Dr. Ronald G. Ritchie
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This article is divided into the following sections which you can jump to here:

1. General Information

Arthritis is a condition in which the joints of the body become inflamed and damaged, subsequently undergoing progressive deterioration. There are many types of arthritis that occur for many different reasons. To understand arthritis we first must start with an understanding of joints. The joints of our body are made of several different types of tissues. Most of the joints in the body are synovial joints, which means that they are lubricated by a fluid called synovial fluid produced from within the joint itself. This fluid is held around the joint by a lining made from connective tissue (joint capsule) much like a plastic bag holds a sandwich. Ligaments cross from one part of the joint to another and hold the joint together. Tendons connect muscles to the bone around joints in order to move the joint. The interior bone of the joint is covered with cartilage that is lubricated by the synovial fluid. This cartilage, called hyaline cartilage, is soft and the rubbery like the end of your nose or ears. This complex joint structure operates flawlessly until some event causes damage and begins the degenerative process we call arthritis.

Arthritis can be generated from injuries, infection, immune response, mechanical abnormalities and other conditions. Most forms of arthritis demonstrate signs of inflammation in or around the joint affected. Signs of inflammation include swelling, stiffness, tenderness, redness and/or warmth. This inflammation can begin suddenly or gradually over months or years. The cartilages inside joints become damaged by roughening (like sandpaper) or brittle and break apart (like dried mud). The synovial lining can become thickened and tough or inflamed producing excess or thick, sticky fluid. Ligaments can become worn and thin initially allowing the joint to move excessively then freezing up. The muscles around the joint will spasm occasionally then become weak in time. The bone around joints can over grow producing bone spurs (osteophytes) or enlargement of the joint generally. Virtually all of these processes are the result of inflammation, either directly or indirectly. Any of these processes can occur, usually in combination, and generate great pain and disability.

The two most common forms of arthritis are Rheumatoid and Osteoarthritis (degenerative joint disease). Rheumatoid arthritis is an autoimmune (our immune system acting against our own body) inflammatory response involving the synovial membrane and cartilage. This immune response is excessive and improper producing damage to the joint and a significant degree of inflammation in an around the joints. Osteoarthritis is the most common form of arthritis affecting one in every ten Americans. Osteoarthritis does not involve the same kind of inflammation as rheumatoid arthritis but does produce significant pain and disability.

Any form of arthritis needs to have specific nutritional supplementation in order to intervene in the course of the condition. There are numerous nutritional substances that should be used to address the specific cause of the form of arthritis present and the uniqueness of each individual. This takes the expertise of a doctor trained in the use of nutritional substances, not the guesswork of anyone else. Without this knowledge, no good will be done and more harm may result.

2. Osteoarthritis

The most common form of arthritis is Osteoarthritis (also called degenerative joint disease). It affects one out of every ten persons in the United States. Osteoarthritis is usually described as “wear and tear” but has many other causes than overuse. People of all ages can develop osteoarthritis but most often affects persons over 55 years of age.

The symptoms of osteoarthritis usually begin gradually over long periods of months or years. One may experience progressive joint stiffness with mild pain starting more as an annoyance with progressive loss of joint motion. There is usually no severe joint inflammation as there is with Rheumatoid arthritis but may occur to a milder degree later as the condition progresses. This inflammation is without the defined redness and is less symmetrical (on both sides) than that of Rheumatoid arthritis. Mostly there is greater stiffness with grating or popping sounds (crepitation) as a result of the cartilage becoming rough and fragile. Nodes or bumps often appear around the affected joints, most noticeably on the fingers at the joints near the fingernails. As the condition progresses the cartilage of the joint wears away exposing the bone causing them to rub together. At this point the joint is completely lost and usually requires joint replacement surgery. The pain of osteoarthritis comes from the injury to connective tissues (ligaments and capsule), muscle strain and inflammation, and bone swelling.

One characteristic of osteoarthritis is the osteophytes (bone spurs) that form at the edges of the affected joints, no matter where they are. At times these spurs can obstruct movement severely and interfere with other body functions. Osteoarthritis predominantly affects weight-bearing joints such as hips, knees, feet and spine but any joint can be affected. One common place is the joint at the base of the thumb.

Several elements have been identified as risk factors for developing osteoarthritis. They include hereditary, excess weight and a history of severe single or multiple injury events. There appears to be a family link of predisposition towards osteoarthritis or at least unusual joint stress that allows its development such as “knock knee” and “hour-glass hip”. Excess weight provides a basis for stresses upon the large weight bearing joints (especially the hips and knees) that will allow osteoarthritis to begin. Weight loss, even when arthritis is present, will reduce the severity of symptoms or slow the progression of the condition. Injury, which appears to be the greatest common factor, can be from one single or multiple smaller events. A single event would be something like a severe injury to a joint or several joints (sprain) and healing is incomplete or incorrect. Smaller events would be when repeated stresses are placed on the same joint over a long period (weeks or years) such as occurs with “housemaids knee” or “gamers thumb” which is the most common traumatic cause. I divide Osteoarthritis into two categories; post-traumatic (where injuries and wear and tear are the greatest commonality) and genetic or familial (where family history and generalized signs and symptoms are present without a history of trauma).

Of special note is that long term consumption of anti-inflammatory medications (NSAIDs), either over the counter or prescription, will actually cause the arthritic disease to become worse and speed the deterioration of the joints (due to prolonged COX inhibition). Several careful studies have demonstrated this very frightening connection. Also there is a strong connection between NSAIDs and high incidents of gastritis and ulcers with protein maldigestion or deficiency and colon problems.

