Arthritis

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Osteoarthritis and Rheumatoid arthritis

Osteoarthritis

osteoDescription: some consider osteoarthritis to be a normal part of aging but it does not have to be.

In every joint, there is a cushion of soft cartilage at each end of the bones to enable them to slide and move on each other without grating. With age or excessive use, this cartilage can wear out, and then the bones start grating upon each other causing pain, stiffness, swelling and deformities. While it can happen in almost anyone, obesity, sports activities (especially exercising on top of injured joints), injected steroids, muscle weakness, injuries - can all make it worse or accelerate its development.

What doctors can do

There is no medical treatment which can heal the cartilage; most medical therapies only help relieve the pain.

  • Anti-inflammatory drugs (NSAIDs (voltaren, Brufen) and COX 2 inhibitors (celebrex, vioxx) are very effective in reducing pain, but have been shown to increase the risk of stomach bleeding. The COX 2 drugs cause less bleeding but increase the risk of heart attack and stroke. There are also topical NSAIDs (diclofinac) which can be rubbed on the skin over the joints and provide some relief.
  • Other pain relieving drugs, such as aspirin and codeine, tend to be less effective.
    Steroid drugs (prednisone) and injected steroids should be avoided if at all possible - they may cause temporary relief, but longer term make the tissues weaker and worsen the arthritis.
  • When the joints have become sufficiently damaged joint replacement surgery can be considered, but joint replacements are never as good as the original.

What you can do

In many cases, complementary therapies are not only more effective than conventional medical therapies, they are infinitely safer and some also aid in the repair of the joint tissue and cartilage.

Lifestyle

  • Weight loss is very important if overweight. Even mild to moderate reductions can make a huge difference. (In one study a 10 pound weight loss over ten years reduced arthritis development of the knee by 50%). It also improves joint function and pain.
  • Rest - when joints are very sore, 12 - 24 hours of rest can often help the pain to subside, but prolonged rest causes weakness of the muscles and decreased mobility.
  • Physical therapy - keeping the joints moving, strengthening the muscles round the joint is very beneficial. Massage and physiotherapy can make a big difference. Osteopath and chiropracters can also help, especially if the joints become misaligned.
  • Regular mild activity without aggravating the joints is important to keep them flexible. Swimming and walking in water is a great option.
  • Soaking in hot mineral pools, spa or epsom salt baths can be very soothing

Nutritional supplements

  • A good multivitamin / multimineral ensures that the cartilage has all the nutrients and minerals it requires to stay strong and repair itself .
  • Vitamin C is essential in the production of fibre, cartilage and bone and there is good evidence that low vitamin C levels increase the risk of arthritis.  Take at least 1 gram of vitamin C daily.
  • Vitamin D is similar, with the Framingham study showing that osteoarthritis progressed three times faster in patients with low vitamin D levels. Take 5 - 8,000iu of vitamin D daily.
  • Omega 3 fish oils, 1–2 grams daily – improves the elasticity and strength of the cartilage. They also improve the strength and flexibility of the tendons around the joint, and improve the quality of the fluid lubricating the joints.
  • Calcium and magnesium, 800-1,000mg/day – help the bones and cartilage to heal, and reduce the risk of osteoporosis which weakens the bones and can lead to their collapse. Calcium is poorly absorbed without magnesium, and a little boron and vitamin D is also necessary.
  • Glucosamine is a complex sugar which forms a vital part of the cartilage tissue. Taking a high dose of glucosamine has actually been shown to repair cartilage tissue. Some also believe that chondroitin is beneficial, but there is little evidence that it is better than glucosamine alone, and there is the risk of seafood allergies or slow virus diseases as it is made from shellfish or cow trachea cartilage.
  • Grape seed extract (proanthocyanidins) is a powerful antioxidant and can reduce pain and inflammation, improving the symptoms without upsetting the stomach.
  • Pomegranate extract (10mls daily) in a small study reduced joint pain - may be worth a try.
  • High dose vitamin C, 2-4 grams per day may also help with inflammation, pain and with tissue repair.
  • Turmeric, a yellow spice, has many properties similar to COX 2 inhibitors without their dangers. Tumeric can help arthritis pain considerably, dose 500mg twice a day.
  • Other treatments which some people have found helpful include SAME (S-adenosyl-methionine), cats claw, MSM (methylsulphanylmethane), rose hip and Boswella

The Nutritional supplements I use and recommend to my patients

For my Osteoarthritis patients I recommend -

USANA - Cellsentials * , Biomega, Active Calcium plus, Procosa2, Proflavanol C, vitamin D - click here for more information

Tumeric - Curcumin (tumeric) - Curcugel from Health Through Nutrition. Obtain from www.johnappletonassociates.co.nz

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Rheumatoid arthritis

f9Description: While osteoarthritis is a wear and tear effects on the joints, rheumatoid is inflammation of the soft tissues round the joints which invades the cartilage and bones causing destruction and distortion.

