Arthritis therapy

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Arthritis therapy has the following goals:

• Relieve pain and discomfort
• Restore function and activities of daily activity
• Minimize toxicity of treatment

The usual approach incorporates both non-pharmacologic and pharmacologic approaches.

Non-pharmacologic approaches are:

• Patient education
• Exercise
• Rest
• Diet and weight reduction (when appropriate)
• Lifestyle modification
• Thermal modalities (heat or ice)

Pharmacologic therapy incorporates:

• Analgesics
• Anti-inflammatory drugs
• Disease-modifying drugs

Although there is no cure for most forms of arthritis, there are medications that help ameliorate pain and reduce inflammation.

An example of a good over-the-counter topical agent that can temporarily ease arthritis pain is Blue Relief (Available at the Arthritis Treatment Center -

Capsaicin-based creams made from hot chili peppers, have been found to relieve pain.

Prescription topicals such as Voltaren gel and Pennsaid contain diclofenac, a non-steroidal anti-inflammatory drug.

Acetaminophen (Tylenol) has been effective and safe for treating mild osteoarthritis, but it can also lead to liver damage.

Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in both relieving pain and reducing the inflammation caused by rheumatoid arthritis. Many are available over the counter, although more potent forms of NSAIDs are available only by prescription. Side effects include gastrointestinal ulcers and bleeding, kidney damage, heart failure, and an increased risk for cardiovascular events such as heart attack and stroke.

While traditional NSAIDs are the most common treatment for pain and inflammation of arthritis, they are estimated to cause about 100,000 hospitalizations and around 15,000 deaths each year in the USA alone, due to severe gastrointestinal side effects such as bleeding ulcers.

Cox-2 inhibitors such as Celebrex,are also considered NSAIDS but with a better gastrointestinal safety record. They too, though, are associated with an increased cardiovascular risk.

Tramadol (Ultram), an analgesic without anti-inflammatory benefits is better tolerated from a stomach point of view. It is available by prescription. The caution here is that it has been linked to seizures in people taking other medications.

Antidepressants, such as the tricyclics, selective seratonin re-uptake inhibitors, and selective serotonin and nor-epinephrine re-uptake inhibitors can help reduce chronic pain in osteoarthritis and fibromyalgia.

Stimulators of GABA, a central nervous system neurotransmitter can be helpful for pain relief as well. Examples are Neurontin and Lyrica.

Corticosteroids or hyaluronan (hyaluronic acid) can be injected directly into a joint, providing some pain relief for four to six months or more.

Common sense approaches such as maintaining proper body weight, good nutrition and muscle tone, proper sitting techniques and regular exercise are immensely beneficial.

There is also evidence to suggest that nutritional supplements such as glucosamine and chondroitin sulfate may be effective in helping to maintain existing cartilage and stimulate new cartilage to grow.

Shifting gears, let's move on to rheumatoid arthritis. The current approach is to treat rheumatoid arthritis as aggressively as possible.

Current conventional treatment of RA consists of fast-acting ‘first-line drugs’, which include non-steroidal anti-inflammatory drugs (NSAIDs)and corticosteroids (e.g. prednisone), and slow-acting ‘second-line’ drugs known as disease-modifying antirheumatic drugs (DMARDs). These include methotrexate, hydroxychloroquine, sulfasalazine and leflunomide.

Methotrexate has become the most widely used ‘gold-standard’ DMARD, particularly in combination therapy with sulfasalazine and hydroxychloroquine.

The 1999 approval of Enbrel and other TNF inhibitors heralded a new approach in RA treatment. These were biologic drugs that targeted a specific immune system abnormality... tumor necrosis factor. Soon, other drugs with the same mechanism of action followed. In more recent years, more biologic therapies with different modes of action have also helped bolster the arsenal against RA.

While these drugs have revolutionized our approach to RA therapy, they also carry a hefty price tag both in terms of potential side effects as well as price itself.

Another research area with exciting prospects is stem cell research, and the ability of stem cells and growth factors to engineer tissue repair. In particular, studies of mesenchymal stem cells that can differentiate into connective tissues are likely to be rewarding. This promises a potential treatment for osteoarthritis.

