Wells Chiropractic Corp.

Arthritis

The word arthritis is a combination of two Latin words, “arthro” meaning joint and “itis” meaning inflammation, so inflammation of a joint. Inflammation is defined as swelling, redness and pain but what is actually going on is part of a healing process. Our bodies create swelling and pain while repairing tissue. That in turn provides a sort of protective cast around the injury. Think of an ankle sprain. A ligament has partially torn so the immune system creates inflammation around the injury to limit movement and promote healing. Specific immune cells cause blood vessels to dilate, leaking fluid into the area. Other immune cells called fibroblasts create threads of connective tissue to glue everything together in a random mat of webbing. As healing progresses and the ankle joint begins moving again, the threads that are in the way of movement break, leaving only the threads that hold the joint together. In this way, the damaged ligament is repaired.

About half the formation of those tiny threads happens in the first two to three weeks. That’s why it’s important to begin moving the injured joint as soon as possible. Movement breaks the dysfunctional threads. Many times people immobilize a joint too long after an injury, leaving a spongy, fluid-filled area in and around the joint, limiting movement. For most injuries, we recommend beginning gentle range of motion starting 3-7 days after an injury or surgery.

Osteoarthritis

So that’s the process. What could go wrong? Severe injuries like a spinal disc rupture or repetitive injuries to the same area cause so much damage in need of repair that the tissue can’t repair properly. This results in osteoarthritis, also called “wear and tear arthritis” or the “normal arthritis associated with aging”. Severe or repeated trauma also causes the attachment sites of ligaments to micro-tear away from the bones stimulating the bone to overgrow. That is how those ligamentous attachment sites form “bone spurs”. Eventually, those bone spurs can grow together, fusing the joint or joints. This is common in the aging spine. Thinking back to our earlier discussion, movement breaks those scar tissue threads and helps to preserve motion. That’s why yoga or other stretching routines are helpful in reducing the effects of osteoarthritis. We know that adjusting the spine also restores motion to individual joints. In this office we use an Activator to adjust the spine and other joints because the depth of thrust is small and precisely controlled, restoring motion without risking overstretching ligaments and other connective tissue.

Besides adjusting and yoga, what else helps or hurts? As we age the ability of our immune system to repair joints is diminished. Exercise that repeatedly pounds on joints such as running or tennis may need to be reduced or modified. The damage is too frequent for the repair process to keep up. Just as a person in their twenties can do strength training to build muscle more frequently than someone in their sixties, the same is true for stress on joints. What repairs overnight in a twenty year old requires two nights in a forty year old and three nights in a sixty year old. Good posture and good form are even more essential as we age. Exercises like Pilates, swimming or water aerobics and Tai Chi promote full function without stressing the joints. Losing excess weight can also help. Remember, not moving or spending hours sitting looking at a screen will make the joints degenerate sooner. When we move, the gentle friction stimulates the cells lining joints to produce more lubricating fluid and to thicken the slick cartilage end plates and spinal discs that make movement possible. The body is very economical. If we don’t use it, we lose it.

Osteoarthritis is also more prevalent in some people who have a genetic predisposition. While everyone is subject to wear and tear osteoarthritis, if it is severe in your parents and/or grandparents, you may be wise to limit your intake of certain foods. This is because there is a form of osteoarthritis that seems to be apart of a broader metabolic or auto immune condition. More on that later.

Everyone is an individual but some people with osteoarthritis get relief by avoiding eating nightshade vegetables such as tomatoes, peppers, potatoes, eggplant and so on. Unfortunately about 30% of the commonly consumed vegetables are nightshades. Many are delicious and are likely among your favorite foods. Even some herbal products are nightshades, Ashwaganda and Goji Berries for example. Tobacco is also a nightshade. Of course there are a lot of reasons to avoid tobacco. So what is it about nightshades? They contain alkaloids such as solanine. Belladonna contains high amounts of toxic alkaloids. That’s why it is called “Deadly Nightshade”. For most of us, small amounts of these alkaloids are just fine. If however you suffer from arthritic pain, you can try avoiding nightshades for a week then re-introducing them into your diet. Let any resulting relief and pain be your guide.

