Arthritis is all around us, yet its impact on
individuals, their families, employers and the country are far greater than
most people realize. Thanks to a physical reminder by my classmate of a gym
dance class, I think it’s time to blog about it.
Arthritis Facts
Arthritis Disability
Arthritis is the leading cause of disability
among adults in the U.S.
Arthritis Prevalence
- By
conservative estimates, about 54 million adults have doctor-diagnosed
arthritis.
- Almost
300,000 babies and children have arthritis or a rheumatic condition.
- The
most common type of arthritis is osteoarthritis, which affects an
estimated 31 million Americans.
- Number
of people expected to have doctor-diagnosed arthritis by the year 2040:
more than 78 million.
Who Gets Arthritis
Doctor-diagnosed arthritis is more common in
women (26 percent) than in men (18 percent). In some types, such as rheumatoid
arthritis, women far outnumber men.
Economic Cost of Arthritis
Almost two-thirds of adults in the U.S. with
arthritis are of working age (18-64 years).
Arthritis and other non-traumatic joint
disorders are among the five most costly conditions among adults 18 and older.
Comorbidities
Arthritis is much more common among people who
have other chronic conditions.
- 49
percent of adults with heart disease have arthritis.
- 47
percent of adults with diabetes have arthritis.
- 31
percent of adults who are obese have arthritis.
Differences Between RA and OA
There are more than 100 types of arthritis, but
for simplicity, let’s take a look at differences between the common rheumatoid arthritis (RA)
vs. osteoarthritis (OA).
Although RA and OA both affect your joints,
they’re very different forms of the same broader condition. RA is an autoimmune
condition, while OA is primarily a degenerative joint condition.
Autoimmune
disorder vs. degenerative disorder
RA is an autoimmune disorder, which means your
body attacks itself. If you have RA, your body interprets the soft lining
around your joints as a threat, similar to a virus or bacteria, and attacks it.
This attack causes fluid to accumulate within
your joint. In addition to swelling, this fluid buildup also causes:
·
pain
·
stiffness
·
inflammation around your joints
OA, the most common form of arthritis, is a
degenerative joint disorder. People with OA experience a breakdown of the
cartilage that cushions their joints. The wearing down of cartilage causes the
bones to rub against each other. This exposes small nerves, causing pain.
OA doesn’t involve an autoimmune process like
RA does, but mild inflammation also occurs.
Risk
factors
Both types of arthritis are more common in
women than in men. RA and OA are more prevalent in older adults, but RA can
develop at any age.
RA can run in families. You have a higher
chance of developing the condition if a parent, child, or sibling has it.
You’re more likely to develop OA if you:
·
are overweight
·
have joint deformities
·
have diabetes
·
have gout
·
have experienced traumatic injuries to
your joints
Symptom
similarities and differences
Many of the basic symptoms of RA and OA are the
same, including:
·
painful, stiff joints
·
limited range of motion
·
warmth or tenderness in the affected
area
·
increased intensity of symptoms first
thing in the morning
Characteristics
of RA
Each kind of arthritis also has its own unique
set of symptoms. RA is a systemic disease, which means it can affect your
entire body — lungs, heart, eyes — and not just your joints. Early signs of RA
can include:
·
low-grade fever, especially in children
·
muscle aches
·
excessive fatigue
People in advanced stages of RA may notice hard
lumps underneath the skin near joints. The lumps, called rheumatoid nodules,
can be tender.
Characteristics
of OA
People with OA are unlikely to experience
overall symptoms. The degenerative nature of OA is limited solely to the
joints.
You might develop lumps under the skin around
joints, but these lumps are different from rheumatoid nodules. People with OA
tend to develop bone spurs, or excess bone growth at the edges of the affected
joints. Learn more about the symptoms of OA.
Joints
most often affected
RA and OA may affect different joints.
Affected
joints in RA
RA usually begins in the smaller joints. You’re
likely to have pain, stiffness, and swelling in the finger joints. As RA
progresses, symptoms can develop in larger joints such as knees, shoulders, and
ankles.
RA is a symmetrical disease. That means you’ll
experience symptoms on both sides of your body at the same time.
Affected
joints in OA
OA is less symmetrical. You might have pain in
both your left and right knee, for example, but one side or one joint is worse.
OA, like RA, is common in the hand and fingers.
OA often affects the spine and hips in addition to the knees.
Treatment
approaches
The primary goal in treating both OA and RA is
to:
- · reduce pain
- · improve function
- · minimize damage to your joints
Your doctor will approach these goals
differently, depending on which condition you have.
