Rheumatoid arthritis - Ask Dr. P

Are You On Your Way to Getting Arthritis?

by Pain Doc | May 8, 2014 | Uncategorized

Arthritis, which translates to “irritation of a joint,” has the potential to develop into a debilitating condition that can significantly reduce your activities of daily living (ADL) and quality of life. It involves pain, stiffness and understandably a reduced ability to move and engage in exercise. Lack of exercise/ mobility promotes weight gain, which can make the arthritis worse as the joint surfaces bear increased weight.

If the pain is strong enough, sufferers resort to over-the-counter medications such as acetaminophen (Tylenol, Paracetamol), NSAIDs, or non-steroidal anti-inflammatories (Ibuprofen, Naproxen); and if the pain is severe, opioid drugs. All of these drugs have dangerous side effects, which become more significant if they are taken long term. This includes liver damage, gastrointestinal problems, muscle and joint pain, and for opioids, constipation, nausea and drug addiction/dependency.

Today, I will address specifically osteoarthritis, or OA. It is the most common form of arthritis and is the major cause of disability in persons aged 65 and over. Osteoarthritis affects primarily the weight-bearing joints such as the ankles, knees, hips, lower spine and lower neck. It starts out non-inflammatory (unlike rheumatoid arthritis, which is an inflammatory auto-immune form of arthritis) and involves gradual wear and tear of the cartilage surfaces of the ends of the bones that form the joint. In advanced stages, the damaged cartilage triggers mild inflammation (swelling, increased vascularity, increased pain) and the condition is better described as inflammatory osteoarthritis.

Osteoarthritis has systemic risk factors and local risk factors.

Systemic risk factors include age, sex, race, bone density, genetic factors, nutrition and hormonal status (which is related to age).

Black Americans have a higher incidence of OA than white Americans; however the association may be rooted in demographics/ cultural factors rather than genetics.
Reduced production of human growth hormone (HGH) and the sex hormones (estrogen, testosterone) are associated with reduced cartilage pliability; i.e. increased brittleness and less thickness.
Cartilage is thought to be highly vulnerable to oxidative stress (free radical damage, oxidation), and high doses of vitamin C and D are protective against the development of OA. Smoking, pollution and a diet high in processed food are factors that promote oxidative stress.

Local risk factors include obesity, occupation, prior joint injuries, existing joint instability, sports/physical activities and congenital joint abnormalities.

Obese individuals experience increased pressure in their weight bearing joints when standing or sitting. This can force water content out of the cartilage and lead to small tears which then lead to larger tears and “bone on bone” contact within the joint.
Occupations that involve repetitious trauma/ forces to the joints increase risk for OA.
Sports, especially football, basketball, long distance running and gymnastics can result in accelerated cartilage degeneration especially after age 40.
Prior injuries/ trauma that subluxated or misaligned a joint will predispose it to accelerated OA as the joint loses its normal mechanical function. The joint surfaces may not articulate properly, and weight distribution along the surface may become uneven following trauma.
Congenital anomalies such as scoliosis and fused vertebral segments can also alter normal joint movement and promote accelerated OA.
Weak muscles can deprive joints of protection and stability, predisposing them to OA. Weak muscles are related to sedentary lifestyles, whether by choice or secondary to an incapacitating condition like advanced Type 2 diabetes.

The bottom line:

If you have systemic risk factors, think in terms of diet and nutrition to ward of their effects. You can’t control aging, you can’t control your sex and race, but you can control the level of oxidative stress in your body and you can “down-regulate” genes that may predispose you to arthritis by adopting a healthy diet and lifestyle.

If you also have several local risk factors for OA, think in terms of minimizing their effects. Unstable joints from prior injuries can benefit from targeted exercises that strengthen the joint; perhaps some occasional spinal and/or extremity adjustments from a chiropractor or therapist; supports/orthotics as applicable; and avoiding activities which over-stress the affected joint. For example, if you have a spondylolisthesis, it’s best to avoid running and instead do speed walking or use an elliptical machine to get your cardio exercise.

If you are suffering from chronic pain in your muscles and joints, nerves and ligaments, stay tuned for a new multi-media educational course being developed, Get Rid of Pain Forever. To receive notice of its launch, visit here.

Can You Grow Cartilage By Eating Certain Foods or Supplements?

by Pain Doc | Feb 21, 2011 | Uncategorized

Cartilage, specifically, hyaline cartilage is the tissue that lines the articular (contacting) surfaces of bones. If the cartilage deteriorates it can lead to pain and inflammation in the weight bearing joints, mostly the knees and hips, as nerve endings in the joint get exposed to abrasive action. This can force the sufferer to elect for knee or hip replacement surgery, as well as artificial disc surgery. Smaller joints such as in the fingers can be affected as well.