In 1993, The New England Journal of Medicine published the results of David Eisenberg's study, which showed that one out of every three people were using alternative medicine. And even more eye-opening, they spent $10 billion dollars to do it!

Since then alternative medicine has become more popular. There are more visits to alternative practitioners than to traditional physicians.

Modern medicine has extended average life expectancy but it has failed to cure many painful conditions, such as arthritis. In one study, one third to one half of the people with arthritis surveyed admitted to using some type of alternative therapy.

Does it work? It depends on whom you ask. Ask someone diagnosed with OA whose treatment of glucosamine and chondroitin sulfate was successful and you will hear an affirmative. Ask a rheumatoid arthritis patient whose trial with magnet therapy was a failure and you'll likely be told it is a scam. The truth is difficult to sort out.

No one alternative treatment will work for everyone, just as no medication works on all people.

When James Coburn won an Oscar for Best Supporting Actor, he also touted his remedy for rheumatoid arthritis, MSM (Methyl Sulfonyl Methane). He claimed it had worked wonders for his rheumatoid arthritis. Nonetheless, it was clear that he still had significant joint deformities.

While it appears to be safe, the Arthritis Foundation considers MSM an unproven remedy and at this point in time, I would have to agree. Until human studies are done, we just don't know enough about it to be sure of its safety or benefit.

Information from the National Institutes of Health

Prolotherapy is a treatment where a proliferant solution of natural substances is injected directly into the site where a weakened ligament attaches to the bone. These injections triggers the growth of new, healthy tissue that stabilizes the bones and joints, relieving pain and stiffness. Prolotherapy is one of the treatments for conditions such as:

Degenerative Arthritis
Lower back or neck pain
Torn ligaments, tendons and cartilage
Carpal Tunnel Syndrome
Sports injuries
Degenerated or herniated discs

Prolotherapy (sometimes called ligament reconstructive therapy) is known to have been in existence for more than 2500 years when Hippocrates used the technique to treat the injured shoulder of a javelin thrower.

Pain occurs when collagenous structures such as ligaments and tendons become stretched beyond their usual limits. This results in irritation of nerves which transmit pain signals. This then causes pain.

Muscle spasm results because with loose ligaments, the muscles need to tighten in order to support musculoskeletal structures. Prolotherapy is used to assist the healing process. The treatment consists of the injection of a proliferant solution into the ligament or tendon near the attachment to the bone. The solutions cause a controlled inflammation at the site of injury stimulating cells called fibroblasts to make more collagen fibers. This in turn "strengthens" the adhesion of the ligament or tendon to the bone, and stabilizes the loose connection. When ligaments tighten, this helps relieve muscle spasm.

As with many treatments, prolotherapy has risks and side effects. Temporary stiffness and bruising at the injection site can occur. In trained hands, prolotherapy is a safe, effective, and highly successful technique when utilized appropriately, to give long sought relief from pain arising from over-stretched ligaments and tendons.

Acupuncture is probably the oldest of the Tradition Chinese Medical Treatments still in use today. One of the primary precepts of acupuncture is that the Vital Substances flow through channels or Meridians in the body. The acupuncture points lie along these meridians.

By stimulating specific acupuncture points, blockages can be removed and the body returned to its natural state.

In Chinese medicine, the vital substances are:

Basically, acupuncture is the insertion of very fine needles to influence the physiological functioning of the body. It can be used in combination with heat provided by burning specific herbs (moxibustion). There also a less invasive variety of the practice known as acupressure (no needles are used).

Unfortunately there is no real answer to why it works.

The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institute of Health has proposed several processes to explain acupunctures effect, primarily those on pain. Acupuncture points are believed to stimulate the central nervous system (brain and spinal cord) to release chemicals into muscles, spinal cord and brain. These chemicals either change the experience of pain or release other chemicals such as hormones, that influence the bodys self-regulating systems. The biochemical changes may stimulate the bodys natural healing abilities and promote physical and emotional well-being. There are three main mechanisms:

Conduction of electromagnetic signals: Western scientists have found evidence that acupuncture points are strategic conductors of electromagnetic signals. Stimulating points along these pathways through acupuncture enables electromagnetic signals to be relayed at a greater rate than under normal conditions. These signals may start the flow of painkilling biochemicals such as endorphins and of immune system cells to specific sites that are injured or vulnerable to disease.

