I received a letter asking about arthritis (Arthur to his friends), which I have
published below as it has some very salient points:
He wrote, “One of the main problems that affect the elderly
as you know, is arthritis. Sometimes that includes bone alteration on feet and
hands that overgrow painfully.
In the years I noticed a dramatic improvement of new
therapies and drugs on many diseases, rarely I read on updated treatment on the
above infirmity.
It should be interesting for your readers affected by
arthritis to read some comments on the last advanced cure, if any, in your
column.”
Thank you for your letter, so let’s get straight into the
nitty-gritty. As you get older, you will get to meet ‘Arthur’. Unfortunately,
there are many types of arthritis, and descriptions of these go back into
antiquity. Perhaps the oldest known type of arthritis, called ‘gout’ or gouty
arthritis, has been described since Hippocrates in the 5th century B.C. Then it
was known as the “Disease of Kings” due to its association with rich foods and
alcohol consumption, something in which the commoners were not able to indulge.
However, today one of the most common forms of arthritis is
‘osteo-arthritis’, and rather than being of a biochemical nature,
osteo-arthritis is much more of a mechanical wear and tear situation. And
arthritis is very common. In America, the estimated incidence is that 37 million
adults are suffering from it.
Unfortunately, we all wear out. Joints in particular are
mechanical devices, with one bone sliding on another with a slippery bit (called
cartilage) in between as the bearing surface, cum-shock absorber.
Most joints, especially knee joints, are designed to last our
three score years and ten, and that’s about it. Medical science has helped us so
we now live longer, but we have not worked out how to make the joints last
longer!
We do know why they wear out, especially knee joints. Since
they are mechanical, increase the loading on the joint and it wears out quicker.
Imagine that your knee has been designed to hold up 80 kg for 70 years, and now
increase that loading to 120 kg. That same knee now has to support 50 percent
more than it was ‘designed’ for, so you can expect it to wear out 50 percent
sooner. Simple and painful.
So they hobble down to the doctor and ask for something for
the pain. The doctor flips mentally through the latest medical drugs for this
condition, and most probably will hand over some Non Steroidal Anti Inflammatory
drugs (NSAID’s) and tell the patient to lose weight.
Now I am not saying that this is totally wrong - but - when
the NSAID’s first came out (hands up all those who remember Indocid) they were
heralded as being the answer to these problems. Some were even supposed to
‘grow’ new cartilage. The answer to a maiden’s prayer, or the osteo-arthritic’s
prayers at least.
Unfortunately, we very quickly found that Indocid and its ilk
drilled holes in the lining of the stomach and were more than slightly
dangerous. So we developed newer and better and more stomach-sparing NSAID’s.
Unfortunately, these too produced problems.
Nothing daunted, we came up with even newer and more
wonderful NSAID’s, which came with even newer and more wonderful array of side
effects. So wonderful that one called Vioxx had to be withdrawn by the
manufacturers. Really, we have been chasing our tails here, and not winning.
So what can the poor patient do? The doctor is not offering
help, only tablets with abominable (read “abdominal”) side effects. Most
patients have already tried paracetamol, hot water bottles, someone else’s great
new tablets, NZ green lipped mussels, a cabbage leaf (which does work for
mastitis, or so the ladies tell me), various herbal or homoeopathic medications,
yoga, meditation, copper bracelets, muttering mantras and goodness knows what
else.
So what can the “osteo” sufferer do? Exercise does help to
improve the mobility in the knee joint, and by strengthening the muscles and
ligaments around the knee, give it more stability. But it will not re-grow
cartilage.
There is another avenue in the treatment, and that is direct
injections into the affected joints. This produces spectacular results, which
unfortunately are very short lived. Back to square one.
This is such an interesting subject, I will continue with
Part 2 next week.
