Newsletter May 2014 – Osteoarthritis v Rheumatoid Arthritis

AVENUE CLINIC NEWSLETTER – MAY 2014

How to Know Whether You Have Ostoarthritis or Rheumatiod Arthritis

Osteoarthritis (OA) – What Is It?

OA occurs when the ability of the cartilage cells that cover and protect joints (the shiny white material that you see on a leg of lamb!)  to release the amount of protein needed to repair and preserve cartilage in the joint reduces. This causes normally firm cartilage to soften. Over time, it wears away – hence OA is often called ‘wear and tear’. This wearing away causes cartilage to lose some of its elasticity and protective surface and pain ensues.

 

Eventually, the pits and cracks in the cartilage deepen further and can cause large areas to deteriorate and wear away completely at which point the joint begins to lose its normal shape, and the space between the joint narrows. In addition, bony growths called osteophytes, or spurs, begin to form where the ligaments and joint capsule attach to the bone. Fluid-filled cysts also often form in the bone and near the joints. In addition, fragments of bone and cartilage may also break off from the damaged joint surface and float freely in the joint space causing the joint to suddenly ‘lock’.

Together, these changes lead to joint pain and a decrease in the ability to move a joint within its full range, known as a joint’s range of motion. The breakdown of cartilage and bone may also result in inflammation. A joint with osteoarthritis is larger than a normal healthy joint, which leads to its swollen and enlarged look.

Characteristics of OA

  • Symptoms include joint pain and stiffness that usually starts later in life and gradually develops, usually over years.
  • Usually a joint on only one side of the body is affected and it is usually found in the knee, hip, the finger joints that are close to your fingernails or base of the thumbs and the spine. Foot arthritis is more common than was thought and gives pain particularly in the arch or midfoot.
  • You will probably experience stiffness for less than an hour first thing in the morning or after you have been inactive for a while. When you move around, you often experience relief but towards the end of the day you will start to feel stiff again.
  • Joints will not be swollen but they ache.
  • Very common – particularly as we become more obese as a nation.

Cause of OA

  • ‘Normal Wear and Tear’
  • Aging joints
  •  Injury
  • Obesity
  • The lower the ratio between your index and ring fingers, the higher the risk of knee OA!

Treatment

  • Exercise

OA responds very well to exercise. Don’t be put off just because the joint hurts.There are many studies show that physical activity is one of the best ways to improve your quality of life. Exercise boosts your energy. By strengthening your muscles and bones, you help keep your joints flexible. Try resistance training using therabands or light weights to build stronger muscles. Your muscles protect and support joints affected by arthritis. If you are overweight then try more aerobic workouts to burn calories, which will help you lose weight. Maintaining a healthy weight relieves stress on painful joints.

  • Maintain mobility

There is moderate quality evidence that hip manipulation is superior to exercise for the treatment of the symptoms of hip OA. Also moderate quality evidence shows that manual therapy of the knee combined with exercise is effective for the symptoms of knee OA. Chiropractic cannot solve the underlying condition of arthritis, but it can help to decrease the pain and increase mobility.

  • Eat a balanced diet.

Studies show that a variety of nutrients may help ease arthritis symptoms. Foods rich in vitamin C, especially fruits and vegetables, may help. Omega-3 fatty acids, found in fish and fish oil, may also help relieve pain. Make sure your menu includes plenty of fruits and vegetables, whole grains, low-fat dairy, fish, and lean meats such as turkey and pork tenderloin. Also, choose healthy fats, such as nuts and avocados, and healthy oils, including olive and canola oil. A trial into eating cabbage is underway in Germany at the moment to establish if cabbage can ease joint pain. Results should be available in December 2015.

  • Lose weight.

Being overweight puts undue strain on weight-bearing joints such as your knees, spine, hips, ankles, and feet. Losing weight can ease symptoms of arthritis. Shedding pounds and keeping them off isn’t easy. Think baby steps. Make small changes each day that help you eat smaller portions and burn more calories.

  • Sleep well. 

A good night’s sleep will help you cope with the pain and stress of arthritis. The pain of arthritis makes it tough for many people to get a good night’s sleep. Worse yet, tossing and turning at night can actually increase the perception of pain. “There’s a reciprocal relationship between pain and poor sleep. The poorer people sleep, the more pain they tend to be in,” says Kevin Fontaine, PhD, assistant professor of rheumatology at JohnsHopkinsUniversity. “If people with arthritis can improve the quality of their sleep, they can usually reduce their day-to-day pain.” To sleep better, try going to bed at the same time every night. Take distractions like television and computers out of your bedroom. If you’re uncomfortable in bed because of arthritis, try using pillows to take the pressure off painful joints. If you have frequent sleep problems, talk to your doctor.

  • Splinting

Particularly of the fingers. Recent research gave 26 people with painful, joint deforming OA customized splints which they wore for three months every night. After three and six months the splints were found to have reduced pain and prevented deformity.

  • Acupuncture

Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups. One study reported “In patients with chronic pain due to osteoarthritis of the knee or hip who were receiving routine primary care, addition of acupuncture to the treatment regimen resulted in a clinically relevant and persistent benefit.”

Joint replacement

See my post on the website entitled ‘Exercise for Osteoarthritis’.

  • Medication

Recently a drug called duloxetine, which is an antidepressant has been tested as a treatment for chronic OA in knees. After 4 weeks, pain severity reduced and the joints functioned better.

  • Natural Remedies

Recent research into glucosamine and chondroitin supplements showed that after two years, those who had taken the supplement had less of a reduction in cartilage volume.

The corydalis yanhusuo plant has recently been examined as a possible treatement for acute inflammation. It is a plant that grows in Siberia and China and is thought to be non addictive. It is not yet known if it is toxic though!

