CAN OSTEOARTHRITIS BE CURED?
What is osteoarthritis? Why is cartilage the focal point of the disease? What are the symptoms of osteoarthritis and which joints are affected? What causes osteoarthritis? Who is affected by osteoarthritis? What is the difference between osteoarthritis and rheumatoid arthritis? How is osteoarthritis diagnosed? What substances are being used to cure osteoarthritis?
It starts with a little stiffness in your right knee. Nothing to worry about. Then you notice that the pain is getting worse, that you sometimes have trouble walking and jogging really hurts. Or perhaps there's a bit of "morning stiffness" in your hip, and it's a chore to go up and down the stairs. Something has to be done about this--you've got a life to live! You visit your doctor.
The examination is routine, hardly more than a bit of probing. As you lie on the examination table in a paper dressing gown, the doctor moves your leg up and down and from side to side. "Does it hurt when I move your leg this way?" she asks. When you nod, she says, "Hmm. I'd like to order an X ray."
The X ray shows an uneven narrowing of the joint space betweenthe bones of your right knee. Frowning as she studies the X ray, the doctor pronounces the diagnosis: "You have osteoarthritis. You know, 'wear and tear' arthritis. Osteoarthritis really starts ten to twenty years before you notice the first symptoms."
"Why didn't you tell me twenty years ago about this so I could have stopped playing tennis on those hard courts and weekend football with my friends? What should I do now?" you ask anxiously.
"Take aspirin or ibuprofen for the pain," she answers reassuringly. "And don't overexercise the knee."
"But how did I get it?"
"Osteoarthritis is practically inevitable," your doctor replies. "Almost everyone your age has it. The problem is the cartilage, which protects the ends of the bones. It's wearing away, and without that cartilage to keep your bones apart, they're grinding together, causing the pain and stiffness. That's essentially all there is to osteoarthritis. We can take care of the pain, up to a point, but unfortunately, there's nothing else we can do about it."
The Number-One Cause of Disability and Chronic Pain
Arthritis causes symptoms and problems in nearly 70 million Americans, or about one in every three adults.1 As the population ages and develops more obesity, diabetes, and joint injuries, this number will only increase. Right now, about 60 percent of Americans over age 65, or some 21 million people, have arthritis. That number is expected to double over the next few decades--by 2030, the number of older adults in the U.S. with arthritis or chronic joint pain will top 41 million.
Arthritis doesn't just cause minor discomfort--it's the leading cause of disability among U.S. adults. In fact, arthritis accounts for some 17 percent of all disability nationwide. That's well ahead of heart disease, which is about 11 percent of all disability.2 Arthritis now limits everyday activities for more than 7 million Americans; by 2020, this number will increase to perhaps 12 million as the population ages.
Disability from arthritis creates huge costs for those affected, their families, and the nation's economy. Each year, arthritis results in about$15 billion of direct medical costs for 44 million outpatient visits and 750,000 hospitalizations. The estimated total cost to society, including lost work productivity, is about $83 billion every year.3
Arthritis is not one disease, but a group of diseases whose common threads are that they cause pain, inflammation, limited movement, and destruction of the joints. Three out of five arthritis sufferers are under age 65--arthritis is not a disease just of the elderly.
Though there are more than a hundred diseases that affect the musculoskeletal system, the most common form by far is osteoarthritis. In fact, osteoarthritis is more common than all other forms of arthritis combined. Because osteoarthritis is one of the forms of arthritis that becomes more common as we age, many people just assume it's a normal part of aging, that pain in the joints is like gray hair or wrinkles, something we should expect. But in fact, osteoarthritis usually starts in middle age or even earlier, often many years before a person first notices symptoms.
