Arthritis Explained

Arthritis can be grouped into two main categories based upon the "localized" or "generalized" areas of the body or joints that are affected and then into sub-categories. Localized Conditions: The arthritis that affects the soft tissue surrounding the joints or bones is considered soft tissue localized conditions, such as bursitis or tendonitis. Another sub-category of the localized conditions only affects one or only a few joints, such as a knee or hip.

Generalized Conditions: The first sub-category for generalized conditions are for those that affect the muscle and soft tissue where there is no evidence of swelling or inflammation. The condition is not associated with joint damage. Fibromyalgia is a common type of arthritis that is placed under this category. The second sub-category of conditions includes arthritis conditions that involve inflammation that affects the entire body. Rheumatoid arthritis is an example of a condition under this category, as well as gout, and psoriatic arthritis.

Other generalized arthritis conditions are polymyositis (muscles); systemic lupus erythematosus (skin, kidneys, or other organs); and vasculitis (any organ). All arthritis conditions affect the musculoskeletal system and joints. Arthritis affecting the joint conditions causes pain, stiffness, inflammation, and damage to the joint cartilage. Cartilage is the tissue that covers the ends of the bones that protect them as they rub together. Cartilage is living tissue. Therefore, it has the same needs as other organs and glands. Cartilage cells are called chondrocytes. All chondrocytes will die and are usually replaced by new cartilage cells.

However, over time inflammation can kill more cartilage cells than the body can replace. This is especially true if there has been an injury or there is not enough proper nutrients in the body to repair the joint. Damage from arthritis can also cause joint weakness, instability and deformities and interrupt daily activities. Typically, arthritis is treated with medication, physical therapy, and changes to the person's lifestyle. Joint replacement surgery is a last resort after healthcare providers have tried other less intrusive interventions to relieve the discomfort.

A person can have more than one type of arthritis. Arthritis includes more than 100 medical conditions that affect approximately 46 million adults and 300,000 children in the United States. Arthritis can start as early as infancy, while it is most common among adults over 60, primarily in the form of osteoarthritis. As the American population ages, the number of people with arthritis is increasing. Arthritis and related illnesses are the cause of major disability in the U.S. and costs over $124 billion a year in medical care and indirect expenses. Individuals can help prevent osteoarthritis by following a few simple steps: -Maintain appropriate weight -Consume fresh fruits and vegetables as a good source of vitamins c and d -Make sure you are getting enough calcium (adults: 1000-1500mg per day) -Exercise -Avoid sports injuries

Taken from :Arthritis and Natural Supplements http://www.1thinkhealthy.com/

I Take Methotrexate For Rheumatoid Arthritis And I’m Concerned About The Side Effects

Since the early 1980’s methotrexate has assumed the position of “gold standard” as a disease modifying anti-rheumatic drug (DMARD) for rheumatoid arthritis (RA). It is effective, relatively safe, and also relatively inexpensive. In the past methotrexate was used either as a single agent or in combination with other DMARDS such as hydroxychloroquine (Plaquenil) or sulfasalazine (Azulfidine). With the advent of the newer biologic drugs, methotrexate is most often used in combination with these biologics for patients with active RA.

Methotrexate works by blocking an enzyme called dihydrofolate reductase. The end result of this action is a reduction in purines and pyrimidines, inhibition of T-cell activation, and reduction of inflammation through the release of a substance called adenosine. Therefore, methotrexate has both anti-inflammatory properties as well as disease-modifying properties. Generally, methotrexate is well tolerated and safe; however, it is discontinued as a result of side effects not infrequently. Most of the side effects related to the low doses used in rheumatoid arthritis are preventable and reversible. Because of the mechanism of action through the antagonism of folate metabolism, there are toxicities that are sometimes seen.

