While Osteoarthritis occurs when the cartilage joint surface wears out, Rheumatoid arthritis occurs when the immune system malfunctions and attacks the synovial membrane that protects the joints. Osteoarthritis usually occurs in the latter stages of life, while Rheumatoid arthritis can occur at any time. Both conditions result in painful joints.
- Osteoarthritis (OA) develops over time and as people age. This has earned it a name; the degenerative joint disease. OA is also known as wear and tear arthritis.
- While OA may occur in any joint, it affects the joints in the hips, hands, knees, neck, and the lower back.
Causes of Osteoarthritis
- A normal and healthy joint has a cartilage. Cartilage is a firm and rubbery material that is made up of a matrix (gel-like substance with high water content) and proteins (proteoglycan and collagen).
- Cartilage acts as a shock absorber, allowing bones to glide past each other when the joint bends or straightens. The matrix’s water content enables the Cartilage to change shape and absorb impact when it is compressed.
- When it comes to people with OA, the cartilage loses lots of water through wear and tear, thus losing its shock-absorbing abilities. The absence of cartilage causes the underneath bones to rub against each other. This results in pain and inflammation at the joint.
OA can be classified as primary or secondary.
- Primary osteoarthritis, the most common, is the wear and tear “that develops over time without a specific cause.” It affects more women, especially past menopause.
- Areas that primary OA effects includes fingers, hips, spine, knees, and big toes
- On the other hand, the wear and tear in secondary osteoarthritis have a specific cause. For instance, young people get secondary Osteoarthritis as a result of holding occupations that require a lot of bodily movements.
- Other causes of secondary osteoarthritis include;
- Sports-related injury
- Congenital joint disorders such as congenital hip dysplasia
- Physical inactivity
- Disorders such as avascular necrosis that block the supply of blood to the joint
- Hemophilia and disorders that cause the joints to bleed.
- The “abnormal growth of bone and cartilage.”
- Other inflammatory arthritis such as gout and rheumatoid arthritis
- Joint laxity conditions
- Paget‘s disease that causes the deterioration of bone tissue.
Symptoms of Osteoarthritis
- Joint pain and stiffness is the most common symptom of OA. The damage of cartilage (slippery tissue covering bone ends) causes the rubbing of joints. Others include
- Cracking or clicking sound when the joint bends.
- Swelling of the area around the joint.
- Muscle weakness in the area surrounding the joint.
- Reduced range of motion, which goes away with movement.
How it is diagnosed.
- The doctor diagnoses OA by reviewing symptoms, examining the joint, and conducting X-rays and lab tests.”
- The doctor will be looking for signs of OA such as;
- More pain as you engage in activity and less pain as you rest
- Patient being above 45 years in age
- Stiffness in the morning in a less than 30 minutes period.
- The enlargement of bony joints
- Reduced range of motion
- The physical exam, on the other hand, will look for osteoarthritis signs such as joint swelling, tenderness in the joints, crepitation or crackling sounds during movement, altered gait, and the instability of the joint
- Although blood tests won’t diagnose OA, they help rule out other potential causes for the symptoms.
- Questions on the diagnosis can be referred to the rheumatologist (doctor specializing in arthritis).
Effective medical treatments
- There is no cure for OA. Doctors treat the pain by prescribing painkillers such as; “acetaminophen, nonsteroidal anti-inflammatory medicines (like aspirin, ibuprofen, or naproxen)”, and sometimes narcotics.
- Shots of steroids can also be prescribed to ease the symptoms.
- Early stages of osteoarthritis can be managed through regular exercises, physical therapy, weight loss, and assistive devices that help manage OA. These changes in lifestyle can be used alongside Over The Counter (OTC) remedies that manage pain, such as;
- “Nonsteroidal anti-inflammatory drugs (NSAIDs)” such as ibuprofen (Motrin IB, Advil) and naproxen sodium (Aleve).
- “Creams and ointments containing NSAIDs or capsaicin.”
- When home and OTC remedies are not effective, the doctor may prescribe medication such as;
- Higher dosages of NSAIDs.
- “Duloxetine (Cymbalta)”
- “Tramadol (Ultram).”
- Corticosteroid injections to the joint.
- When physical therapy and medication won’t work, knee-joint replacement through surgery is another alternative. But this is only recommended when OA has advanced to a later stage.
