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A Current Look at the Treatment of Arthritis

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   By: Dr. Jean Antoine Boodhoo

   2011-08-08 04:11 PM

Arthritis is a group of medical disorders that affect one or more joints. Over 100 different types of arthritis have been described with osteoarthritis and rheumatoid arthritis being the most common. Arthritis affects children and adults alike, women more than men, with an increase in the number of sufferers with age. 

In the U.S.A. data reported by the Centers for Disease Control and Prevention (CDC) in a 2007-2009 survey, showed some 49.9 million adults aged 18 years or over as having a doctor diagnosed arthritis (1). In Canada approximately 5 million adult men and women are postulated to suffer from arthritis by 2011. This figure is expected to rise to 6.36 million by 2026 (2). Europe is reported to have 103 million sufferers (3),  the UK about 8 million (4) and China 100 million (5). About 1% of the world community is affected by rheumatoid arthritis, while 18% of women and 9% of men have osteoarthritis (6). These disorders are quite disabling and they inflict a significant financial burden on the person and the community. It has been estimated that within 10 years of onset of rheumatoid arthritis, at least 50% of the patients in developed countries are unable to hold down a full-time job. Similarly 80% of those with osteoarthritis will have limitation of movement, while 25% cannot perform the major activities of daily living (7).

Moreover, the cost of caring for these disorders is enormous. Canadians spend approximately $18 billion annually on the care of these disorders (8). In the U.S.A. the CDC. reported that it cost $127.8 billion to care for arthritis and other rheumatoid disorders, including $47 billion in lost earnings (9).

The treatment of arthritis requires a multidisciplinary approach with focus on reducing pain, maintaining wellness, functionality and reducing the burden of this condition. While emphasis on lifestyle changes are necessary, reliance on physical therapies, pharmacological and surgical interventions, psychological support (13) and the use of some complementary (alternative) therapies form an important part of the overall management.

Lifestyle changes focus on exercise, proper nutrition and various types of active relaxation including Yoga, meditation and Tai Chi. There is increasing evidence that exercise benefits people with arthritis through weight loss and pain reduction. For people who are more restricted, hydrotherapy, water walking and aqua size have been advocated. Exercise and appropriate nutrition will assist with proper weight management and pain control. Evidence shows that joint pain is strongly associated with body weight, with overweight women being 4x more affected than non overweight women. Overweight men are 5x more affected (10).

Proper nutrition can be effective in reducing the symptoms of arthritis.  Foods high in Omega 3 Fatty Acids such as  fish (salmon, sardines, mackerel, among others), olive oil and fruits (strawberries and raspberries) have been shown to be of significant benefit. Patients with arthritis may also require supplementation with folic acid, Vitamin C, Vitamin D, Vitamin B6, Vitamin B12, Calcium, Zinc, Magnesium and Selenium. (11).  There are some claims that eliminating meat, milk products, wheat and vegetables; such as tomatoes, potatoes, eggplant and peppers can be effective in reducing arthritic pain. 

Various forms of active relaxation have been shown to be beneficial in relieving the pain of arthritis.  Yoga has been shown to have significant physical benefits (12).  Tai Chi can relieve arthritic pain, improve reach, balance and wellbeing(13).  Acupuncture has been shown to be effective for osteoarthritis of the knee(14).  Psychological support can also help to reduce the pain and disability caused by arthritis(15).  Physical, manual and occupational therapies are effective in managing the symptoms of arthritis, improving function and assisting with daily living activities. 

No medication to date has been found to cure arthritis. Many drugs, however, have been helpful in reducing arthritic pain and slowing the progression of the condition. These include analgesics, corticosteroid therapy, non steroidal anti-inflammatory drugs (NSAID), disease modifying antirheumatic drugs, immunosuppressant’s and biologic response modifiers.  Genetically designed drugs that can impact on the immune system are also being considered.

A variety of “non-drug” treatments have shown some limited benefit, although not fully backed by the scientific evidence. These should therefore not be used without consultation with the Primary Care Physician/health care provider. They include Boswellia Serrata (an Ayurvedic herb), Tripterygium Wilfordii (Hook F) a herbal remedy used by the Chinese community for years, and SAMe (S Adenosylmethionine E).  Glucosamine (Glucosamine sulphate) has been shown in double blind treatments to improve the symptoms of arthritis compared to non steroidal anti-inflammatory medication.  

Various surgical interventions have been advocated in the management of arthritis including arthrodesis (fusion of bones in a joint), arthroplasty (joint replacement), arthroscopy, osteotomy (surgical cutting of bone), and synovectomy (removal of diseased tissues from a joint) (16).

While many treatments have been advocated in the treatment of arthritis, the need towards a holistic orientation through a multidisciplinary approach may go a long way to reducing the morbidity and associated burden. The need to work closely  with the Primary Care Physician/Primary Health Care Provider and the multidisciplinary team when starting on a course of treatment can go a long way to reducing the morbidity associated with these challenging conditions.  Given the rising prevalence of what is a group of crippling and burdensome disorders, the need for ongoing research and appropriate interventions are critical.

Relevant Links:

http://www.foods-that-heal.com/

http://www.arthritis.org/

http://yoga.com/ 

References:

(1) Mobility and Mortality Weekly Report – October 8, 2010 | 59 (39) | Pages 1261 – 1265
(2) Bradley E, Wang P – 1998 J. Rheumatology Vol 25 Page 138 – 144
(3) Jones R – Manifesto for the 3rd Millennium Patient’s Network 2000 5:23
(4) Arthritis Research Campaign, website URL:  www.arc.org.uk
(5) www.china.org.nc/english/2006/oct/183877.
(6) Woolf Anthony D, Pfleger B (2003) Bulletin of the World Health Organization Vol 81, No 9.
(7) WHO Report Chronic Diseases and Health Promotions Chronic Rheumatoid Condition
(8) Canadian Arthritis Network.
(9) Yelin E et al, Division Adult and Community Health and National Centre for Chronic Disease Prevention Health Promotion CDC.
(10) Anderon J, Felson DT (1988) Ann J Epidemiology, Factors Associated with Osteoarthritis of the Knee in the First National Health and Nutrition Examination (NHANES 1) Volume 128, 179 – 189.
(11) Hindrall M, Illness and Disease – Vitamins, Minerals and Dietary Supplements 1999, Minneapolis, MN, Chromimed 42 – 44.
(12)  Garfinkel MS, Schumacher HR Jr, Husain A, Levy M, Reschetar RA, Evaluation of a Yoga Based Regimen, for the Treatment of Osteoarthritis of the Hand – Journal of Rhematology (1994); 21(12); 2341-2343.
(13) University of North Carolina School of Medicine (2010, Nov 8) Tai Chi relieves arthritis pain, improves reach balance and wellbeing, Study suggest.  Science Daily Retrieved July 24, 2011 from www.sciencedaily.com.
(14) Annals of Internal Medicine, Dec 2004 141, 901 – 910, Berman BM Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee – a randomized control trial.
(15) IQWIG – German Institute for Quality and Efficacy in Health Care, initially published 12thNov 2007 Vol 17:24.
 (16) Health Care Information Directory.

I wish to thank Dr. Joseph Javier MD FRCPC for reviewing this article.


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