Tag Archives: Arthritis

Health: Foods That Fight Inflammation (Harvard)

OSTEOARTHRITIS: SYMPTOMS & TREATMENT OPTIONS (UVA)

Osteoarthritis is a “wear-and-tear” form of arthritis. Over time, the protective tissue at the ends of the bones wears down, so simple tasks like standing up or taking the stairs becomes painful. Orthopedic surgeon James Browne, MD, discusses the causes of the disease, and the many treatment options available at UVA.

Find out more at: https://uvahealth.com/services/joint-..

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #42: HIP JOINT PAIN

Hip pain is a very common condition as one gets older, though it can also occur in younger people. The most common cause of hip pain is OSTEOARTHRITIS , a condition that I discussed a little more than a year ago, mainly in the context of pain in the joints of the hand:  press the search button and type in “osteoarthritis”. I think you’ll enjoy reading it, as I did upon rereading.

Large joint arthritis seems to be a different animal as compared to small joint arthritis, to which I can personally attest; I have had significant arthritis in the joints of my hand and somewhat in my feet for a long time now, while I am fortunate enough not to have any problem with my hips or knees. It may be a coincidence, but I have been taking glucosamine and chondroitin  for sometime now.

It is also of interest that I have stood without sitting down in much of my medical career, and I have continued walking for exercise 1 to 1 1/2 hours a day. This would be against the idea that it is only ordinary wear and tear on the joints that determine the loss of articular cartilage so characteristic of osteoarthritis.

Unusual wear and tear, such as in football, soccer and Long term running on a hard surface, is a different matter, however. Pain in the groin is the most characteristic location for hip-joint arthritis. Pain in the side of the hip joint may be trochanteric bursitis, and that in the buttocks area could be from the nerve root compression of sciatica. Knee pain can refer to the hip. Rheumatoid arthritis, and even rheumatic fever in younger people can also cause hip inflammation and pain.

Sports injuries and falls can cause a hip fracture or a tear in the hip labrum that can declare as pain, but here’s the problem is more about how to treat it, rather than the diagnosis. As you get older, remember to take your calcium and vitamin D to prevent osteoporosis, and maintain your muscle strength and balance to prevent falls. Please type in “falls” for a discussion on how to prevent this often devastating problem in the elderly.

The hip joint can actually get infected with a septic arthritis, which is more typical of younger individuals, and those with immune deficiency. Cancer and infection of the hip bone can also be quite painful. The hip bone can suffer a loss of arterial supply, causing avascular necrosis in the process. Adolescents can get a slipped epiphysis.

When hip pain interferes with your exercise routine and ordinary life activities, it is time to check with the doctor to see what is going on and what can be done about it. If you have not already decided upon surgery, I would suggest a family practitioner or internist as your first stop.

Please refer to the mayo clinic article for more information.

—Dr. C.

Read Mayo Clinic article

DR. C’S JOURNAL: Stress & The Effects Of Cortisol

Cortisol (hydrocortisone, 17-OH-corticosterone) is produced by stress, and is a bad word these days. When I was a practicing allergist, Cortisol worked wonders with asthma, and as a salve helped my patients with eczema.

It functions in the body as a key part of the stress reaction, which preparers the animal body for “Fight or flight”.  Cortisone raises the blood pressure, heart rate and blood sugar, and shuts down The immune system, which is not as necessary in times of emergency. It is this last function which helped my patients with asthma and eczema, which are diseases of excessive immune reactivity. You may have heard of the use of dexamethasone( A relative of cortisol ) in severe Covid, which is made worse by an excessive immune response.

Modern life is a pressure cooker, requiring continuous activity and deadlines. The blood Cortisone level, which is raised by stress, is helpful in the short term, but deleterious when persisting over the long term. The prolonged elevation of blood Pressure, blood sugar and heart rate, coupled with a decrease in bone and collagen formation can lead to all kinds of problems including weight gain, diabetes, cardiovascular problems, osteoporosis and mental decline.

Although  cortisol in the short term can enhance memory (think of flash – bulb memory), in the long run it decreases hippocampal function, impacting memory.

For these and other reasons, Modern Life makes it desirable to reduce stress and the accompanying elevation of cortisol . Our old friends, Proper sleep, diet and exercise are critical, and help activities such as laughter and yoga to reduce stress. The following reference will cover this in more detail.

—Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #8: GOUT (GOUTY ARTHRITIS)

If you develop severe big toe pain in the middle of the night, and it is so tender that you can’t even stand the pressure of the sheet on it, you may have GOUT, an increasingly common form of ARTHRITIS.