In a joint afflicted with osteoarthritis, the cartilage that covers and cushions the ends of the bones degenerates, allowing bones to rub together. In addition, bone spurs and cysts may develop and the structures around the joint, such as tendons, ligaments, and muscles, may become strained, inflamed, and painful. The major symptom of osteoarthritis is pain; inflammation (swelling, redness, and warmth in the area) is usually a problem only later in the course of the disease. Often, however, osteoarthritis can occur without pain--the main symptom is that the affected joints become stiff and less flexible. Some people don't notice this loss of range of motion, because it tends to occur very gradually. For instance, you may not be able to turn your head to the side as easily as you could in the past while trying to back up your car. Even if you don't have any neck pain, this could be a sign of osteoarthritis in the upper spine.
Up until recently, doctors in the United States thought that osteoarthritis was incurable. That's why the commonly prescribed treatment is strictly palliative, designed only to relieve the pain without addressing the true causes of the disease or the condition of the joints. For mild cases, doctors prescribe painkillers such as acetaminophen (Tylenol®) or nonsteroidal anti-inflammatory drugs (NSAIDs) such asaspirin or ibuprofen (Motrin®, Advil®). Steroid injections such as cortisone and opiates (narcotics) are reserved for the more resistant cases. Unfortunately, the painkillers and anti-inflammatories have problems. They temporarily relieve pain, but in the long run they simply cover up the symptoms while the disease progresses further. These drugs have side effects that range from the annoying to the downright dangerous--each year, thousands of people die from the adverse effects of anti-inflammatories, acetaminophen, and steroids. To add insult to injury, recent research suggests that nonsteroidal anti-inflammatories, including the new COX-2 inhibitors (such as Vioxx®, Celebrex®, and Bextra®),4 may actually cause certain features of osteoarthritis to progress faster.5,6,7 In addition, these new drugs can have other potentially serious side effects (see chapter 7 for more on this).
So, after years of masking your pain with drugs while your disease becomes progressively more severe, you may have to call in a surgeon to replace your hips or knees with artificial ones. Even with the new joint, however, you don't have as much function as you did before your arthritis developed. Surgery is painful, expensive, and not permanent--in ten years or so the replacement will probably begin to fail and the operation will probably have to be redone. And every time you have surgery, there's always the risk of dying or becoming permanently disabled from complications. But as the doctor said, there's nothing else to be done for osteoarthritis. Or is there?
A New Approach Emerges
Instead of simply dulling arthritis pain with drugs or performing expensive and potentially dangerous surgery, many doctors today are actually curing the symptoms of osteoarthritis. How? With three safe, inexpensive, readily available dietary supplements: glucosamine, chondroitin, and a newly available supplement called ASU. These three supplements can be purchased without a prescription in almost any drug store or health-food store in America. The facts about this revolutionary but simple approach to solving a widespread problem are amazing:
• Since they are substances we already consume, and also produce in very small quantities in our bodies, glucosamine and chondroitin have no known significant side effects. This amazing fact stands in stark contrast to painkillers such as the nonsteroidal anti-inflammatories and cortisone injections, which can wreak havoc on the body.
• ASU, made from highly purified and concentrated fractions of avocado and soybean oil, is also safe and extremely well-tolerated. It has been used in France as a mainstay treatment for osteoarthritis for a number of years, with excellent results. Like glucosamine/chondroitin, ASU is now known to be the third, disease-improving treatment for osteoarthritis.
• An extensive body of clinical research--decades' worth--proves that glucosamine/chondroitin and ASU work in both humans and animals.
• Although these safe and effective therapies have long been used by physicians in Europe and elsewhere, they have been largely overlooked by the American medical community. Fortunately, this is starting to change. We are now on the brink of a revolutionary improvement in the treatment of osteoarthritis and a revolutionary change in the way people think about this disease.