While the idea that nightshades can cause arthritis remains controversial, there is a wealth of anecdotal evidence to support it. The best support for the hypothesis is that forage animals that eat nightshades often develop crippling arthritis. This is due to the fact that nightshades contain high amounts of Vitamin D2. This is not the same as the Vitamin D that is good for us and that we make in our skin in response to sunlight. The “good” Vitamin D is known at D3. You might think of D2 as the “evil twin” of Vitamin D3. Instead of moving calcium from the soft tissue to the bone as Vitamin D3 does, Vitamin D2 moves calcium from the bones to the soft tissues, causing calcification of soft tissues, including muscles, tendons, joints, blood vessels and kidneys.

In contrast with Vitamin D2, Vitamin D3 is helpful to prevent osteoarthritis. To quote from the journal of Arthritis Rheumatology, February 2010, “Men with Vitamin D deficiencies are twice as likely to have prevalent radiographic hip OA, and therefore vitamin D therapy to augment skeletal health in the elderly is warranted.”

Vitamin K2 works with Vitamin D3 to move calcium from the arteries and other soft tissue to the bones. You can earn more about K2 in my article on Osteoporosis.

One factor that can help reduce all types of arthritic pain is to reduce intake of salt and MSG. These cause the body to hold more water, including more water, including swelling in the joints.

Another nutritional factor to consider is that connective tissue, spinal discs, joint cartilage and joint fluid is made from chondroitin sulphate and glucosamine sulphate. These nutrients are most readily available from eating animal products or bone broth soup. Ever wonder why a dog will gnaw on the end of a bone? Of course you can also take supplements. Bear in mind if you are vegan, the supplements are likely to be be sourced from connective tissue. An alternative is MSM or Methysulphonylmethane. It can be made in the lab and is a precursor molecule to connective tissue.

What about herbs? Ginger is a strong anti-inflammatory. A compound in ginger is the basis for the drugs, Celebrex, Vioxx and Bextra. Those drugs however, have a black box warning because they cause in increase in heart attack deaths. Ginger on the other hand, has an excellent safety record. In fact, throughout Southeast Asia, where ginger is consumed in large amounts, the people have lower levels of dementia. This is attributed to the anti-inflammatory effects of ginger and other herbs.

How does it work? Let me get technical for a moment. Your body makes pro-inflammatory prostagandins. Ginger works by directly inhibiting prostaglandin synthesis, acting as a COX-1 and COX-2 inhibitor. Ginger also inhibits 5-lipooxygenase, inhibiting the production of leukotrienes. Leukotrienes promote and sustain inflammation and are involved in asthma, allergy, arthritis, cancer, cardiovascular and neurological disease. Ginger also prevents inflammation and pain by inhibiting NF-kappaB, also known as the “master switch” of inflammation. Unlike non-steroidal anti – inflammatories such as ibuprofen, aspirin, etc., ginger does not cause ulcers, heart attack, or kidney failure. In fact, ginger will reduce the risk of ulcer and heart attack.

Turmeric has all the same benefits of ginger and can be used in place of ginger. The Chinese name for turmeric is “yellow ginger”. Turmeric tastes a little bitter, so I find better patient compliance with ginger when taken as a single herb. Turmeric is of course what makes curry yellow, and is the basis of much of Indian cuisine.

Another general dietary strategy to reduce inflammation is to eat more foods high in omega-3 fatty acids and fewer foods high in omega-6 fatty acids. Why? Because omega 3’s feed into the production of anti-inflammatory prostaglandins while omega 6 fatty acids increase the production of pro-inflammatory prostaglandins. How do you know what foods are high in which type of fatty acid? To keep it simple, corn fed animal products and grains are high in omega 6 fats. Cold water fish, flax or chia seeds, many vegetables and pasture raised animal products are high in omega 3’s. Considering that corn is the base of the American food chain. It’s not surprising how much we collectively suffer from inflammatory diseases.

Since osteoarthritis and other types of arthritis are typically seen in the same individuals, the nutritional information above may be applicable even with another arthritic diagnosis. It is also true that these general measures will help with all types of arthritis.

So how do you know if you have osteoarthritis? You may find out because it is seen on an x-ray or other test. It may not be painful. You may also have characteristic nodules on your finger joints called Heberden’s Nodes. These swellings appear on the knuckles closest to the end of your fingers or the next closest ones, not the knuckles where your fingers join your hand.