- Partial surgery is suitable when OA is not advanced or is a result of an injury.
- There are various types of OA surgery;
- Arthroscopic debridement is where the surgeon removes loose bone and cartilage pieces that have broken due to OA damage.
- With Cortisone injections surgery, the doctor numbs the area around the joint, places a needle with medication. The procedure is limited to only 3-4 injections in a year since this medication can worsen the joint over time.
- Lubricant injection is where the surgeon injects hyaluronic acid to “offers pain relief by providing some sort of cushioning in the knee.”
- In Osteotomy, the surgeon “reshapes the bone to improve the alignment of the joint.”
- Total joint replacement is when the surgeon makes a replacement of the damaged tissue with an artificial joint. Risks involved include infections and blood clot. Sometimes, artificial bones can wear out and come loose. According to the American Academy of Orthopaedic Surgeons, over 90% of patients who undergo knee replacement, report improved mobility and less pain levels.
Recent advancements/developments in treatments
1. Adenosine injection testing is showing promising results
- The testing of new treatment methods for OA is showing promising results. The test is being carried out at the New York University school of medicine.
- Researchers have injected adenosine in the joints of rodents whose limbs were damaged by inflammation through injury or by torn ligament or massive weight pressure in joints.
- A weekly dose of adenosine prompted the regrowth of cartilage by 35-50%.
- According to the Lead study author Carmen Corciulo, PhD, a postdoctoral fellow at NYU Langone, preliminary results of the study show that replenishing adenosine stores by injection as a treatment for osteoarthritis is promising. So far, there are no apparent side effects. However, Corciulo adds that it is too early to conduct studies on humans.
2. New drug for Osteoarthritis has powerful anti-inflammatory effect
- Researchers at the University of Liverpool in the UK are testing a new OA drug that could help keep the immune system in check while ensuring its protective functions remain intact.
- According to the recent study published in the Inflammopharmacology Journal, APPA (apocynin and paeonol) “modulates pathological aspects of human neutrophil function, without suppressing antimicrobial ability, and inhibits TNF expression and signaling.”
- Prof. Steve Edwards, a neutrophil expert at the university says that the therapeutic targeting of neutrophils has been long overdue.
- So far, the results of the trials are positive. Not only has APPA shown potential to dampen down bad inflammation in osteoarthritis, it has also shown potential for broader application, in COVID-19.
Risk factors, complications associated with OA
- The long term use of painkillers and steroids in the treatment of RA of any other disease can lead to serious side effects.
- Surgery to replace the knee joint is not recommended for everyone. Factors such as age and other conditions come into play and may affect the decision.
Risk factors of OA
- Certain lifestyle factors can increase the risk of OA’s occurrence. These factors include;
- The overuse of joints
- Other risk factors that are beyond a person’s control include;
- Family history. Sometimes, OA runs in the family and can be unavoidable. No gene has been identified as the cause of OA yet
- Age. OA is linked to the wear and tear on joints and becomes more common as people get older. The Center for Disease and Control Prevention asserts that more than a third of adults over 65 have symptoms of OA.
- Gender. Although it can affect both genders, the National Institute of Health asserts that OA is more common in men until the age of 45, after which it becomes more common in women.
- Occupations. Repetitive actions that put undue stress on joints can risk OA. Some job tasks that fit the category include; lifting, walking, climbing stairs, kneeling or squatting for more than an hour a day, and joint-intensive sports.
- Previous injuries. People who have injured a joint at a point in time are more likely to develop OA in that joint.
Holistic treatments that can help with arthritis
- According to Everyday Health, gentle weight training and aerobic exercise is a natural treatment for Osteoarthritis.
- A study published in a 2015 Plos One Journal found that women with osteoarthritis, who did yoga movements at least thrice a week experienced reduced knee pain.
- In another study published the same year in Pain Research and Management, people with osteoarthritis who spent at least 150 minutes in a week walking, reported less pain than their peers.
- Exercise strengthens the muscle around the affected joint, thus providing support and keeping it healthy.
- Strong leg muscles ease the stress on the knee joint and act as shock-absorbers, thus deflecting the strain caused by activities such as walking.
- Some recommended exercises for knee osteoarthritis include; Straight leg raises, sitting exercises, lying down leg bends, wall slides, standing heel raises, hamstring stretches, calf stretches and rear leg lifts.
