Chronic Joint Pain - Arthritis - Uncovering
The Truth
The $65 Billion Dollar Disease
Since most of us suffer from some degree of osteoarthritis, let’s
take a look at the current medical treatment as well as alternate treatment
protocols of America’s $65 billion dollar disease. The number
of us diagnosed with arthritis continues to rise as does the number
of those becoming disabled by the disease (11 million Americans by
2020).(1) In fact, a recent study reported by the CDC (Centers For
Disease Control) indicated that the number of people with arthritis
has increased by 750,000 each year and that by 2020 they estimate that
the US is on track to have 60 million sufferers!
Now Bear With Me
Before we can understand what the best treatment is we have to understand
the process better. Please bear with me through this part, I promise
it will be worth it. Osteoarthritis (OA) is the most common form of
arthritis – about 70% of people over the age of 40 have at least
x-ray evidence of OA somewhere in their body.(2)
Osteoarthritis typically attacks two types of joints; those that bear
weight (such as the low back, hips and knees), and those involved with
repetitive motions (such as hands, wrist and shoulders). Osteoarthritis
can also develop in injured joints, for example in the vertebrae of
the neck after a whiplash or in a football players’ knees.
Although “osteo” means bone, and “itis” means
inflammation, osteoarthritis is actually a disease originating in the
cartilage, not the bone. This is why the more recent and accurate name
for osteoarthritis is degenerative joint disease or DJD.
Anatomy Of A Joint
A joint is made of two bones connected by a capsule or envelope made
of ligaments. At the end of each bone is a thin, smooth layer of cartilage.
This cartilage layer acts as a protective cushion between bones to
absorb the stress on joints during movement.(3)
Although cartilage is very strong, it can be damaged when a joint is
injured. Cartilage is made of protein strands called collagen that
form a tough, mesh-like framework. The mesh is filled with substances
that hold water, called proteoglycans, that act much like a sponge.
When weight is placed on cartilage, water is squeezed out of the mesh.
When weight is removed, the water returns. Cartilage does not contain
blood vessels, which makes healing more difficult. It also does not
contain nerves, which means problems may go undetected until significant
degeneration has occurred.
Similar to our skin, there is a normal balance between the wearing
down (known as catabolic activity) and building up (known as anabolic
activity) of cartilage cells (chondrocytes). This is a delicate and
extremely important balance and anything that alters this balance will
ultimately affect the health of our joints.
This cartilage balance in our joints is the key to understanding a
costly mistake in the typical medical treatment of osteoarthritis.
Here’s why. In osteoarthritis the cartilage breaks down faster
than it is rebuilt and therefore it gradually wears away. So it is
reasonable to say that anything that promotes the building up of the
cartilage cells would be a benefit to the joint, whereas anything that
promotes the breakdown of the cartilage cells would be destructive
to the joint.
Now let’s see what treatment builds up and which breaks down
the joint.
The Osteoarthritis Epidemic
Do today’s over-the-counter and prescription drugs contribute
to the progression of osteoarthritis? I’ll let you decide. The
typical treatment of osteoarthritis is NSAIDs (non-steroidal anti-inflammatory
drugs). Treatment begins with over-the-counter medicine, such as ibuprofen
and aspirin. If symptoms persist, treatment progresses to prescription
drugs like Naproxen, or the newer COX-2 inhibitors such as Vioxx and
Celebrex. NSAIDs come with well-known side effects like stomach irritation
and ulcers, but also have some not-so-well-known side effects like
swelling and increased blood pressure and the potential for liver and
kidney damage (this is why your doctor may require periodic blood tests
to check for liver damage).(4)
Safety of Arthritis Drugs in Question
A new study published by the Journal of the American Medical Association
suggests that the newer NSAIDs may actually double the risk of heart
attacks! (Since coming on the market in 1999, Advil, Aleve, Celebrex
and Vioxx have been huge moneymakers for their manufacturers, with
annual sales of over 6 billion). The New England Journal Of Medicine
acknowledges that NSADs inhibit prostaglandins which are involved with
the healing mechanism of the digestive system and therefore increase
the risk of abdominal bleeding. According to the American Journal of
Medicine, “Conservative calculations estimate that approximately
107,000 patients are hospitalized annually for (NSAID)-related gastrointestinal
(GI) complications and at least 16,500 NSAID-related deaths occur each
year among arthritis patients alone. The figures of all NSAID users
would be overwhelming, yet the scope of this problem is generally under-appreciated.”
