Last week Mrs C, a 55 year-old dressmaker stopped by for a "check-up."

"Good morning, Mrs C. how can I help you today?"
"Doctor, my knees killing me. I can hear them creaking when I walk. I know it is arthritis and I want a prescription for a pain killer."

"Mrs C, writing a prescription for pain killers is not going to solve your problem. There is more to treating arthritis than just writing a prescription," I replied.
Mrs C leads a sedentary life. She is five feet 2 inches tall, weighs 206 pounds (she is obese), hypertensive and has osteoarthritis of the knees.

So how can she be helped?

I recommend the following:

. WEIGHT LOSS
. EXERCISE
. RELAXATION
. NUTRITION and
SUPPLEMENTATION
. MEDICATIONS

WEIGHT LOSS

The risk of developing osteoarthritis can be lowered by developing an active lifestyle, preventing joint injuries and staying at a healthy weight. Weight loss can help if osteoarthritis is already present. When walking occurs, the knees absorb a force equal to three times the body weight with each step. A weight loss of 10 pounds relieves each knee of about 30 pounds with each step taken. At a height of five feet 2inches and weight of 206 pounds, Mrs C has a BMI (body mass index) of 37. The BMI, a standardised ratio of weight/height, is used to determine if a person is of normal weight, overweight or obese. Mrs C is obese. At a height of five feet two inches, she should be weighing less than 135 pounds. So Mrs C needs to lose 71 pounds.

EXERCISE

Mrs C leads a sedentary life and needs an exercise programme. If some form of exercise is not performed, there will not be any increase in strength or function - thereby worsening the arthritis. Walking, stretching, aerobic exercise and exercises to strengthen the muscles around the joints are recommended. Strengthening the muscles around an arthritic joint actually supports the joint and lessens pain. Tai chi, a form of martial arts, and yoga can help to improve joint function and promote relaxation. Exercise will also help by keeping off excess weight.

RELAXATION

Stress can make pain worse. When under stress, pain is perceived as more intense than when relaxed. Stress causes tensing of the muscles resulting in worsening of pain
Practise relaxation techniques such as deep breathing and relaxation exercises. For example, lie flat on your back, with your palms facing up - this is called the corpse pose in hath yoga. Slowly take deep breaths using the abdominal and chest muscles. As you slowly breathe in and out, begin relaxing the toes, then the ankles and the knees, and work your way up to the head. The effectiveness of any relaxation exercise can be enhanced by the use of relaxing essential oils such as lavender, sweet orange, geranium, and chamomile.

NUTRITION AND SUPPLEMENTATION

I recommend a programme that is based on the concept of cellular nutrition. It involves replacing meals with soy-based shakes and taking high quality multivitamin and mineral supplements. This programme can be used to lose weight or to maintain weight. Also:

. Eliminate meat from the diet

. drink eight glasses of water

. antioxidants - such as lateen, lycopene, vitamin C and beta carotene.

. vitamin E

. Glucosamine. This can decrease pain and reduce nonsteroidal anti-inflammatory drug (NSAID) use.
Glucosamine may keep cartilage - the slippery tissue that covers the end of the bones of the joints - from deteriorating. (When the cartilage deteriorates, bone may rub on bone resulting in pain, swelling and limitation in movement of the joint.) Glucosamine occurs naturally in the body where it helps in cartilage formation and repair. It is made from the shells of crabs or other shellfish. Many supplements combine glucosamine with chondroitin.
Chondroitin is derived from animal cartilage - such as pig, shark and cow parts. It disarms enzymes that destroys cartilage.

. Avocado/soybean Unsaponifiables. This has been used by osteoarthritis sufferers in France for the past 10 years. It is a refined mixture of avocado and soybean oils and is taken by mouth.

. SAMe ( S - adenosylmethionine ) This may improve joint mobility and relieve pain from osteoarthritis.

. Green tea - the polyphenols in green tea reduces the pain and swelling of rheumatoid arthritis and osteoarthritis.

. Fish oils - the omega-3 - fatty acids in fish oil, EPA eicosapentanoic acid and DHA docosahexaenoic acid may ease pain and swelling of rheumatoid and osteoarthritis.

. GLA (gamma linolenic acid) The body converts GLA into anti-inflammatory compounds. GLA is available in evening primrose oil, borage oil and black currant seed oil. Please note that evening primrose oil may counteract the effects of anti-convulsant drugs.

. Anti-inflammatory herbs such as ginger & tumeric

. Creams containing capsaicin, a derivative of hot pepper
Many persons in Jamaica have been using pimento, nutmeg or cannabis soaked in white rum to rub affected joints with good results.

MEDICATIONS

Medications such as aspirin, ibuprofen, diclofenac (NSAIDs), celecoxib (COX -2 inhibitors) are commonly prescribed for the treatment of arthritis. They often do a good job of easing pain, stiffness and inflammation that accompany arthritis.

They are not without adverse effects, including gastrointestinal bleeding. The risk is quite small with occasional use. However, as the dosage increases and the length of the drugs used increases, the risk of adverse effects increases.

The goals of management of persons suffering from any form of arthritis must emphasise:
. Reduction of the symptoms
. Lessening of any disability
. Improvement in the quality of life.

Dr Jacqueline Campbell is a family physician in private practice. Send comments to drjcampbell14@yahoo.com

©Dr Jacqueline Campbell

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