The problem and its solution can be neatly summed up: Millions of Americans suffer from osteoarthritis, a painful and debilitating disease. Millions more are developing osteoarthritis now but do not yet have any symptoms. Osteoarthritis, the number-one cause of chronic pain, is one of the most widespread diseases in Western society. Although most physicians consider it to be incurable, osteoarthritis can actually be stopped in its tracks by using glucosamine/chondroitin and ASU. (These amazing natural substances may also be effective against other musculoskeletal conditions.) This astonishing information is well known and widely accepted in many other countries across the globe. The original edition of The Arthritis Cure brought the good news about glucosamine and chondroitin to the United States in 1997 and over 60 countries thereafter. Since then, these supplements have been widely accepted by most physicians, but some others still aren'tconvinced. They're concerned about accepting medical advances that come from abroad.
After all, we have a wonderful medical system. If something is that good, shouldn't American doctors have thought of it first? Shouldn't they at least know about it? And what about quality control and scientific studies? Aren't they less rigorous outside the United States? American doctors may not like to admit it, but physicians in other countries are often ahead of us in many areas of medicine. The first heart transplant was performed in South Africa; the first "test tube" baby was born in England; France was a forerunner in the development of the AIDS drug AZT. Angioplasty (using a balloon to open clogged arteries) and coronary stents (devices used to hold the artery open after an angioplasty) originated in Europe and are more advanced there than they are in the United States. Medications in Europe are rigorously tested and regulated, just as they are here. In fact, many drugs widely used in the United States and two-thirds of drugs overall, such as omeprazole (Prilosec®), were developed overseas.
We certainly have a good medical system, but it has traditionally been slow to accept new therapies or ideas. This is partially due to the federal Food and Drug Administration's decidedly unfriendly attitude toward the use of vitamins and other supplements for anything other than assuring that you meet your recommended daily nutritional requirements. And it's partially due to a relative lack of solid research into alternatives here in the United States. Indeed, a fair amount of the best scientific research on alternative approaches has been conducted in Germany and other European countries. The studies haven't all been translated into English, so they're not widely read by physicians here in the United States. Still, it's quite surprising that treatments used so successfully overseas for such a widespread and debilitating ailment have gone largely unnoticed in this country. Fortunately, that has started to change.
What Is Osteoarthritis?
The literal Greek translation of the word osteoarthritis is osteo (of the bone), arthro (joint), and itis (inflammation). But "bone/joint inflammation"may not be the most accurate description of osteoarthritis, since joint pain rather than inflammation is its most important characteristic. Indeed, while inflammation is a characteristic of many forms of arthritis, it is not found in most cases of osteoarthritis. This may be why some physicians feel that we should call the problem arthrosis, which means "degenerative joint disease."
Osteoarthritis is just one of many forms of joint disease. It is, however, the most common form of arthritis, affecting the articular cartilage, the smooth, glistening, bluish-white substance attached to ends of the bones. (Have you ever looked at or touched the end of a chicken drumstick? That's articular cartilage.) In fact, articular cartilage is one of the smoothest substances known. In addition to the articular cartilage, osteoarthritis, called OA for short, affects several other areas in and around the joints. These include:
• the subchondral bone (the ends of the bones, where the cartilage is attached)
• the capsules that surround the joints
• the muscles adjacent to the joint
The pain of osteoarthritis comes not just from the damaged articular cartilage but from the rest of the joint and the area around it. That's why exercise to strengthen the muscles supporting the joint is a part of the arthritis cure (see chapter 8 for more about this).
Cartilage: The Focal Point of Osteoarthritis
Osteoarthritis begins in the cartilage, the rubbery, gel-like tissue found at the ends of bones. About 65 to 80 percent water, cartilage is designed to do two things: reduce the friction caused by one bone rubbing against another, and blunt the constant trauma inflicted on bones during everyday life.