There’s no cure for RA or OA in conventional
Western medicine. However, treatments are
available to manage the symptoms of both conditions. Anti-inflammatory and
corticosteroid medications are generally effective for both OA and RA. If you
have RA, conventional drugs that suppress your immune system can prevent damage
by stopping your body from attacking your joints.
Explanation from Chinese Medicine Point of View
According
to Traditional Chinese Medicine (TCM), arthritis arises when the flow of Qi and
Blood are blocked and prevented from passing through the body's energy
pathways. The Chinese believe that when wind, cold, and dampness penetrate the
body's defenses and enter the muscles, tendons and joints, they can cause
stiffness and pain.
According to TCM, there are basically four types of arthritis:
Zuo Bi-The afflicted parts of the body become heavy and numb, and
the pain worsens on damp days.
Re Bi-This produces swelling, tenderness and sharp pain in one or
more joints.
Xing Bi-Here, the pain wanders about the body in patients who are
often slender.
Tong Bi-Severe pain that settles in one or more joints; cold and
in activity will worsen the pain, heat will reduce pain.
Once the type of arthritis is diagnosed, TCM practitioners use a
variety of techniques to treat its painful symptoms. Among the most popular
techniques are acupuncture, acupressure, herbal remedies, diet changes and Qi
Gong massage and exercises.
An old Chinese saying advises that the wise doctor begins his cure
of disease with good food. When using herbal medicines to treat arthritis, a
traditional Chinese herbalist will ask many questions about a patient's overall
health before creating a formula that will relieve the symptoms of pain. Each
formula has a single goal to move the Blood and Qi. In general, royal jelly,
papaya and black soybeans can be helpful for rheumatoid arthritis.
Commonly used
dietary supplements include fish oil and Gamma-linolenic acid (GLA). Other than these, a research
published in the BMJ in 2014 suggests that a Chinese herbal remedy is just as
effective as methotrexate. The herbal
remedy, called Triptergium wilfordii Hook F (TwHF), is an herbal
remedy used in traditional Chinese medicine for the treatment of
swelling, inflammation and joint pain. The remedy comes from extracts of the Triptergium
wilfordii plant, also known as the "thunder god vine."
However, NIH’s NCCIH site warns that
thunder god vine can cause severe side effects.
As a
complement to herbal techniques, TCM often employs acupuncture to treat the
symptoms of arthritis pain. Needles are placed at key points along the
meridians to move Blood and Qi. (Meridians are invisible lines corresponding to
the flow of energy or chi in the body and are connected to specific organs and
systems.) It usually takes a number of weeks for acupuncture to produce
prolonged relief from arthritis. Many patients say they feel better after even the
first treatment.
For those who prefer less invasive techniques of pain relief,
there's acupressure. Here, pressure, using the practitioner's fingers, is
applied over the same points along the meridians. For example, applying
pressure over the "Aspirin Point"--located between the Achilles
tendon and the anklebone--may provide some relief from arthritis pain.
Finally, there's Qi Gong exercises. These include Tai Qi
Quan and the Eight Brocade exercises, which provide the gentle motions and
stretching needed to remove obstructions and help alleviate pain. Some patients
also undergo Qi Gong massage therapy, which can further increase the flow of Qi
and help reduce pain.
Recently, a study revealed that TaiChi might help reduce the pain
of arthritis. The study analyzed seven eligible randomized controlled trials
that used TaiChi to treat patients with musculoskeletal pain. The results
demonstrated that TaiChi exercises relieved pain and disability in patients
suffering from arthritis. I'll mention towards the end of this post.
Herbs for
Chronic Arthritic Pains
Although our company, WeCare Holistic, is currently focusing on
mobile health, my passion and hobby in Chinese medicine and home remedies
remain. Some herbal treatments were discussed above and more easily available:
Several traditional Chinese herbs
have been shown to demonstrate significant analgesic activity in animal studies
by acting on nociceptive neurons and pain pathways to relieve pain and calm over-sensitized
nervous systems.
• Gastrodia
root has been shown to exert novel pain relief and
inflammatory-mediating activities, as well as in vivo and in
vitro inhibitory activity on nitric oxide (NO) production.
• Activated
Aconite exhibits especially potent analgesic properties, according to a
recent study conducted by researchers with the Department of Anesthesiology, Perioperative
and Pain Medicine at Harvard Medical School. Their research
reveals that one of the active ingredients in aconite–Bulleyaconitine A, or BLA–
strongly reduces sodium channel currents to block overactive pain signals for
prolonged periods of time. In China, BLA has been approved for the treatment of
chronic pain and rheumatoid arthritis.
