Osteoarthritis (Part Two)

 Read more from Eric Bakker ND

 Read Part One here.

Common Osteoarthritis Risk Factors

A number of predisposing factors can hasten this degenerative process, even in young people. They include:

• Increasing age

• Sports (for knee arthritis)

• Family history (several gene variations have been identified as putting someone at increased risk for OA.

• Previous joint or cartilage injury including accidents, infection, fractures and ligament tear causing joint instability,

• Certain types of inflammatory arthritis (like rheumatoid arthritis or gout)

• Repetitive occupational or exercise-related joint movements.

• Diabetes melitus. (Type 2 diabetes)

• Joint mal-alignment problems such as Perthes' disease of the hip.

• Obesity (more weight stress on weight- bearing joints, especially the knees and lower back).

• Occupational arthritis (knee arthritis in athletes e.g rugby, elbow arthritis in those working with pneumatic drills, etc).

• Ethnic origin (more common in white Europeans).

Signs and Symptoms of Osteoarthritis

The most commonly affected joint is the knee joint, and the second most commonly affected is the hip joint. As mentioned earlier, it is the hips, knees, ankles, neck, low back and hands in general which are the most commonly affected joints. Hip pain can be especially severe, even making walking extremely painful and difficult. Some people's fingers may develop a knobby and gnarled appearance (Heberden's nodes). Osteoarthritis of the spine is a common cause of chronic pain and decreased neck and back mobility. In some cases, large bone spurs may compress the spinal cord or pinch its nerve.

Stiffness

Osteoarthritis is usually experienced as aching joints and stiffness. The pain is aggravated by movement and weight-bearing on the involved joint. The osteoarthritis sufferer may feel worse when they are cold or with little movement. As they warm up, the joint may not feel quite as bad and even improve a little with mild exertion. This is not always the case however, as it may aggravate significantly and may even feel much worse for continued motion. With rheumatoid arthritis however (the inflammatory type of arthritis) this will not be the case. Although swelling may occur with OA, warmth and redness and heat of the affected joint usually imply an inflammatory-type of arthritis like rheumatoid arthritis (RA) or gout.

Typical signs and symptoms of osteoarthritis may include:

• Joint pain that is exacerbated by exercise and relieved by rest.

• Rest and night pain can occur in advanced arthritis.

• Knee pain can be felt in one or in both knees and is felt in and around the knee.

• Hip pain is felt in the groin and the front or side of the thigh.

• Hip pain can also be referred to the knee and, in males, the testicle on the affected side can even be tender.

• Joint stiffness in the morning or after rest.

• Reduced function and participation restriction.

• Reduced range of joint movement.

• Pain on movement of the joint or at extremes of joint movement.

• Joint swelling.

• Pain and tenderness in and around the joint.

• Crepitus. ("creaking", clicking or clunking noises felt when the joint is moved).

• An absence of systemic features such as fever, heat, and rash means osteoarthritis, not rheumatoid arthritis, which is the arthritis of heat, inflammation and infection. Rheumatoid arthritis can cause fever and pain throughout the whole body.

• Bony swelling and deformity in the fingers which presents as swelling of the joints more near your finger nails (known as "distal" joints), which are called Heberden's nodes, or swelling of the joints closer to your hand (known as the proximal joints) which are called Bouchard's nodes.

• Joint instability – the knee may feel unstable. There may be times when you get up off a chair and the knee feels like it is going to temporarily "give way".

• Muscle weakness/wasting around the affected joint.

What about a hip or knee replacement?

Did you know that almost 85% of all knee and hip replacements are carried out because of osteoarthritis? You replace your car, your toothbrush, and other items commonly used on a regular basis. Some folk even change their partners on a regular basis, but you don't replace your joints, they just keep on going day after day, year in and year out. Some of us may get a knee or a hip replacement, and for some, it is the only way to improve the quality of their lives when the pain is just too much to bear.

In my experience, I have found that some patients end up replacing the opposing joint down the track. The problem is that the corresponding joint to the one replaced (the healthier one on the other side of the body) may take more strain and may need attention in due course.

Your mechanic would rather replace both brake shoes and shock absorbers on your car when only one needs replacement, or both tyres are replaced simultaneously as a set rather than one at a time. Why? Because your mechanic can see the need for balance, a brand new tyre on one side of your vehicle may act and respond differently (more favourably) in various driving conditions. Replacing both tyres at the same time ensures that you don't place unnecessary strain on your shock absorbers and other parts of the car's driving train.

Similarly, if only one hip is replaced, or one knee joint, you may end up with lower back or knee problems, I've see this happen on many occasions. If you do have a knee or hip replaced, take it easy for at least 3 to 6 months and I'd highly recommend a course of Feldenkrais or Tai Chi to bring about more balance and harmony to your body's scaffolding.

