A closer look at Arthritis

Arthritis defies stereotypes. That’s because arthritis is not a singular, specific disease: There are more than 150 different types of arthritis in existence, affecting more than 50 million Americans and counting. Cases are expected to reach 67 million by 2030, according to the Centers for Disease Control and Prevention (CDC).

Arthritis—a general term for conditions affecting the joints and surrounding tissues—is the most common cause of disability in the United States, limiting mobility for 21 million Americans. But thanks to advances in understanding and treating arthritis, many patients like are able to live full lives free of disabling pain.

The range of arthritic conditions runs the gamut from common, well-known disorders such as gout to lesser-known conditions such as ankylosing spondylitis, a form of inflammatory arthritis that mostly affects the spine. Bursitis, tendonitis and carpal tunnel syndrome also fall under the arthritis umbrella. But osteoarthritis (OA) and rheumatoid arthritis (RA) are two of the most common and potentially debilitating forms.


More than half of arthritis-related hospitalizations stem from OA. This degenerative form of “wear-and-tear” arthritis occurs as
cartilage is worn down over time. Unlike other tissue in the body, cartilage can’t regrow, and when too much cartilage is lost, symptoms of osteoarthritis—pain, stiffness and swelling—can result. Symptoms generally appear after age 40, often in the hands, hips and knees.

The most common type of arthritis, OA affects an estimated 27 million American adults. More than two-thirds of people will have degenerative joint changes by age 70. Today’s longer life spans and higher rates of obesity (a risk factor for OA) mean that stressed joints must perform longer, putting more people at risk, he says.

“There’s no substitute for a complete family history and medical exam,” says Nathan Wei, M.D., clinical director of the Arthritis Treatment Center in Frederick, Maryland. In addition to a family history and a physical examination, a doctor may use laboratory tests, X-rays and MRI tests to determine the extent of joint damage.

There’s no known cure for OA, though emerging research is paving the way for new treatments in which patients may be able to retain and even regrow cartilage in arthritic joints. But for now, common treatments include nonsteroidal anti-inflammatory pain relievers such as ibuprofen, combined with exercise and lifestyle modifications, such as weight loss to reduce joint strain.

Once frowned upon for OA patients, exercise is now viewed as essential for successful treatment. “Exercise is as important as medication,” says Wei. Low-impact forms of exercise such as swimming, resistance training and stretching are ideal.

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease that causes chronic joint inflammation and a wide range of symptoms, from pain, joint swelling and weakness to weight loss and low-grade fever. RA and OA are quite different, says Philip J. Mease, M.D., director of rheumatology research at Swedish Medical Center in Seattle: “Osteoarthritis is a more natural process [of] cartilage loss, while rheumatoid arthritis is a specific disease state caused by abnormal immune system function.”

The CDC estimates that 1.5 million adults have RA, which is two to three times more common in women. While OA is generally discovered later in life, RA is often discovered earlier, says Wei. The 30s and 40s are prime years for diagnosis.

There is no singular test for RA, so doctors use a combination of physical history and examination, blood tests and X-ray imaging to make a diagnosis. Thanks to emerging science concerning RA biomarkers— biological clues to the existence and extent of RA disease activity—sophisticated blood tests can now aid in the detection and management of RA, says Mease.

As recently as the 1980s, RA patients routinely received gold injections as a primary form of treatment. Today, the gold standard for RA treatments is disease-modifying antirheumatic drugs and biological therapies—protein-based prescription medications that fight the abnormalities that cause RA.

While RA can’t be cured, between 10 and 25 percent of RA patients reach remission. In remission, the disease is inactive and patients don’t experience symptoms, but must continue taking medication and remain under a doctor’s care. When RA is caught early, patients have a better chance of reaching remission, says Mease. “Remission doesn’t happen for everyone,” he notes. “But when it does, patients are overwhelmed by how good they feel.”



Source: CostcoConnection

Getting a Grip on Arthritis

If you experience joint discomfort, swelling, or stiffness, you might suspect arthritis. But what exactly is it? The 2 most common types are rheumatoid and osteoarthritis, and while they have different causes, their symptoms overlap. If the signs ring a bell, it might be time to see a doctor about those nagging aches and pains.

