Arthritis

Half of all people age 65 and older have arthritis. There are over 100 different forms of arthritis and many different symptoms and treatments. We do not know what causes most forms of arthritis. Some forms are better understood than others.

Arthritis causes pain and loss of movement. It can affect joints in any part of the body. Arthritis is usually chronic, meaning it can occur over a long period of time. The more serious forms can cause swelling, warmth, redness, and pain. The three most common kinds of arthritis in older people are osteoarthritis, rheumatoid arthritis, and gout.

Osteoarthritis (OA), at one time called degenerative joint disease, is the most common type of arthritis in older people. Symptoms can range from stiffness and mild pain that comes and goes to severe joint pain and even disability.

OA usually affects the hands and the large weight-bearing joints of the body: the knees and hips. Early in the disease, pain occurs after activity and rest brings relief; later on, pain occurs with very little movement, even during rest.

Scientists think that several factors may cause OA in different joints. OA in the hands or hips may run in families. OA in the knees is linked with being overweight. Injuries or overuse may cause OA in joints such as knees, hips, or hands.

Rheumatoid arthritis (RA) can be one of the more disabling forms of arthritis. Signs of RA often include morning stiffness, swelling in three or more joints, swelling of the same joints on both sides of the body (both hands, for example), and bumps (or nodules) under the skin most commonly found near the elbow. RA can occur at any age and affects women about three times more often than men.

Scientists don’t know what causes RA but think it has something to do with a breakdown in the immune system, the body’s defense against disease. It is also likely that people who get RA have certain inherited traits (genes) that cause a disturbance in the immune system.

Gout occurs most often in older men. It affects the toes, ankles, elbows, wrists, and hands. An acute attack of gout is very painful. Swelling may cause the skin to pull tightly around the joint and make the area red or purple and very tender. Medicines can stop gout attacks, as well as prevent further attacks and damage to the joints.

Treatments for arthritis work to reduce pain and swelling, keep joints moving safely, and avoid further damage to joints. Treatments include medicines, special exercise, use of heat or cold, weight control, and surgery.

Medicines help relieve pain and reduce swelling. Acetaminophen or ACT should be the first drug used to control pain in patients with osteoarthritis (OA). Patients with OA who don’t respond to ACT and patients with RA and gout are most commonly treated with nonsteroidal anti-inflammatory drugs such as ibuprofen. People taking medicine for any form of arthritis should limit the amount of alcohol they drink. (For more information, see the Age Page "Arthritis Medicines.")

Exercise, such as a daily walk or swim, helps keep joints moving, reduces pain, and strengthens muscles around the joints. Rest is also important for the joints affected by arthritis. Physical therapists can develop personal programs that balance exercise and rest.

Many people find that soaking in a warm bath, swimming in a heated pool, or applying heat or cold to the area around the joint helps reduce pain. Controlling or losing weight can reduce the stress on joints and can help avoid further damage.

When damage to the joints becomes disabling or when other treatments fail to reduce pain, your doctor may suggest surgery. Surgeons can repair or replace damaged joints with artificial ones. The most common operations are hip and knee replacements.

Arthritis symptoms may go away by themselves but then come back weeks, months, or years later. This may be why many people with arthritis try quack cures or remedies that have not been proven instead of getting medical help. Some of these remedies, such as snake venom, are harmful. Others, such as copper bracelets, are harmless but also useless. The safety of many quack cures is unknown.

Here are some tip-offs that a remedy may be unproven: claims that a treatment like a lotion or cream works for all types of arthritis and other diseases too; scientific support comes from only one research study; or the label has no directions for use or warnings about side effects.

• Swelling in one or more joint(s)
• Morning stiffness lasting 30 minutes or longer
• Joint pain or tenderness that is constant or that comes and goes
• Not being able to move a joint in the normal way
• Redness or warmth in a joint
• Weight loss, fever, or weakness and joint pain that can’t be explained

If any one of these symptoms lasts longer than 2 weeks, see your regular doctor or a doctor who specializes in arthritis (a rheumatologist). The doctor will ask questions about the history of your symptoms and do a physical exam. The doctor may take x-rays or do lab tests before developing a treatment plan.

Natural Treatments:

A low-fat, low-cholesterol diet filled with the complex carbohydrates found in vegetables and grains has been shown to be very helpful in dealing with many cases of arthritis. This type of diet reduces the fat in the tiny arteries that supply blood to the joints, allowing more oxygen and other nutrients to nourish them.

In addition to a good low-fat diet, a number of vitamins, minerals and other nutrients are useful for arthritis.

Vitamin therapy may relieve certain arthritic symptoms. Beta carotene (vitamin A) has an antioxidant effect on cells, neutralizing destructive molecules called free radicals. Vitamins C, B6, and E, as well as zinc, are thought to enhance collagen production and the repair of connective tissue. Vitamin C may also be advised for people taking aspirin, which depletes the body's vitamin C balance. Niacin (vitamin B3) may also be helpful, although excessive use may aggravate liver problems.

Boron plays a major role in bone health. It helps the body regulate calcium, keeping it from leaving the body and weakening the bones. Epidemiological studies from several countries have shown that in areas where the soil contains more boron and people are presumably eating boron-rich foods grown in that soil, there is less osteoarthritis. When boron supplements were given to hospitalized arthritis patients, some 90 percent reported "complete remission" of symptoms. Apples, nuts and green leafy vegetables are good sources of boron. 

Bromelain, an enzyme derived from pineapple, has a notable anti-inflammatory action. Take 200 to 400 milligrams three times daily, between meals.