These
conservative figures are equivalent to 293 hospitalizations and 45
deaths each day. The New England Journal of Medicine also stated “If
deaths from gastrointestinal toxic effects from NSAIDs were tabulated
separately in the National Vital Statistics reports, these effects
would constitute the 15th most common cause of death in the United
States. Yet these toxic effects remain a ‘silent epidemic,’ with
many physicians and most patients unaware of the magnitude of the problem.
Furthermore the mortality statistics do not include deaths ascribed
to the use of over-the-counter NSAIDS only those prescribed.”
NSAIDs Affect Cartilage Production
This is the most important part of the story. Research reveals that
there is another little known side-effect that NSAIDs have on cartilage,
which may promote the progression of osteoarthritis.
Studies have shown that over-the-counter and prescription NSAIDs can
lead to the degeneration of joint cartilage! In fact several NSAIDs
inhibit chondrocyte (cartilage cells) production and accelerate degeneration
of joint cartilage!(5)
Can Somebody Please Explain This to Me?
The fact is that Americans are spending upwards of $10 billion dollars
per year on drugs that actually contribute to the condition they are
suppose to help!(6)
As we said before, these drugs
1. Can lead to bleeding of the
stomach and gastrointestinal tract causing ulcers and gastritis
2. Can lead to increased risk of liver and kidney damage(7)
3. Can lead to swelling and increased blood pressure(8)
4. May cause a rise in the risk for heart attacks(9)
5. AND promotes the breakdown of our joints!
What Should I Do?
Most of us take these medications because when it comes to pain, we
want relief NOW. This is where the appeal of these medications comes
from. You absolutely do get quick relief, which is fine for acute flair-ups.
But with the serious side effects of long term use, you had better
get a game plan for your long term care. So knowing now what you do
about joint health and cartilage, what would make sense to take for
arthritis? Something that builds cartilage! If you are one of the millions
that suffer from osteoarthritis, you’ve probably heard about
the supplement called glucosamine and chondroitin. These supplements
have been used for years in Europe as an effective alternative to drugs
for the treatment of osteoarthritis.
Glucosamine/chondroitin – Hype or Help?
In 2005 the prestigious British medical journal, Lancet, published
a ground-breaking study regarding the long-term effects of glucosamine
sulfate. This was a clinical trial, in which 212 patients with OA of
the knee were randomly assigned to take 1500mg of oral glucosamine
sulfate or a placebo (a pill with no active ingredients) once daily
for 3 years. The study revealed the following:(10)
Pain Levels. The patients taking glucosamine sulfate had decreased
pain compared to the group not taking glucosamine.
Cartilage Balance. The glucosamine group experienced no significant
loss of cartilage, and in fact some patients actually experienced
a growth in cartilage. This effect was reported as due to glucosamine’s
stimulus of building up cartilage while depressing the tearing down
of cartilage.
Safety. There were no differences in safety between the glucosamine
and placebo groups which means they found no side effects what-so-ever.
Conclusion. The long-term combined joint structure-modifying and symptom-modifying
effects of glucosamine sulfate suggest that it could be a disease modifying
agent in osteoarthritis. In plain English, glucosamine is safe and
effective in preventing the progression of osteoarthritis!
In the long run, patience and consistency with safe and effective
products like glucosamine-chondroitin, combined with commitment
to proper nutrition
and exercise for treatment of osteoarthritis beats short-term relief
with medication that will eventually make your condition worse.
References:
1. Archives of Internal Medicine, Vol. 158 June 8, 1998
2. Gleberzon BJ Chiropractic care of the older patient. 1st edition.
Oxford: Butterworth Heinemann 2001
3. Guyton, WB Textbook of medical physiology 10th edition. Aaunders
Company, Philadelphia
4. Fored, CM. Onoarcotic analgesic use tied to development of chronic
renal failure. New England Journal of Medicine, 2001; 345; 1801-1808
5. Brandt, KD. The effects of nonsteroidal anti-inflammatory drugs
on chondrocyte metabolism. University School of Medicine, Indianapolis,
IN.
6. Buffum, JC. Nonsteroidal anti-inflamatory drugs in the elderly.
The American Society of Pain Management Nurses, June 2000, 2(1).
7. M. Michael Wolfe, MD. COX-2-Selective NSAIDs, New and improved?
Boston Medical Center, Section of Gastroenterology, 650 Albany St.
Boston, MA.
8. Frishman, W.H. Effects of nonsteroidal anti-inflammatory drug therapy
on blood pressure and peripheral edema. Am J Cardiology. 2002; 89(6A);
18D-25D
9. Journal of the American Medical Association, August 22, 2001
10. Lancet 2001; 357: 251-56
11. Journal of Arthritis and Rheumatism, July 2002
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