- Gurjit S. Kaeley, MD, a professor of medicine and head of Rheumatology and Clinical Immunology at the University of Florida College of Medicine in Jacksonville says that cartilage is sponge and needs exercise for nutrients.
2. Ice or Heat Therapies
- Thermotherapy is another common natural treatment to relieve osteoarthritis pain.
- Dr Kaeley asserts that icing may be used to relieve acute pain. He adds that patients have reported relief from chronic pain after using moist heat.
- In addition, heat therapy can be especially good before exercise and has often increased joint’s mobility. This is according to Theodore Fields, director of the Rheumatology Faculty Practice Plan at the Hospital for Special Surgery in New York.
- Caution is however advised. “Too much or too can be damaging,” says Kirt Kimball, MD, an orthopedic surgeon in Provo, Utah. 10 minutes of warm heat to an area is enough for most people, adds Fields.
- Experts like Dr Fields and Robin K. Dore, a UCLA rheumatologist professor, recommend heat treatments to osteoarthritis pain such as; heating pads, paraffin baths, hot water bottles, store brought patches, packs, belts and wraps, and hot showers, baths and pools.
3. Weight loss
- Being overweight exerts tremendous pressure, stress and strain on hips and knee, which worsens osteoarthritis pain
- According to Roy Altman, a rheumatologist at UCLA, weight loss can improve symptoms and slow the progression of osteoarthritis. Dr Altman says that even the modest weight loss of 10 to 20 pounds can be very beneficial. He adds that patients with osteoarthritis should aim at eating a balanced diet, regulate calories and exercise as often as possible.
- Benefits of weight loss for people with osteoarthritis include; reduction in pain, better joint function, less inflammation, better heart health, feeling better and having a goodnight sleep.
- Acupuncture, an ancient Chinese practice that involves inserting thin needles to specific points of the body has been found to relieve pain for patients suffering from osteoarthritis.
- The treatment ha been complimented by the National Center for Complementary and Integrative Health.
- Dr Altman asserts that acupuncture has been found to be of value, although it is difficult to evaluate the treatment.
- How does it work? According to Chinese theories, there are 14 meridians responsible for transporting energy. When energy is flowing smoothly trough the meridians the body experiences less pain. When they get blocked, energy cannot flow and thus more pain. Thin needles stimulates energy points, which cause the meridians to reopen and allow a smooth flow, thus relieving pain.
- On the other hand, the western standpoint shows that acupuncture stimulates the brain to release endorphins, a natural body pain reliever.
- Acupuncture treatment has also been shown to stimulate the release of cortisol, which is an anti-flammatory hormone. The hormone eases inflammation that is associated with osteoarthritis.
- Another benefit of acupuncture on knee arthritis is the increased blood circulation around the area.
5. Massage therapy
- According to data from the Alternative and Complementary Medicine journal, one hour massages weekly, for two months has been shown to treat osteoarthritis, increase mobility, relieve pain, and stiffness.
- According to Dr Altman, Massage therapy soothes the muscle around the joints. Stroking the sore muscles stimulates blood flow and relaxes the stress muscle.
- According to the Athritis Foundation, some helpful massages specific to osteoarthritis include; Trigger point, Reiki, Shiatsu, Swedish and Reflexology
Supplements / herbs / natural products that can help with arthritis pain
1. Glucosamine and Chondroitin
- The use of a combination of glucosamine and chondroitin and not either supplement alone, has been found to be effective with osteoarthritis
- A 2016 study published in the Aging Clinical and Experimental Research showed that when patients took the two supplement for 12 weeks or longer, it gave them more ease of movement.
- In another 2015 study published in the Annals of the Rheumatic Diseases, taking the combination for a year led to less joint pain and less joint space narrowing when taken for two years.
2. Avocado Soybean Unsaponifiables (ASU)
- According to a research review published on Cartilage, avocado soybean unsaponifiables (ASU) is effective in treating osteoarthritis. The natural vegetable extract likely slows the progression of the disease and reduces the dependence of narcotic drugs.
- According to the Athritis Foundation, ASU aids in blocking chemicals that cause inflammatory and prevents the deterioration of synovial cells.
3. Methylsulfonylmethane (MSM)
- According to studies published by BMC Complement Alternative Medicine, a 12-week does of MSM can lead to significant reduction in pain and disability.
