Arthritis types and treatments

[Guest guest]

12/26/2001

S. Sy, MD

MOST " arthritis " is not arthritis at all! Misunderstanding comes from a

different use of the term of doctors and by patients. The " arth " part of the

word means " joint " - not muscle, tendon, ligament or bone. The " itis " means

" inflamed. " Thus true arthritis affects the joints, and the joints are red,

warm, swollen, and painful to move.

The first thing to get out of the way is the myth that there is such thing

as

a single disease called arthritis. The truth is that the word arthritis is

about as useful and specific as the word infection; and just as these are

over hundred different types of infection so there are over a hundred

different types of arthritis.

The four most common types are " Osteoarthritis, " " Rheumatoid arthritis, "

" gouty arthritis " and " ankylosing spondylitis. "

Osteoarthritis: The wear and tear disease.

This type of arthritis affects more people than any other type. Physicians

may refer to it as degenerative joint disease. Patients usually know this

disease best as old age arthritis.

Why does Osteoarthritis occur?

In a normal joint a smooth, elastic material called cartilage covers the

ends

of your bones where they met. Cartilage enables the bones to glide smoothly

across each other and gives joints their flexibility. When the cartilage

wears away, it becomes painful to move the joint. The ends of the bones may

thicken. It usually becomes apparent in older people, in the larger,

weightbearing joints including the hips, knees, and spine.

What are the symptoms?

Episodes of pain, swelling and stiffness in the affected joint occur at

intervals of months or years. The major symptom is pain, in and around the

joints. In different individuals the type of pain varies. It may be a

constant aching, a feeling of soreness, or a more severe pain when you move

your joints. The pain occurs because the pressure is placed on the nerve

endings due to the deterioration of the smooth cartilage between the bones.

Tense muscles may radiate to other muscles that seem unrelated to your sore

joint.

How is Osteoarthritis diagnosed?

Often if a person complains of pains in joints, the physician will order

x-rays because damage to a joint may be seen that way. However, x-rays are

only part of the procedure to diagnose Osteoarthritis. The history of your

symptoms and the findings of the complete physical examination also will be

valuable factors in the diagnosis. Your explanation of how you feel will be

very important. For example, persons with Osteoarthritis usually do not have

a feeling of being ill, do not experience severe weight loss, and do not

have

poor appetite or fever. Also, the pain in the involved joint is usually

maximal with activity (walking; etc.) and decreased by rest in patients with

Osteoarthritis.

How is Osteoarthritis treated?

There is no cure for Osteoarthritis. The goal of therapy is to control the

disease and possibly slow its progress by keeping the affected joints

mobile,

preventing further disability, and relieving pain.

In some cases drugs, special exercise, rest and heart therapy are effective.

If you are overweight, your physician will probably suggests weight-reducing

diet. Reducing weight will help reduce strain on your joints, particularly

if

your Osteoarthritis is in the hips or knees.

In other cases, orthopedic surgery and rehabilitation therapy are helpful.

Rheumatoid Arthritis: The inflammatory disease.

Rheumatoid arthritis may begin at any age; it most commonly affects people

between the ages of 20 and 40. The cause of rheumatoid arthritis is not

know,

but some researchers say it is caused by infection. Heredity is definitely a

factor. There is some agreement among researchers that the body's immune

system is somehow involved in the development of rheumatoid arthritis. It

usually begins with inflammation in the synovial membrane, a thin tissue

that

lines the capsule surrounding the joint.

What are the symptoms?

Rheumatoid arthritis may begin without obvious symptoms in the joints. When

your joints are affected, they become red, warm, swollen, tender to the

touch, painful to move, and stiff. The stiffness is usually most noticeable

first thing in the morning. As you move and exercise the joints, the pain

and

stiffness gradually becomes less severe.

Usually more than one joint is affected by rheumatoid arthritis. When

rheumatoid arthritis affects the hands, the fingers may become deformed and

everyday tasks become difficult to perform. The pain may become more severe

with strenuous activity.

Because rheumatoid arthritis often affects connective tissues throughout the

body, there may be fever, poor appetite, weight-loss and anemia.

How is Rheumatoid Arthritis diagnosed?

Your physician will find several laboratory tests helpful in addition to a

complete physical examination, medical history, and x-rays. A test called

erythrocyte sedimentation rate (ESR) will indicate the presence of any

inflammation in your body. Another test is to determine the presence of

rheumatoid factor, an abnormal antibody present in most people who have

rheumatoid arthritis.

How is Rheumatoid Arthritis treated?

The goals of therapy are reduction of inflammation and pain, preservation of

function, and prevention of deformity. Therapeutic programmes for people

with

rheumatoid arthritis are individually designed, depending on the extent of

the disease and the organs involved. Your treatment may include a mix of

exercise and rest; use of heat, cold or both; anti-inflammatory drugs;

possibly surgical repair; and in some cases use of special braces and other

supports.

