Arthritis & Rheumatism

There are over 100 types of arthritis and rheumatic diseases including osteoarthritis, rheumatoid arthritis, and fibromyalgia. This site provides the latest arthritic and rheumatic information including the treatment options available.



Arthritis is a common disease that affects millions of people worldwide. This can be felt in the person's joints, skin and organs inside the body. Should the person feel anything wrong, it is advisable to go straight to the doctor. Doctors have discovered that there are over 100 types of arthritis. Given the number, the doctor will not be able to know which one is affecting the person without an examination.

There are 2 common forms of arthritis. The first is rheumatoid arthritis which is considered a chronic disease. There is inflammation in the joints caused by cartilage damage. Anyone who has this will suffer long term joint damage that will lead to chronic pain and disability. Pain is usually felt when waking up in the morning and will gradually disappear during the day.

Rheumatoid arthritis is a problem that will not go away. This happens in three stages. The first is swelling. The second is the rapid division and growth of cells. The third is when these cells release enzymes that will eat the bone causing the joint to lose shape until the person will not be able to move it anymore.

Since this is systemic disease, it can spread and affect other organs in the body. The best way to prevent is from happening is detecting it early to prevent the person from being disabled. This can be treated with proper medication and therapy. There many drugs available that the patient can use. Some drugs offer pain relief to reduce the inflammation. Others can just do one function.

The second is called osteoarthritis. This happens more often than rheumatoid arthritis but unlike the first, there is no inflammation present. The cartilage in the joint is damaged and will eventually degenerate. Pain will slightly be felt when the person gets up but this will hurt later on during the day. Osteoarthritis can either be primary or secondary. When it is primary, it is often associated with age. It is similar to a car where the parts have to be replaced due to wear and tear. Doctors consider this to be normal as people grow older.

The secondary type is often associated with something else that has caused this to happen. Some of these factors are an injury that took place, heredity, obesity and bone density. Osteoarthritis can be treated with medication, exercise, weight control, joint protection, physical and occupational therapy. This is done to relieve the pain and slow the progression of the disease. Both of these are caused by different things. The common thing between these 2 types is that joint pain can happen anywhere in the body.

Given the many medications available to treat this disease, the patient has to be aware of the side effects of each before choosing which one to use. The doctor should explain these to the person in order to make the right decision.



Tuesday, November 06, 2007

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

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