Black currant seed oil, borage oil, evening primrose oil, fish oil, and flaxseed oil contain essential fatty acids that increase the production of anti-inflammatory prostaglandins. Take 500 to 1,000 milligrams of any of these oils twice daily. It may take several weeks to notice an improvement in symptoms.

DLPA (dl- phenylalanine ) is a simple nutritional amino acid. Studies have shown that DLPA effectively blocks arthritis pain and joint inflammation in many patients. It is much safer than the standard arthritis medications. It longer than standard anti-pain and anti-arthritis drugs.

Glucosamine, a compound of the simple sugar glucose and the amino acid glutamine, has been shown to be an effective natural means of slowing cartilage breakdown and encouraging cartilage repair. With continued use, it helps to relieve joint pain and stiffness. Several studies have shown that glucosamine can be a more effective pain reliever than ibuprofen for arthritis. Take 500 milligrams of glucosamine three times daily. It may take as long as six to eight weeks to attain maximum relief.

Many people with arthritis are deficient in manganese, a trace element that activates important enzymes and is necessary for normal skeletal development. Take 5 milligrams twice daily for one month.

Methylsulfonylmethane (MSM), a natural source of sulfur, can help relieve arthritis pain and maintain joint health. Sulfur is an essential component of make up connective tissue. Take 500 milligrams three or four times daily, with meals. Sulfur is naturally found in meat, milk, poultry and fish.

Omega-3 fatty acids, found in many fish, have shown promise in fighting arthritis. Some 26 osteoarthritis patients ranging in age from 52 to 85 were given either an omega-3 fatty acid called EPA (eicosapentaenoic acid) or a placebo. Six months later, those who had received the EP A had less pain and were better able to perform normal activities, as compared to the placebo group.

Pantothenic acid, part of the vitamin B complex, has been shown to help prevent and alleviate arthritis. The connection between this nutrient and arthritis was made nearly forty years ago. But there is definitive study that shows precisely how it works. Many people do find relief from their symptoms with pantothenic acid. Take 3 g. daily. It will take one to two weeks before you see any result. If no results are seen in three weeks, discontinue the supplement. Some physicians recommend up to 12 g. of pantothenic acid a day, but this should be taken only under your doctor's supervision. 

S-adenosylmethionine (SAM or SAM-e) is an amino acid derivative that has been shown in clinical trials to be comparable in effect to the combination of glucosamine and chondroitin. Like glucosamine, SAM plays a role in the formation of cartilage. It also exerts a mild analgesic effect. In one study, it was shown to be even more effective than Motrin in treating the pain of arthritis. Try taking it as follows: 
Week 1: Take 400 milligrams three times a day. 
Week 2: Take 400 milligrams twice a day. 
Week 3: Reduce to a maintenance dosage or 200 milligrams twice a day.

Selenium is a powerful antioxidant that fights free-radical damage. Take 200 micrograms of selenium daily. You'll find selenium in almonds, barley and oranges.

Shark cartilage may be useful. Each day, take one 750-milligram capsule per 11 pounds of body weight (or 1 gram of powder per 15 pounds of body weight), divided into three equal doses. Once you have achieved relief of pain, reduce the dose to one 750-milligram capsule per 30 pounds of body weight (or 1 gram of powder per 40 pounds of body weight). 

Superoxide dismutase, also known as SOD, has also shown promise as an arthritis fighter. When 253 people with noninfectious joint inflammation were given a supplement containing SOD, 228 of them reported decreased pain and swelling, along with increased mobility of the afflicted joints.

Vitamin E protects against muscle-wasting and is essential in cellular respiration, thus helping remove toxins. Vitamin E, like the nonsteroidal anti-inflammatory drugs used for arthritis, inhibits the prostaglandins that play a role in pain. When 50 patients were given either 400 IU of vitamin E or a placebo, the vitamin E group reported greater pain relief and had to use less pain medication. In another study, 29 patients were given either vitamin E or a placebo for 10 days. Then the groups were switched without their knowledge, so that the vitamin E group was getting a placebo and the placebo group the vitamin E for an additional 10 days. The vitamin E produced "good" pain relief in 52 percent of the patients, compared to 1 percent for the placebo. Wheat germ, nuts and tomatoes are natural sources of Vitamin E. 

Choose a product containing mixed tocopherols and start by taking 200 international units daily, then gradually increase the dosage until you are taking 400 international units twice daily, once in the morning and again at bedtime.

Caution: If you have high blood pressure, limit your intake of supplemental vitamin E to a total of 400 international units daily. If you are taking an anticoagulant (blood thinner), consult your physician before taking supplemental vitamin E.

Vitamin C is important for the synthesis of collagen and the repair of connective tissue.

Vitamin B6: Many older people are found to be deficient in B6. The first symptoms of a deficiency include tingling, pain, and stiffness in the hands. Arthritis patients are recommended to take a supplement of B6 in addition to the B6 that's in your recommended daily antioxidant vitamin/mineral supplement.

Vitamin B1 and B12: One study found an important relationship between doses of NSAIDs and vitamins B1 and B12. When administered to persons with arthritis these two B vitamins enhanced the effectiveness of the pain killing drugs, allowing for a lower dosage of the drugs. The effect was seen in as little as seven days. If you take drugs for pain relief, it would be worth taking vitamins B1 and B12 to see if they help you reduce your dosage.

Vitamin A and the minerals zinc and copper are crucial to the formation of collagen and connective tissues. Be sure that your daily multivitamin contains at least the minimum RDA of these. 

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