Think of healthy cartilage as being something like a sponge between the hard ends of the bones. This spongy material soaks up liquid (specifically, synovial fluid, the fluid found naturally in your joints) when the joint is at rest. When you move the joint and put pressureon it, the liquid is squeezed out again. For example, every time you take a step, your leg supports the pressure of your body weight. With each step, the cartilage in your knee joint is squeezed, forcing much of the synovial fluid out of it. But then when you pick up your foot to take another step, the fluid rushes back into the cartilage. The fluid "squishes" in and out as the cartilage responds to the constantly changing force exerted on the joint. Unlike a sponge, however, healthy cartilage does not flatten so easily. Filled with negatively charged chondroitin molecules that repel one another, increasing weight on the cartilage causes an increase in the repelling force. This is the same thing that happens when you try to push two magnets together that are trying to repel each other. It gets harder and harder to keep the magnets together the closer they are in proximity to each other.
Over time, unfortunately, osteoarthritis can cause the loss of the chondroitin molecules and other cartilage components, eroding this protective buffer between the bones. As you'll learn in chapter 2, the problem has been growing in the cartilage matrix, the "birthplace" of cartilage, long before any symptoms are felt. As the disease progresses, the cartilage begins to soften and crack. The magnetic repelling effect is diminished and the cartilage cells die. In advanced cases, bone spurs (osteophytes), abnormal bone hardening (sclerosis or eburnation), and fluid-filled pockets in the bone (subchondral cysts) can form. And, of course, the more the cartilage wears away, the more the bones rub together, creating greater amounts of pain, bone deformities, and eventually inflammation. In severe cases the cartilage may disappear altogether, leaving the bone ends completely exposed in some places.
You can easily see cartilage damage and erosion by looking at an X ray of an osteoarthritic joint. The joint is narrowed and uneven--it's no longer held wide apart with the even contours of healthy cartilage. In fact, if you could actually look inside an arthritic joint, you'd immediately notice two things that distinguish it from a healthy one: First, the cartilage is breaking down, revealing an uneven, pitted surface that might even have holes in it. Second, new cartilage and new bone is being laid down by the body in an attempt to compensate for what has been lost. Unfortunately, this new cartilage and bone tissue can't completely replace what has been lost, and it is inferior to the original, healthy tissue.
Pain, Stiffness, and Other Forms of Misery
After many months or years of unnoticed damage to the cartilage, symptoms besides loss of flexibility or range-of-motion of the joints may become apparent. The major symptoms of osteoarthritis are pain, stiffness, crackling, and enlargement and deformities of the afflicted joint or joints, with inflammation possible in the advanced stages.
Pain. The hallmark of osteoarthritis is pain described by patients as anything from a mild to moderately dull aching to a deep and throbbing pain. It usually begins as a minor ache that appears only after the joint has been used; the pain often disappears with rest. Cartilage itself doesn't have any nerve endings, so you don't feel the loss of cartilage until the osteoarthritis is actually fairly advanced and portions of the bone are exposed. Bone does have nerve endings--lots of them--and so do all of the major structures around a joint. The pain of OA comes from a variety of sources, including the places where muscles, ligaments, and tendons attach to the bones of the joint, the bone covering, the bone cavity, and inflammation around the joint capsule. As the disease progresses, a sharp pain may strike as soon as the joint is moved or used even a little. Eventually the joint aches even when it's in a resting position, unused and unpressured. In severe cases, osteoarthritic pain can disrupt sleep, making life even more miserable.
Stiffness. Osteoarthritic joints are often stiff, especially for the first couple of minutes in the morning. They may also "lock up" after long periods of inactivity, such as sitting in a car or a movie theater. Early in the disease process, the stiffness lasts only briefly and can easily be "worked out" when you start to move again. But as the disease worsens,a permanent loss of range of motion occurs, one that doesn't improve even with warmup exercises and continual motion. Stiffness from OA isn't always associated with pain. In fact, some people develop severe stiffness without any pain. Don't assume you don't have OA just because you don't have pain. If you've noticed that you've become a little stiff and have lost some range of motion--you find it harder to bend down to pick something up off the floor, for instance--osteoarthritis could be the cause.