• Scrophularia has
demonstrated a powerful painkilling ability equal to that of cortisone and
twice as effective as indomethacin, a popular NSAID used to
treat arthritis. As with the other herbal ingredients, scrophularia exerts
these significant analgesic effects with virtually no side effects.
• Notoperygium
root is used in traditional medicine to relieve discomfort due to
aching in the limbs and joints, especially in the upper part of the body.
Recent studies reveal that Notoperygium works to
support joint discomfort, in part, by inhibiting 5-Lipoxygenase (5-LOX) and COX,
two key enzymes involved in the arachidonic acid pathway that constitutes one
of the main mechanisms for the production of pain and inflammation.
• Eucommia
bark is derived from the Eucommia, or hardy rubber
tree. In traditional Chinese medicine, Eucommia bark is used
to strengthen the bones and muscles and alleviate discomfort in the lower back
and legs. Eucommia bark contains a substance, iridoid
glycoside, that has a long history of use for inflammation.(5) One
glycoside, aucubin, has been shown to be a specific
inhibitor of NF-kappaB activation in mast cells, which
might explain its beneficial effects.
• Chinese
Ligusticum root contains alkaloids that have been shown in
studies to inhibit TNF-alpha production
and TNFalpha- mediated NF-kappaB activation.(7)
One study conducted in Japan showed that active compounds found in Ligustici
Sinensis have both anti-inflammatory and pain reducing
effects, exerting its anti-inflammatory benefits in the early and the late
stages of processes in the inflammatory pathology.
Chinese Herbs and Inflammation
Inflammation is the body’s front-line
defense against infection and damage. The five primary symptoms of inflammation
– redness, heat, swelling, pain, and restriction of movement – are signs that
the body is bringing in more blood and immune resources, such as white blood
cells and macrophages, to remove microorganisms and other foreign matter.
Redness is a sign that vasodilation is allowing more blood and other fluids to
reach the affected area; local heat reflects the increased flow of warm blood
from deep within the body; swelling (edema) is caused by the local accumulation
of fluids; pain and restricted mobility arise from the added pressure caused by
the swelling.
With osteoarthritis, inflammation
is initially triggered either by trauma or irritation resulting from
age-related damage to joint tissues. With the onset of inflammation the immune
system responds by releasing additional pro-inflammatory factors (i.e., TNFalpha,
IFN-gamma, IL-1beta, IL-2, IL-4, LTB(4), and NO)
that accelerate cartilage damage. In time the cartilage begins to degrade,
shedding pieces of cartilage throughout the interior joint capsule. This new
“foreign” material is, in turn, targeted for destruction by the immune system,
further fueling the inflammatory response as the body struggles to eliminate
the cellular debris. In time this process results in the eventual destruction
of the joint.
Once again, a number of
traditional Chinese have been shown to exhibit potent anti-inflammatory
properties for both short and long-term support for countering inflammation,
dampening pain, reducing swelling and stiffness, and restoring cartilage
integrity (Table 1).
• Tang-kuei
root has been shown to reduce edema (swelling) in early and late
stages of inflammation by decreasing leukocyte counts, neutrophil density, and interleukin-6
(IL-6) expression.Tang-kuei has also been
found to increase levels of PGD2, an important natural
anti-inflammatory prostaglandin. Most significantly, tang-kuei is a natural
source of ferulic acid, a potent antioxidant that protects cells from damaging
reactive oxygen species (ROS) implicated in the pathology and progression of
arthritis.
• Achyranthes
(Cyathula) inhibits collagen-induced arthritis and acute edema. Most
significantly, two novel triterpene glycosides isolated from achyranthes have
been shown to be 1,000 times more potent than Sialyl Lewis X (SleX),
an important blood group antigen that inhibits excess recruitment of
neutrophils to injured tissues. This is an extremely important property. With
arthritis, when too many white blood cells are recruited to an injured joint
the neutrophils attack and destroy healthy tissues, leading to conditions such
as septic shock and rheumatoid arthritis.
• Rehmannia contains
a unique iridoid glycoside, catalpol, that has been
shown to exert protective effects on dopaminergic neurons to help inhibit
microglial activation, thereby reducing the production of pro-inflammatory
factors.