Rheumatoid Arthritis (RA) What is it?

The normal immune cells of the body suddenly start to attack your own body instead of protecting you against bacteria and viruses. When the first immune cells invade a joint, they send out chemical messages through the bloodstream to call in reinforcements. These chemicals cause changes in the tissues around the joint and increase blood flow to the region around the joint and make the blood vessels more leaky so that fluid (and more immune cells) can leave the blood vessels and travel into the tissues.

 

This response is called an inflammatory response and leaves the joint warm and swollen from the fluid accumulation. It also causes joint pain because of destruction of bone and cartilage tissue (see OA) in the joint and because pain-causing chemicals are released.

The chemicals also encourage the immune cell recruits to divide, further increasing their numbers and also induce other cells to divide that leads to overgrowth of the cells that line the inside of the capsule surrounding the joint and that secrete the fluid that fills the joint hence the joints look swollen.

Normally, the joint lining is a single or few layers thick. In rheumatoid arthritis, it is filled with immune cells, blood vessels, and fibrous cells that form a structure called a pannus. This pannus not only fills the joint space but it also grows so aggressively that when it runs out of space within the joint it erodes through the cartilage and surrounding bone as it expands. The pannus is also responsible for the joint warmth, swelling, and pain associated with rheumatoid arthritis.

In an attempt to heal the wounds caused by the attack, the cartilage and bone cells initially try to correct the damage by dividing and growing, creating new tissue. This new joint tissue does not form correctly, however, and often is the wrong shape or is less functional than the original joint, which is when you see people with finger joints that seem to bend the wrong way and don’t move properly.

Characteristics of RA

  • Symptoms can start any time in life and progress rapidly over weeks or months.
  • Joints affected are usually on both sides of the body symmetrically eg both hands, both wrists, both feet, both elbows or the balls of both feet.
  • Stiffness lasts longer than an hour.
  • Joints will be swollen, painful and stiff.
  • You will probably feel fatigue and generally unwell.
  • Only on tenth as many people will get RA as OA.
  • Greater risk of infections
  • New studies suggest that breastfeeding can reduce the risk of developing RA. In one study women who had at least one child and breastfed were around half as likely to have RA.

Cause of RA

  • Your body’s immune system attacks healthy tissue in your joints. This makes the joints swollen, stiff, and painful. Over time, it may destroy the joint tissues and make it hard for you to walk and use your hands.
  • RA is a disease, not ‘wear and tear’ like OA. It is an autoimmune disease. The immune system is the natural defence system of the body which helps fight infections and consists of antibodies, white blood cells and chemicals and proteins that destroy bacteria and viruses that can attack the body. When RA develops, the body’s own immune system starts to attack the body’s joints, thinking that they are foreign substances to be destroyed. This leads to inflammation and joint destruction. It is not known why this happens although it has been suggested that sudden stress, certain types of diabetes and thyroid disease are connected to autoimmune reactions.

Treatment

  • There is no cure for RA but there are treatments that slow down the condition and keep joint damage to a minimum.
  • Four main drugs are used to treat RA, these are painkillers and non-steroidal anti-inflammatory drugs (NSAIDS), disease modifying anti-rheumatic drugs (DMARDS) and steroids. Usually patients are prescribed a mixture of these depending on how they react to them.
  • Looking after your joints is very important in the treatment of rheumatoid arthritis. Exercise is an important part of this type of arthritis too. Splints can help on the hands or wrists.
  • Surgery is occasionally needed and may include joint replacement. Shoulder replacements  are becoming more successful and predictable too.
  • Acupuncture has not been shown to prevent joint damage, and study data is conflicting as to whether acupuncture controls inflammation. Although there is no positive proof that acupuncture addresses inflammation, this has occasionally been seen. Acupuncture can, however, help with RA-related pain, just as it does with other types of pain, through the stimulation of endorphin production. Acupuncture should not be used as the sole treatment for RA, but rather as an additional treatment, in conjunction with RA disease-modifying medications. It is a tool to fight pain with minimal side effects, which can be undertaken along with medication treatment.
  • Use hot or cold packs. By increasing blood flow, hot compresses can ease pain and stiffness. Cold compresses reduce swelling. You may want to experiment with heat versus cold packs to see what works best for you.
  • Keep pain under control. .
  • Eat well because whatever type of arthritis you have, what you eat can help keep your joints and the bones that support them strong.
  • Eating an anti-inflammatory diet will help your joints
  • Eat less-processed foods, while avoiding fried and processed foods, trans fats, and charred meat because they all increase inflammation.
  • Try to include the following foods in your diet:

1. Cherries

Cherries get their crimson color from natural plant chemicals called anthocyanins. Several studies recently have shown that fresh cherries and tart cherry juice may curb inflammation, also few studies have also linked fresh cherries to fewer flare-ups of gout.

2. Highly coloured fruits

Other richly colored fruits (such as blueberries, blackberries, and pomegranates) could also deliver similar effects.

3. Red Peppers

Red peppers are full of vitamin C. Vitamin C helps your body make collagen, which is part of your cartilage, tendons, and ligaments that cushion your joints and hold them together.

4. Citrus fruits

Such as grapefruit and oranges, tomatoes, and pineapple

5. Canned Salmon

Salmon – particularly canned has calcium and vitamin D to help keep your bones strong. Salmon is also loaded with omega-3s, which help curb inflammation. Try other naturally oily fish, such as trout or sardines, for their omega-3s.

6.  Yoghurt

Or milk, which are both high in calcium and vitamin D. A small study in 2013 showed that people who took probiotic supplements had reduced disease activity and less inflammation.

7. Oatmeal

Whole grains like oatmeal are linked to lower levels of inflammation. Refined grains, such as white flour, have the opposite effect. Also try brown rice, and barley

 

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