The most common are mouth ulcers, soreness in the mouth, drop in white blood cell counts, drop in platelet counts, and anemia. These side effects can usually be prevented by giving a patient supplemental folic acid. In our clinic we give patients anywhere from one to three mgs per day. One tactic that seems to help with some of the side effects is to split dose the methotrexate- ie., have the patient divide up their dose so that they are taking their tablets over a 24 hour period of time once a week instead of all at gulp.

Patients who develop gastrointestinal upset with tablets occasionally do better with subcutaneous methotrexate. There are also side effects that are not dependent on folate metabolism. These include fatigue, rheumatoid nodule formation, liver damage, and lung damage. Lung damage can be due to fibrosis which can occur over time or there can be an acute syndrome consisting of pneumonitis (lung inflammation), accompanied by fevers, chills, shortness of breath, and respiratory failure. Rare instances of kidney damage have occurred. A much more common scenario though occurs when patients with poorly functioning kidneys are given methotrexate and develop methotrexate toxicity as a result of accumulation of the drug.

There is some data that implicates adenosine as being responsible for some of these side effects. Since methotrexate increases adenosine levels, this is an intriguing possibility. This is being evaluated particularly in a liver disease model. Methotrexate and ethyl alcohol both appear to increase adenosine output from liver cells. In animal models, this paves the way for liver fibrosis. When compounds that block adenosine are given, the liver fibrosis doesn’t occur. The trend now is to use somewhat lower doses of methotrexate and institute biologic drugs earlier. This may also help offset methotrexate toxicity since toxicity to a certain extent is dose dependent. Monitoring for methotrexate toxicity through the use of monthly laboratory testing of blood count and liver function tests, as well as clinical evaluation goes a long way towards preventing many of the potential problems associated with this drug.

Author :Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine.

Gold… How Does It Work For Rheumatoid Arthritis?

Serendipity is what first lead physicians to use gold salts to treat arthritis. Initially, gold was tested as a treatment for tuberculosis; however, it was observed that gold had salutary effects in patients with rheumatoid arthritis. Gold was used extensively until the early 1980’s when it was supplanted by methotrexate as the disease-modifying anti-rheumatic drug (DMARD) of choice. (DMARDS are drugs that actually slow down the progression of rheumatoid arthritis (RA) as opposed to non-steroidal anti-inflammatory drugs that merely help with symptoms).

More recently, biologic treatments have also entered the arena and are capable of putting RA into remission. Gold treatment, while often effective, also was associated with a host of problems. The shots took months to take effect and side effects included rashes, mouth sores, kidney damage, inflammation of the lung, and occasionally, damage to the bone marrow causing life-threatening reductions in the number of red and white blood cell counts and platelet counts.

Dr. David Pisetsky, chief of the division of rheumatology at Duke University School of Medicine, says "We rheumatologists have really never understood how gold works." His hope is that once the mechanism of action is understood, then it might be possible to create new and better gold-like drugs to treat arthritis. Pisetsky’s interest in gold comes from his work with a particular molecule, HMBG1, which causes inflammation, the linchpin to the development of rheumatoid arthritis. He states, “HMBG1 is a molecule which has two functions; it behaves one way when it's inside the nucleus of a cell, and …another way when it's released from a cell.” Inside the nucleus, HMGB1 acts as a messenger and is responsible for converting genetic information from DNA to RNA. But when HMGB1 is released from the cell, for whatever reason, it stimulates the immune system and promotes inflammation… Pisetsky feels that if HMGB1 were kept within the nucleus, it would help reduce the inflammation associated with arthritis.

HMGB1 prodcution in the body is heterogenous- it is not produced in the same concentration in every tissue of the body. There is an unusually high amount of it present within joints where arthritis occurs. The experiments went like this... researchers at the University of Pittsburgh, the Karolinska Institute in Sweden, and Duke stimulated mouse and human immune system cells to make HMGB1, then treated the cells with gold. They found that the gold blocked release of HMGB1 from the nucleus.