Activation of the opiod systems: Research has found that several types of opioids may be released into the central nervous system during acupuncture treatment, thereby reducing pain.

Changes in brain chemistry sensation and involuntary body functions: studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones in a good way. Acupuncture also has been documented to affect the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes whereby a persons blood pressure, blood flow and body temperature are regulated.

Acupuncture and You: The NCCAM is cautious in recommending acupuncture as a sole treatment. The NCAAM states that The use of acupuncture, like many other complementary and alternative treatments, has produced a good deal of anecdotal evidence. Much of this evidence comes from people who report their own successful use of the treatment. If a treatment appears to be save and patients report recovery from their illness or condition after using it, others may decide to use the treatment. However, scientific research may not substantiate the anecdotal reports.

The NCCAM continues its analysis with the fact that Lifestyle and age, philosophy, and other factors combine to make every person different. A treatment that works for one person may not work for another who has the very same condition. You, as a health care consumer (especially if you had a pre-existing medical condition), should discuss acupuncture with your doctor. Do not rely on a diagnosis of disease by an acupuncturist that does not have substantial medical training. If you have received a diagnosis from a doctor and have had little or no success using conventional medicine, you may wish to ask your doctor whether acupuncture may help.

You as a consumer are responsible for checking the practitioners credentials and being comfortable that you are working with a trained professional. Today, many Doctors have established practices that encompass both the Traditional Chinese Medicine and Western Medical practices. Many States have now established training standards for certification to practice acupuncture. If you are inclined to try this protocol, a list of doctors who practice acupuncture can be obtained from the American Academy of medical acupuncture.

Information from the FDA

Dietary supplements come in many forms, including tablets, capsules, powders, softgels, gelcaps, and liquids. Though commonly associated with health food stores, dietary supplements also are sold in grocery, drug and national discount chain stores, as well as through mail-order catalogs, TV programs, the Internet, and direct sales.

FDA oversees safety, manufacturing and product information, such as claims, in a product's labeling, package inserts, and accompanying literature. The Federal Trade Commission regulates the advertising of dietary supplements.

Dietary supplements are not considered to be drugs. A drug is intended to diagnose, cure, mitigate, treat, or prevent disease. Before marketing, drugs must undergo clinical studies to determine their effectiveness, safety, possible interactions with other substances, and appropriate dosages, and the FDA must review these data and authorize the drugs' use before they are marketed. FDA does not authorize or test dietary supplements.

Federal law requires manufacturers of dietary supplements to ensure that the products they put on the market are safe. But supplement manufacturers do not have to provide information to FDA to get a product on the market. FDA review and approval of supplement ingredients and products is not required before marketing.

To help protect themselves, consumers should:

• Look for ingredients in products with the U.S.P. notation, which indicates the manufacturer followed standards established by the U.S. Pharmacopoeia.
• Realize that the label term "natural" doesn't guarantee that a product is safe. "Think of poisonous mushrooms," says Elizabeth Yetley, Ph.D., director of FDA's Office of Special Nutritionals. "They're natural."
• Consider the name of the manufacturer or distributor. Supplements made by a nationally known food and drug manufacturer, for example, have likely been made under tight controls because these companies already have in place manufacturing standards for their other products.
• Write to the supplement manufacturer for more information. Ask the company about the conditions under which its products were made.

Consumers who use dietary supplements should always read product labels, follow directions, and heed all warnings.

Supplement users who suffer a serious harmful effect or illness that they think is related to supplement use should call a doctor or other health-care provider. He or she in turn can report it to FDA MedWatch by calling 1-800-FDA-1088 or going to on the MedWatch Website. Patients' names are kept confidential.