Joint crackling. Also known as crepitus, the crackling sound and crunching feeling coming from the affected joint(s) (most often a knee and less commonly a hip) usually indicates cartilage that is roughened or fragmented (normal, smooth cartilage is silent). As frightening as it sounds, crepitus is usually painless until some of the underlying bone is exposed or if cartilage fragments lead to inflammation in the joint. The sound may be more pronounced in advanced stages of osteoarthritis. It may be caused by the joints rubbing together during regular use, or when the joint is passively manipulated during a medical examination. Most often striking the knees, the "creaking" sound can sometimes be heard all the way across a room!
Deformity and joint enlargement/inflammation. As the cartilage degenerates, its shock absorption properties are decreased. The body tries to compensate for this and keep the bones from getting small microfractures by adding bone to help strengthen the joint. This leads to an enlargment of the bone and sometimes bone spurs. Bone spurs, also called osteophytes, can tug on the joint capsule or the covering of the bone (called the periosteum), leading to further pain and inflammation. When this phenomenon occurs in the finger joints, it's usually from one of two conditions: Heberden's nodes or Bouchard's nodes. Heberden's nodes can disfigure the joints of the fingers closest to the fingertips, while Bouchard's nodes can cause enlargement of the middle joints of the fingers. (Heberden's nodes and Bouchard's nodes are more prevalent among women. They are thought to be an inherited form of osteoarthritis, since they often occur in members of the same family.)
Other symptoms. OA may also cause bone cysts, gross bony overgrowth, bowed legs, and knock knees. Excess synovial fluid in the joint can also be a problem. In some cases, a doctor may have to take out as much as 100 milliliters of fluid (about four ounces) from a single osteoarthritic joint.
Although osteoarthritis can strike any joint, its "favorite" targets are the fingers, weight-bearing joints such as the knees and hips, the neck, lower back, and some joints in the feet. Most of the disability is caused by hip and knee OA, however, since this affects your ability to walk and exercise more than the other areas.
Osteoarthritis can appear in one or more joints anywhere in the body, in no particular order, but it usually does not strike symmetrically (that is, not in both hips or both knees, at least not at first). When someone first develops hip or knee OA, he or she often favors the affected area and places more stress on the opposite side, causing the cartilage there to break down more quickly. OA can then develop in the opposite joint as well. OA doesn't travel like a rash, as some people believe; the adjacent or opposite joints become affected because of the extra load they have to bear to compensate for favoring the area affected first.
Primary Versus Secondary Osteoarthritis
Osteoarthritis appears in two general forms: primary and secondary.
Primary osteoarthritis, the more common form, is a slow and progressive condition that usually strikes after the age of 45, affecting mostly the weight-bearing joints of the knees and hips, as well as the lower back, neck, large toe joint, and fingers. Primary osteoarthritis usually develops in one of two ways: when excessive loads are placed on normal joint tissues (cartilage and subchondral bone), or when a reasonable load is applied on inferior joint tissues. The exact cause of primary osteoarthritis has not yet been determined, although family history and obesity are known risk factors.
The famous Framingham Heart Study, which began in 1948 and is still continuing, was primarily designed to identify the causes of heart disease in a large group of people who were followed over the course of decades. As part of the Framingham study, researchers also looked into the origins of osteoarthritis. What they found was a conclusive link between this disease and obesity. The study showed that obese people are more likely to develop osteoarthritis than are their slim counterparts.8 And no wonder! The knees and hips, which are the primary weight-bearing joints of the body, handle loads anywhere from 2.5 to 10 times a person's body weight. This means that if you weigh 200 pounds, some of your joints may be handling as much as a ton of pressure as you walk, run, squat or otherwise use them. Clearly, theload on your joints can become incredibly difficult to bear as your body weight increases. Researchers have found that middle-aged women can greatly reduce their risk of developing osteoarthritis simply by losing weight. (You'll learn more about this crucial subject in chapter 9.)