Local muscles and ligaments are often also weakened and the inflammatory effects can be seen elsewhere in the body affecting the eyes, heart and pericardium, lungs, kidneys and blood forming cells (anaemia). It is an inflammatory and immune disease and many believe it may be caused or aggravated by poor gut function allowing bacteria, toxins or allergens into the circulation. Treatment is therefore best addressing these causes as well as the effects of the disease.

What doctors can do

  • DMARDS - 'disease modifying antirheumatic drugs' - Until relatively recently, most medical therapies were aimed at reducing the inflammation and relieving pain but not affecting the underlying disease. As most of the joint damage appears to happen early in the disease process, rheumatologists are now looking at attacking the immune inflammatory cause with very powerful drugs, many of which are used to treat cancer - methotrexate, azathioprine, hydroxychloroquine, sulphasalazine, gold, penicillamine. This treatment is still relatively new and the treatment does have significant side effects, but if tolerated can greatly reduce the long term damage to the joints. Even newer are biological agents affecting tumour necrosis factor alpha, interleukin and monoclonal antibodies. These newer agents currently have many side effects, but may well with time find a real place in the treatment and prevention of this very debilitating disease.  Monoclonal antibody drugs such as Rituximab do seem to be the ones most likely to give benefit with reduced side effects, but they are usually very expensive.
  • Anti-inflammatory drugs (NSAIDs) such as Voltarin and Brufen are very effective in reducing pain, but have been shown to increase the risk of stomach bleeding and do not affect the disease process. A newer group of NSAIDs called COX2 inhibitors (Celebrex, Vioxx) were initially claimed to cause less bleeding, but this is now uncertain. However they have been shown to increase the risk of patients developing heart attacks and stroke.
  • Steroid drugs - prednisone, hydrocortisone can reduce inflammation and relieve pain, but long term may do more harm than good. Many doctors inject cortisone into inflamed joints causing almost immediate pain relief, and this is probably safer than oral steroid treatment, but there is always the risk of infecting the joints.
  • Other pain relieving drugs such as aspirin and codeine tend to be less effective.
  • When the joints have become sufficiently damaged joint replacement surgery can be considered – but joint replacements are never as good as the original.

What you can do

Because rheumatoid arthritis can be such an aggressive and crippling disease, and also because the medical therapies are so potentially toxic, it is better and safer to utilise all the therapies recommended below first, as these may reduce the number and amount of medical drugs needed. However, in early and severe cases, the use of the DMARD drugs discussed above may well reduce the long-term severity and joint damage.  But at the same time, try the suggestions below:

Lifestyle

  • In most cases the cause of the immune system’s attack on the body is not known, although some people believe it may be due to some unknown infection, allergy or ingested foreign protein. Detoxification of the body and reducing the stress on the immune system may reduce the inflammation:
  • Low stress diets – eliminate all milk products and gluten from the diet. Also, if any foods (chocolate, red wine) appear to aggravate the arthritis, then eliminate them too, and see if this makes any difference.
  • A leaky or unhealthy gut may allow large molecules into the body which can cause immune diseases. Plenty of fibre to cleanse the bowel, and take regular pro-biotics (which provide good bacteria in the gut) and omega 3 fish oils,improves absorption and reduces gut wall damage (leaky gut).
  • Low dose naltrexone - may well help (click here for more details) - and after a discussion with your health provider, should be considered.
  • Mild movement of the joints is important to maintain a good movement range and suppleness, but don’t overdo the workload.
  •  If overweight, then losing weight to ideal or even less, is essential to reduce stress especially on the ankle, knee and hip joints.
  • Acupuncture performed by a skilled practitioner has been shown to both reduce pain and also improve joint function. Massage can also help ease the pains and
    reduce muscle spasm, but dont do it if it aggravates the pain

