ARTHRITIS


Arthritis is second only to heart disease as a cause of non-work. Every year, more than 100 different diseases effect the joints. These disease are collectively called Arthritis. Most of the cases are diagnosed as Osteoarthritis.
The number of Arthritis sufferers is expected to grow from approximately 16% of the population today, to 18% of the population by the year 2020. Women and Men seem to be affected equally after the age of 45 up to the age of 55. After the age of 55, women are more likely to be victims of arthritis than men are. Osteoarthritis is not only more frequent it is also more severe in Women after the age of 55.
There are more than 100 types of arthritis.  We will restrict ourselves here to speaking only about osteoarthritis.  This may not be as narrow a focus as it seems, because osteoarthritis is by far the most common variety.  


Osteoarthritis


Osteoarthritis is the most common form of arthritis affecting the articular cartilage. Articular cartilage plays an important role in optimal joint function by providing smooth, low friction surface between articulating bone ends while transmitting load forces to underlying bone.

Cause of Osteoarthritis


Although no one seems to know exactly what causes osteoarthritis (from now on, we'll simply call it arthritis), the following explanation seems consistent with all the known facts:  
Cartilage (together with the synovial fluid) is the material in our joints that provides the cushioning and the lubrication necessary for healthy, pain-free functioning in the course of ordinary pursuits. It exists in a state of dynamic equilibrium. By its very nature, cartilage, as a slippery, load-bearing covering on the ends of the bones that form joints, is subject to a lot of wear and tear. That is, it is constantly being eroded away by the activities of everyday living. In its usual highly adaptive manner, the body removes the worn out cartilage with the help of some enzymes.  At the same time, the body is constantly reconstructing new cartilage.  As long as these two processes remain in balance, our joints remain healthy.


