ARTHRITIS

WHAT IS ARTHRITIS?

Arthritis is the swelling or inflammation of the joints and the surrounding tissues. Some common body parts which arthritis affects are the knees, fingers, wrists, toes, and hips (1,7). Arthritis results in severe joint pain which impedes on one’s quality of life by affecting their ability to complete basic tasks (2).  In fact, it is identified as one of the leading causes of work disability in the U.S. and is a chronic condition in the country (3).

The prevalence of arthritis is high and is continuously increasing, especially in adults with comorbidities such as obesity, diabetes and heart disease (3). Comorbidity refers to multiple diseases, illnesses or chronic conditions present in a person simultaneously (5,6).

Arthritis is grouped into three main categories: (24)

1. Septic (or infective) arthritis is an infection but is also differentiated and identified as an inflammatory disease affecting the joints. It is generally considered a secondary infection because it is of a result of a bacterium which escapes from the bloodstream and contaminates surrounding tissues. The most frequent causative organism is Staphylococcus aureus. Other causative agents include Streptococci from groups A, B, C and G, Streptococcus pneumoniae, Escherichia coli, Proteus sp., Salmonella sp., Serratia marcescens, Neisseria sp. Speed and accuracy of treatment is often required to avoid irreversible joint destruction which contributes to extensive morbidity and mortality (25,26).

1. Reactive arthritis is also known as postinfectious arthritis and is characterized by inflammation of the tissues and joints occurring post gastrointestinal or genitourinary infections. It occurs approximately four weeks post an acute diarrheal illness (17,27,28,29,33).

1. Inflammatory arthritis. Historically, pain is identified as the main reason why patients with inflammatory arthritis seek the expertise of a rheumatologist. One of the main contributors to pain in inflammatory arthritis is peripheral inflammation (31,32).

The most common types of inflammatory arthritis are osteoarthritis and rheumatoid arthritis: (3,8)

• Osteoarthritis- the clinical syndrome of joint pain coupled with varying degrees of functional limitation and reduced quality of life. It is the most common form of arthritis. It occurs when the equilibrium between the breakdown and repair of joint tissue is interrupted. Osteoarthritis is characterized pathologically by the loss of cartilage, transformation of adjacent bone as well as accompanying inflammation. In contrast to the widespread belief, osteoarthritis is not caused by aging and it does not guarantee deterioration. It affects peripheral joints such as hips, knees and small hand joints (12,36,38).

• Rheumatoid arthritis is an autoimmune disease that affects the lives of 1.3 people in U.S. Onset generally occurs between 30-50 years, mostly in adulthood and in females. It is characterized by the inflammation of the synovium and is responsible for fluid production in the joints. Synovium refers to the soft tissue which lines the spaces of diarthrodial joints, tendon sheaths and bursae and is often the pathological point of focus in several inflammatory joint diseases (13,100).

Other types of arthritis include:

• Psoriatic arthritis- an inflammatory musculoskeletal disorder linked to psoriasis. Psoriasis is an inflammatory condition which presents scaly skin lesions frequently occurring on the knees and elbows but can sometimes affect other body parts (16).

• Gout – the most common form of inflammatory arthritis. It manifests as an intermittent occurrence of synovitis resulting in joint swelling and pain. These occurrences are also known as acute gouty arthritis attacks or flares. Gout can also progress to develop tophi (crystals in the joints due to deposits of monosodium urate-MSU). Hyperuricemia is the main contributory factor behind episodes of gout. It is the inadequate excretion of uric acid or the overproduction of uric acid. Other factors include genetics, hormones, pharmacological and dietary factors, advancing age, and family history (19).

ARTHRITIS TYPES, SYMPTOMS, AND RISK FACTORS

Septic arthritis (25)

Risk factors and potential causes of arthritis:

• Prior surgery
• Alcohol and/or intravenous drug abuse
• Diabetes mellitus
• Leg ulcers
• Intra-articular corticosteroid injection
• Immunodeficiencies
• Elderly and very young children

Symptoms:(34)

• Hot, swollen and/or tender joints
• Joints with a minimized range of movement

Reactive arthritis (33,35)

Risk factors and potential causes of reactive arthritis:

• Predominantly young adults between the ages of 20-40
• Gender: males are more affected than females 3:1 respectively
• Patients who are HLA B27 (human leukocyte antigen (HLA) class I molecule B27) positive- there is a 50% chance of developing reactive arthritis as it restricts immune responses to bacteria (102,103).

Symptoms:(33)

• Musculoskeletal manifestations- lower limb, knees, metatarsophalangeal (MTP) joints and ankles are affected. Some patients may even experience pain in the lower back and buttocks.
• Defects in the skin and nail
• Ocular dysfunctions
• Gastrointestinal involvement- acute or chronic lesions found in the large or small intestines.
• Cardiac involvement- Proximal aortitis depending on the severity may lead to cardiac arrest or death.

