MODERN MEDICINE’S THEORY OF ARTHRITIS
Arthritis isn’t a new disease. It has plagued humankind ever since we’ve been able to keep any sort of records; in fact, some of the mummies of ancient Egypt showed signs of it. And, unlike so many chronic conditions, it isn’t confined to the West: most nations of the world are recording increasing levels of the disease.
One phenomenon of modern times is the extraordinary increase in the incidence of arthritis. It’s been estimated that nine out of 10 of us will suffer from some form of it to a lesser or greater extent before we die. So why has it become so prevalent in recent years? And have the 10 per cent of people who don’t develop the condition anything to teach us?
In the early part of the 20th century, scientists were convinced that arthritis was a chronic infection of the joints. This has given way to more recent theories, particularly the idea that arthritis is largely hereditary – a genetic tendency – or else an infection, caused by the bacterial micro-organism Mycoplasma, or even a malfunction of the body’s metabolic and immune systems. All agree, though, that the exact cause can’t yet be identified with any certainty.
Statistics do show that autoimmune diseases such as rheumatoid arthritis and Crohn’s disease often run in families. However, of the three theories, the notion that arthritis is a malfunctioning immune system is the most favoured and the most actively researched in laboratories; this is a credible possibility for autoimmune conditions like rheumatoid arthritis, but an inadequate explanation for all of the diseases lumped under the arthritis umbrella (see below).
The catch-all term arthritis can be broken down into six specific disease groups:
Since arthritis is a misleading, catch-all term for a variety of diseases of the bones, joints and tissues, it’s not surprising that there is also a range of different causes. However, before looking at some of the specific arthritic diseases, it’s important first to understand what constitutes a healthy joint.
Joints comprise bone with a layer of smooth, less brittle cartilage known as the articular cartilage, which is separated from the opposite bone and cartilage by a lubricating synovial fluid, contained within a synovial membrane (synovium).
The bone consists of a matrix of collagen, a form of protein, which binds together calcium, the main constituent of bone and phosphorus. The cartilage protects the bone ends, and is composed of proteoglycans, a type of mucopolysaccharide made from protein and carbohydrate.
Under the catch-all term ‘arthritis’ the following conditions are included:
Osteoarthritis is the most common form of the disease, affecting more than 70 per cent of adults between the ages of 55 and 78, the majority being women. Doctors mainly view osteoarthritis as a ‘normal’ degenerative process related to age, or a condition that commonly strikes after infection or injury, or among people who are overweight.
Osteoarthritis, also known as ‘wear-and-tear’ arthritis, affects the cartilage of joints, causing it to break down. The job of this tough, elastic tissue is to cover the bones that adjoin at every joint, reducing their friction as they rub together. As the cartilage breaks down, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing pain. Over time the cartilage dries out, becoming cracked and pitted, no longer allowing smooth movement of the joint. When cartilage wears away in a weight-bearing joint such as the hip or knee, this can produce severe pain, deformity and loss of mobility.
The disease is most commonly found in the hands, but it also affects weight-bearing joints such as the knees and hips, and also the joints of the spine.
In the early stages, you just feel stiffness, and movement may become a little difficult. Patients may not suffer any pain at this point. However, in the late stages of the condition, bone spurs called osteophytes – abnormal bone projections that develop along the edges of bones – can form. The cartilage can even disappear completely in severe cases, leaving the bone ends exposed. A common feature of osteoarthritis is hard knobs called Heberden’s nodes, which develop around the edges of the finger joints, caused by the breakdown of cartilage.
This variety of arthritis can be detected from blood tests, such as the erythrocyte sedimentation rate (ESR), which measures the speed at which red blood cells settle in a tube, indicating the amount of inflammation.
X-rays are used to reveal the degree of deterioration in the joints – and doctors tend to look out for joint narrowing and the presence of bone spurs, although these can only help to determine how much bone and cartilage damage has already been done.
Rheumatoid arthritis (RA) is also a chronic inflammatory disease, typically affecting the synovial lining of joints, most often in the hands and feet, but also in multiple joints throughout the body, especially elbows, wrists, ankles and knees. It also attacks shoulders and hip joints. Unlike osteoarthritis, where the joint itself breaks down, RA causes the synovium, or membrane lining around the joints, to become inflamed, which attracts more joint fluid to ease it. Eventually the joint becomes swollen, stiff and warm because of the increased blood flow.
Classified as an autoimmune disease, RA occurs when white blood cells produce antibodies that attack and destroy healthy tissue instead of attacking infection and disease. Doctors have no idea why this happens, but the chronic release of antibodies over time thickens the synovium and damages the cartilage and bone of the affected joints, causing crippling pain, deformity and eventual bone erosion. Other symptoms can include tiredness and muscle pain.