Nutritional supplements

  • A good multivitamin/multimineral to make sure that the cartilage and tissues have all the nutrients and minerals they require to stay strong and repair themselves. It can also help the immune system to work more accurately and not attack the body.
  • Vitamin D is now being appreciated as extremely important in patients with immune diseases. Regular exposure to the sun or taking vitamin D supplements (5,000 to 10,000iu daily) may help in the management of rheumatoid arthritis. (Vitamin D seems to have many beneficial actions, including turning the genes on and off when required. Low D levels are present in many diseases and it does seem important to have adequate levels all year round).
  • Grape seed extracts (proanthocyanidins) are powerful antioxidants and can reduce the inflammation and can improve symptoms without upsetting the stomach. In rheumatoid arthritis high doses should be used.
  • Omega 3 fish oils, 1–2 grams daily. These improve the elasticity and strength of the cartilage. It also improves the strength and flexibility of the tendons around the joint, and improves the quality of the fluid lubricating the joints.
  • Calcium and magnesium, 800-1,000mg/day help the bones and cartilage to heal, and reduce the risk of osteoporosis which weakens the bones and can lead to collapse. Calcium is poorly absorbed without magnesium, and a little boron, vitamin D, molybdenum and silicon is also necessary. Magnesium also reduces muscle spasm and tension.
  • Glucosamine is a complex sugar which forms a vital part of the cartilage tissue. Taking a high dose of glucosamine has been shown to actually repair cartilage tissue. Some also believe that chondroitin is beneficial, but there is little or no evidence for this.
  • Turmeric, a yellow spice (curcumin), has many properties similar to COX 2 inhibitors but without their dangers, and can effectively reduce some of the arthritis pain. Patients with rheumatoid arthritis should regularly take a preparation containing tumeric
  • High dose vitamin C 2-4 grams per day may also help with the inflammation and pain, as well as helping with tissue repair.
  • Co-enzyme Q10 is essential for energy production in the cell . It also has anti-inflammatory actions, and some people find 30-100mg of good quality CoQ10 helps their symptoms as well as giving them more energy.
  • Fibre drinks and shakes, additional to the fibre found in vegetables. Because the benefits of bowel cleansing are so important, taking good quality fibre drinks and shakes on a daily basis seems wise advice.
  • Probiotics - poor gut health can let large food molecules into the blood stream (leaky gut) and these can cause allergies. Taking a good probiotic product can recolonise the gut with healthy bacteria, and with a good diet and fibre drinks (which can also contain pre biotics) may help the arthritis.

The Nutritional supplements I use and recommend to my patients

For my Rheumatoid arthritis patients I recommend -

USANA - Cellsentials *, Biomega, Active Calcium plus, Procosa2, Proflavanol C, vitamin D, Coquinone, Probiotic and also Fibre shakes
Tumeric - Curcumin (tumeric) - Curcugel from Health Through Nutrition. Obtain from www.johnappletonassociates.co.nz

Other therapies

There are a number of other therapies which you might like to look at.  They have not been specifically included with this disease because some are a form of treatment which is applicable to most diseases and many focus on the mind, body, spirit, and the universe. These include - acupuncture, Ayurvedic medicine, energy healing, homeopathy, naturopathy, prayer, visualisation and some people with this condition might like to look at these topics (I have described them more fully on another page on this website click here .) With my personal experience and reading, I do not think that I can comment of whether one or a number of these might help.    They fit well with most conventional and complementary treatments and I suspect some or even all of them can be extremely powerful - if performed by an experienced practitioner.    My only caveat is that if in the course of one of these therapies, you are given potions or herbs, do check with your health practitioner that they will not interfere with other treatments or drugs you are receiving.

Nutritional supplements

I believe in today's world that nutritional supplements are so necessary as to be an essential component of any form of both prevention and treatment. Not only is today's food lacking in nutrients because of the way it was grown and processed, but also most of us make the wrong choices in diet. It is virtually impossible to obtain optimal levels of most of the vitamins, minerals and other nutrients although many people try to do so, and even then fresh produce is not available all year round. *There are many quality supplements available on the market, including –Thorne, NFS, Douglas Labs, Xtend Life, True Star Health, USANA, and Metagenics. There are others, but do your due diligence before choosing one. USANA Health Sciences has added a new adjunct to its multivitamin and multi mineral called CellSentials. These are a patented blend of phyto-nutrients which they believe affects cell signaling and growth, and increases the production of preventative antioxidants within the cell. These should add to the value of the multi, so these are the multivitamin/mineral preparation I recommend.