Heredity also appears to play a role in the development of primary osteoarthritis. Researchers have long known that osteoarthritis tends to run in families, which suggests a strong genetic component. For instance, a study in 2000 showed that if you have severe OA in the hip, there's a very good chance that one or more of your siblings will have the same problem. Numerous studies have suggested a number of different genes as the culprits, but so far there's no one gene that can be identified as the arthritis gene.9
Secondary osteoarthritis is quite different from the primary form. Secondary simply means that the osteoarthritis appears as the result of some other known condition. As we learn more about arthritis, some patients who were classified as primary OA sufferers are found to have a known cause for their disease and are subsequently reclassified. In the future, we may actually classify OA as a number of separate conditions, each with specific features and properties.
Secondary osteoarthritis often appears before the age of 45 and has clearly defined causes: trauma or injury, joint laxity (a loose or "trick" knee, for example), joint infection, metabolic imbalances (gout or calcium deposits, iron overload, thyroid diseases, or chronic use of certain medications), or even just joint surgery.
Trauma appears to be the main culprit in secondary osteoarthritis, especially in younger people. The trauma can be acute (such as a sudden, serious injury) or chronic (recurring over time). Chronic trauma causes cumulative damage to the joint, one little "ouch" after another. The individual "ouches" may not be particularly severe, but added together over long periods of time, they can cause the joint tissues to fail. You'll often see chronic trauma in a joint that's unstable or "loose" because a supporting ligament was torn sometime in the past.
Repetitive impact loading is another form of chronic trauma. Repetitive impact loading involves repeated motions that traumatize the joint. A baseball pitcher throwing a ball hundreds of thousands of times, a pneumatic drill operator absorbing the vibrations of his drill inhis shoulders for years, and a ballerina going from a flat foot to standing on her toes can all suffer from repetitive impact loading. Given time, these repeated motions can damage the cartilage and subchondral bone and cause secondary osteoarthritis. Repetitive impact loading is a major cause of secondary osteoarthritis, especially in joints already suffering from abnormal alignment or that are used in ways that they aren't meant to be.
Not all high-stress activities damage the joints. For example, the graceful divers of Acapulco who daily plunge from heights of more than 100 feet do not suffer from osteoarthritis of the spine. Researchers have no explanation for the divers' apparent immunity. Most of us aren't like these divers, however, and the wear and tear of high-stress activities over time often lead to osteoarthritis.
Your osteoarthritis may also be caused by poor bone alignment, joints that are not formed "quite right," or by something as simple as the way you walk. In addition to a careful biomechanical examination, using today's advanced computer technology and high-speed video cameras, doctors can infer what might be happening inside your joints. They can find out how well your joints function under pressure, whether there are biological abnormalities, if your gait or stride length is contributing to your osteoarthritis, and how walking or running on different surfaces affects your joints. If what's "bugging" your joints is simply that they're being stressed in an abnormal way, your doctor and physical therapist can devise special ways of "unloading" them, removing excessive pressure. Techniques for taking a load off your joints include:10
CHANGING YOUR BODY INTERNALLY
• losing weight, if necessary
• manipulating tight structures (muscles, tendons, connective tissues, or joint capsules) that lead to strain on adjacent areas
• exercises designed to help spread the forces of everyday activity to many joints, which helps protect the arthritic joint
• strengthening muscles and other structures around the joint
CHANGING YOUR EXTERNAL ENVIRONMENT
• using a cane in the hand on the side opposite the affected lower extremity joint
• using soft neck collars, shoulder slings, splints on the wrists or fingers, and back corsets for brief periods of acute pain
• changing your chair, bed, flooring or exercise conditions (for example, walking on dirt or grass instead of cement or asphalt, or standing on carpet, rubber, or wood)
• wearing athletic or soft-soled shoes, and replacing them frequently
• using special shock-absorbing shoes called Z-coiLs
Who Is Affected by Osteoarthritis?