• Scrophularia reduces
edema, cell infiltration and proliferation of activated Tlymphocytes in damaged
joint tissues. Additionally, scrophularia has been shown to inhibit a number of
inflammatory factors, including prostaglandin E2, leukotriene B4, NO,
interleukin-1beta, interleukin-2, interleukin-4, interferongamma and tumor
necrosis factor-alpha (TNFa), but had no negative effect on
the production of interleukin-10, a powerful
anti-inflammatory cytokine. Moreover, scrophularia is the source of a unique
glycoterpenoid, Verbascosaponin A, that has been shown to be
twice as potent as the NSAID indomethacin for relieving inflammation and pain.
Herbs for Joint Circulation
Arthritis results in impaired
blood circulation to the joints, contributing to joint deterioration, cold
sensations, weakness and stiffness. Advanced arthritis also inhibits ability to
engage in physical exercise, further contributing to poor limb circulation.
Arthritis-related changes to blood chemistry also increase risks of developing
blood clots (thrombosis) in the veins and arteries, just the type of condition
aggravated by COX-2 inhibitor drugs. Contemporary research reveals several
traditional herbs that have been shown to counter the negative effects of
arthritic inflammation on circulation.
• Gastrodia has been
shown to interact with human fibrinogen to act as a natural anticoagulant. By
inhibiting interactions between fibrin molecules, gastrodia effectively
inhibits the formation of arthritic-related thrombosis (blood clots) without
interfering with normal clotting required for tissue maintenance.
Herbal Support for Relaxation of Joint Muscles, Collagen Synthesis
Arthritis causes painful swelling
and stiffness that restricts joint movement. In time, limited movement leads to
atrophy of the muscles surrounding the joints due to lack of use. Several herbs
have been shown to relax arthritic joint muscles.
• Tang-kuei, in
particular, has been shown in animal studies to exert a muscle relaxant effect
to relax muscles and aid in restoring joint mobility.
• Eucommia has been
shown to support recovery of joint mobility by promoting collagen synthesis.
Researchers working with extracts of eucommia report that
collagen synthesis was significantly increased when the herb was administered
to laboratory rats raised to model age-related loss of joint cartilage.
Summary: Long-Term Benefits
By supporting natural pain relief
through analgesic, anti-inflammatory and circulatory actions, as noted above,
traditional Chinese arthritis herbs have been shown to enhance restoration of
healthy joint function while reducing pain, inflammation and swelling. In
addition to enhancing comfort and flexibility, many users of Chinese herbs
report long-term health benefits, including improvements in memory,
normalization of blood pressure levels, and antispasmodic and sedative effects.
External Home
Remedies & Chinese Medicine Approaches
Besides internal healing through medicinal
foods, I translate and put together commonly used external Chinese medicine methods for arthritis here:
1.
Heated
Towel
Turn up the heat! Sometimes a little hot
therapy may be all you need to relieve your osteoarthritis-related joint pain.
When it comes to treating osteoarthritis joint pain, sometimes simpler is
better. Such is the case with heat therapy, which has been shown to relieve
pain and improve mobility in many people with arthritis.
Wrap a hot towel around painful area, or for
added safety, use a thermophore moist heating pad by putting a towel around it
and apply to the skin.
If you have sharp pain, try something cold.
Unlike heat, cold slows circulation, reduces swelling, and numbs nerve endings
that send pain signals to your brain.
Cold baths are no fun, but your aching joint
might like one. Parts of your body, like your hands, feet, knees, or elbows,
can take a short swim in a bowl of ice and water.
2.
Baking
Soda and Water Mixture
Baking soda has been used as a home remedy for
generations due to its antacid properties. Yet its benefits run even deeper,
and while new Western research continuously explain why it is an effective aid
in the treatment of autoimmune diseases such as arthritis.
Soaking the painful joints in baking soda can also
help with arthritis. Balneotherapy is the technique of bathing in tap or
mineral water for health purposes. Preliminary research on balneotherapy for RA
has been conducted not only in China, but in areas where it is most popular,
such as Europe and Israel’s Dead Sea region.
You can also try warm paraffin was bath for
sore hands and feet. Buy one at drugstores and beauty supply shops. Plug in the
paraffin bath to melt the wax. This can take up to 30 minutes. Dip your arm or
foot in a few times to coat and wrap with a plastic bag to keep the heat in.
Peel off the wax after 20 minutes.
3.
Laughter
lol
Laughter can be a
great pain medicine too. Laughing with friends releases feel-good brain
chemicals, which also relieve pain. Researchers believe that the long series of
exhalations that accompany true laughter cause physical exhaustion of the
abdominal muscles and, in turn, trigger endorphin release. These pain-relieving
chemicals are created in response to exercise, excitement, pain, spicy food,
love and sexual orgasm, among other things.