Consumers also may call the toll-free MedWatch number or go to on the MedWatch Website to report an adverse reaction. To file a report, consumers will be asked to provide:

• name, address and telephone number of the person who became ill
• name and address of the doctor or hospital providing medical treatment
• description of the problem
• name of the product and store where it was bought.

Consumers also should report the problem to the manufacturer or distributor listed on the product's label and to the store where the product was bought.

Glucosamine and chondroitin sulfate, two naturally occurring substances found in the joints. Glucosamine is synthesized in the body and is one of the building blocks of cartilage, which becomes degraded in osteoarthritis. Chondroitin is also a part of cartilage and may also block enzymes that degrade cartilage.

A few studies have been done, most with results favoring the supplements. One compared glucosamine to ibuprofen, a commonly prescribed NSAID. The results of this study showed glucosamine to be more effective at relieving the pain of OA. It should be noted that 10% of the ibuprofen subjects dropped out of the study because of a variety of adverse reactions to the medication, whereas no subjects in the glucosamine group dropped out for drug-related reasons. Another large, multicenter, randomized, double-blind, placebo-controlled trial study of 150 patients showed that fifty-five percent of the glucosamine group were responders compared with 33% of the group receiving placebo. Very few studies have been done on chondroitin sulfate, which is usually sold in combination with glucosamine.

The National Institutes of Health GAIT study has been widely touted as a negative trial. It included more than 1,000 patients. The results of this study has furthered muddied the water as far as claims regarding the efficacy of glucosamine and chondroitin.

Side effects of the combo seem to be relatively minor. Most often reported are GI complaints, which often can be avoided by taking it with food or switching brands. There is some concern that glucosamine can raise the blood sugar of diabetics and that chondroitin sulfate may enhance the blood thinning effects of anticoagulants. Diabetics and people taking coumadin or heparin should be observed for these side effects.

We should point out that not all brands are the same, buyer beware. The FDA does not regulate these supplements and there are some unscrupulous people out there passing off pills that contain virtually none of the promised ingredients. A recent study of thirty-two chondroitin-containing products purchased from pharmacies and health food stores showed twenty-six products had contain less than 90% of the chondroitin sulfate stated on the label, with 17 products containing less than 40% of label claim. Only 5 out of the 32 products analyzed contained the greater than 90% of the labeled amount of chondroitin sulfate in the product. Most experts recommend the following dosage:

Under 120 lbs: 1,000 mg glucosamine and 800 mg Chondroitin sulfateBetween 120 and 200 lbs: 1,500 mg glucosamine and 1,200 mg Chondroitin sulfateOver 200 lbs: 2,000 mg glucosamine and 1,600 mg Chondroitin sulfate.

You should expect to take the supplements for at least two months before noticing any results. As with any other supplement or medication we recommend that you let your physician know you are taking it.

At this time there are no indications that glucosamine or chondroitin have any benefit for any other type of arthritis. It has been studied only in OA.

Information from the The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institute of Health

Aromatherapy is the art and science, of using oils extracted from aromatic plants to enhance health and beauty. Essential oils can have subtle effects on the mind and emotions as well as physical benefits.

The ways to use essential oils in aromatherapy are many and varied. Baths, massage, inhalation, vapors, compresses and others may be used.

For the most part if used correctly aromatherapy is safe. A few people may suffer allergic reactions to the oils.

There are no legal standards of aromatherapy training or certification in the United States, but there are many schools and individuals offering aromatherapy training. The practitioners calling themselves aromatherapists are most often trained in some other form of therapy, such as massage, aesthetician, or chiropractor, and have incorporated the use of essential oils into their practice.

The National Association for Holistic Aromatherapy has in place Suggested Guidelines for Aromatherapy Education & Certification in an effort to provide guidance for students and teachers. In addition this organization provides safety and efficacy guidelines for interested parties.

Thundergod vine is a plant has been used for years in China as a treatment for autoimmune diseases. Recently Western medicine has become interested in its uses. At least one study has proven that extracts of the plant can suppress collagen induced arthritis in rodents. But we're not rodents, so does it work on humans?

