Arthritis has been around for a long time, in fact there is archaeological evidence that even Neolithic man suffered from this painful condition. Hippocrates, often known as the ‘father of medicine’, described the condition in the fourth century B.C., and referred to rheumatic diseases, or diseases of the joints, in several ancient publications. Today, it is estimated that over 2.6 million Australians, or 15 per cent of the population have some form of arthritis. It is a condition that imposes a heavy burden on the community, in the form of nursing, hospital and residential care, medications and lost productivity, not to mention the consequences for the people affected. Arthritis generally causes joint stiffness which is often worse in the morning or in cold and damp weather, reduced mobility, swelling and fluid retention in the affected part, grating or cracking in the joint, joint deformation and joint pain, which can be excruciating. Severe pain puts the body in a state of stress, which can have damaging physical and emotional consequences, including depression and anxiety.
The word ‘arthritis’ simply means inflammation of the joints, and is a general term for a number of inflammatory joint diseases. The most common forms are rheumatoid arthritis, an auto-immune condition in which the body attacks the cells of its own joint tissue; gout, that extremely painful condition of uric acid build-up in the joint, particularly the big toe; and osteoarthritis, often known as the ‘wear and tear’ disease of the joints, and by far the most prevalent form. In fact, by the age of 65, nearly 30 per cent of women, and 18 per cent of men report having osteoarthritis, and this incidence increases further as the years go by. The incidence will certainly continue to rise as the average age of the Australian population increases.
The pain and other symptoms of arthritis are caused by the destruction of the ‘shock absorbing’ cartilage, which is found within the joint, plus the growth of bony spurs, or ‘osteophytes’ at the edge of the joint space, which act a little like rough sandpaper to further wear away the joint. The condition is progressive, in that the symptoms generally worsen over a period of years, as progressive destruction of joint tissue occurs. Osteoarthritis mainly affects the weight bearing joints of the hips, lower spine, knees and ankles, although it can also affect joints where there is a lot of use such as the fingers. Rheumatoid arthritis often first manifests in the joints of the hands and wrists, but can affect any joint in the body.
We tend to think of arthritis as ‘just part of the aging process’, and whilst the risk of having arthritic conditions does increase with age, there are several factors which are likely to increase or decrease our chances of suffering from this condition. Weight management is extremely important, as the incidence of arthritis increases with the amount of weight that the joint has to support. In a couple of scientific studies, it was shown that weight loss was associated with a significant reduction in the risk of developing symptoms of osteoarthritis in the knee. Avoiding joint trauma is also important – we’ve all heard of the competitive sportsperson who has developed arthritis due to the repeated stress and trauma inflicted on their joints, but think also of occupational hazards, such as the jarring effect of the use of some power tools. There is little information that can be used to compare the incidence of arthritis that occurs in different countries around the globe, although some preliminary studies show that ‘non-westernised’ countries have a lower rate of arthritis. This may be due to lifestyle factors and/or lower reporting of arthritic conditions.
Additionally, it is clear that there is a genetic predisposition to arthritic conditions, which we can unfortunately do nothing to alter. However, it is important to remember that these conditions are multi-factorial, that is there is probably a whole collection of reasons why an individual develops arthritis.
The first stop for many people suffering joint pain and stiffness is a visit to their GP. If a diagnosis of osteoarthritis is made, the general treatment will be painkillers and/or anti-inflammatory medication. This, of course, helps greatly with symptom relief, but does not get down to dealing with the underlying destruction of the ‘shock absorbing’ cartilage.
Treatment with Natural Therapies
Complementary medicine works by addressing not only the symptoms, it also aims to deal with the underlying causes of disease and dysfunction. This involves using a holistic approach, including diet, lifestyle, therapies and the use of additional nutrients and herbs where necessary.
When we start looking at treatment options, it is easy to be overwhelmed by the huge range of choices, particularly in the field of complementary and alternative medicine (CAM). Because arthritis is such a relatively common condition, it has led to a veritable overload of potential treatments, some of which are inadequately tested, and are of dubious efficacy. Some, however, have been extensively tested, or have been used for centuries, and have proven their worth.
Glucosamine
Glucosamine is a substance extracted from crustacean shells, such as crabs, lobsters and crayfish. As well as being found in creatures of the sea, glucosamine naturally occurs in the cartilage of our joints and in our connective tissue (the stuff that holds us together). It is a substance that has a key role in contributing to the strength, integrity and general cushioning properties of our cartilage. Glucosamine production reduces with age, which increases the risk of suffering damage to our joints. Any cartilage damage can benefit from a supplement of glucosamine, which is often recommended for sports injuries, as well as the degenerative effects of arthritis. The useful effects of this substance include arresting the deterioration of cartilage, stimulating the regeneration of cartilage and reducing inflammation. Clinical trials have shown that glucosamine sulphate reduces joint inflammation and swelling, increases joint mobility, and provides temporary relief of the pain of osteoarthritis. In fact, in one study, it was found to be as effective as drug therapy for the symptoms of degenerative joint conditions such as osteoarthritis. There are a couple of forms of glucosamine available – glucosamine sulphate, and glucosamine hydrochloride. To date, most studies have been conducted with glucosamine sulphate, with a clinically validated dosage being 500mg three times daily.
