As reported by the Middletown Press, April 10, 2005.
Arthritis Causes Unknown; Early Treatment Helps
By Tricia Stuart
Arthritis is one of the most prevalent chronic health problems and the nation's leading cause of disability among Americans over the age 15, according to the Arthritis Foundation.
Although there are rarer forms of arthritis, the three most common forms of arthritis are rheumatoid arthritis, osteoarthritis, and gout, said Santhanam Lakshminarayanan, assistant professor of Medicine at the University of Connecticut Health Center.
"Most people would be covered if these three main forms of arthritis were taken care of," he said.
Different people respond to the same stimulus in different ways; depending on what genetic background people come from, and what causes the arthritis (which is unknown), who will get arthritis, cannot be predicted.
Lakshminarayanan sees how severe arthritis is during assessment, and looks for the features of the disease that are evident.
"Some gene types are at risk, but you can't tell," he said.
While most people will have heard of the first two forms of arthritis, not everyone will know about gout, which is an acute inflammatory arthritis caused by uric acid crystals formed in the blood that settle in the joints and cause intense pain.
The presence of too many uric acid crystals in the blood can cause either arthritis or kidney stones. Treatment by a sub-specialist (someone who treats that type of arthritis) isn't necessary for gout; a general practitioner can treat it.
Doctors and researchers don't know the cause of rheumatoid arthritis.
"Rheumatoid arthritis is not as cut and dry as gout because we don't know that causes it," he said. But he cautions, "Just because rheumatoid arthritis blood factors are present, doesn't necessarily mean the patient has arthritis. There are other factors. A diagnosis has to be done on the history of the patient, and the exam and the blood tests are only an adjunct to the assessment." The opportunity for treating rheumatoid arthritis is in the early part of the disease. Even though detected early, the newest treatments for it may not be necessary, but follow-up treatment should be with a sub-specialist.
Swollen joints, joint stiffness, nodules, small joints, small wrists, fingers and toes, and blood factors indicate arthritis, but the arthritis picture is complicated.
"If the patient doesn't have pain, but has positive blood factors, it doesn't mean the patient has arthritis. Blood factors may indicate another disease; it may be Hepatitis C or another inflammatory disease. The diagnosis should be made on the clinical picture and not on the blood test," he said.
Osteoarthritis is common, but again, doctors and researchers don't know the cause. The most important thing with arthritis is early recognition and early treatment with a sub-specialist.
Physicians know how to treat inflammation, and the damage that is done to the arthritis joints is caused by inflammation.
"All medications try to decrease the inflammation, and by doing so, decrease the damage to the joint. All succeed in varying degrees, but not all work in all patients," he said.
Drug treatments that change the course of inflammation include Prednisone; Etanercept (trade name Enbrel, which is injectable); Infliximab, an injectable infusion that can be used over a prolonged period of time (brand name Remcade); Adalimumab (brand name Humira, which is injectable); the generic drug Methotrexate Sulfasalazine, and; Lefluno-mide (trade name Arava). The injectable drugs are effective for and can be used for rheumatoid arthritis.
Side effects of the drugs are to be reckoned with., Prednisone can cause osteoporosis, diabetes, weight gain, and cataracts, among other problems. Most of the other drugs can decrease immune response and make the patient susceptible to infections.
Newer injections that attempt to influence the mediators of inflammation will be coming out in the next few years, and treatment is becoming more specific. Yet the causes that set off inflammation aren't known. The biologics target specific chemicals that cause inflammation, but use of those medications should be be weighed against the side effects of risk and infection.
Patients may decide that the risk is too high and seek other alternatives. Lakshminarayanan is wary of naturopathic remedies since nothing has been proven for those aids within the scientific community, he said. Yet, he admits the scientific community doesn't have all the answers and current medications cause side effects.
"If the patient uses it and it seems to help, then I don't have anything against it." He doesn't know what is in natural products and this makes him leery. Some evidence shows Glucosamine Chondroitin Sulfate is protective against osteoarthritis in the long term, but that is not effective in other kinds of arthritis. Oil of Evening Primrose and Borage Oil have been used to combat fatigue and achiness by some patients, he said, but there is no hard evidence that it works. "But if it helps the individual, that's fine."
Borage is created with a "calming and anti-inflammatory action" in "The Herb Book" by John Lust. Earl Mindell's "Herb Bible" states that gamma linoleic acid (GLA), a fatty acid found in evening primrose oil, was used successfully to treat rheumatoid arthritis patients in a double-blind study, reducing swelling, joint pain, and stiffness. A