Ankylosing Spondylitis:

Ankylosing spondylitis is inflammation of the joints that link the

vertebrae;

it usually occurs in young men. In Ankylosing spondylitis, the inflammation

subsides but leaves behind damaged joints and thickened long spinal

ligaments

that, in effect, fuse together the individual bones of the spine. The cause

of this debilitating disease is not known.

The first joints to be affected are the sacroiliac joints, which link the

base of the spine to the pelvis, or hip bone. Bony growths fuse the normally

separate bones together, and the resultant stiffness may move slowly up your

spine until it affects many if not all, of the joints between your

vertebrae.

What are the symptoms?

Ankylosing spondylitis often starts with pain in the lower portion of the

back, which may spread to the buttocks. The pain and stiffness are generally

most severe in the morning. You may have stiff, painful hips and a general

feeling of stiffness in your spine. Other possible symptoms are vague chest

pains. You may also have loss of energy, weight loss, a poor appetite, and a

slight fever. For reasons that are not clear, your eyes may become red and

painful.

What are the risks?

Ankylosing spondylitis is much more prevalent in men than in women and

occurs

mainly in the 20 to 40 age group. It also seems to run in the families.

The disease may be confined to the lower part of the spine, or it may be

more

generalized, resulting in a stiff spinal column that may cause your head to

be permanently bent down onto your chest. The ribs can also become involved

at the point where they join your spine, and this reduces your ability to

breath. Chest infection then becomes a risk. Also your jaw may be stiff,

which causes difficulty in both eating and speaking.

What is the treatment?

Self-help: A regular daily exercise routine is essential. Breath deeply,

sleep on a firm mattress and do not use pillow. Try to learn to sleep on

your

stomach rather than on your back or side. All of these self-help measures

help keep your back muscles stronger and provide more mobility.

Professional help: Your physician may refer you to a physical therapist for

appropriate exercise regimen. Your physician may prescribe pain-killing and

non-steroidal anti-inflammatory drugs.

If your spine is very badly bent, it may be improved by osteotomy, a

surgical

procedure that is sometimes used to straighten bent, fused bones. However,

osteotomy is performed only in extreme cases.

Gouty Arthritis:

Gout develops only after years of elevation of serum uric acid. The high

uric

acid level sometimes results from hereditary defects in the body chemistry

or

after use of certain types of medications. The normal range of uric acid in

blood serum is 3.0 to 6.0 mg/ 100ml. Only about one out of 10 people who

have

an elevated serum uric acid develop needle-like crystals in their joints,

which leads to severe inflammation, swelling, and tenderness, characteristic

of gout. Although gout can affect almost any part of the body, the large

joint of the big toe is usually attacked first. It occurs most often in

people who are overweight and/or who indulge regularly in purine rich foods

and alcohol. Purine rich foods are the following: mussels (tahong), meat

extracts, internal organs such as brains, liver, kidneys, pancreas, gravies

(sarsa), patis, sweetbreads (mulyehas), yeast, anchovies (dilis & bagoong),

sardines, Herring (tamban, tawilis, tunsoy, lapad, silinyasi, mackerel,

alumahan, hasa-hasa, tanigi), spinach, mushroom, cauliflower, legumes,

beans,

& lentils.

Recommendations:

* Eat fresh pineapple frequently. Bromelain, an enzyme found in pineapple,

is

excellent for reducing inflammation. To be effective, the pineapple must be

fresh, as freezing and canning destroy the enzymes.

* Eat some form of fibers - such as oat bran or rice bran daily.

* Reduce the amount of fat in your diet. Do not consume too much milk, dairy

products or red meat.

* Avoid caffeine, citrus fruits, salt, tobacco and everything that contains

sugar.

* Eat more sulfur-containing foods such as asparagus, garlic and onions. It

helps repair and rebuild bone, cartilage and connective tissue, and aids in

the absorption of calcium.

* If you use ibuprofen or other non-steroidal anti-inflammatory drugs

(NSAID's), avoid sodium (salt), which causes water retention.

* In the morning, take a hot shower or bath to help relieve morning

stiffness.

* Get more exposure to the sun (morning sunshine) to help synthesis of

vitamin D, which is needed for proper bone formation.

* Get regular moderate exercise. It reduces pain and retarding joint

deterioration. Bicycle riding, walking and water exercises are good choices.

Avoid weight bearing or impact aerobics.

* If you are overweight, lose the excess pounds.

(Dr. S. Sy, M.D. is the Medical Director of Life Extension Medical

Center located at 1370 General Luna St., Paco, Manila. He is a diplomate in

Gerontology and Geriatrics, advocates Diet-Nutritional Therapy, and conducts

free seminar every Friday about age-related health problems. For more

details, please call telephone numbers: 400-4205 or 522-4835 local 315.

E-mail address: lifeextension@...; Webpage:http//:

www.mb.com.ph/oped/sy)