PRESENT TREATMENT


Anyone who has experienced the pain due to arthritis knows how wonderful it is to find relief, even though temporary, from aspirin, ibuprofen, or some other NSAIDS (non-steroidal anti- inflammatory drugs).  After a while, however, the pain returns, and your first inclination is to take another dose of the NSAID.  As long as this is only
occasional, it would seem no more dangerous than taking an aspirin for an occasional headache.  The problem arises when the need for pain-killers is frequent, and perhaps growing.  Every year, about 3000 Americans die from the side effects of substantial doses of aspirin and other NSAIDS.  Another 41,000 people, per year, wind up in the hospital from them.
For short term use, NSAIDS serve a very useful purpose.  But for long term use at high dosages, as in osteoarthritis, they can be very dangerous.  Some examples of the harm they can cause are the following:
1. kidney damage
2. liver damage
3. hypertension
4. gastrointestinal damage
5. asthmatic attacks
6. ringing in the ears
The Secret is in the Synovial Fluid
A membrane called the synovial membrane, which forms a capsule around the ends of the bones involved, surrounds our joints. This membrane secretes a liquid called the synovial fluid. It has many functions, all of them important. Among these, it serves as a lubricant, a shock absorber and a nutrient carrier.
As a lubricant, it is without equal, when the joint is healthy. It makes the joint slicker than wet ice! When our bodies can’t produce enough glucosamine and chondroitin, however, the normally thick synovial fluid becomes thin and watery. In this state, it can’t do the job it was intended to do as a lubricant.
As a shock absorber, our cartilage, immersed in the synovial fluid, protects our bones from the tremendous impact they would receive when we walk, run, jump, etc.  This fluid has remarkable properties as a shock absorbing, or hydraulic, fluid.  It belongs to a rather unusual group of liquids known as dilatent liquids.  These liquids are characterised by the rare quality of becoming thicker, that is, more viscous, when shear is applied to them.  Thus, the synovial fluid in our knees and hips assume a very viscous nature at the moment of shear in order to protect the joints, and then it thins out again to its normal viscosity instantaneously to resume its lubricating function between shocks.  All this happens over and over again, very rapidly, during the course of vigorous exercise, such as during an engagement in sports, dancing, walking, etc. When our bodies can’t produce enough glucosamine and chondroitin, this whole mechanism breaks down, resulting in the pain and decreased mobility that characterises osteoarthritis.
Now we will discuss the role of our synovial fluid as a nutrient carrier.  Cartilage itself is avascular; that is, it doesn’t have any blood vessels.  Hence, the synovial fluid is the liquid that carries the raw materials to the cartilage.  Think of our cartilage as a
sponge immersed in the synovial fluid.  When we exercise our knee, for example, it’s like repeatedly squeezing that sponge out in a bucket of synovial fluid.  In this way, the glucosamine/chondroitin dissolved in our synovial fluid when we exercise our knee is constantly supplying our cartilage.  With this newly acquired abundance of nutrients, plus the exercise to supply them efficiently to our cartilage, our own body can re-build and replace the worn-out cartilage as fast as possible.
What can go wrong with this system?  Obviously, for this system to work, our body has to produce new cartilage as fast as it removes the old, worn-out cartilage. When we are young this is almost always the case.  (Sports injuries are examples of the exceptions.)  The body both produces and ingests glucosamine and chondroitin sulphate (the building blocks of cartilage), which it then uses to build new cartilage to replace the old, much as new skin grows to replace that lost to a wound.   As we mature, however, our bodies often can’t produce enough glucosamine and chondroitin to maintain the necessary balance.  The result of this imbalance is called osteoarthritis, or arthritis for short.
Years are not the only factor that tends to lead us toward arthritis, however. Frequently, young people get it also.  Sometimes, this is the result of a sports injury. In such a case, we call it secondary osteoarthritis, to distinguish it from primary osteoarthritis, which is usually, but not always, more often associated with people who are past 50 years old.
REFERENCES
1.  Theodosakis, Jason, Brenda Adderly and Barry Fox. 1997. The Arthritis Cure. New York. St. Martin's Press.
2.  Bucci, Luke R. 1995. Healing Arthritis the Natural Way.  Arlington, TX.      Summit Publishing Group.
3.  Weil, Andrew. 1997. 8 Weeks to Optimum Health. New York. Alfred A. Knopf.
4.  McIlwain, Harris, et al. 1997. Winning with Arthritis. New York. John Wiley & Sons. 
5.  Kandel, Joseph and David B. Sudderth.   1997. The Arthritis Solution.          Rocklin, CA.  Prima Publishing.
6.  Katzenstein, Larry. 1997. The Arthritis Solution.  New York.  Signet -            Penguin Putnam.
7.  Theodosakis, Jason Brenda Adderly and Barry Fox. 1998. Maximising the Arthritis Cure.  New York. St. Martin's Press.
8.    Jane E. Brody, The Arthritis Is at Bay, Thank You,  New York Times,       January 13, 1998, p. F9
9.   Bucci, Luke R.  1995.  Nutrition Applied to Injury Rehabilitation and Sports Medicine.   Boca Raton, FL.  CRC Press.                       
10. McCarty, M.F., The Neglect of Glucosamine as a Treatment for Osteoarthritis - A Personal Perspective.  Medical Hypotheses 42                323-327 (1994)
11. Mazieres, B. et al. Chondroitin sulphate in the treatment of gonarthrosis and coxarthrosis.  5-months result of a multicenter double-blind  controlled prospective study using placebo.  Rev. Rhum. Mal. Osteoartic. 59 (7-8)  466-472 (1992).  In French.
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14.  Pujalte, J. M. et al. Double blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthrosis.  Curr. Med. Res. Opin. 7 (2)  110-114  (1980)
15. Thilo, G.  A study of 35 cases of arthrosis treated with chondroitin sulphate.  Schweiz Rundsch. Med. Prax.  66 (52)  1696-1699  (1977).  In French.
16. Qiu, G. X.  Efficacy and safety of glucosamine sulphate versus ibuprofen in patients with knee osteoarthritis.  Arzneimittelforschung 48 (5) 469-474  (1998)
17. Pipitone, V. R. Chondroprotection with chondroitin sulphate. Drugs Exp. Clin. Res. 17 (1)   3-7 (1991)
18. Drovanti, A  et al. Therapeutic activity of oral glucosamine sulphate in         osteoarthritis: a placebo-controlled double-blind investigation.  Clin. Ther. 3 (4)  260-272  (1980)
19. Leeb, P. F. et al. Results of a multicenter study of chondroitin sulphate (Condrosulf) use in arthrosis of the finger, knee and hip joints. Wien Med. Wochenschr.  146 (24)  609-614  (1996).  In German.
20. Kelly, G.S.  The role of glucosamine sulphate and chondroitin sulphates  in the treatment of degenerative joint disease.  Altern. Med. Rev. 3 (1) 27-39 (1998)

      

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