RA strikes roughly three times as many women as men and can affect any age group, although those younger than 35 years are a very low-risk group. Signs and symptoms of rheumatoid arthritis may include:
An average of one in 10 patients are thought to recover within two years. However, RA is known to ‘come and go’ frequently, with varying periods of acute symptoms followed by apparent remission.
Also known as crystal arthritis, gout is one of the most common types of inflammatory arthritis, affecting 1.4 per cent of adults in the UK, or an estimated 225,000 men and 57,000 women. An acute form of inflammatory arthritis usually affecting the metatarsalphalangeal joint at the base of the big toe, gout causes intense pain in the affected joints, which can also include wrist and finger joints.
Gout is a disease of middle age, affecting 15 times more men than women, and has long been linked to overindulgence of rich foods and alcohol consumption, although alternative practitioners have found that food allergies and the use of diuretic drugs, often prescribed for heart conditions, can also trigger the disorder.
Pain and swelling occur when minute crystals form in the joint space. The crystals are caused by excess uric acid in the body. The immune system attacks these crystals with phagocytes (scavenger cells,) and the toxic by-product of this clash causes the joint inflammation. Patients receive their first warning signal when they experience an arthritic attack in one of their big toes or one of the other common sites, when the joint becomes tender and painful. Classic signs are redness, swelling and attacks of severe pain.
Spondylitis, meaning ‘inflammation of the joints of the spine,’ affects the point where ligaments and tendons join the bone. This is the most common type of arthritis to affect young and middle-aged men, occurring most often between the sacrum (the last bone in the spine) and the pelvis. The classic sufferer has a rigid, painful spine and difficulty holding up the head when walking. Along with severe back pain, another warning sign of the disease is the development of iritis, an inflammation of the iris of the eye.
This disease, which usually strikes young women, can affect any joint. It’s thought to be genetic or caused by drugs and even to have some relation to sunlight, although it is generally accepted that SLE is an autoimmune condition. A red rash over the nose and cheeks is a warning sign.
Polymyalgia rheumatica is mostly a muscle disorder, but can affect the joints of people over 50 years old. It attacks the hips and shoulders and causes tenderness and distinct muscle pain.
Doctors have found a strong link between arthritis and the skin disorder psoriasis. Psoriatic arthritis occurs in 7 per cent of patients with psoriasis, and 20 per cent of patients with psoriatic arthritis have psoriasis. At times, the only symptom is a change in the nails – either pitting or discoloration. The condition usually affects only one or two joints.
This form of arthritis comes from a bacterial, viral or fungal infection that spreads from another part of the body. The types found include viral arthritis (caused by a virus such as rubella), septic arthritis (due to bacteria such as staphylococci) and rheumatic fever (from a throat infection caused by streptococci or the like). However, medical scientists are also just beginning to make the link between joint pain and persistent unwanted guests such as parasites (see Chapter 6).
Symptoms of infectious arthritis include intense pain in the joints, and redness and swelling there, along with chills and fever.
Post-traumatic arthritis is a form of osteoarthritis that develops after an injury, such as a wrist fracture or dislocation of the shoulder.
Osteoarthritis, the mildest and most common form of the disease, is blamed by medicine on ‘wear and tear,’ and wrongly viewed as an inevitable consequence of old age. However, when it comes to rheumatoid arthritis and the many other forms of the disease, medicine admits it’s at a loss to understand the causes.
Very early studies have drawn a link between, on the one hand, vitamin D deficiencies associated with lack of sunshine and, on the other, the by-product of other autoimmune diseases such as Crohn’s disease and multiple sclerosis (MS) as RA is generally considered an autoimmune disease. A study profiling 461 women with rheumatoid arthritis comparing them to 9,220 healthy controls revealed that women in the northeastern states of America, such as Vermont, New Hampshire and southern Maine, which have less sunshine than more southerly states, are more likely to suffer from rheumatoid arthritis.1 But so far no definite conclusions have been formed.
Evidence is accumulating for a link between rubella immunization and the development of arthralgia, or general joint stiffness, or arthritis. In a recent randomized, placebo-controlled trial, 30 per cent of women given the rubella vaccine developed acute, short-term joint problems, compared with 20 per cent of those given a placebo. The groups were followed up at one, three, six, nine and 12 months after immunizations. Although the gap between the two groups in terms of severity of symptoms did narrow over time, the authors still conclude that some women are more susceptible and may experience arthritic symptoms after rubella immunization.2
The truth is that there’s no consensus within the medical community on the causes of any of the forms of arthritis, which is why its only response is to prescribe painkillers and anti-inflammatory drugs to control the symptoms.