Understanding Arthritis - A Naturopathic Approach

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What Is Arthritis?

The word “arthritis” means “inflammation of the joint” and comes from the Greek words ἄρθρον (árthron, “a joint”) and ῖτις ( îtis, “pertaining to” *).^[1] A common misunderstanding is that arthritis is a single disease; however, arthritis just refers to any joint pain or joint disease. In fact, arthritis consists of more than 100 different conditions, which range from relatively mild forms of tendonitis to more systemic forms, such as rheumatoid arthritis. It also includes pain syndromes and arthritis-related conditions such as fibromyalgia and systemic lupus erythematosus, which involve every part of the body.^[1]

Arthritic conditions can involve any of the joints in the body, often occurring in the hip, knee, spine, or other weight-bearing joints, but can also affect the fingers and other non–weight-bearing joints. People of all ages, genders, and ethnic backgrounds can be affected by arthritis; however, certain factors such as genetics, age, and lifestyle can all play a role in increasing one’s risk of developing arthritis. Arthritic conditions are estimated to affect over 4.6 million adults and children in Canada each day.^[1] Common arthritis joint symptoms include swelling, pain, stiffness, and decreased range of motion. Symptoms may come and go. They can be mild, moderate, or severe. Symptoms can stay relatively the same or can potentially progress or get worse over time.

Inflammatory Arthritis

“Inflammatory arthritis” refers to a group of arthritic conditions that involve the immune system. The inflammatory process occurs when the immune system begins to attack the tissues of the joints, causing stiffness, pain, and swelling. These conditions are also known as autoimmune diseases. As a result, the joint tissue becomes damaged and can lead to changes in the shape of the joints as well as the development of deformities.^[2] Due to the involvement of the immune system, the inflammatory process can also trigger inflammation in other organs in the body. This is why inflammatory arthritic conditions are also considered to be systemic diseases where the skin, eyes, heart, lung, renal, nervous, and gastrointestinal systems can also be affected.^[2] The damage that occurs in the joints are irreversible, therefore early detection and treatment is important to reducing inflammation and joint damage as well as preventing the involvement of other organs in the body. The most common forms of inflammatory arthritis are rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis.^[1]

Degenerative Arthritis

Also known as osteoarthritis (OA) or degenerative joint disease, degenerative arthritis is the most common form of arthritis, affecting most people to some degree by age 70. The disease evolves slowly and is often due to the “wear and tear” of the joints and the body’s inability to repair damaged joint tissues.^[3] The joints most commonly affected are the knees, hips, and those in the hands and spine. Distinguishing features include limited range of motion and pain that is worsened by movement and alleviated by rest. As the condition progresses, joint enlargement and deformities can develop as well. The degeneration of the joint tissue can also lead to inflammation but is limited to the affected joints, unlike inflammatory arthritic conditions which can affect other joints and organs in the body via autoimmune processes. The development of osteoarthritis depends on a number of factors including increasing age, obesity, repetitive joint use, joint instability, and history of joint trauma.^[3]

Conventional Treatment

The conventional approach to inflammatory arthritis involves pain management, inflammation reduction, and immunosuppression using a wide range of pharmaceutical agents. Treatment plans typically include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen to reduce inflammation.^[3][5]
• Disease-modifying antirheumatic drugs (DMARDs) to slow the progression of the disease by decreasing immune system activity.[^4][5]
• Biological response modifiers (also known as biologics) to reduce inflammation and structural damage to the joints by inhibiting specific targets in the immune system that upregulate the inflammatory pathways.^[4][5]
• Corticosteroid injections to reduce pain and inflammation; considered in cases where only a single joint is involved.^[3][5]

The conventional approach to degenerative arthritis is fairly limited in comparison to the approach to treat inflammatory arthritis, as there are no drugs available to prevent or modify the disease progression. Pain management comprises the bulk of treatment plans for degenerative arthritis, because pain is the most prominent symptom. The most common pharmacological recommendations include:

• Oral NSAIDs to reduce pain and inflammation.^[4]
• Oral analgesics such as acetaminophen to aid in pain management.^[3]
• Corticosteroid injections to reduce pain and inflammation; like with inflammatory arthritis, considered in cases where only a single joint is involved.^[4]
• Topical NSAIDs or capsaicin to reduce pain and inflammation.^[4]

Other treatments for the management of both inflammatory and degenerative arthritis include surgery, physical therapy, modified exercise programs, lifestyle modification, weight management, and devices that ease physical stress on the joints (e.g. splints).^[4] Due to the potent antagonistic nature of many of these pharmaceuticals and their typical long-term use, it is common for patients to experience several side effects. Patients are usually prescribed a combination of these medications based on their individual case and need to be closely monitored by their medical doctors or rheumatologists.