Heberden’s Nodes

Do not be fooled into thinking that osteoarthritis only occurs in the hand and spine. Osteoarthritis of the knee is the most common form of arthritis in the world, affecting an estimated one third of all adults, though only 15% of those with radiographic findings are symptomatic. Incidence rises with age and is also associated with being overweight.

Acupuncture on Osteoarthritis of Knee

Texter’s Thumb or Radialstyloid Tenosynovitis

An increasingly common form of osteoarthritis is colloquially called, “Texter’s Thumb.” It used to be called “Washer Woman’s Thumb” because women held fabric in a pinch with one hand while scrubbing with the other. It develops through prolonged periods of holding the thumb and one of the fingers together. Holding a cellphone and typing messages with your thumb will lead to this painful condition. Even just holding the phone for hours a day will do it. The pain starts in the wrist closest to where the thumb attaches. Over decades, it will cause fusion of the thumb joint at the wrist and compensatory hypermobility of the joint where the thumb attaches to the palm. Many older people, particularly women, will appear to have their thumb held close to their hand. It’s fused there.

I send texts frequently but I talk them into the phone, not type them. If you have this condition, let us know. There are in-office treatments and followup stretches and exercises that can help.

Gouty Arthritis

The usual location of gouty arthritis is joint where the big toe joins the foot. Gout should however, be suspected in any single joint arthritis. On X-ray, gout displays identifiable proliferative changes. Needle biopsy of the affected joint will confirm the diagnosis if a high concentration of uric acid crystals are found.

Known as the “Rich man’s disease, gout is associated with a high purine diet. In all other mammals except primates, uric acid is converted to ascorbic acid. Presumably that enzyme was not needed because our primate ancestors ate a lot of fruit and very little meat.

So what foods are high in purines? All animal products contain purines, so someone suffering from gout should limit the amount of animal product in the diet to between 4 and 6 ounces per day. Some animal products are particularly high in purines. These include organ meats, herring, anchovies, mackerel, beef, pork, lamb, tuna, shrimp, lobster and scallops.

It is also best to reduce saturated fat and alcohol as they interfere with the elimination of uric acid. I suggest eliminating soft drinks and other processed foods as high fructose corn syrup causes the liver to increase uric acid production. Drink plenty of water to eliminate excess uric acid. Cherries, strawberries and blueberries reportedly neutralize uric acid. I have found that Vitamin B5 (Pantothenic acid) can markedly reduce symptoms in an acute attack if taken at a dose of 200 to 500 mg, three times per day.

Rheumatoid Arthritis

This form of arthritis belongs to the rheumatic class of diseases such as Lupus. Unlike osteoarthritis, this is very specifically a heritable auto-immune disorder. There is a blood test to see if you are susceptible and there are other blood tests to determine how severe and in what way it is affecting you. We can order those for you or you can see a rheumatologist.

As opposed to gout, which is typically a single joint arthritis, rheumatoid is a multi joint arthritis. It most characteristically affects the knuckles where the fingers join the hand, the wrists and the finger joints closest to the knuckles as opposed to the joints closest to the ends of the fingers as is the case with osteoarthritis.

Rheumatoid can also affect similar joints in the feet, plus the elbows, knees, hips, etc. Rheumatoid arthritis (RA) is a chronic, progressive disease and can be distinguished from acute viral polyarthritis, which usually resolves in six weeks. You may have noticed an overlap between rheumatoid arthritis and osteoarthritis in that both can affect the middle joints of the fingers. The difference is that while osteoarthritis makes the joint swollen, rheumatoid arthritis erodes those joints. This is very clear on x-ray but can also be seen by a characteristic deviation of the fingers towards the little finger called a “swan neck deformity”.

“Swan Neck Deformity”of Rheumatoid Arthritis

You can also see evidence of “Texter’s Thumb” above

To the touch, swollen tissue in rheumatoid arthritis feels soft and swollen while thickened joints in osteoarthritis feel hard because they are an overgrowth of bone.

A sub type of rheumatoid arthritis is called ankylosing spondylitis. This condition mostly affects men between age 20 and 40 and results in compete fusion of the spine. Because it occurs gradually, it is often missed before fusion is nearly complete.