Theoretically, that should lessen the amount of HMGB1 available to promote an inflammatory response. Pisetsky feels that gold works by interfering with the action of interferon beta and nitric oxide. These two substances help control the release of HMGB1. (The study will appear in the January, 2008 issue of the Journal of Leukocyte Biology, but will be available ahead of print on the journal's website. Co-authors of the study include lead investigators Weiwen Jiang, from Duke University, and Cecilia Zetterstrom, from the Karolinska Institute; Heidi Wahamaa, Therese Ostberg, Ann-Charlotte Aveberger, Hanna Schierback and Ufl Anderson from the Karolinska Institute; Helena Erlandersson Harris, senior co-author, from the Medicine and Rheumatology Unit of the Karolinksa University Hospital and Michael Lotze, from the University of Pittsburgh).

This description about how gold may work is fascinating to an arthritis specialist who started practice in 1981. At that time we had hydroxychloroquine, gold, and d-penicillamine. None of these treatments was ideal and both gold and d-penicillamine were very toxic. Our treatment options have increased greatly and we are now able to get many patients with RA into remission. However, we still have a ways to go. Research into the mechanisms of disease will help us find better therapies in the future. It may be that some of the older therapies like gold- if we can develop drugs that have the good effects… without the bad, may be very useful. For more information on gold treatment go to:
http://www.arthritis-treatment-and-relief.com/gold-treatment.html

Of all the medical conditions that exist, arthritis is the one that is most often treated with alternative types of therapies. That is because it is a chronic condition for which there is no cure yet. In addition, people with arthritis are in pain and therefore need relief. And, quite frankly, there is mistrust and fear when it comes to conventional treatments, particularly pharmaceuticals. Yet, it is a mistake to assume that because a remedy is touted as being “natural” or “organic” or “an alternative to harmful drugs” that it is necessarily safe and effective. There are certain items that should be looked for in any type of alternative or complementary therapy (The terms “alternative” and “complementary” can be used interchangeably. An alternative therapy, when used in combination with conventional therapies is referred to as a complementary therapy) .

Therapies that fall under this label are acupuncture, herbs, vitamins, massage, music therapy, etc. First of all, look for the “warning signs”. These are tip-offs that the treatment being touted may be bogus. 1. If the seller of the product accuses the medical community of a conspiracy, watch out! This is a favorite tactic of unscrupulous vendors. 2. If solid evidence is lacking. Testimonials alone should not be relied upon because it is easy to fake them. 3. If a remedy is touted as being effective for a wide range of medical problems, be very wary. Nothing works for every disease. 4. A treatment referred to as a “miracle cure” or “new discovery” or “discovery suppressed by the medical establishment” should be viewed with skepticism. 5. Jargon words such as “detoxify” or “purify” or “oxidize” should also raise red flags.

These words sound impressive but unless there is scientific proof, it is probably a lot of hocus-pocus. Check to see if the treatment is supported by well-designed clinical trials. With arthritis, the placebo response (response to a sugar pill) can be as high as 40 per cent! Therefore, it is critical to see if the treatment has been tested extensively against placebo. If an alternative health provider is soliciting your business, make sure you look into their qualifications and credentials. National organizations should offer a means of checking to see if the person you’re planning to see is certified.

A note of caution... just because a provider lists an impressive sounding organization doesn’t mean it is a valid one. Beware of this and look into their reputation. You can also check your state government listings for agencies that regulate and license health care providers. These agencies may list practitioners in your area and offer a way to check credentials. Many arthritis sufferers take herbal remedies as well as vitamins and minerals. These nutritional supplements don't have to undergo the same rigorous testing and labeling process as over-the-counter and prescription medications. Some of these substances, including products claimed as "natural," have drug-like effects that can be potentially dangerous.