Naturopathic Treatment

Since patients with arthritis often seek options outside of conventional medicine, naturopathic doctors can integrate effective treatment plans to complement conventional means. Modalities practiced by naturopathic doctors can play integral roles in helping patients with arthritis manage and cope with their chronic condition.

Acupuncture has been widely used for pain management when treating conditions of the musculoskeletal system. Acupuncture modulates pain transmission by stimulating the body to release endorphins and neuropeptides upon needle insertion.^[6] Studies have shown that acupuncture is significantly better or just as effective as corticosteroid injections in OA of the knee and hip.^[6] In addition to the analgesic effects, acupuncture can also be used to influence the functioning of the nervous, endocrine, and immune systems which can address underlying factors that may be contributing to the cause and progression of the disease, especially when inflammatory activity is present.^[7] Following an indicated traditional Chinese medicine protocol, patients should receive acupuncture treatments at least twice per week for 4–6 weeks.

Essential fatty acids are known for their anti-inflammatory properties that offer benefit to a multitude of different systems in the body. Omega 3 fatty acids, found in cold-water fish and in fish-oil supplements, competitively inhibit proinflammatory signals in the body and have also been found to specifically inhibit proinflammatory signals expressed in the joints affected by RA. The main types of omega 3 fatty acids are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Studies suggest a minimum daily dose of 3 g of combined EPA and DHA for at least 12 weeks.^[8] gamma-Linolenic acid (GLA)—an omega 6 fatty acid found in evening primrose, black currant, and borage oil—acts as a precursor to several anti-inflammatory pathways. Studies suggest a daily dose of 1400–2800 mg of GLA for at least 6 months.^[9] Both omega 3 and omega 6 fatty acids show convincing evidence in arthritis, including shorter duration of joint stiffness; fewer tender, or swollen joints; less joint pain; decreased long-term use of NSAIDs; and reduced markers of inflammation detected in blood work.^[9]

Curcumin, the yellow pigment found in turmeric, is a compound with antioxidant and anti-inflammatory properties which proves to have great benefit in arthritis. Some studies have compared the effects of NSAIDs with curcumin where both forms of treatment showed improvements in all assessments, but curcumin proved to be statistically superior in patient satisfaction, duration of joint stiffness, pain during walking or stair climbing, and joint swelling at a dose of 1500–2000 mg per day.^[10] Similar to essential fatty acids, curcumin has also demonstrated the ability to decrease inflammatory markers detected in blood work.^[10]

Diet and exercise are also important factors when it comes to keeping arthritis in check. Dietary modifications and exercise have proven to be of significant benefit for weight management, preventing disease progression and reducing inflammation. In patients with arthritis who are overweight, weight reduction confers significant improvement in pain and disability. Making dietary changes to reflect a Mediterranean, whole-food, or more plant-based diet can provide great benefit to not only the joints, but all functions and systems in the body as well. Gentle exercise programs have long been documented as an effective technique to improve physical mobility and overall wellbeing in patients with arthritis. Low-impact exercises, such as tai chi and aquatic fitness, have a profound effect on stress management, reducing disease progression, pain management, and improving strength and mobility.

Conclusion

Arthritis is a symptom of several conditions which can originate from inflammatory or degenerative causes. The key to effective treatment is to first determine the cause. While there are several conventional treatment options, naturopathic treatment has shown to be just as effective. Naturopathic doctors can integrate effective treatment plans to either complement or substitute conventional means based on the patient’s choice.

*This suffix is now associated with disease, as it was used with the feminine noun νόσος (nósos, “disease”), e.g. ἀρθρῖτις (νόσος) (arthrîtis (nósos), “disease of the joints.”