Arthritis: A Real Pain in the Neck
First published in Beyond India, November 2016 edition.
Dr Rahul Barmanray
Oof! When I roll chapathi my hands hurt, if I carry the grandchildren my back hurts and when I walk my knees hurt! I can do nothing!
Arthritis is a word that means ‘inflammation of a joint’. Joints have many nerves so this inflammation is often quite painful. Initially treatment is with lifestyle changes and pain relief, followed by stronger medications. Over years the inflammation eventually destroys the joint and patients may require surgery or even joint replacements. There are a few different types of arthritis and the joints affected, progression, and treatment can be very different between types.
This is the most common type of arthritis and is due to wear and tear on a joint that wears away the cartilage. The joint affected depends on the activity done by the patient. If you spend every second morning churning your own ghee you may get osteoarthritis of your shoulders, if you walk up the temple steps every afternoon your knees and hips are at risk. The pain of osteoarthritis gets worse with activity and goes away with rest.
If a doctor thinks your joint pain is due to osteoarthritis they will often take an x-ray. This may show loss of cartilage and later on, damage to the underlying bone. Initially a doctor may recommend changes to lifestyle that reduce the stress on the affected joints. Pain relief medications are the next step followed by injections into joints. If these don’t work then a joint replacement may be the only option. Osteoarthritis is the most common reason for both knee and hip replacements.
A word about supplements: There is some controversy over whether glucosamine or chondroitin help with osteoarthritis. Large studies have shown conflicting results but the good news is they have few side-effects so are relatively safe to try. They just may be of no benefit.
Rheumatoid arthritis or rheumatism is an inflammatory disease where the body’s immune system attacks the cells of the joints. It is 2-3x more common in women than men and in people aged 50-70. The main modifiable risk factor is smoking but interestingly, drinking more than 4 cups of black tea (not green or herbal) per day might also increase the risk. It most commonly affects the small joints of the hands, often causing them to deform in a typical manner, but may also affect the wrists, neck, shoulders, knees, ankles, and toes. When you wake up you feel like you’ve been rolling chapathi all night, but this pain and stiffness improves with activity over the course of the day.
This type of arthritis is best diagnosed through a combination of x-rays and blood tests. Because it is due to the immune system attacking the body it is treated by a wide variety of medications that dampen the immune system. Unfortunately these can all have side effects so a type of specialist doctor known as a rheumatologist will need to care for patients with rheumatoid arthritis very closely. Since the joints are often deformed in this condition, some patients with long-standing disease will need surgical correction, especially to improve the use of their hands.
Gout is a very common cause of arthritis. From its earliest descriptions including in the Charaka Samhita Ayurvedic text written in 300-100 BCE gout has been associated with kings and wealthy people. This is no surprise as the condition is due to a chemical known as urate that builds up in joints and causes inflammation. Urate is produced from purines (one of the components of DNA), which are naturally found in many foods including alcohol and seafood. In ancient times, it was only kings or emperors who could afford to eat significant quantities of these food. Now we know that gout occurs in people who have genetic risk factors and consume significant purine-containing foods. Thus, not everyone at risk will develop gout and neither will everyone who consumes lots of purines.
Gout most commonly affects the joints of the feet and toes but can affect any joint. It preferentially affects joints that are already damaged, so it is not uncommon to have osteoarthritis and gout in the same joint. The diagnosis is made by a combination of x-rays, blood tests, and taking a sample of fluid from an affected joint during an attack. The treatment for an attack is anti-inflammatory medications until the inflammation subsides. Following the attack a doctor may recommend preventative medications as well as a low-purine diet so that attacks don’t recur.
There are many other types of arthritis. Some of these affect specific joints while others can affect the whole body. Many medical conditions may also affect the joints and each has its own specific treatment. As you can see, since there are so many possible causes of joint pain, it is important to see a doctor to make sure that you are getting a treatment that is right for you.