Osteoarthritis: (12,37)

Risk factors and potential causes of osteoarthritis:

• Genetic factors; 40-60% hereditary, however, the exact genes are still unknown.
• Constitutional factors- high bone density, age, female sex, obesity.
• Biomechanical factors- joint injury, reduced muscle strength, occupational/recreational usage, joint malalignment.

Symptoms: (37)

• Joint pain

Rheumatoid arthritis: (39)

Risk factors and potential causes of rheumatoid arthritis:

• Genetics
• Alterations in the female hormonal environment due to factors such as breastfeeding, pregnancy and the use of oral contraceptives
• Smoking and/or second-hand smoking
• Occupational hazards such as exposure to silica dust
• Diet- excessive caffeine and red meat consumption as well as foods low in antioxidants

Symptoms: (13,40)

• Warm, swollen and painful joints
• Stiff joints resulting from long periods of rest
• Muscle weakness from lack of use
• Physical weakness and exhaustion
• Rheumatoid nodules (small, hard lumps develop under the skin as the disease progresses)
• Genetic susceptibility is identified as an influential factor in rheumatoid arthritis. Research shows the importance of T cells, B cells, and cytokines in the pathological process of rheumatoid arthritis.

ARTHRITIS FACTS AND STATISTICS

As the population ages, the prevalence of arthritis cases diagnosed increases. By 2040 it is estimated that 78.4 million adults (age 18 years and older) will suffer from the chronic symptoms that accompany arthritis.

• Between 2013-2015, 54.4 million (1 in every 4) U.S. adults were diagnosed with arthritis. A higher age prevalence was identified in females compared to males; 23.5% to 18.1% respectively.
• Osteoarthritis is known as the eleventh cause of disability in the world.
• The annual incidence rate of reactive arthritis is 0.6-27 per 100,00 patient years.
• The annual incidence of early inflammatory arthritis ranges between 115-271 per 100,000 adults (2,3,4,25,27,32).

MEDICAL TREATMENT OF ARTHRITIS

1. Acetaminophen/paracetamol has been the first line of numbing or analgesic agent since the late 19th century and general practitioners use it for spinal pain and osteoarthritis of the hip and knee (43).

Common side effects:(43,53)

• High doses of paracetamol can result in hepatotoxicity (drug-induced liver damage) (104).
• Increased blood pressure in ambulatory patients with coronary artery disease (even from licensed doses)

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used and known for their effectiveness as anti-inflammatory and numbing agents. They inhibit the production of prostaglandins by hindering any activity of cyclooxygenase enzymes. Prostaglandins are lipid autacoids that play a major role in the production of an inflammatory response (41,42).

Common side effects include esophagitis, stomach ulcers, weight gain and edema, sodium retention, acute renal failure, and hypertension.

1. Conventional Opioids are the oldest analgesic agents, drugs or treatment used to manage or relieve pain (107) and are commonly prescribed to patients with arthritis-related pain. However, guidelines established by the CDC indicate that there is insufficient evidence to support the use of such drugs and long-term usage is hazardous for patients.

If NSAIDs or paracetamol are unable to alleviate the pain caused by arthritis, then opioids may be considered after risk assessment (especially in elderly people) (3,41).

Common side effects include sedation, dizziness, nausea, vomiting, constipation, and addiction (10).

HOW TO KEEP LUNGS HEALTHY NATURALLY

Practices to Support Healthy Joints:

Exercise therapy- lessens pain and improves function by approximately 40%. Physical activity is cost-saving in the long run because it reduces annual healthcare cost. An analysis of arthritis patients enrolled in a fitness program (as an evidence-based physical activity intervention) revealed that each person’s healthcare cost was reduced by $945 (3).

Cognitive Behavioral Therapy (CBT)- studies reveal that a combination of tailored CBT and exercise training in high-risk patients with fibromyalgia improves long-term physical and psychological functioning. Similarly, it is also seen as effective in patients at risk in the early stages of rheumatoid arthritis and osteoarthritis (45,46,47).

Natural Supplements That Help Support Healthy Joints:

• Glucosamine sulfate (49,50,51,52,54,55,56,57,65,66,67,70)
• S-adenosyl-L-methionine (71,72,73,74,75,76,77,78,79,80)
• Ashwagandha (58,59,60)
• Capsaicin (61,62,63,64)
• Collagen (81,82)
• Borage seed oil (83,84)
• Boswellia (85,86)
• Chondroitin sulfate (49,55,67,91,92,93,94,95,96,97,98,99)
• Guduchi Root Extract (48,68,69)

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