What causes arthritis?

It is an inflammatory disorder and its causes are varied. The two most common and well known forms of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is caused by wear and tear in the joints beginning slowly and gradually over years. It is a common disorder in older people being a part of the ageing process. The cartilage and bone seems unable to keep up with the normal body's repair and restore function.

Rheumatoid arthritis (RA) is probably an immune disorder and tends to strike in varied ways sometimes gradually and sometimes coming and going. It may affect any joint and other body parts. However it does tend to affect joints of both sides of the body. Although RA is a classic example of a multifactorial disease, where a variety of genetic and environmental factors contribute.

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What happens with arthritis?

Arthritis refers to inflammation of the joints and muscles. It can cause pain, stiffness, swelling and may limit limb movement.

Osteoarthritis is also known as degenerative joint disease and involves a specific joint or more typically involves the knees, hips, spine and the hands. The cartilage, the shock absorbing gel substance of joints, ceases its prime function as a weight bearing absorber and is eroded. Stiffness and pain occurs when the joint is moved and here the pain tends to become continuous. As the joints that bear weight, hips, knees, and lower back tend to be the most affected, overweight will add to the problem. Osteoarthritis is the most common form of arthritis.

The onset of osteoarthritis can be subtle with morning stiffness the initial symptom. Generally it is gives rise to a numbers of problems including early morning stiffness, stiffness following rest periods, pain that worsens with joint use and a degree of loss of functional joint use. It exhibits local joint tenderness (relieved by rest), soft tissue swelling, joint cracking or grating sounds, enlargement of joints (gradual), restricted range of movement, and other signs of degenerative loss of articular cartilage.

Rheumatoid arthritis manifests with painful swelling, inflammation and stiffness in arms, legs, wrists and fingers usually in the same joints on both sides and is very apparent on awakening. Swelling of joints, leading to deformation. Fatigue, loss of appetite, weight loss and low grade fever. It is more serious and tends to become worse over time. Rheumatoid arthritis (RA) is a chronic inflammatory condition that affects the whole body but especially the joints. The onset of RA is usually gradual but occasionally is quite abrupt. There is abundant evidence that RA is an autoimmune reaction, in which antibodies develop against components of joint tissue.

General effects that may precede the appearance of painful swollen joints include fatigue, low grade fever, weakness, weight loss, joint stiffness and vague joint pain. Several joints are usually involved in the onset, typically in symmetry ie: both hands, wrists or ankles. Involved joints will characteristically be quite warm, tender and swollen. The skin over the joint is purplish. As the disease progresses, deformities develop in the joints of hands and feet.

Traditional Pharmacy

The pain and discomfort experienced will depend upon the type of arthritis. Pain can become severe and interfere with normal activities and sleep. Always consult your medical practitioner or pharmacist to help with ways to reduce discomfort and support lifestyle. Rheumatoid arthritis is usually treated by a team approach using several modalities. Usually your pharmacist or physician will recommend normal over-the counter analgesic medication such as paracetamol and non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen and diclofenac to help relieve discomfort and pain. In more difficult situations your physician may prescribe more potent medications. The treatment of pain is similar with osteoarthritis. Paracetamol or over the counter non-steroidal anti-inflammatory drugs relieve mild discomfort with more potent NSAID's prescribed by your physician where necessary.

Treatment overviews in both focuses on pain relief, reduction of further damage and help in maintaining a normal lifestyle.

Natural Pharmacy

The anti-inflammatory herbs ginger (an age-old treatment for pain and inflammation), turmeric and feverfew offer an effective natural therapeutic approach to symptomatic relief of the discomfort and pain. Glucosamine has been shown to be effective in the treatment of osteoarthritis. It reduces joint inflammation, improves joint mobility and provides temporary relief of pain. Glucosamine is a key building block of cartilage between the joints and polysaccharides involved in joint lubrication and cushioning. Glucosamine protects and slows degenerative changes to cartilage and increases the rate of cartilage generation. The use of supplementary herbs and glucosamine may help lower the requirement for NSAID therapy the cornerstone in inflammatory pain and discomfort relief.

Topical capsaicin preparations help reduce pain.

What else to do?

For osteoarthritis dietary therapy focuses on achievement of a normal body weight to reduce weight bearing stress. A healthy diet rich in complex carbohydrates, plenty of vegetables and high in dietary fibre is recommended. Dietary antioxidants found in fresh fruit and vegetables protect against osteoarthritis. Other particularly beneficial foods include cold-water fish (mackerel, sardines, salmon).

Gentle physical therapy and exercise is of benefit, as long as it is monitored.

For rheumatoid arthritis dietary therapy focuses on the elimination of any food that aggravates RA. Avoid/reduce intake of the nightshade family vegetables (tomatoes, potatoes, eggplants). A generally healthy diet rich in whole foods, vegetables and high in dietary fibre, low in sugar, meat, refined carbohydrates and animal fats, is recommended. Dietary antioxidants from fresh fruit and vegetables play an important role in protection against the disease.

Proper physical management and exercise is of benefit, as long as it is monitored. Heat is generally used to help relieve stiffness, pain and relax muscles.

Prevention and Cautions

Arthritis is a disease that requires regular check-ups with your medical practitioner in order to monitor your condition and medication.

Seek professional advice if

• Any pain is accompanied by fever
• Any pain or stiffness that is sudden

References

• The Merck Manual, 17th Edit. 1999
• The Encyclopaedia of Natural Medicine 2nd Edit. 1998