Nutritionally there are several things that should be done to address the symptoms and limited movement associated with Osteoarthritis. Changes in lifestyle, diet and a specific nutritional program are necessary for best long-term results. This should be performed by competent physicians familiar with nutritional products.

3. Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic and fulminating inflammation in the lining of the joints and/or other internal organs. This type and degree of inflammation separates rheumatoid arthritis from other forms. Rheumatoid arthritis is an autoimmune disease, which means that it is a condition in which the bodies own immune system begins to attack and destroy normal body tissues. Rheumatoid arthritis can affect people of all ages but most commonly appears between the ages of 25 and 50. Rheumatoid arthritis affects women three times more often than men. It is a chronic disease, affecting many joints throughout the body resulting in damage to cartilage, bone, tendons and ligaments. Although there is no cure or prevention, there are ways to help relieve the pain and keep people active and productive.

Rheumatoid arthritis may start gradually or with a sudden, severe attack. Common signs and symptoms that may be indicative of RA include pain and swelling of the joints, morning stiffness of the joints and muscles, general weakness and fatigue, and possible fever with weight loss. Rheumatoid arthritis symptoms vary from person to person and may be mild with periods of no pain and then flair ups with significant pain and joint stiffness. Some individuals will experience continuous pain with only mild change of symptoms.

The process by which rheumatoid arthritis produces the pain and damage to the joints is through a malfunction of or inappropriate activity of the immune system. The immune system suddenly becomes activated and begins to destroy the cartilage and synovial linings of many joints in the body as well as other tissues of the internal organs (autoimmune). This attack of the normal tissues in the body is what separates rheumatoid arthritis from other forms of arthritis. Why this malfunction begins is still not understood and appears to be the key to discovering a cure. Some scientists believe that the abnormal immune response is triggered by an infection. There has been no proof that this is true but it may not be the infection that is the problem, but the challenge to the immune system that causes it to go “hay wire”, turn on and not turn off. This autoimmune action continues and provides the cause for the progressive pain and disfiguration common with rheumatoid arthritis. It has also been thought that certain people develop rheumatoid arthritis because of genetic predispositions toward either immune system errors or DNA synthesis failures. It seems most likely a combination of the two; immune system challenge that over-activates the system and a genetic predisposition towards the condition.

Some distinguishing features of rheumatoid arthritis are that it affects the wrist, knuckles and joints close to the knuckles but not the joints near the fingernails. There is also a great tendency for the inflammation of rheumatoid arthritis to be symmetrical. This means that the inflammation is uniform affecting both sides of the body equally. Commonly other tissues of the body are involved where there may be nodules under the skin, inflammation of the veins, dry eyes and mouth along with other rheumatoid symptoms. Rheumatoid arthritis tends to occur in families and is passed down from generation to generation, hence the belief that there is a genetic pre-disposition towards the condition as noted above. Although this is true, there may be individuals in a family who will not manifest rheumatoid problems although it is in their family history.

Given the complex nature of Rheumatoid arthritis, the nutritional intervention also takes more specific design. Specific nutrients are beneficial for reduction of inflammation (proteolytic enzyme therapy, bioflavinoids, greater gangala, etc.) and aiding in the repair of injured tissues (MSM, vitamin C, etc.). Aspects of detoxification and avoidance of immune challenges in the environment are also of paramount importance.

4. Nutritional Treatment for Arthritis

With the upsurge in desire to improve the quality of life and find alternatives to drugs in an aging society, there has been an explosion of research and knowledge in natural substances that address conditions common to aging. Arthritis is one such condition. It is estimated that some form of arthritis affects one in every eight Americans. Therefore treating arthritides through “natural” means is vital to any alternative medicine physician.

As discussed in an earlier article, there are several types of arthritis, each having both common and unique characteristics. Therefore determination of the specific arthritis present is necessary in order to construct a valuable health care program. Unique physiologic features of each patient such as metabolic type, allergies or sensitivities, digestive status, toxicity status, etc. must also be determined as these circumstances will influence the affectivity of therapy or present conditions that must be first corrected before effective intervention can be introduced. Concurrent health conditions should be known such as diabetes, hypertension, renal disease, dysbiosis, circulatory problems, etc. for the same reasons as above. Assessment of these factors should be made in all patients in order to construct an effective program. As I am sure you know some nutrients will not function optimally unless their metabolic avenues are clear of traffic. Detoxification, adequate hydration (40% of body weight in ounces daily without underlying cardiac, pulmonary or renal complications), reduction of allergic load, reduced sugar consumption, etc. will all “clear the road” for nutraceuticals to do their work in the best possible way.

Exercise is also a major factor for all patients with arthritis. But the same exercise for all arthritis sufferers will not work either. Generally speaking, aerobic level activity will provide a good constitutional basis for all individuals. For most patients with arthritis aquatic exercise seems to work the best. The buoyancy of the water helps mitigate gravitational and impact load on the joints while providing moderate resistance. There are many fine books that will give guidance in this area. Focusing the patient on proper form and the purpose for the exercise as well as challenging specific muscle groups or joints should be a focus for all physicians. Care must be taken not to over stress arthritic joints but this usually is not a problem. More often than not keeping the patient motivated when they do not immediately improve is a greater problem.

Specific nutrients that are valuable in the treatment of patients with arthritis are the following. This is certainly not an exhaustive list as the constellation of nutraceutical substances that address the various aspects of arthritis is vast. All of these nutrients are not necessary for every patient with arthritis, some being more helpful for specific types.

  • Glucosamine Sulfate
  • Chondroitin Sulfate
  • MSM (methylsulfonylmethane or dimethylsulfone)
  • Bromelain
  • Omega 3 Fatty Acids
  • Hyaluronic Acid
  • Type II Collagen
  • Vitamin C
  • Calcium
  • Magnesium