Green-lipped mussel extract
Green lipped mussels were known to have health-giving properties by the indigenous people of New Zealand, and in recent years, capsules containing green-lipped mussel extracts have been widely available. This substance is known to be anti-inflammatory, to reduce pain and swelling associated with any form of arthritis, and is particularly useful for rheumatoid arthritis, where the inflammation is generally severe. It works by inhibiting what is known as the ‘LOX pathway’ and the ‘COX-2 pathway’. These pathways represent inflammatory processes in the body that may lead to the development of particular inflammatory conditions such as arthritis and asthma.
Fish Oil
Fish oil contains omega-3 fatty acids, which are a type of fat that reduces inflammatory processes in the body. It has been recommended to arthritis sufferers for many years, and some people find it very effective. The key action of fish oil is anti-inflammatory, so it has been used more often for rheumatoid arthritis, where there is usually a greater level of inflammation than that found in osteoarthritis, however, it can be used effectively for both conditions. It is vital with fish oil to take the correct therapeutic dose. The minimum therapeutic dose is 3,000mg daily, or one 1,000mg capsule three times a day. This is the minimum dose, but some therapists have recommended doses of up to three times that amount for a short period of time. In studies conducted, people report a reduction in pain, and less interference from their arthritis in their daily activities.
Chondroitin
Chondroitin is extracted from the cartilage of cows or sharks, and is found in the form of chondroitin sulphates. There is some debate about the effectiveness of this substance as a supplement, as it may be poorly absorbed when taken orally as a tablet, capsule or powder. Like glucosamine, this substance is used by the body for cartilage repair, and also like glucosamine, has been found to be useful in pain reduction. In one study, which compared the effects of chondroitin sulphate (CS) with that of a commonly used non-steroidal anti-inflammatory drug (NSAID), the authors concluded that, although NSAID-treated patients showed prompt pain reduction, their symptoms reappeared at the end of the study. In contrast, the CS-treated patients had a slower onset of therapeutic effect, but the effects lasted for up to three months following treatment. One caution in regards to this supplement relates to the fact that structurally, it is similar to the substance heparin, which is an anticoagulant found in the body. It is therefore advised that it is not taken at the same time as other anticoagulant medication.
Celery
There are several herbs that have a long tradition of use for arthritic problems. Because of its effectiveness, and easy availability, celery has become a favourite. It increases the elimination of uric acid, and possibly other acids, through the kidneys. This is important, as a decrease in the elimination of acids (which are the result of metabolic processes) has long been linked with arthritic problems. Celery helps to reduce arthritis symptoms, and is particularly useful for gout. It can be found in tablet form either on its own, or in combination remedies that usually include other herbs and nutrients. It can also be taken as a tea made from the seeds, or as a fresh vegetable or juice.
Devil’s Claw
Devil’s claw is another herb recommended for arthritis. Its key effects are to reduce pain and inflammation. Its dramatic name derives from the shape of the root, which is supposed to resemble a wizened and devilish hand. It was used by the Native American Indians for joint problems and also digestive disorders, because of the bitter taste of the herb (bitter tastes stimulate the secretion of digestive juices and enhance the digestive process).
White Willow
Many people are unaware that this herb is the original source of salicylic acid, or aspirin. It has been used for centuries to help relieve pain and inflammation, particularly arthritic pain. Unlike aspirin, it does not cause irritation to the stomach lining, due to other active constituents in the herb; however, its action is not quite as potent as the pharmaceutical agent.
Minerals
Minerals are nutrients that come from the earth. They are vital for all body processes including the activation of vitamins. They can be considered as essential synergistic nutrients, and are often consumed in suboptimal amounts because of poor dietary choices, and due to the depletion of nutrients from the soil from intensive farming practices.
Silica is a mineral found in particularly high concentration in cartilage, ligaments, skin, hair and nails. It is involved in the processes of calcification of bone, and the production of connective tissue, including cartilage. It may be a useful long-term remedy to improve the health of cartilage and thereby reduce the risk of deterioration of this tissue with the resulting joint problems.
Sodium phosphate is quite a different substance to sodium chloride, or table salt. It does not have the effect of increasing blood pressure, which sodium chloride can do in susceptible individuals. It is known as a buffering agent, that is, it neutralises acids. Increased acidity of the tissues is a feature of arthritis, which may be decreased with the use of this mineral. It can also be found in homeopathic form as a tissue salt.
SAMe
SAMe, or S-Adenosyl-L-Methionine, is a much more recent addition to the CAM dispensary. It is produced from the amino acid (building block of protein) L-methionine, and helps to reduce pain, and the heat and inflammation that affect arthritic joints. Several studies have compared the effects of SAMe with non-steroidal anti-inflammatory drugs (NSAIDS) and have suggested that their therapeutic activity is similar, but SAMe generally causes fewer side-effects. The dose used in these studies was 1,200mg daily.
