Otto Hartleben, A German Poet, was feeling very ill, so he went to a doctor. After the examination, the doctor advised Hartleben to stop drinking and smoking. As Hartleben went to the door, the physician mentioned that the charge for his advice was three marks. "But I'm not taking it," Harleben said and left.
Though Hartleben did not pay for the advice, it is possible that he made lifetime payment for not taking it. Responding to the question of arthritis prevention, physicians may ask, "What are you willing to do to prevent it?"
Who is most likely to get Arthritis?
There is evidence that some of the many forms of arthritis are genetically linked or, as Grandma says, it runs in the family, In studies of identical twins, for example, it has been shown that, if one twin has rheumatoid arthritis, the other twin in 30 times more likely tom get the same disease than a normal, unrelated person would be. Thus, some people will get arthritis, regardless of how they live, because of the biological blueprint in their genes.
In the general population, however, just about everyone who lives to middle age or older is subject to arthritis, says Dr. John W. Ewing, Professor of medicine at Northeast Ohio University's College of Medicine. "Arthritis is a generic term. Simply translated, it means 'inflamed joint'. In a complex, naturally occurring process, aging joints thin and wear out. Statistics show that more women than men get arthritis, but women live longer than men, and that may figure into the equation"
What causes the joints to wear out?
"It has a lot to do with a substance called collagen", says Dr Ewing. "Collagen is what we're made of. It is a specialized form of protein that is found in every tissue of the body. The hard sub stance that makes bones rigid is calcium, which deposits on the collagen fibers of bone but not in the collagen fibers of tendons, ligaments and cartilage.
"Sometimes collagen is damaged by bacterial infections, such as staph or gonorrhea", Dr. Ewing Continue. "More commonly, though, the water content of collagen is reduced over time. At 10 to 15 years of age, the water content in a joint is about 70, the content the content has decreased to only about 30 per cent. The difference is like that of jumping on a tilled waterbed, versus jumping on one that is only one-third filled." Ouch!
Will the wear and tear on joints be made worse by activity?
Surprisingly, the answer is no. Numerous studies on the role of exercise and stress on joints have proven otherwise, says Dr. Harvey B. Simon, Assistant professor of Medicine at Harvard Medical School and member of the Cardiovascular Health Centre at Massachusetts General Hospital. In numerous, separate studies of industrial populations and competitive athletes, no link was found between repetitive use of joints and arthritis. In fact, the greater danger to health is in not exercising. Bones and joints are strengthened, not weakened, says Dr. Simon, by the increased blood circulation that occurs in exercise. And, of course, a sedentary lifestyle leads to other problems, such as increased risk of a heart attack.
Do people get arthritis because they are unfit? Or do people become unfit because they have arthritis?
Researchers have found that people with arthritis are, indeed, generally unfit. It seems that the best thing you can do, while you ponder this chicken-or-the-egg question, is to take a walk or a swim. Marian A. Minor, RPT, and Donald R. Kay, MD, of the University of Missouri, recently studied the effects of an exercise programme on 120 people with arthritis. The average age of the people was 60.5 years. After a 12 week programme of aerobic walking or aerobic swimming, the group showed significant improvement in aerobic capacity, endurance and activity, and some improvement in flexibility. Furthermore, the patients seemed happier; they reported significant decreases in anxiety and depression.
Then, I can take up jogging without worry?
Whoa! "Not if you're 50 years of age or older," says Dr. Ewing. "And not if you already have been diagnosed by your physical as having arthritis. Jogging stresses the weight-bearing joints (knees, hips and ankles) with four to five times the body weight per square inch. Walking reduces the stress to only one to one-and-a-half times the body weight per square inch. Though it appears that arthritis can't be prevented, it is possible to prevent further damage and pain."
Other excellent ways to exercise, suggests Dr. Simon, are swimming and biking, which are very well tolerated, even by persons with arthritis.
How much exercise is too much for the health of my joints?
Dr. Ewing and Simon agree: "Listen to your body"
If it hurts, says Dr. Simon, something's wrong. "Your equipment may be improper. Your technique might be poor. Perhaps you're not warming up, stretching, and cooling down appropriately. Or there may be a muscle imbalance or lack of flexibility."
"Get an okay from your doctor first," suggests Dr. Ewing. "Train carefully, work out on a mat, do only low-impact aerobics, and stick with what your body can do. Don't compete to the point of injury."
If you're having symptoms of joint problems, walk - don't jog to your physician's office for an evaluation, as soon as possible. "It's very important," says Dr. Ewing, "that you don't say, 'Oh, it's just arthritis and there's nothing that can be done about it'. For one thing, it may not be arthritis. It may be something else.
"Some wonderful new diagnostic techniques make it possible to see exactly what is going on in a joint, and to repair it, even before the damage becomes visible on an X-ray," Dr. Ewing points out. "If it is arthritis, it's important to work hand-in-hand with a rheumatologist (a specialist in the treatment of arthritis), and to stay on appropriate medications. This won't stop the disease from occurring, but it will stop or slow its progress."
Is it just aches and pains, or is it arthritis?
Dr. John W. Ewing recommends that you walk -don't jog to your physician if:
- You're having symptoms of persistent pain or stiffness at the beginning or end of the day.