Cartilage is made by special cells called chondroblasts. These cells make the extracellular matrix of cartilage, comprised of Type II collagen and ground substance, which is comprised of proteoglycans and elastin. Another important constituent is hyaluronic acid, which improves the resiliency and hydration of cartilage. Without going into too much detail, a proteoglycan is a protein molecule with a chain of sugar molecules attached called glycosaminoglycans, or GAGs. The two GAGs that are best known to the public are glucosamine sulfate and chondroitin sulfate, the key ingredients in most cartilage and bone supplements. Glucosamine sulfate is the one found in the exoskeletons of shellfish, as well as some fungi.

Persons suffering from the various forms of arthritis such as osteoarthritis and rheumatoid arthritis have cartilage tissue that is undergoing inflammation and degradation, either mechanical in nature or auto-immune.

Collagen is a group of naturally occurring proteins found mostly in animal connective tissues– tendons, ligaments, and skin. What makes collagen useful in cartilage is its ability to withstand pressure and return to its original shape (deform and rebound). This is what is necessary in joints of the human body, which are subjected to forces multiple times throughout the day. The simple act of sitting or standing places enormous pressure on the joint surfaces of the feet, knee, hip and lower back. Using one’s hands to type or grip things places pressure on the smaller joints of the fingers and wrists.

So, if your have thinning cartilage in your knees, can you grow it back simply by taking glucosamine sulfate and chondroitin supplements? Unfortunately, the latest research on their ability to reduce joint pain show minimal improvement. Why is this?

It’s because that, just because you give the body supplements through your diet, it doesn’t guarantee that your body will do things you want it to do with these nutrients. They could be going somewhere else besides you joint, which is more likely the case.

The harsh reality regarding all muscle and connective tissue building dietary supplements such as collagen, bone broth, protein powder, etc. is that they get broken down in your GI tract into their amino acid constituents, and need to be reassembled. But as mentioned, your body will not reassemble them into the desired tissue 100%. These proteins may go to your skin, hair, nails, or may be made into an enzyme or cell receptor. In other words, the amino acids in those glucosamine sulfates pills may wind up forming new hair, not cartilage.

That being said, if you hope to build cartilage through your diet, it may be more effective to eat the actual cartilage. At least it consists of the actual amino acid sequences in the proper percentage the body uses to build cartilage..

Consider consuming bone broth soup regularly if you are suffering from achey joints; or do so as a preventative measure. Most butcher shops in the grocery store will have large joints of beef or pork, usually the hips, knees and spine. And they are cheap, usually less than $2.00 a pound. They will saw them in small pieces for you if you request. What’s great about them is that they still have tendons and cartilage pieces attached. Get a large pot, add a gallon of water and bring to boil; lower temperature and boil for two hours. The broth will be rich in nutrients that your body can use to help regenerate damaged cartilage.

For preventive measures to protect the health of your joint cartilage, remember to:

do functional exercises regularly to improve whole-body muscle & joint responsiveness
avoid sitting for too long at your work
avoid activities that require repetitive trauma to the joints such as long distance running
avoid ingesting toxins like cigarette smoke, alcohol, and highly processed food
get enough daily rest to allow your body to regenerate
drink filtered water (not distilled)
get enough sun exposure for Vitamin D synthesis

How to Tell if Your Pain is from Arthritis

by Pain Doc | Aug 28, 2010 | Arthritis, Bone Pain, Hand and Wrist Pain

Image via Wikipedia

If you have deep, achy pain in a joint that doesn’t go away with time it’s likely some form of arthritis. Lower back pain can be arthritic in nature (as opposed to muscle) if it behaves similarly– deep, achy, doesn’t seem to ever go away entirely; and you have a history of repetitive, physical impact to your body such as construction workers/ laborers, martial art practitioners and gymnasts. However, with rheumatoid arthritis (explained below) no history of trauma is necessary.

Most people associate arthritis with the elderly. But did you know it can affect younger people as well?

The word arthritis translates to “joint inflammation.” There are several forms of arthritis, the two most common types being rheumatoid arthritis and osteoarthritis.

Image via Wikipedia

Rheumatoid arthritis (RA) is an auto-immune disorder, where the body’s white blood cells attack the synovium of synovial joints. Synovium is the inner lining of a synovial joint— encased (capsular) joints like in the spine, hips, knees and shoulders. The synovium produces synovial fluid, which lubricates the inner surfaces of the joint as it moves.

People suffering from rheumatoid arthritis will have bouts of severe joint swelling, redness, heat and pain. RA is typically bilateral; meaning, for the extremities it strikes both sides, not just one. It is an awful condition that can can severely impact mobility. Those with rheumatoid arthritis in the knuckles of the hand will have difficulty gripping things and doing fine dexterity movements such as writing and buttoning a shirt. Areas commonly affected by rheumatoid arthritis are the hands, spine, and feet.

Currently, drugs are the only medical treatment for RA including non-steroidal anti-inflammatories– NSAIDS (aspirin, Motrin, Tylenol, Ibuprofen), corticosteroids and immunosuppressives.