Common sense? I think so, and it is often lacking in medicine. I'm certainly NOT advocating that you get both hips or knee joints replaced at the same time, this is simply not feasible or even possible in most situations.

Food and Nutrition For Osteoarthritis

Osteoarthritis is like any chronic ongoing health complaint you may have, it will be aided by superior nutrition. Nutritional factors are very important in the successful treatment of arthritis, and it is important to focus on foods to avoid as they may well aggravate arthritic problems. Let's take a look at food allergies and the nightshade family of foods.

Should you avoid the nightshade family?

The nightshade family includes tomatoes, potatoes, peppers (capsicum), chilli, and eggplant along with tobacco in any form. I have found over the years that a sensitivity to certain natural chemicals called alkaloids (naturally present in the nightshades) only cause pain and swelling in a minority of individuals with arthritis.

The problem with nightshade sensitivity is that it is not detectable by any current laboratory tests, so you will only determine this by trial and error, and the only way to figure out whether nightshade vegetables bother you is to totally eliminate them. Even if you believe that you are nightshade sensitive and totally eliminate all of these, it can still take three to four months for symptoms to recede. I have found in my clinic over many years that only a handful of those who have entirely avoided nightshades have ever noticed significant relief.

Many natural medicine practitioners automatically exclude nightshade family foods from a person's diet if they complain of OA or RA (rheumatoid arthritis) as if it is "standard treatment" in naturopathic practice. In my practice, firstly I like to see how much of the nightshade the person consumes, in what form/s and if it is possibly connected to their aggravations.

The problem with many "self-help" books the internet with regard to health related information is that one website may simply regurgitate information from another website, and so the nonsense is perpetuated. Mark Twain once said: "Be careful when reading health-books, you may die of a misprint". If Mark Twain had lived today, he would have meant "Be careful when browsing the internet and viewing websites". I question how many people who set these sites up ever see patients with arthritis to know whether nightshades really cause the pain and aggravations they claim.

Would I exclude nightshades from a person's diet who complains of arhritis? Possibly, but then I probably would exclude just the one night shade food from that person's diet they consumed the most, and then only after having worked with a "low-allergy" diet and having repaired the digestive system first. This to me is like taking a person off all gluten and wheat products before you eliminate dairy products, peanuts and the most likely allergenic foods first. And remember, nightshade sensitivity is that – a sensitivity, and not an allergy.

Food allergies

Food allergies have nothing to do with nightshade sensitivity. Immediate (IgE) and delayed (IgG) food allergies can cause all sorts of grief for the patient, and in my opinion are more of an issue than nightshade sensitivities. I have certainly seen many OA patients improve their pain levels after being placed on a "low-allergy" diet.

I have a special Hypo-Allergenic Diet sheet which I give to patients who see me, it has proven to be very effective and pinpoints the foods you are most likely to react to. If you've had allergies in the past, have them now, or if a member of your family has allergies, this is a definite possibility. But why would allergies increase the inflammatory responses, how is it linked? This is easy to explain, especially if you have a history of "pain killers" like Paracetamol, Ibuprofen, or various other drugs your doctor may have recommended. Such drugs dramatically affect your digestive system over time, and one of the biggest issues your small bowel will face is "leaky bowel syndrome" where the small intestine becomes "leaky" or permeable allowing tiny protein molecules to come into contact with your immune system more readily, setting up an antigen-antibody response. What this means in English is that your immune system will come into contact with foreign molecules from your diet which it isn't supposed to. When this occurs, chemicals are produced in turn by the immune system which in turn wreak havoc on your system and produce symptoms like pain and inflammation.

A good tip for you is to go on a ten day cleansing type diet which can bring about symptom relief, and sometimes dramatic. If you do find relief in the ten day period then it's very likely you have significant food allergies. If this occurs, then I'd highly recommend you stay on a low allergy type of diet for 3 months.

A basic exclusion diet for OA

Exclusion diets produce the best results in the earlier, more painful stages of the drawn out disease process known as flavouringsn any long-term chronic health complaint, it will be found that  there is a balance that must be found between a very rigid nutritional program that might not be too effective as well as eating habits that have a positive psychological effect on the person. I try to achieve this in a clinical sense, but it can be a real challenge at times with some people! Try these following exclusion suggestions for 3 months to see if they have any effect on your arthritis:

• Alcohol and coffee.

• Red meat.

• Vegetables that contain high levels of plant acids. e.g. tomatoes and rhubarb.

• Berries rich in fruit acids such as gooseberries, red and black currants

• Refined sugar and products that contain it.

• Refined white flour and its multitude of products.

• Artificial additives, flavorings and preservatives.

• Processed foods, many supermarket foods. Cook at home & prepare your own meals.

• Carbonated drinks. Avoid all forms of "fizzy" drinks, including soda and sparkling water.

• Any food or beverage that causes you to aggravate or feel worse in any way.

Part 3 – Investigations and Management of Osteoarthritis (Coming soon)