Some supplements can cause problems during surgery such as changes in heart rate or blood pressure or increased bleeding. Others may have significant interactions with prescription drugs. Make sure you let your physician know about any nutritional supplements you are taking. Many people with arthritis use the Internet for their medical information. While the ‘net is a great place to get good information, it is also a prime source of misinformation. Beware of sites that muddy the distinction between good information and a “hard sell.” of products. Make sure you know the credentials of the person making the claims. When arthritis patients ask me about why some questionable alternative therapies seem to work, I often to refer to the wisdom of Joe Schwarcz. [Joe Schwarcz is director of McGill University's Office for Science and Society (www.OSS.McGill.ca)].

He writes, “If there is no efficacy in these alternative treatments, why do people flock to them? Because alternative practitioners are charismatic and often offer hope where mainstream medicine cannot. They use the placebo effect to great advantage and capitalize on the fact that many diseases are self-limiting and resolve by themselves. But when contemplating a course of treatment, it is prudent to reflect upon the words of Victor Herbert, renowned hematologist and champion of evidence-based medicine: "for every complex problem there is a simple solution, and it is always wrong."

Does Weather Really Affect Arthritis?

In the 1960s, a famed arthritis specialist named Dr. J. Hollander orchestrated a study to demonstrate how high levels of humidity along with low barometric pressure increased stiffness and joint pain in patients who suffered from arthritis. The fibromyalgia sufferers in this study indicated more pain only during days of high pressure. At the end of this study, no significant links between changing weather patterns and an increase in arthritis pain were ever found. Why Weather is Believed to Affect Arthritis Pain " Cold and rainy weather is often accompanied by a distinct drop in air pressure. The Types of Weather Changes That May Affect Arthritis Pain

" Barometric or air pressure: Although rising barometric pressure, which is the amount of force or weight exerted by the air around us, may also affect some types of arthritis pain, more often than not it is a rapid decline in air pressure, such as the drop that's associated with stormy weather, that causes an increase in aches and pains.

" Humidity: The amount of water vapors in the air is referred to as either humidity, absolute humidity, or relative humidity. - Temperature: Cold weather has long been associated with arthritis pain and stiffness in the joints, as well as triggering a host of other conditions such as migraine headaches or circulatory problems. For example, in one arthritis pain study, people living on the western coast of the United States in a milder climate reported just as much pain as those living in the eastern, colder portion of the country.

Does the Weather Really Affect Arthritis?

For as long as man has been aware of the changing weather, there has been speculation that it may also affect one's health and certain ailments besides simply altering the temperature.
Hippocrates, the ancient Greek "Father of Medicine" suspected as long ago as 400 B.C. that different weather conditions have a great influence on how our bodies feel. A few thousand years later, the modern world of science and medicine is still divided on whether or not fluctuations in the weather actually affect some health conditions.

Arthritis, and its numerous forms, is just one of the conditions that some believe is directly affected by the weather and changes in barometric pressure. A great majority of people diagnosed with arthritis say they can easily predict the weather based on how they're feeling, or how sore or tender their joints may be, making perfect sense of the saying "I'm feeling under the weather."

Although there are many people with arthritis who swear by this meteorological method of gaging the severity of their pain, there still is no actual scientific evidence to back up the claims.

Weather and Arthritis Pain Research

In the 1960s, a famed arthritis specialist named Dr. J. Hollander orchestrated a study to demonstrate how high levels of humidity along with low barometric pressure increased stiffness and joint pain in patients who suffered from arthritis. He indicated that neither of these weather changes individually had an impact on pain, but only when they occurred simultaneously.
Dr. Hollander concluded that when barometric pressure drops, the swelling around inflamed joints increases, causing more irritation to the surrounding nerves, which then also increases the amount of pain felt. This particular study has been refuted by many scientists as inconclusive due to the small number of patients (12) who participated.

One similar, more recent study also examined the association between arthritis pain and the weather involving people diagnosed with osteoarthritis, rheumatoid arthritis, and fibromyalgia, which is another rheumatic disorder causing sore, tender joints. All of the participants lived in the same, warm climate and kept a log for one year, recording any changes in their level of pain. These logs were then compared with daily changes in the weather such as the relative humidity and temperature.