- The Athritis Foundation asserts that MSM contains sulfur which is needed to form connective tissue. Furthermore, MSM acts as an analgesic by reducing nerve impulses that transmit pain
- Early studies show that 6,000 mg of MSM led to the significant reduction of pain and improvement of physical functions without major side effect.
4. Ginger Extract
- Early evidence suggest that the use of ginger could have similar benefits with OTC pain relievers.
- Ginger switches off certain inflammatory genes, thus acting as a pain reliever.
- Research has confirmed that a dose of 500-1000 mg of ginger extract can achieve pain reduction in hip and knee joint areas for OA.
- According to the Athritis Foundation, more recent studies suggest that extracts of ginger that contain gingerols and ginger essential oils may be more effective for chronic inflammation.
5. Aloe Vera
- A commonly used herb, known for its healing properties, Aloe Vera can also help with joint pain.
- Known benefits of using Aloe Vera include anti-inflammatory benefits and no negative gastrointestinal effects.
- While Aloe Vera gel can be applied on the skin, research also suggest that it can be taken by mouth to relieve OA pain
6. Turmeric (curcumin)
- Curcumin, which is the active compound in turmeric and is part of the ginger family, may also help with OA.
- The substance, according to studies, help fight inflammatory compounds and reduce stiffness and pain associated with OA.
- According to the Athritis Foundation, 400-600 mg of Curcumin capsules, taken up to three times a day or 0.5-1 gram of powdered root extract is the recommended dosage
RHEUMATOID ARTHRITIS (RA)
- Rheumatoid arthritis (RA) “is a chronic inflammatory disease of the joints.”
- RA is an autoimmune condition where the “immune system mistakes the lining of the joints as foreign and attacks them”, resulting in damage, thus inflammation and pain.
- The condition affects the wrist, hands and knees in a symmetrical manner.
- The condition develops when white blood cells enter the synovium. What follows is inflammation after the synovium thickens and causes redness, swelling, warmth and pain in the synovial point
- With time, the inflamed synovium can cause damage to the bone and cartilage within the joint. This results in the weakening of support muscle and ligament
- Researchers are yet to discover the cause of the immune system invading the synovium, although genes and certain environmental factors might play a role.
- Studies have shown that people with human leukocyte antigen (HLA) genes are more likely to develop RA than others.
- Environmental factors that may trigger RA include;
- Bacteria and viruses
- Female hormones
- The exposure to certain fibers and dust
- Stressful events
- The exposure to secondhand smoke
- Smoking and a family history of RA also increase the risk.
- RA is a complex condition which has not been well understood by researchers and practitioners.
- Some early signs of the disease include joint pain, joint swelling and stiffness.
- The signs and symptoms begin in a small and gradual manner and develop in weeks and months as it gets worse.
- The condition is progressive and can begin developing in other parts when left untreated. Long progression of RA can result in long-term disability.
How it is diagnosed
- According to the CDC, RA is diagnosed by reviewing the symptoms, conducting a physical examination, lab-tests and X-rays.
- According to Everyday Health, RA cannot be definitively diagnosed with a single test.
- The process begins when the doctor examines your medical history and conducts a physical examination.
- They will ask for symptoms and look for signs such as prolonged joint swelling and morning stiffness that lasts at least 30 minutes after waking up.
- The doctor will order a blood test that will check the rheumatoid factor and anti-citrullinated protein antibodies (ACPAs). These are “specific markers that indicate RA.”
- At some point, the doctor may decide to conduct imaging tests such as ultrasounds, X-rays and magnetic resonance imagery scans. These tests help the doctors to detect erosion, joint inflammation, fluid buildup and whether joints are damaged.
- Early diagnosis and treatment to suppress the inflammation can reduce the damaging effects of RA.
Effective medical treatments,
- Treatment of RA involves the use of medication that “slow the condition and prevent joint deformity.”
- Disease-modifying anti-rheumatic drugs (DMARDs) are “biological response modifiers that are effective second line treatment.”
- Self management strategies have been “proven to reduce pain and disability” associated with RA.