Osteoarthritis occurs when joint-cushioning cartilage deteriorates, caused by aging — it’s rare in people under 40 — heredity, injury, obesity, and muscle weakness. And, for unknown reasons, women are more likely to suffer from the disease than men. Symptoms include:

Pain when using joints

Tenderness in response to light pressure

Difficulty grasping or manipulating objects

Stiffness after waking up or after inactivity

Grating sensation or bone spurs in the affected area.

Rheumatoid arthritis is an autoimmune disorder. Many of the signs are similar to osteoarthritis, and it can be accompanied by redness, swelling, fatigue, fever, and weight loss. While this form, too, is more common in women and those over 40, children can also display the symptoms — there are almost 300,000 cases of juvenile rheumatoid arthritis in the US.


Leaky gut is the root cause of many chronic health conditions—including food allergies and autoimmune disease—as it allows unwanted organisms and larger antigenic moieties into the bloodstream. This causes the immune system to “react” to these foreign invaders, as it assumes these particles are dangerous and creates antibodies against them. This can also lead to a situation where different foods set off an immune reaction every time they are eaten. These antibodies may also attack cells in the body that are structurally similar to the unwanted antigens.

Autoimmune diseases include psoriasis, eczema, fibromyalgia, chronic fatigue syndrome, lupus, Crohn’s and inflammatory bowel disease, Hashimoto’s thyroiditis, diabetes type 1, rheumatoid arthritis, scleroderma, autoimmune hepatitis, ankylosing spondylitis, pernicious anemia, Sjögren’s syndrome, and multiple sclerosis. To prevent and manage these conditions, it is important to fix the gut.

1) Remove the potential causes of the leaky gut or damage to the intestinal lining. Such things include a long list: alcohol, caffeine, parasites, bacteria, chemical food additives, inadequate chewing, excessive fluid with meals, enzyme deficiencies, refined carbohydrates, processed food, prescription hormones such as birth control pills, medications, fungus or mold, mercury amalgams and other dental toxics, gluten (a protein found in wheat and other grains), and stress.

2) Replace all the enzymes necessary for the digestion of proteins, carbohydrates, and fats, including protease, cellulose, and lipase, strengthening the system and improving overall digestive function.

3) Reinoculate with probiotics or friendly bacteria such as Lactobacillus and Bifidobacterium to help restore the proper bacterial balance in the gut. Bifidobacteria should predominate in the small intestine while Lactobaccilli should be the predominant species in the colon.

4) Repair the intestinal lining to prevent further damage. Fortunately, if the offending substances are removed and other nutrients are added, new intestinal cells can emerge, tightening the junctions and repairing the leaky gut condition.

Living with diabetes – drugs for chronic illness

I take pills for high blood pressure. Will these affect my diabetes control?

Certain medicines that may be prescribed for high blood pressure, including thiazide diuretics such as hydrochlorthiazide, and beta blockers such as propranolol, can affect your blood glucose level. You might need two or three different types of pilsl in combination to treat your high blood pressure effectively. Even if your blood pressure pilsl affect your blood glucose, you still need to take them, because reducing yoru blood pressure is just as important as lowering your blood glucose.

Is it true that steroids can affect my blood glucose?

Yes, steroid pills or injections increase your blood glucose level because they make it harder for your insulin to work effectively. Even if you are only taking steroids for a short time, you may need to increase the dose of your pills or insulin to compensate. Consult your doctor if you are unsure. Steroids may be prescribed to reduce inflammation if you have Crohn’s disease, ulcerative colitis, or rheumatoid arthritis. They are also used to treat chronic lung conditions, such as asthma.

My blood pressure pills affect my blood glucose level but my doctor says they are the ones I need. What can I do?

Controlling your blood pressure is as important as controlling your blood glucose level in terms of preventing the long-term complications of diabetes. If your blood pressure pills are effective, you may need to work out with your doctor what food or activity changes you can make to control your blood glucose level, or what changes in medication you need.

Going into the hospital

I am having an operation unrelated to diabetes. Should I keep up my normal diabetes routine?