In addition to giving
us a "buzz," these endorphins raise our ability to ignore pain.
Don't forget the
everyday joys that shift the focus off your pain. Surround yourself with photos
of people you love, spend time in the sunshine, and listen to music that makes
you happy. Good smells and comfort food (but not too much!) get the positive
juices flowing, as well.
4.
Biking
Bicycling is a great
exercise option for people with osteoarthritis. A regular routine of bicycling
keeps your knees moving through their range of motion and, at the same time,
strengthens the muscles that support your knees. It makes sense to continue
bicycling for as long as you are able.
However, if you have
a significant amount of joint damage in your knees or hips, your ability to
ride a bicycle may become increasingly limited.
5.
Try
TaiChi
A few small studies have been conducted on tai
chi for RA. In general, tai chi has not been
shown to be effective for joint pain, swelling, and tenderness, although
improvements in mood, quality of life, and overall physical function have been
reported.
6.
Electroacupuncture
In a study from the University of Ottawa,
participants with knee pain due to RA had some relief with electroacupuncture. This type of acupuncture uses an electric
current that pulsates through the needles. The participants noticed a reduction
in pain both 24 hours after the treatment and four months later. Although
in that study per se the sample size was too small for it to recommend
eletroacupuncture as a treatment, this approach has been used China without recorded
numbers, and The Pacific College of Oriental Medicine mentions two studies that
show the benefits of acupuncture and eletroacupuncture.
An article in the journal Rheumatology notes
that most of the positive trials come from China, and negative studies
performed in China are rare.
7.
Bee
venom acupuncture (BVA)
This is the most controversial one due
to a death accident in the news. Bee venom acupuncture (BVA), as a kind of
herbal acupuncture, exerts not only pharmacological actions from the bioactive
compounds isolated from bee venom but also a mechanical function from
acupuncture stimulation.
Despite of the negative news, BVA is
growing in popularity, especially in Korea, and is used primarily for pain
relief in many kinds of diseases. Two randomized
controlled trials and three uncontrolled clinical trials showed that BVA was
effective in the treatment of arthritis.
Sources:
Alex A. Kecskes. “TCM approaches to relive
arthritis”. Pacific College of Oriental Medicine.
Arthritis Foundation. “Supplements & Herbs
for Arthritis”. https://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/
“Arthritis by the Numbers”. https://www.arthritis.org/Documents/Sections/About-Arthritis/arthritis-facts-stats-figures.pdf
Chen SY, Shou P, Qin Y. “Treatment of Rheumatoid Arthritis by Bee-venom
Acupuncture”.
Healthline. “Differences Between RA and OA.” https://www.healthline.com/health/rheumatoid-arthritis/ra-vs-oa
“Managing
Arthritis Pain”. https://www.healthline.com/health/chronic-pain/managing-arthritis-pain#prescriptionmedications
Honor Whiteman. “Chinese herbal remedy 'just as effective as methotrexate against
arthritis'”. https://www.medicalnewstoday.com/articles/275504.php
Jennifer Welsh. “Why Laughter May Be the Best
Pain Medicine”. https://www.livescience.com/16038-laughter-soothes-pain.html
Lu Yang, Wenbo Peng, Jon Adams, David William
Sibbritt. “Treating people with arthritis with traditional Chinese medicine
(TCM): an examination of the perception of TCM practitioners”. BMJ. Acupuncture
in Medicine. http://dx.doi.org/10.1136/acupmed-2017-011527
NCCIH, NIH. “Rheumatoid Arthritis: In Depth.” https://nccih.nih.gov/health/RA/getthefacts.htm#research
“Traditional Chinese medicine in patients with
osteoarthritis of the knee”.
Susana Seca and Giovanna Franconi. “Understanding
Chinese Medicine Patterns of Rheumatoid Arthritis and Related Biomarkers”. Medicines
(Basel). Published online 2018 Feb 3. doi: 10.3390/medicines5010017
WebMD. “5
Common Types of Arthritis”. https://www.webmd.com/rheumatoid-arthritis/guide/most-common-arthritis-types
刘佳。上海中医药大学。《类风湿性关节炎的十大中医外治法》。
骨大夫网。《冬季防治关节炎，老中医给你五条妙法》https://mp.weixin.qq.com/s/N_ruJTB4wB8ecsDTcJYB6w
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