Arthritis afflicts countless millions of people worldwide, including nearly 70 million Americans, or one in three adults. Osteoarthritis, the most common form, is more prevalent than all other forms combined. It strikes all animals with bony skeletons, including birds, amphibians, and reptiles--even underwater mammals such as whales and porpoises.11 And it seems as if osteoarthritis has plagued just about anything with bones since the beginning of time. The famous Roman baths were originally used to ease the pain of arthritic joints. Archaeologists have found evidence of osteoarthritis in Egyptian mummies, and paleontologists have discovered it in the skeletons of early humans dating back half a million years. In fact, the dinosaurs had it 200 million years ago.
Between 33 and 66 percent of any given group of people is afflicted with osteoarthritis. The statistics aren't exact, but it's fair to say that about 2 percent of those under the age of 45, 30 percent of those between 45 and 64, and 63 to 85 percent of those over the age of 65 suffer from osteoarthritis.12 The true numbers may actually be higher, for many people with osteoarthritis have not yet developed symptoms. Among osteoarthritis victims under age 45, secondary osteoarthritis is more common, while primary osteoarthritis is rare.
Men are more likely to suffer from osteoarthritis than are women up to the age of 45, perhaps because males tend to engage in more strenuous physical activities and are more likely to suffer serious joint injuries.
From age 45 to 55, however, men and women begin to have an equal chance of suffering, while women are more likely victims after the age of 55. Not only is osteoarthritis more frequent in women age 55 or older, but the symptoms are also more severe. Millions of women of all ages have osteoarthritis and are affected about twice as often as men.
Osteoarthritis patterns vary according to ethnic background. For example, osteoarthritis of the hips is rarely seen in Japan and Saudi Arabia but is quite common in the United States.
Osteoarthritis Is Not Rheumatoid Arthritis
Osteoarthritis and rheumatoid arthritis are often confused because their names are similar and they both afflict the joints. But they are very different diseases. Rheumatoid arthritis is an autoimmune disorder that can lead to weakness, fatigue, fever, anemia, and other problems, including inflamed joints. (An autoimmune disorder is one in which the body attacks its own tissues, as if they were foreign invaders.) Rheumatoid arthritis tends to strike symmetrically, which means that it hits both sides of the body at once (both wrists, both hands, and so on). Some two and a half million people in the United States have rheumatoid arthritis.13 The chart below shows some of the major distinctions between osteoarthritis and the far less common rheumatoid arthritis:
Diagnosing the Joint Malady
Before making a diagnosis of osteoarthritis, a good doctor will carefully note your complaints, review your medical history, and examine you from head to toe. During the examination he or she will look for several distinct signs, such as limited range of motion in the joints, tenderness to touch (palpation), pain upon bending and flexing your joint (passive motion), and joint crackling and grinding (crepitus).
Limited range of motion in the joints. At first, the inability to move a joint as well as before may be subtle and hard to measure, but with time the limitation of movement becomes obvious. If the osteoarthritis is in the hand, for example, you may have difficulty opening a jar or grasping a ball. If it's in the knee, bending or extending the joint can become very uncomfortable. If your spine is affected, you may have trouble twisting or bending. And if the problem is severe enough, the weight-bearing joints of the hips and knees may not be well enough for you to do simple activities. Fine hand movements such as pinching are not usually affected by osteoarthritis.
Tenderness to touch. The joint may not feel tender at all in the early stages of the disease, but as OA progresses swelling can develop as thebody produces more synovial fluid in the joint. The excess fluid puts pressure on the tissues surrounding the joint, which causes pain and tenderness to the touch. Bone spurs and inflamed tendon and ligament attachments can also be sensitive areas and may cause pain that seems to be outside the joint.
