wrist; e.g., computer use], post-traumatic inflammation and pain, heartburn and hyperacidity, headaches and back pain, and allergies. Researchers say that those taking MSM may notice other benefits -- softer skin, harder nails, thicker hair, and softening of scar tissue. A minimum time of about a month, they add, may be needed before significant improvement is seen, with the use of MSM.

MSM, researchers also point out, is safe. In a survey conducted at the Oregon Health Sciences University, US, patients who received oral MSM, as part of their treatment, showed no toxic build-up, even after years of taking more than 2,000 mg of MSM each day. Experts recommend patients to take MSM in pill or liquid form, though the substance is also available in topical formulas. It may be mentioned that MSM topical creams may not be worth trying, because the heating process may destroy the bioavailability of MSM. A body of opinion also favours the use of MSM with other natural compounds, because MSM has the ability to allow fluids to pass through the tissue more easily. This can lead to better absorption.

The combined use of glucosamine and MSM for symptomatic pain relief and tissue repair in joints is preferred in some of the scientific literature today, thanks mainly due to their low percentage of side-effects. Also, side-effects, even if they occur, are often mild in nature and controllable.

Topical formulas are also thought of as a good option by some prescribers -- when they are combined with a good delivery system, they are said to offer better local transfer of ingredients directly to the site of annoyance. However, it will be some time when studies, which are now in progress, could provide us a better understanding of the topical action process and also better treatment options.

SAMe [S-adenosylmethionine]

SAMe [S-adenosylmethionine], like MSM, is also a natural product that has been proven to offer many benefits in osteoarthritis. In addition, it appears to promote production of cartilage proteoglycans, and is, therefore, therapeutically beneficial in osteoarthritis in well-controlled oral doses. Needless to say, SAMe and/or other safe nutritional measures, which support proteoglycans synthesis, may also offer a practical means of preventing or delaying the onset of osteoarthritis in older people or athletes.

One of the most preferred supplements in the market, SAMe is not an herb, hormone, vitamin, or “nutrient” per se. In the human body, SAMe is known to be essential for maintaining the structure of cell membranes and manufacturing substances vital to transmitting nerve impulses, including emotions and moods.

When SAMe made it into health and other stores, it created a storm, thanks to publicity blitz, in both print and electronic mediums, not to speak of promotional books, advertisements, and a glut of Websites. To those who adhere to the “SAMe” message, the substance is nothing short of an effective, even miraculous, treatment for not only osteoarthritis, but also disorders like depression, and liver disease.

Studies have found 400-1,200 mg/day of SAMe as being safe. It is also free of side-effects; however, authorities caution that patients, who have bipolar disorder, or Parkinson’s disease, should avoid its use.

Other Useful Natural Remedies

Boswellia has been used for centuries in ayurveda, the ancient Indian system of medicine to maintain healthy joints. It inhibits inflammation, decreases cartilage synthesis, improves blood supply to the joints and maintains the integrity of blood vessels.
Vitamin C is said to protect and enhance cartilage formation. High intake of vitamin C, a powerful anti-oxidant, has also been suggested to reduce the risk of cartilage loss and slow down the progression of osteoarthritis.

Vitamin E is another powerful anti-oxidant that protects the joints from free radical damage and increases joint mobility. Rheumatoid arthritis affects joints which, in turn, depletes the joints of vitamin E. Vitamin E supplementation is attributed to relieve symptoms of rheumatoid arthritis.

Essential fatty acids [EFA] are necessary to produce substances that lubricate the joints. The most important is EFA [Omega-3], found in cold water fish, flax seed, and other food sources.

Some authorities also recommend the use of vitamin B5 and B6, zinc, copper and boron for the manufacture and maintenance of normal cartilage structure. A deficiency of any one of these nutrients is suggested to hasten joint degeneration.

Efficient, But Not Instant

These natural products, though very effective, are not quick-fixes or cures. You’d first need to realise that the inflammation must be stopped and the tissue rebuilt before arthritic pain can come to a standstill -- completely.

Also, the elder or older the person is, the longer the rebuilding process. However, while some people notice results in a week or two after using natural remedies, a clear-cut difference should be felt after about six weeks. Make sure, however, that you use good quality natural arthritis products combined with appropriate lifestyle modifications. This can really speed up the curative process.

One thing you would do well to bear in mind is -- the damage to the joints didn’t happen suddenly. It was a slow process. Hence, its repair will also take time. Once this happens, you and your joints will be all the more happier for it!