JOINT ACTION

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Medical practitioners and researchers are hard at work to find a cure for osteoarthritis, a degenerative disorder that affects millions

Did you know that the most common form of joint affliction, osteoar­thritis (OA), is a degenerative disorder that affects millions of people worldwide, and is seemingly more common than heart disease and diabetes. Call it a paradox, or what you may, one major fact remains — OA is only going to expand in its intensity and get firmly rooted in one’s middle years, sooner rather than later. Experts estimate that it may afflict over 250 million worldwide in the next 15 years. What’s more, there is no easy answer, much less a complete cure for it.

OA is a chronic disorder; its name is derived from the Greek, ‘osteo,’ for bones; ‘orthro,’ for the joints involved; and, ‘itis,’ to the inflammatory process of the disorder. It is estimated that Americans alone spend over US$15 billion a year in an attempt to alleviate arthritis pain. Add to this, the expenditure on arthritis drugs worldwide, and you have a huge market, nay an industry, catering to ‘joint’ patients’ needs.

To cull a common example. One of the foremost conventional modes of treatment to ease arthritis pain is the use of prescription drugs — non-steroidal anti-inflammatory drugs (NSAIDs) — which are quite expensive. Furthermore, the long-term use of such medications is known to lead to dangerous side-effects. Reports estimate that thousands of patients suffer from gastro-intestinal bleeding as a direct result of NSAID use, every year. Ironically, though these drugs are used for arthritis pain relief, they are known to actually hasten the destruction of cartilage itself.

One study, conducted in Europe has found that OA patients taking Indocin, an NSAID, had far more rapid destruction of the hip than the group not taking any NSAID. The Journal of the American Medical Association (JAMA), to underline the point, reports of severe liver damage caused by Voltaren, an NSAID most frequently prescribed for arthritis in the US. The journal reports that patients developed hepatitis within 4-6 weeks of taking the medication, and possible liver damage too, some weeks after taking the drug.

Corticosteroids, like NSAIDs, are used to control inflammation and stifle symptoms. They seem to have just as many bad effects as NSAIDs; perhaps, more. According to Dr Julian Whitaker, a physician, “These agents (corticosteroids) are so powerful that, even at lower doses, a handful of side-effects are not just possible, they are expected. On less than 10 mg per day, an individual will feel increased appetite. Salt and water will be retained. The individual will gain weight. And, will get sick more often.

Research shows an increased susceptibility to infections in arthritis patients on corticosteroids.” Whitaker elaborates, “If the dose is stepped up, a cascade of problems can emerge. There are cosmetic issues such as acne and increasing facial hair in women. Some individuals may begin to feel muscle cramps and weakness. The individual’s skin may thin and weaken. Peptic ulcers may develop. Blood pressure may rise, with its attendant risks. Diabetes can develop. So can osteoporosis. Susceptibility to blood clot formation increases. It is suggested that over one half (57 per cent) of individuals on corticosteroids have depression, or other emotional disturbances. This is not surprising, considering the onslaught of side-effects overlaid on their original disease.”

To augment the exemplar, when NSAIDs and steroids stop to ‘halt’ the progression of arthritis, patients are often asked to switch over to a third option, down the line — this drug therapy consists of methotrexate, cyclophosphamide, penicillamine, hydroxychloroquine, azathioprine, and gold therapy. They are, in essence, toxic disease-modifying drugs, which are administered concurrently with NSAIDs and corticosteroids.

According to a study published in the medical journal The Lancet, which looked at a group of patients who were on such aggressive drug therapy over a 20-year period, one-third (35 per cent) had died and another fifth (19 per cent) were severely disabled. Most of the mortality and morbidity, the study pointed out, was directly related to arthritis and its treatment.

Interestingly, the study observed that only 18 per cent of patients were able to lead normal lives. Wait a moment. There are, in addition, anti-inflammatories such as aspirin and acetaminophen (paracetamol) that can lead to serious, unfavourable effects. It is estimated that almost 15-20 per cent of individuals or patients who take large doses of these non-prescription, or over the counter (OTC), drugs are likely to develop serious gastric ulcers.

In the US alone, it is estimated that 15,000 of them die from gastro-intestinal haemorrhages, every year. It is also said that kidney failure is another possible side-effect of NSAIDs, especially in individuals whose blood flow is inadequate, owing to age and/or on account of medications.

Now, the big question — what happens when drugs, like NSAIDs or steroids, no longer help? You are witness to the most likely scenario. Your doctor will hurl his/her hands up in the air, with a touch of disgust, and say, “There’s nothing much we can do for you, apart from surgery.” So, you move on to the next step — with hope and also apprehension.

Arthritis surgery often consists of one or more of the following procedures: synovectomy, or removal of badly inflamed joint synovium; anthroplasty, or joint realignment and reconstruction; joint fusion, or tendon repair; and, artificial joint replacement, which is the most expensive, but also the most effective in ‘advanced’ cases, when nothing provides tangible relief.

Yet, on the downside, it is estimated that 50 per of joint replacement patients continue to have pain and restricted mobility following the procedure. Many also experience extreme discomfort than before the surgery. Patients, who manage to get through, tend to often have problems with the operated joint three to four years later and may require undergoing the procedure again in eight to 10 years. Add to this the cause of joint problems having not been corrected fully, and you will probably come back with the disorder in a different form, or edict.

Hence, the big question — if existing drugs don’t really work, in certain instances, is there anything else, which is useful in the long-term and free of deleterious side-effects the arthritis sufferer can resort to for subjective and objective relief? There are no easy answers, nor solutions. The best thing to achieve, or aim at, is prevention, as some physicians and clinicians suggest and incorporate an integrated approach which synthesises the best of the two worlds — modern medicine with natural approaches, such as certain herbs, like boswellia (Indian frankincense), or dietary supplements, such as glucosamine, chondrotin, fish oil, multi-vitamin-mineral supplements and methylsulphonylmethane, that have it in them to offer ‘palpable’ degree of relief in ‘medically preventable or treatable’ cases — although this is sometimes easier said than done, or achieved.

All the same, the caveat is natural products, though relatively safe and useful, are not ‘quick fixes’ or ‘swift’ cures. You’d first need to realise that inflammation must be stopped and the tissue ‘rebuilt’ before OA pain can come to a standstill. Also, the elder or older the person is, the longer the rebuilding process. However, while some individuals notice results after using natural remedies, it should be borne in mind that the damage to the joints didn’t happen suddenly. It was a slow process. Hence, its repair, perforce, will take equal or more time. zz

(The writer is a wellness physician and author)

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