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The Honolulu Advertiser
Posted on: Thursday, March 25, 2010

Arthritis comes in various forms


By Tamar Hoffmann, M.D.

Q. What is arthritis and what is the best way to treat it?

A. Basically, arthritis is simply joint (arthro) inflammation (itis). There are many forms, including osteoarthritis, rheumatoid arthritis, gout arthritis, lupus arthritis and traumatic arthritis. An estimated 46 million people 21 percent of all Americans suffer from some form of arthritis.

The most common type is osteoarthritis, associated with age. Osteoarthritis is often characterized by swelling or thickening of the joints near the fingertips.

Rheumatoid arthritis, often characterized by swelling of the large knuckle joints, is potentially much more serious because it is an autoimmune arthritis, one in which the body's immune system is actually attacking and actively damaging the joints. Lupus arthritis, psoriatic arthritis and ankylosing spondylitis (autoimmune arthritis of the spine) fall into this category.

While the approaches to these types of arthritis differ to some extent, they have some features in common. The main common element in the treatment of these diseases is to control inflammation.

Anti-inflammatory medications such as ibuprofen and aspirin are generally useful in treating arthritis. More powerful drugs are sometimes used to treat rheumatoid arthritis, because the potential damage caused by the disease warrants a more aggressive approach.

Another feature that the approaches to these diseases have in common is that the medications have side effects. For example, some of the non-steroidal anti-inflammatory drugs (including aspirin) can cause nausea, heartburn, ulcers, ringing in the ears, hearing loss and kidney damage.

More recently, some anti-inflammatory drugs such as Vioxx were found to increase the risk of heart disease and were taken off the market. At the same time, some useful new drugs have been found for rheumatoid arthritis, such as "tumor necrosis factor" (TNF) blockers, which have a different side-effect profile.

Many doctors are now using a more whole-person approach that includes treatments with fewer side effects including diet, herbal medicine, acupuncture and supplements, in conjunction with prescription medication. Scientific studies on many of these approaches are lacking or are controversial, but they are used anyway because of their low side-effect profile. For example, there are conflicting studies as to whether glucosamine-chondroitin sulfate is useful. Ayurvedic herbs, guggulu and boswelia serata, have been in use for thousands of years in India, but studies confirming their effectiveness are sparse.

Acupuncture can also be useful in managing pain with virtually no side effects.

Some experts say there is no diet that helps with arthritis and yet, adequate studies on this approach have simply not been conducted. Meanwhile, there is substantial evidence that a diet low in saturated fat and omega-6 fats and higher in omega-3 fats (even as supplements) may be useful in reducing inflammation. In any case, there is no reason not to try a dietary approach, which is likely to be healthy in other ways.

If you want the best approach to arthritis, you must first consult your physician to determine what type of arthritis you have, so you can understand what is the best therapy.

Then, taking a whole-person approach, work with your doctor to maximize your health and minimize your need for medication. In this way, you can get the best outcome with the fewest side effects and minimize the damage that can be caused by arthritis.