Pain with passive motion. We don't normally know if we have pain upon passive motion because our movement is almost always active. It's usually only when a doctor moves our arms and legs about that we experience passive movement. Many times, however, we'll feel pain and a crunching or creaking of the bones when the doctor manually bends and flexes our afflicted joints. In addition to checking for these physical signs of osteoarthritis, the doctor will request a simple X ray to confirm the diagnosis. Osteoarthritis shows up on an X ray first by changes in the bone just beneath the cartilage. Narrowing of the joint spaces is often seen as well. In advanced cases, bones spurs, abnormal denseness, abnormal joint alignment, and pockets of fluid in the bone (bone cysts) may also be apparent. Osteophytes, or bone spurs, which can be seen on an X ray, are a sign that the bone is trying to repair itself in order to support the load on an affected joint.
More sophisticated imaging techniques, such as arthrography, CT (computerized tomography) scans, and MRI (magnetic resonance imaging), may also be used to help assess the extent of cartilage damage, but these are not yet the standard and your health insurance may not pay for these tests if they are done solely to diagnosis osteoarthritis. MRI scanning is rapidly becoming the most sensitive (and earliest indicator) of the radiographic techniques to detect OA. Sometimes fluid from the joint will be removed for analysis to differentiate OA from gout, infection, or other causes of swelling. A good doctor will spend some time exploring secondary causes of OA so the root of the problem may be uncovered before treatment begins. A more comprehensive list of these causes is available at www.drtheo.com.
What Does Not Cause Osteoarthritis?
Despite plenty of evidence to the contrary, three common misconceptions about osteoarthritis persist: that it is a normal part of the aging process, that it is simply a "wear and tear" disease, and that it cannot be halted or reversed. Nothing could be further from the truth! Osteoarthritis is not inevitable--there are things you can do now to prevent or delay the onset of OA. We used to believe that the joint deterioration found with aging was the same kind of deterioration seen in those with osteoarthritis. Now we know that there are striking differences between joints and cartilage that are affected by osteoarthritis and those that have simply aged normally. These differences are described in the chart below.
While it is true that osteoarthritis occurs more frequently and severely in older persons, this is due to prolonged exposure to theeveryday traumas and repetitive motions that occur throughout a lifetime and a decrease in the ability for minor self-repair. While osteoarthritis may occur more often and with more severity as we age, it is not caused by the aging process.
Primary osteoarthritis is not caused by wear and tear on the body due to strenuous activity or exercise. Recent scientific studies have conclusively proven that regular exercise does not predispose us to osteoarthritis. In fact, the opposite is true: vigorous exercise actually increases the functional status of those with osteoarthritis.14 Secondary arthritis due to injuries or repetitive impact loading may be caused by use and abuse of a joint, but normal amounts of exercise actually help to prevent primary arthritis and can play a major role in treating the disease.
We can relieve the pain and disability of osteoarthritis. Most doctors in the United States shrug their shoulders and accept the "inevitable" when treating patients with osteoarthritis, prescribing nothing more than painkillers. But advances in the understanding of cartilage and years of experience with numerous patients have shown that it is definitely possible to slow, halt, or prevent the degeneration of cartilage that is characteristic of osteoarthritis. Specifically, there is strong evidence suggesting that restoring the normal balance to the cartilage matrix can have a positive impact on the course and outcome of the disease.15
The traditionally minded American medical establishment has been slowly adapting to the dramatic changes in the field of osteoarthritis. The growing body of evidence is beginning to force doctors to reevaluate their thinking and to open their minds to the promise of the treatment program described in The Arthritis Cure. Today more and more physicians suggest that their patients with OA use glucosamine/chondroitin; in the future, they will also suggest using ASU. Doctors are slowly beginning to realize that osteoarthritis is not inevitable, and that it may even be cured.
There Is Hope
Osteoarthritis is a very common affliction that most doctors in the United States think is both inevitable and incurable. Fortunately, they are wrong! The Arthritis Cure has helped to relieve the pain of osteoarthritis and slow the disease for many people around the world, allowing them to once again enjoy normal and productive lives.
THE ARTHRITIS CURE, REVISED EDITION. Copyright © 2004 by Jason Theodosakis, M.D. All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles or reviews. For information, address St. Martin's Press, 175 Fifth Avenue, New York, N.Y. 10010.