And you would be in famous company: King Henry Vlll, Isaac Newton, and Benjamin Franklin all had Gout. There is even a famous dialogue between Franklin and his Tormentor.

Gout is caused by a buildup of URIC ACID in the bloodstream. This buildup can be caused by eating too much nucleic-acid-containing foods, like meats, “sweetbreads” and shellfish, and drinking too much alcohol, especially beer.

Reduced Clearance of Uric acid in the kidneys may contribute, and may be responsible for some of the familial tendencies of gout. The uric excess acid in the blood stream gets into joint tissues, most famously the big toe, although ankles, knees and other joints may be involved.

When deposited in joint tissues, the uric acid crystals attract inflammatory cells, which secrete their Interleukins and produce all of the symptoms of painful, red and swollen joints.

Risk factors include Obesity, diabetes, and the usual suite of problems of the METABOLIC SYNDROME. Just look at a picture of Henry Vlll with a mug of beer in one hand, and a leg of mutton in the other, and your big toe will start to hurt.

Dietary regulation is one of the best ways of reducing PURINE AND PYRIMIDINE intake and consequently the metabolic BYPRODUCT, Uric Acid, in the circulation.

There are DRUGS, called uricosurics, which will cause the kidneys to Clear more Uric acid, and other drugs, such as thiazide diuretics, which will reduce clearance and excretion of gout’s causative agent.

Yes, UNHEALTHFUL EATING CAN BE PAINFUL.

–DR. C

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #6: OSTEOARTHRITIS (OA)

Osteoarthritis (OA) was considered a Degenerative disease when I went to Med School in the late 50s. I am more interested in OA since I have developed it myself.

There is a 40-60% hereditary component. My father’s mother had arthritis badly in her hands, as did my mother’s mother, and so on. A lot of genome-correlation work has shown many different genes involved,

But without a single big contributor, OA appears to be “multifactorial”, similar to a lot of common diseases like Diabetes l. Trauma can be a factor. Old sports injuries, like an ACL tear, that you thought a thing of the past, may come back to haunt you in later years.

INFLAMMATION, the most popular explanatory cause of the decade, may be operating in OA. For instance, you can imagine that OBESITY would contribute to hip and knee OA simply through the traumatic force of gravity. But obesity is also a disease of Inflammation, and increases IL-6 and other cytokines as well.

My own OA involves the classic distal 2 interphalangeal joints (go to the wikipedia manekin for a color-representation of OA classic locations). The base of my thumb, neck and back are also a problem.

Strangely, but wonderfully, my “wheels”, the Hips and Knees, are spared. I have exercised a lot in my life. Clearly, you can’t “wear out” your joints with ordinary exercise.

Our joints have evolved to allow us to move. Since bone has a lot of pain fibres, it would be painful to move the joints, directly bone-on-bone. So we have cartilage on the ends of the bones and discs between the vertebrae. The cartilage is slick to reduce friction.

Cartilage has no blood to supply it with nutrients. Instead, it relies on the joint (synovial) fluid. The cartilage is like a sponge. Walking alternately compresses and relaxes the spongy cartilage, increasing the synovial fluid circulation, thus improving the nutrition of the cartilage. If the Cartilage disappears, there is pain.

I am not a fan of pain medication. My belief was strengthened by the side effects of the study of a medication designed to genetically block pain transmission by injection into the painful joints. The side effect was virtual dissolution of the joints in a fraction of those treated. I felt more comfortable with my pain after reading the article.

Although Acetaminophen helps a little, NSAIDs usually work better, perhaps because of their anti-inflammatory action.

If, like me, you have stomach issues, there are the COX-2 inhibitors like Celebrex. The one dose I recently took was almost magical in its effects. Maybe if you don’t use pain Meds much, they work better.

I do take Glucosamine-Chondroitin, thinking that providing building blocks for cartilage couldn’t hurt. Along this line I also EAT CARTILAGE whenever I eat Chicken or ribs, being careful not to damage my teeth in the act of of exercising my jaws.

I also take Curcumin, hoping to relieve some pain, in spite of the fact that it is poorly absorbed (some brave souls take it by injection). I don’t know if any of this helps, How can you know in such a variable disorder, in the absence of controlled studies.

And pain has no OBJECTIVE markers, and is notoriously hard to study. We literally know more about the surface of mars than we know about Pain.

SLEEP, DIET, and EXERCISE, by minimizing OA factors kike OBESITY and INFLAMMATION are the best bet for preventing and treating OA at present.

–DR. C