If you are asked not to eat or drink anything before your operation, you may need to reduce your dose of pills or insulin before you go into the hospital – consult your doctor about this. Once you are in the hospital, the staff will probably take over your diabetes care around the time of your operation. If you have to remain in the hospital, you may be able to do your own blood glucose tests and manage your own medication.

What do a glucose drip and an insulin infusion do?

This treatment closely controls your blood glucose level when you are not able to eat properly, for example, when you are having an operation. An insulin infusion and a glucose drip are inserted into your vein – the rate at which insulin enters your bloodstream is adjusted according to your blood glucose level, which is measured every hour. As soon as you are eating properly again, the glucose drip and insulin infusion are replaced with your usual pills or insulin.

When I’m discharged from the hospital should I go back to my old diabetes routine?

During your hospital stay, changes may have been made to your diabetes medication because of the effect of your illness or operation. Before you leave the hospital, ask your doctor if your medication has changed or what the effects of the change may be. If you have been far less active in the hospital than normal and you take insulin-stimulating pills or insulin, you might be at risk of a hypoglycemic attack if you continue to take the same dose of medication when you resume your normal life at home.

Sleep Problems in Kids with Arthritis

Children with rheumatoid arthritis are more likely than their healthy peers to suffer from sleep-related problems that can interfere with daily activities.

Doctors know adults with rheumatoid arthritis are more likely to suffer from disturbed sleep. These patients often report frequent waking in the night and sleepiness during the day. The new research, from investigators at Hasbro Children’s Hospital in Providence, R.I., assessed whether children with the disease also have these symptoms and whether they lead to bedtime resistance and anxiety about sleeping.

Researchers compared sleep habits of 25 kids to the sleep habits of 45 healthy children. Children were evaluated for sleep problems using an array of standard tests, including a questionnaire answered by the children.

Investigators found children with rheumatoid arthritis had higher scores on a number of the evaluations. This included night awakenings, sleep anxiety, sleep-disordered breathing, and sleepiness upon awakening in the morning and during the day. The questionnaire filled out by kids with arthritis also correlated to increased pain.

Authors of the study conclude sleep problems are common in children with rheumatoid arthritis and come from a number of sources ranging from physical abnormalities to behavioral factors like sleep-related anxiety.

SOURCE: The Journal of Rheumatology, 2002;29:169-173

Treatment of Chronic Pain


NERVE BLOCKS can relieve pain by stopping the impulses that travel along nerves in the body. The physician injects a local anesthetic along the course of the nerve or nerves associated with the pain.

SPINAL INFUSION involves the delivery of low doses of medications like morphine through a catheter inserted in the spine.

Most experts say that surgery is a treatment of last resort. For many patients surgery can magically cure their pain, but, the risks are high. Surgery can destroy other sensations in the body or become the source of new pain.

IMPLANTED DRUG DELIVERY SYSTEMS are used for patients with very resistant pain. These systems are expensive but offer a more convenient, portable and efficient way to take medications.

IMPLANTED DORSAL COLUMN STIMULATOR is a device that allows a patient to stimulate spinal nerves with mild doses of electricity, producing relief by short-circuiting pain impulses. This method is being used to treat pain caused by nerve damage and angina.

JOINT REPLACEMENT is the surgical replacement of a joint with a prosthesis. This procedure can be a successful treatment for rheumatoid arthritis and osteoarthritis.

SYMPATHETIC BLOCKS cut some of the sympathetic nerves, reducing pain for some patients.

ABLATIVE SURGERY cuts one or more sensory nerves and blocks sensation from the parts of the body affected by that nerve.


PHYSICAL THERAPY helps patients with chronic pain to improve flexibility, strength, endurance and conditioning thereby reducing the disability caused by chronic pain. Techniques include postural correction for patients with back pain, hot and cold therapy, ultrasound and massage.

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) uses mild electrical impulses delivered to the skin by hand held device. It is a popular method of relieving joint and muscle pain. TENS works by increasing endorphins and stimulating the nerve fibers, altering the balance of painful stimuli entering the spinal cord. It can be worn in a pocket and transmits an electrical impulse through electrodes taped to the body in the area of pain.