- You're having pain, tenderness or swelling in any of your joints.
- You're unable to move one or more joints normally.
- You have recurrent pain and stiffness in the joints.
What about diet? Do some foods prevent arthritis?
It's not so much what we eat, as how much we eat that contributes to arthritis. "We are a fat bunch of people!" says Dr. Ewing. "This is one of our biggest problems. I sometimes see youngsters, 16, 18, or 19 years old, who are 50 pounds overweight. And obesity is more prevalent in people who are over age 50, because they are even less active. If I give a patient a cane, he feels relief because the cane bears 30 per cent of the body weight. Why not just lose 30 per cent of the excess body weight?"
Some people with arthritis may be able to reduce their pain and the inflammation in affected joints by eliminating certain foods from their diets but this is far rarer than the foods allergy proponents would have you believe. In terms of prevention, "There is no magic food," says Dr. Ewing. "Alfalfa seeds will not prevent arthritis. Ironically, the people most at risk nutritionally are those going to the health food stores. They have peculiar dietary ideas. Instead of getting hung up on buzzwords, we need to stick with a commonsense, back-to-basics diet."
What, then, is a commonsense, back-to-basics approach to the prevention of arthritis?
Within the limits of present knowledge, it does not appear that arthritis can be prevented, but a sensible lifestyle can minimize joint damage and pain. Here are the strategies that most experts can agree on:
- Exercise regularly, using appropriate equipment.
- Listen to your body when you exercise, and stop if pain occurs.
- Allow injuries to joints or surrounding tissues to heal before resuming strenuous activities.
- Eat a well-balanced diet.
- Keep your weight down to recommended limits.
- If you have joint complaints, see a physician immediately.
- If you are diagnosed with arthritis, stay on the medications your physician prescribes, even if you are feeling better.
A possible cure for Arthritis?
If you detect arthritis in its early stages, what hope do you have of nipping it in the bud -of actually stopping it before it gets worse? Or if you can't catch it early, what hope is there of stopping it at all?
The answer used to be: none. But now preliminary research hints that there may be a chance to do the impossible after all: to halt the pain, joint damage and inflammation. And not just for a few hours or days, but for good. This new hope hinges on factors like a new arthritis "vaccination" which, if confirmed in studies going on right now, could revolutionize treatment.
Here's a look at this promising anti-arthritis strategy:
GETTING THE LIGHT TREATMENT
Imagine someday "vaccinating" rheumatoid-arthritis patients and putting their bodies' immune systems to work destroying the cells responsible for the inflammation and pain of the disease and slowing or even stopping the disease process. You may not have to imagine this treatment too much longer, for medical researchers across the United States are testing it in clinical trials right now.
This experimental treatment, called photopheresis, combines a light-sensitive drug with a high-tech machine and ultraviolet light to selectively modify the disease-producing cells so the immune system can better identify and destroy them.
Dr. Barr, whose Loyola University Medical Center is one of the centers participating in the national trials, says that the treatment is based on the knowledge that abnormal T-cells from the immune system are involved in rheumatoid arthritis..
"We know that T-cells are important to the disease," says Dr. Barr, "Because if you look at the synovial lining (tissue surrounding the joints) in an arthritic, you'll see increased numbers of T-cells. If you remove T-cells from the blood, the patient will improve."
Dr. Barr and his colleagues administer the drug 8-methoxypsoralen (8-MOP), a medication that works only when activated by exposure to ultraviolet-A light. Next, a machine pumps blood out of your arm and, before returning it to the other arm, separates it into red cells and white cells. Then, the machine exposes the white cells, including the abnormal T-cells containing, 8-MOP, to ultraviolet-A light. Once activated, 8-MOP modifies the T-cells in such a way that the immune system recognizes them as harmful and destroys them. Other cells are not affected.
Photopheresis has already been used successfully in two serious diseases involving renegade T-cells: T-cell lymphoma, a deadly form of leukemia, and scleroderma, and arthritis-like disease. A very early pilot study using photopheresis in rheumatoid arthritis resulted in an impressive decrease in the number of swollen and painful joints in four out of seven patients.
Though this study is small, researchers are excited about the results because T-cell vaccinations are a whole new approach to therapy. T-cell vaccinations have already been shown to work in animals. And amazingly enough, the treatment is essentially non-toxic. Its nearest kin -the broad-spectrum immune, Suppressing drugs for rheumatoid arthritis -carry severe side-effects with them. The drugs kill good cells and bad, so people can end up with recurrent infections, among other things.
"The real question is how long-lasting the benefit is," says Dr. Grayzel. "This research looks promising, but they've treated only a small number of people. There's a lot of work to be done before it gets applied in a widespread fashion to rheumatoid arthritis. Nevertheless, this is definitely something that is under active investigation."
How long will it be before photopheresis is adequately tested and widely available for arthritis patients? The treatment is currently FDA-approved (in the U.S.) only for treatment of T-cell lymphoma. An appeal is before the FDA now for approval for its use in the chronic skin disease, scleroderma. Dr. Barr estimates that the nation-wide study will be complete in two years. If the results prove that the process is effective, the world will be much closer to wider availability of photopheresis.