One study says it does. This randomized, double-blind, crossover study of 70 people with rheumatoid arthritis showed that the patients receiving the extract showed significant improvement in all parameters of clinical disease activity and laboratory abnormalities as compared to those receiving the placebo.

Another open study in people with lupus also showed significant improvement. In fact, 42 of 100 people were able to decrease their daily dose of prednisone, while 12 people were able to discontinue prednisone altogether.

It is important to note that these studies used extracts of the root of the vines, not the root itself. No standard safe does have been established, further studies are needed. The leaves and flowers of this plant are highly toxic and can cause death; only the root of the plant is used for the extracts. This herb should only be used under the direction of a physician.

Homeopathy is probably the form of alternative treatment that confuses conventional science the most. The confusion is because it violates every known law of chemistry and physics. Yet many claim it works.

Homeopathy uses diluted portions of natural substances to cure symptoms of disease. The more diluted the substance, the better. The treatment is aimed at revving up an invisible life force or vital energy. At first this may actually stimulate the symptoms, which homeopaths consider good. They believe symptoms are the body's way of healing itself.

Homeopathic practitioners also believe that illness is unique for each person. Two people with the same condition may be treated very differently.

Homeopathy is based on a very unusual group of ideas:

Like cures like. You can cure a problem with a little bit of the same thing that caused it. They take very diluted doses of substances that in large doses would produce the symptoms you are having. This is called The Law of Similars. As an example, large amounts of coffee would make you wired and excitable so they use tiny diluted amounts to treat insomnia. The system of healing by "similars" dates back to the Greek physician Hippocrates in the 5th century BC. And was modernized in the 1790s by a German physician named Samuel Hahnemann. Some modern conventional medical treatments, such as allergy treatments and immunizationa, act on the same theory.

Nothing may be something. The substances used are so diluted that they may contain one millionth of a drop of the active ingredient. A standard remedy may be made by taking a single drop of a plant substance and mixing it with 100 drops of water. After that a drop of this mixture is added to 100 drops of water. This process may be repeated as many as 30 times. They call the result a 30C dilution-30 separate 100-1 dilutions.

Water with a memory. The dilutions have to be shaken not stirred. (like a martini??) They claim this leaves an imprint of the substance on the water molecules so it remembers whatever was in it before.

The healing crisis. The part of homeopathy that disturbs people most is that you have to expect your symptoms to get worse before they get better. This makes sense when you look at the belief that a symptom is the body's way of healing itself.

If after researching the most confusing of all alternative treatments you want go give homeopathy a try, find someone who has completed at least one of the five programs accredited by the Council of Homeopathic Education. Because no national standards exist at least you know they have received some training.

People with arthritis increasingly turn to water exercise for several key reasons:

• The buoyancy of water supports your joints while you exercise.
• Warm water raises your body temperature, which increases your circulation, and can help ease stiffness.
• Water provides greater resistance than air, helping you build muscle strength.

Strength training improves muscle tone and helps with joint stability. Lightweight dumbbells or resistance bands both work well. A physical therapist or certified trainer can get you started. In addition, increasing muscle bulk can offset bone loss that can lead to osteoporosis.

Stretching involves range-of-motion exercises that reduce stiffness and help keep joints flexible. Stretching provides greater flexibility and less pain.

Cardio training to improve cardiovascular strength also helps arthritis by providing improved blood flow and providing general all around well-being.

All three forms of exercise- stretching, resistance, and cardio- form the foundation of a good exercise program for patients with arthritis.

Get more information about arthritis therapy as well as...

• Insider arthritis tips that help you erase the pain and fatigue of rheumatoid arthritis almost overnight!

• Devastating ammunition against low back pain... discover 9 secrets!

• Ignored remedies that eliminate fibromyalgia symptoms quickly!

• Obsolete treatments for knee osteoarthritis that still are used... and may still work for you!

• The stiff penalties you face if you ignore this type of hip pain...

• 7 easy-to-implement neck pain remedies that work like a charm!

• And much more...

Click here Second Opinion Arthritis Treatment Kit

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