Palliative care to manage pain levels include acupuncture, yoga, and chiropractic. Cannabis (medical marijuana) is a popular choice for many sufferers.

Osteoarthritis (OA) is described as joint pain and inflammation from wear and tear of the cartilage. It is usually found in people who have suffered repeated joint trauma, like football and basketball players. Marathon runners can develop it in the knees and hips as well. OA is found in the weight bearing joints of the feet, ankle, knees, hips, lower spine and neck.

When repeated trauma impacts a weight bearing joint, over time it creates tiny fissures in the cartilage, which thins the cartilage and exposes the bone underneath. From there, the bone forms bone spurs called osteophytes. Radiologists describe these changes (disc degeneration plus osteophytes) as spondylosis of the joint.

Both types of joints can be painful, with RA being more acutely painful. The symptoms are pain, joint stiffness and reduced range of motion.

MAKING BONE BROTH SOUP FOR ARTHRITIS PAIN:

In both cases, eating a low-inflammation diet will be helpful: reduce sugar intake including high fructose corn syrup; limit carbohydrates to 150 grams per day; emphasize protein and fat, especially fish with high Omega 3 content; nut oils (walnut, almond, Brazil nuts), virgin olive oil, and raw plants (green leafy salads, lightly steamed vegetables). Raw milk and butter from grass fed cows, and coconut oil are also good for an anti-inflammatory diet.

Eating bone broth soup every day will give your body the constituents for rebuilding cartilage: Visit your local butcher and ask for the large beef and pork joints. They can saw these in little pieces in the back and give them to you in a bag; they price them pretty cheap; too!

You’d be amazed as to how cow/ pig knee and hip joints look very much like a human’s. If you want to understand the anatomy of these joints, this is a great way to do it. You will see and feel the smoothness of the cartilage on the femur head. You’ll see the anterior and posterior cruciate ligaments (ACLs and PCLs). You will see the patella, fat pad; and collateral ligaments, condyles and meniscus. Make sure to eat all of these parts in addition to drinking the broth to get all the proteins needed to rebuild tendons, ligaments and cartilage.

MAKING THE BROTH:

Add a couple of pieces of joints into a tall pot; fill half-way with water; add salt. For extra bone-building strength add some eggshells (from cracked RAW eggs– You want the inner shell membrane to be intact; with boiled eggs the nutrient-rich membrane sticks to the egg). Bring to a strong boil; reduce heat to low and cook for 60 minutes. Steep out the eggshells, and drink the soup. Eat any pieces of tendon stuck to the bones, and eat the bone marrow as well. You can add spinach to the soup the last minute of boiling for more variety. (chicken and turkey carcasses and whole fish bones work well, too).

The calcium and cartilage nutrients you get from this bone broth can help your joints feel better.

HOME THERAPY FOR ARTHRITIS

Arthritis pain comes from inflammation and stimulation of pain receptors in damaged cartilage by the inflammation and also by physical abrasion.

Pulsed electromagnetic field therapy (Pulsed EMF or PEMF) can help by energizing the affected cells. The electromagnetic field produced by PEMF machines are similar to the naturally-occurring fields produced by the biological activity of your cells; adding an external source helps those cells function better. The few cells that exist in the cartilage and ligaments and tendons have more energy to synthesize matrix and collagen which goes towards joint rebuilding. Use in conjunction with red light therapy for maximum effect. Red light at around 660 nm wavelength initiates photobiomodulation, which also gives cells more energy to function, much like photosynthesis in plants.

For temporary relief, heat works best with chronic pain and stiffness. An infrared heat lamp is a good choice, as it is easy to set up and penetrates all the way down to the affected tissue, unlike a hot pack which only heats the skin. Heating is not advised for rheumatoid arthritis when it is in a flare-up, hot and acute phase.

As far as medical care, joint replacement is a more drastic option but can effectively reduce pain while preserving some joint functionality. There are also experimental procedures that involve culturing cartilage cells in a lab and injecting them into the joint space, hoping that they will bond to existing cartilage and thicken, but results are mixed at this point.

If you don’t have arthritis, do things that will help prevent you for getting it. Build up your joint strength with the diet mentioned above, and avoid repetitious trauma to the weight bearing joints (activities that involve jumping and landing on a hard surface). Strengthen surrounding ligaments of your knee and hip joints with exercises like weightless squats, knee bends, and simple uphill hiking.

Your joints are the most neglected part of your body; we often take them for granted. But when one is injured or develops arthritis, you will realize very quickly how important they are to your happiness and well-being. Don’t wait until it is too late; strengthening and nurturing your joints should be a definite part of your fitness routine.

Are You On Your Way to Getting Arthritis?

Can You Grow Cartilage By Eating Certain Foods or Supplements?

How to Tell if Your Pain is from Arthritis

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