In this study, some people with rheumatoid arthritis seemed to be most affected by high levels of humidity and air pressure, while others in the osteoarthritis group felt more pain when only the humidity was high. The fibromyalgia sufferers in this study indicated more pain only during days of high pressure. However, none of the findings were strong enough to rely on just the weather itself to predict impending changes in pain levels.

Yet another research study involved over 100 people living in Florida who were diagnosed with osteoarthritis. For two years participants were told to score the severity of their arthritis pain so that researchers could match the results with local temperatures, whether or not there was precipitation, and what the barometric pressure was for each day. At the end of this study, no significant links between changing weather patterns and an increase in arthritis pain were ever found. However, some women did report experiencing more pain in their hands when barometric pressure was its highest.

Why Weather is Believed to Affect Arthritis Pain

Cold and rainy weather is often accompanied by a distinct drop in air pressure. One theory exists that this drop in pressure causes the body's tissues to expand, causing the already inflamed areas to swell more and increase pain. And then there are those doctors who argue that just a gloomy, rainy day itself may cause some to feel as if their pain is worse than it actually is.

Another theory simply suggests that people's threshold for pain drops along with the air temperature. Therefore, colder weather affects one's mood, making people less likely to be outdoors, remaining active, and getting the exercise that helps keep some arthritis pain under control.

There are also those who believe that arthritis sufferers look to the climate as an explanation for their increase in pain simply because there is no other plausible reason, only noting when the weather is inclement, but not noticing weather conditions as much when their pain is under control and stable.

The Types of Weather Changes That May Affect Arthritis Pain

- Barometric or air pressure: Although rising barometric pressure, which is the amount of force or weight exerted by the air around us, may also affect some types of arthritis pain, more often than not it is a rapid decline in air pressure, such as the drop that's associated with stormy weather, that causes an increase in aches and pains.

- Precipitation: Precipitation, meaning any form of water reaching the ground, includes not only rain and snow, but hail and sleet as well, and is accompanied by changes in air pressure and humidity.

- Humidity: The amount of water vapors in the air is referred to as either humidity, absolute humidity, or relative humidity. Increases in absolute humidity, which measures the amount of water vapors in relationship to the amount of moisture the air can hold at that particular temperature, are said to cause an increase in arthritis pain especially during the summer months.

- Temperature: Cold weather has long been associated with arthritis pain and stiffness in the joints, as well as triggering a host of other conditions such as migraine headaches or circulatory problems. Temperatures that quickly rise or fall are again the result of changes in barometric pressure.

It's important to remember that although certain types of weather may adversely influence some of the symptoms of arthritis such as pain and swelling, there is no scientific evidence that those climate changes are what causes one to develop arthritis in the first place, or to suffer from joint damage.

While it's true there is some evidence that some people living in drier, more arid places have fewer episodes of arthritic pain, there is no type of environment that guarantees complete relief from arthritis pain. It is also known that temperature and climate changes do not affect the actual course or progress of the disease.

People considering relocating to a warmer climate may want to consider the fact that most scientists believe that the body acclimates itself to its new environment over a relatively brief period of time. Which means that moving to a dry climate may seem to provide relief at first, it isn't believed to be beneficial over the long-term. For example, in one arthritis pain study, people living on the western coast of the United States in a milder climate reported just as much pain as those living in the eastern, colder portion of the country.

If you aren't able to spend time outside for exercise, be sure to compensate by exercising and remaining active indoors during times of inclement weather.

In many Asian countries and parts of Europe, homeopathic treatments are rather common for dealing with the pain associated with arthritis. Various herbs and natural substances are often combined to create remedies for arthritis pain as opposed to using traditional medications. Of course, as is with any type of disease or condition not just arthritis, a proper diagnosis by a qualified medical professional is imperative for any successful pain relief treatment plan.
www.help-with-arthritis-pain.com