- The CDC recommends five simple and effective arthritis management practices;
- Learning about arthritis management
- Being active
- Losing weight
- Visiting the doctor regularly for early diagnosis
- Protecting your joints
Recent advancements/developments in treatments,
1. JAK inhibitors relieve RA pain
- Healthline mentions a recent addition (2019) of upadacitinib (Rinvoq) as a JAK inhibitor by the Food and Drug Administration (FDA) in the treatment of RA. Studies, comparing other JAK inhibitors; tofacitinib (Xeljanz) and baricitinib (Olumiant) are additionally being conducted.
- In a recent research involving more than 1600 people, scientists found that a combination of upadacitinib and methotrexate was more effective than adalimumab and methotrexate in the reduction of “pain and improving function.”
2. More BTK inhibitors in the near future
- Healthline also noted that clinical trials experimenting new JAK inhibitors were underway, including the testing of filgotinib.
- During the phase 3 clinical trial of filgotinib, the drug was found more effective than placebo in treating RA. However, more research studying its long term safety and efficacy was still needed.
3. Studies on neurostimulation show promising results
- Researchers are also studying the risks and benefits of “vagus nerve stimulation” in the treatment of RA. The nerve is responsible for regulating inflammation.
- The first human pilot study saw six people being treated with vagus nerve stimulation every day for 12 weeks. While four participants showed improvement, a few experienced adverse effects which were not serious.
4. Omega-3 helpful with RA
- Omega-3 fatty acids continued to show positive results in regard to treating RA. Consumption of the fatty acids has been directly liked to reduced inflammation. This is per a report by the University of Houston.
- Of the 20 trials that were conducted, 16 showed positive results were credited to omega-3 supplementation. In addition, the observation of 1557 people with RA found that participants that took omega-3 supplements experienced less swollen and less painful joints, and lower disease activity scores than those who did not take the supplement.
- The results were reported at the 2019 ACR/ARP Annual Meeting.
5. “RA medication linked with heart health benefits”
- Separate studies presented at the 2019 ACR/ARP Annual Meeting found that certain RA medications including methotrexate and hydroxychloroquine may have benefits to the heart.
- Researchers following over 2,168 veterans with RA found that participants who received methotrexate treatment were unlikely to suffer from heart attack, stroke or heart failure.
- In another separate study conducted by Canadian researchers, people with RA and systemic lupus erythematosus (SLE) who were treated with hydroxychloroquine were less likely to suffer from cardiovascular events like stroke and heart attack
Risk factors, complications,
- Unavoidable risk factors associated with RA include;
- Age-commonly affects people between 40 and 60 years
- Gender. Women are more likely to develop RA than men
- Avoidable risk factors include;
- According to the CDC, smoking increases the risk of OA with a 1.3-2.4 times likelihood for people with a history of smoking. In addition, smoking can cause the symptoms to advance quickly
- Obese people are at a higher risk of developing RA.
- Reports by Mayo Clinic suggest that there is a higher chance that women with RA at 55 or younger are overweight
2. Environment pollutants
- Pollutants such as asbestos and silica may increase RA risk to individuals in the exposed environment.
- It is recommended that people wear safety gears at all times when working with hazardous chemicals
3. Delaying treatment
- Any symptoms of RA should be treated early.
- The CDC asserts that early treatment can delay serious RA side effects and risk of developing joint damage
Holistic treatments for Rheumatoid Arthritis
- Ice baths and cyrotherapy might be uncomfortable, but can be good for people with inflammatory conditions and muscoskeletal chronic pain like RA.
- Treating by cyrotherapy was first invented in 1978 by a Japanese doctor to treat rheumatoid arthritis.
- There are two types of cryotherapy; local and systemic
- According to Professor Carlo Selmi, head of Rheumatology at Humanitas, local cryotherapy is effective for patients with arthritis. He adds that by changing the influx of blood, cold temperature acts as an analgesic in relieving joint pain.
- While it is difficult to evaluate this treatment technique, ice is well tolerated and safe for most patients, and has a negligible cost.
- Besides being used as treatment for OA, the ancient Chinese remedy also works for patients with RA.
- The technique involves inserting thin needles on the body or pain area and leaving them up to an hour.
- Patients with RA have reportedly felt better after undergoing acupuncture and acupressure treatments, hence, some doctors recommend it.
- The treatment method works by stimulating connective tissues, nerve and muscles to improve blood flow and activate natural painkillers
3. Physical Therapy
- According to a published clinical guideline, targeted physical therapy can benefit patients with RA.
