“The pain passes but the beauty remains.” This was how artist Pierre-Auguste Renoir described the crippling arthritis that plagued him from the age of 47. For the rest of his life, the condition kept him wheelchair bound and deformed his hands, even though he continued to paint slowly and in great pain. Had the French Impressionist been diagnosed in the 21st century and not the late 1800s, his outlook would have been more positive. As our knowledge of arthritis management improves, the condition no longer automatically means a life sentence of unending discomfort and disability.
Arthritis is an umbrella term for any number of disorders that cause inflammation of the joints. The condition leads to chronic pain, swelling and stiffness, most commonly in the fingers, toes, wrists, knees, elbows, hips and ankles. Arthritis may prove a small ripple in a person’s life, making it harder to get out of bed, or a major disruption, causing inability to walk or write. According to Arthritis Australia, the disease affects one in six people (or around 3.1 million Australians). More women (roughly 60 per cent) are affected than men.
A disease with many faces
There are more than 100 different forms of arthritis, including lupus (which causes inflamed connective tissue) and gout (which occurs when uric acid accumulates in joints). Most Australians are diagnosed with osteoarthritis (OA), which affects about 75 per cent of arthritis sufferers. OA results when the wear and tear of age erodes the cushion of cartilage that provides a smooth protective covering between the bones in a joint. It usually occurs in people aged 50 and over. Risk factors include a family history, being overweight, getting older, chronic stress across joints (such as the big toe joint in people who wear tight shoes) or joint trauma (for example, sports injuries). The first signs of OA are usually stiffness, pain and tenderness in weight-bearing joints such as the hips, knees, lower spine, feet and hands.
Rheumatoid arthritis (RA), which affects three times as many women as men, can be far more debilitating than OA. It occurs in around 1 per cent of the population, usually between the ages of 25 and 45. RA is caused by an autoimmune disorder. This means the body attacks its own tissues lining the joints, inflaming the synovium, which contains a thick synovial fluid, which looks a little like egg white and lubricates the joint. In RA, the inflammation that occurs around joints causes pain, heat and swelling, sometimes accompanied by weight loss, fever, lethargy and painless, hard, round nodules under the skin.
Joint protection
Exercise is the best way to keep joints nourished. It keeps synovial fluid circulating around the joint and that fluid also supplies nutrients to the cartilage. If you suffer from arthritis and don’t exercise, your muscles weaken to the point where everyday activities become harder because joints stiffen. In the long term, this can speed up the rate of deterioration. However, people without arthritis should also aim to keep joints well lubricated through regular movement throughout their life. Good exercises include swimming (which is also gentle on joints), strengthening with weights, walking, tennis and golf (for muscle strength and improving balance) and tai chi, which improves muscle strength and flexibility as well as balance.
Once arthritis is diagnosed, treatment involves medication to alleviate pain, reduce inflammation and prevent joint damage. Surgery may sometimes be needed to correct joint deformity, reconstruct a diseased joint or completely replace a joint with a prosthesis (such as a new hip). A minor operation called arthroscopy can also provide some relief by smoothing over or removing ragged joint edges, debris and loose material in the joint. Prevention of further damage may involve splinting to stabilise joints (the simplest example is a knee bandage) and orthotics (shoe inserts) to correct weight distribution.
It’s not clear what sets off the inflammation that causes arthritis and no one has yet found a cure for the condition. However, contributing factors may include genetic predisposition, environmental causes such as diet or stress and random triggers such as infection or psychological stress (for example, bereavement). In roughly two-thirds of patients, arthritis will prove temporary and go away permanently. In one-third, the condition is permanent. Some will go in and out of remission. Many natural health practitioners report great improvement with changes in diet such as eliminating dairy and gluten.
Though there is no foolproof way to protect yourself against developing arthritis, you can lessen the risks. A lifestyle that minimises stress and distress appears to reduce internal inflammation. Other important preventive strategies include maintaining a healthy weight, following a healthy diet, taking precautions to reduce repetitive strain injuries at work, warming up before regular exercise and ensuring that all joint injuries are properly and promptly treated.