As you can see, many of these supplements can be used at the same time, in fact there may be an increased benefit in doing just that. For example, decreasing the destruction of cartilage with a substance such as glucosamine, whilst reducing inflammation with fish oil, or a selection of herbal remedies, is a valid and usually effective approach. It has to be mentioned, however, that everyone responds individually to any kind of medication, be it pharmaceutical or complementary. Generally, complementary medicines take a little longer to have an effect than pharmaceutical medicines, but the two can be used together (hence the term complementary!). If you wish to do this, please check with your doctor, or other suitably qualified healthcare professional about the safety of combining your medications.
Having looked at some supplement options, lets have a look at other vital approaches to help manage this condition:
Diet
Diet plays an important role in many, if not most, disease states, and arthritis is no exception. Here are a few common dietary nasties, which can exacerbate the condition.
Avoid:
- Citrus fruits – particularly oranges, seem to worsen arthritic symptoms for many people.
- ’Acid forming’ foods – Arthritis is commonly referred to in naturopathic circles as an ’acidic’ condition. This means that there is a very slight increase in the acidity in the tissues of the body that appears to affect the health of the musculoskeletal system. This is also a build-up of acidity in the joint spaces. This is particularly true of gout, where there is a deposition of crystals of uric acid within the joint, making movement of the joint extremely painful. Red meat and dairy foods are seen as ‘acid forming’ foods and therefore should be reduced in the diet. In the case of gout, shellfish and offal are seen as prime culprits, as well as alcohol, which acts as a diuretic, concentrating the levels of uric acid in the bloodstream, and increasing the chance of this acid being deposited in the joint space.
- Nightshade foods – Plants in the nightshade family include potatoes, capsicums, eggplants and tobacco. In some people, ingestion of these plants has been linked with worsening arthritis symptoms.
- Allergies – Because everyone is different, there can be many potential dietary factors that may contribute to arthritis. If you feel that you might suffer from an allergy or intolerance to a particular food or food group, it may be wise to see your local naturopath to work out some dietary changes.
Increase:
In order to reduce acidity, increase ‘alkalising foods’. These are basically, all fruit and vegetables (except citrus fruits), particularly vegetables and vegetable juices. A daily glass of freshly juiced celery, beetroot and ginger, diluted with filtered water, is a great alkalising and anti-arthritic remedy. Fish really is a super-food, particularly deep-sea fish, which contains higher levels of omega-3 fatty acids. Eat fish 3-4 times a week, and remember that tinned fish as well as fresh contains these goodies.
Antioxidant rich foods help the whole body, and may help in reducing inflammation. Choose foods that are (naturally) brightly coloured, like blueberries, papayas, leafy greens, pumpkins and carrots. These natural colours are fabulous antioxidants and should be regularly included in everyone’s diet.
Get Moving
Movement therapies have an important role to play in the management of joint problems. In Europe particularly, physical therapy is considered a main component of treatment, even in advanced cases. In Australia, we tend to follow the American model, which relies more heavily on pharmacological intervention. However, there are plenty of tailored options around, from physiotherapists, to aqua classes. Exercise in water is particularly beneficial for those with arthritis, as body weight is taken off the joint in water, allowing a greater range of movement than normal. Practices such as Tai Chi and Chi Gong can also be really useful. They can harness the power of the breath and the ‘chi’ to enhance healing in a gentle way. Check your local community advertising to find a local class.
Mind matters
Some people regard the mind, and what we do with it, as the most important factor in disease and healing. Balance is important in all aspects of life, and looking at mental-emotional patterns is as valid as looking at the physical manifestations and causes of disease. There are many, many books written on this subject, which the reader may find useful, and I would encourage the reader to travel his or her own journey of discovery, and remember, this approach is not about apportioning blame, rather it is a learning process.
So start looking at strategies to improve joint health early, as the old maxim holds true that ‘prevention is better (or easier) than cure’. This article does not attempt to be completely comprehensive in the range of treatment options available, as are many valid modalities that I haven’t mentioned. Acupuncture, Bowen therapy, reflexology, and many other complementary therapies can offer much needed relief for this increasingly common condition.
If you do suffer from arthritis I would encourage you to look at all of the above options. There will be times when professional assistance is appropriate, so ask around for the best therapists. Your local health food store will usually be able to offer you some recommendations for CAM practitioners. To ensure that your practitioner is suitably qualified, ensure they are a member of one of the professional associations (A.N.T.A., N.H.A.A., A.T.M.S., A.H.A., A.A.A. etc.), or you can contact these associations directly to find a practitioner in your area. Tell your doctor if you are using CAM treatments, and also tell your CAM practitioner what medications you are taking – and you can build a team of people, with you at its centre, who can make some differences that can radically improve your quality of life, and that’s what its all about.