- Exercise, stretching, and alternating between hot and cold are physical therapies that work for people with RA.
- As per a 2015 study that was published in Health Technology Assessment, simple stretching and strengthening could help alleviate RA symptoms in the hands and wrists.
- The same study also found that stretching can support other conventional methods of care.
- In addition to stretching, dynamic and low stress exercise are also beneficial for people with RA. Cycling and swimming strengthens the muscles surrounding the affected joint and can help slow RA progression and reduce the overall impact on the joints.
- Sharon L. Kolasinski, a professor of clinical medicine at the University of Pennsylvania says that exercise is critical for everybody with arthritis. Flexibility and strength is important and the only way to do it is by exercising. Dr Kolasinski advises patients to choose activities that they enjoy and not overdoing.
4. Mind-body therapies
- It is a term for therapies that that helps you use your mind to relieve body pains.
- Some approaches include mindfulness meditation, breathing exercises, biofeedback and guided relaxation.
- Other exercises such as Yoga, Tai-Chi and Qi-Gong that help focus on the mind can assist people with RA to cope with pain and improve flexibility and strength.
- Research has proven that mediation and Tai chi practices improve mood and the quality of life.
- According to Dr Kolansiski, evidence has shown that mind-body therapies assist with chronic pain and other arthritis.
- Massage can be very beneficial for RA patients when muscles and joints aren’t too tender.
- People with RA have found various types of massage useful. They use them as a part of self-care
- Among the massages that are effective include trigger point massages, spa-like massage, deep tissue and more.
- Other treatments that can be helpful include floating therapy, herbal tea, Infrared heat and LED light therapy
Supplements / herbs / natural products that can help
1. Fish oil
- Fish oil eases the pain and inflammation in people with RA. In fact, fish oil capsules may be as effective for pain relief as nonsteroidal anti-inflammatory drugs. This is according to Dr Kolansinski, a professor of clinical medicine at the University of Pennsylvania.
- As per the report by Health, there were positive results in RA patients who took high doses of fish oil; 4 grams or 4 fish capsules in the studies that found fish oil helpful.
- According to Medical News Today, fish oil from mackerel, salmon, tuna, herring and cod, have high amounts of omega-3 fatty acids. By blocking inflammatory receptors, the acid helps in combating inflammation.
- In a 2010 study that investigated the effects of fish oil on RA, researchers found that a combination of fish oil supplements and “non steroidal anti-inflammatory drugs” had the positive result of less joint tenderness. The study concluded that indeed, fish oil can be a beneficial supplement.
2. Turmeric and Curcumin
- A 2016 report published by the Journal of medicine approves curcumin and turmeric as promising supplements for patients with RA. According to the Athritis Foundation, studies in 2016 found that curcumin might help in preventing bone breakdown which is related with people with RA.
- Multiple studies have also complemented the use of turmeric and curcumin in preventing and combating inflammation and reducing stiffness associated with RA.
- The Athritis Foundation recommends curcumin extracts, 500 mg capsules taken twice every day.
- Ginger has been used for centuries in Asian medicine because of its anti-inflammatory properties.
- According to research published in the 2014 Arthritis journal, ginger has the abilities to suppress leukotrienes molecules and synthesize prostaglandins, (hormone like substances that cause inflammation and pain).
- Galina Roofener, a Chinese herbalist and licensed acupuncturist at the Cleveland Clinic recommends ginger as a beneficial product in the control of arthritis symptoms
- Thyme, a fragrant herb with high antioxidant capabilities, has been found to have anti-microbial and anti-inflammatory properties that are therapeutic for RA. This is per a research that was published in Pharmacognosy Communications in 2015.
- According to another study published in the December 2018 issue of Complementary Therapies in Medicine, thyme was the most used herb among people with rheumatoid arthritis.
5. Green Tea
- Green tea has polyphenols, which are antioxidants-rich substances that help “reduce inflammation and protect joints.” Polyphenol properties in green tea also help trigger immune responses that ease the severity of arthritis
- A study published in the February 2017 issue of the International Journal of Rheumatic Diseases compared green tea and black tea. Results found that green tea has superior anti-inflammatory effects.
- Everyday Health asserts that a cup of iced green tea, hot green tea is enough to do you good.