Nature’s remedies
Though the copper bracelet has shown mixed results in reducing arthritis, other remedies have been found to be of substantial benefit, including:
- Glucosamine: Glucosamine is one of the primary components of cartilage, while chondroitin provides the cartilage with elasticity. The ageing process sees a decline in the body’s ability to synthesise both. Supplementing can reduce pain, inflammation and stiffness associated with joint degeneration. Dosage: Glucosamine sulfate is the form on which most research has been undertaken and is derived from crustacean shell or can be synthetically manufactured. It comes in tablet, capsule or powder. The optimal dose of glucosamine is 500mg three times daily and 400mg of chondroitin three times daily is recommended as well. Cartilage rebuilding may take about three months.
- Ginger: Gingerols (the active component in ginger) are effective in alleviating pain and inflammation by inhibiting an enzyme called COX-2 (cyclo oxygenate), which causes inflammation in arthritis. COX-2 is the same enzyme that some of the newer anti-inflammatory drugs also target. The ginger binds to the enzyme after it crosses the cell wall and stops it from triggering prostaglandins — naturally occurring fatty acids that cause pain and inflammation. Ginger also blocks the reaction of a particular pain receptor in the brain, which recognises painful stimuli such as heat and acidity. Some studies suggest ginger is as potent as the anti-inflammatory drugs in the pain management of osteoarthritis, without any of the side-effects. Dosage: Up to two grams of powder, extract, tincture or capsules, divided into three daily doses, or up to four cups of ginger tea.
- Evening primrose oil: This may benefit people with rheumatoid arthritis or a tendency to stiff and sore joints. It is rich in an essential fatty acid called gamma-linolenic acid (GLA). In the body, this can act a little like a hormone to reduce inflammation. Dosage: About 2–4g per day. You may need to persist for three months before you notice any improvement in symptoms.
- Carathron: This is a natural formula based on traditional Chinese medicine. It contains three different herbs that have been shown in clinical trials to have strong anti-inflammatory and pain-relieving effects in people with arthritis. As well as analgaesic effects, carathron may help in the maintenance and support of surrounding tissue and protect against cartilage degeneration.
Dosage: Three 200mg tablets a day for the first two weeks, then one tablet per day.
Know the signs
Arthritis causes the following symptoms in the joints:
- Swelling
- Early-morning joint stiffness for longer than a few minutes
- Recurring pain resulting in an inability to move normally
- Obvious redness or warmth
- Pain accompanied by unexplained weight loss, fever or weakness along with joint pain
Consult your doctor if you have symptoms for two weeks or more. Blood tests can assess inflammation and rheumatoid factor, an antibody present in about 80 per cent of people with rheumatoid arthritis. A rheumatologist may take fluid from the joint via a needle to be examined for infection, micro-organisms or uric acid (prevalent in gout). X-rays can also help determine whether damage to the bones or cartilage has occurred — usually in the later stages of the illness.
Anti-inflammatory foods
There is no such thing as an anti-arthritic diet. Foods that upset some people will not be a problem for others. However, if you are experiencing joint pain or have a history of arthritis in the family and want to take preventive measures, consider:
- Keeping a diet and symptom diary to identify any foods that cause joint pain or other symptoms of sensitivity. Some people with arthritis find that foods belonging to the nightshade family — tomatoes, potatoes, eggplant and peppers — can exacerbate their symptoms. For others, cutting out foods such as wheat and dairy products can lessen inflammation.
- Eating three meals a week containing oily fish, such as sardines and salmon, rich sources of omega-3 fatty acids, which have anti-inflammatory effects.
- Cutting back on saturated fats from foods such as full-cream dairy products and fried foods, which encourage the production of inflammatory chemicals called prostaglandins, which contribute to joint pain.
- Eating more curries — studies suggest ingredients such as curcumin in turmeric may reduce arthritis onset and symptoms of arthritis due to its anti-inflammatory actions.
- Avoiding alcohol and foods high in purine, such as shellfish, herrings, offal, bacon and yeast if you suffer from gout, as these may trigger inflammation that causes flare-ups of joint pain.