Nutritionally, it can help to stop eating gluten, all dairy products and bananas. It is difficult to know whether or not you are sensitive to any of these food categories and avoiding them is hard. To figure out if you are sensitive, I recommend stopping one food group at a time for 1-2 weeks then introducing that food in a single meal. So for example, stop having all forms of dairy for two weeks then have a meal consisting of a glass of milk and chunk of cheese. If your symptoms subside then return, that’s your answer. You will have a stronger reaction to the dairy meal this way because your immune system will attack the offending food with renewed vigor after a period of rest. If you are a little bit inflamed all the time, you won’t notice a reaction from continuing to eat an allergen.

It also appears that Vitamin D3 plays a positive role in preventing the genetic expression of rheumatoid arthritis in susceptible individuals, “Vitamin D has immunomodulatory activity relevant to rheumatoid arthritis (RA) and acts by binding nuclear receptors that regulate gene transciption.” ⁱ

Rheumatoid arthritis patients seem to have an especially high need for Vitamin D according to a study in Clin Exp Rheumatol. July, 2012. “Vitamin D deficiency is common in patients with RA, even in patients who are regularly using supplements. Vitamin D supplementation is often ineffective even at the recommended dose of 800 IU/day.”ⁱⁱ That 800 units is not sufficient should not be too surprising, as a person who is naked in the tropics will make an estimated 35,000 units per day of Vitamin D3 in their skin.

Besides diet and gentle exercise, what else can a person with rheumatoid arthritis do? Since the immune cells are sensitive to neurotransmitters and other peptide molecules that are released under the influence of emotions, learning to cultivate peaceful, loving feelings may modulate the course of this or any autoimmune disease. Circulating white blood cells know what is going on because they have receptor sites for endorphins, serotonin, oxytocin, adrenaline, etc. When we are stressed, those hormones inform the white cells that we are under attack and they go on the offensive. When we are in love and at peace with the world, our immune cells get the message that everything is fine. Tai Chi, Chi Gung, Yoga, Pilates, meditation, relaxing with your loved ones (including pets), are all ways of calming an autoimmune disease. At the very least, having more pleasure in life is good in and of itself.

Psoriatic Arthritis

Generally, psoriatic arthritis is mild and just affects the distal joints of the fingers and toes. In some cases, it may be severe and affect the spine, hips and other large joints. Usually it is associated with psoriatic skin rash and pitting of the fingernails. The skin sign of psoriasis is red patches of skin with silver flakes peeling off the red patches. People with pitting in the nails are most at risk for psoriatic arthritis. Five percent of people with psoriasis progress to psoriatic arthritis. The disease occurs most often between the ages of 30 and 50.

Pitting of Nails

Psoriatic arthritis is a largely a diagnosis of exclusion. If the rash and pitting of the nails are present in a case of arthritis, then psoriatic arthritis can be presumed. Otherwise, x-ray appearance of the affected joints in conjunction with exclusion of rheumatoid by blood work and gout by aspirating the joint fluid is needed to confirm the diagnosis. Another visible indicator is a “sausage like appearance” of the fingers. The fingers will not only appear swollen, but feel puffy all over, not a firm swelling at the joints as in rheumatoid or a hard bony overgrowth as in osteoarthritis.

People with psoriatic and rheumatoid arthritis often have subtypes of an antibody called HLA-B27. HLA stands for Human Leucocyte Antibody and is similar to the ABO red blood cell testing. HLA types are inherited. Various HLA-B27 subtypes are associated with increased risk of rheumatoid arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, celiac disease and gluten intolerance. Because of the association with celiac disease, people with either psoriatic or any form of rheumatic disease are likely to improve by avoiding gluten-bearing grains.

Hopefully this article has provided you with an understanding of the most common types of arthritis and what you can do at home to feel better. You should also know that we are able to provide considerable relief with treatments performed in this office. Acupuncture can ease pain, reduce swelling and improve your immune response. Joint manipulation can increase range of motion and some specific nutrients or herbal formulas can go along way to reduce pain. Massage and other soft-tissue work can also be a big help. A woman who arrived last week as a new patient with considerable pain, swelling and reduced mobility left our office with half the swelling, pain and motion restriction eliminated just with massage work. Call and make an appointment. We want you to feel better.