A clear understanding of Arthritis

 

Introduction

People understand Arthritis to be a disease of the joints. Indeed, the symptoms of the disease manifest in the joints. But, it should be considered a disease of the entire body. Although the symptoms may appear in a particular part of the body, no disease is exclusive to that specific part. When a part of the body suffers, the rest of the body does get affected. Appreciation of this fact will help us take a holistic view of our bodies rather than treating it as an assembly of various organs and tissues.

Any disease ending in ‘tis’ at the end of its name indicates Inflammation. So, Arthritis is an inflammatory disease of the joints. One may ask if Inflammation is the cause of Arthritis or vice-versa?

We will discuss Osteoarthritis (OA) as this form of Arthritis is most common. The old concept of OA was that it is a wear and tear disease, which happens to people in older age. We will discuss the new findings on the causes of Osteoarthritis.

At Perfect Svasthya we do not associate a disease with old age. You may say that a disease is more common in old age, but you should not call any disease an “old age disease”. It is presumptuous that people in older age are unhealthy and prone to several diseases. The disease may be more common because most people do not lead a healthy lifestyle when young and hence experience health issues in their mature years.

Background

In the 1980s, histopathology of the synovium in Osteoarthritis demonstrated abundant Inflammation in Osteoarthritic patients. Goldenberg et al. (1982) noted that inflammatory synovitis is often present in osteoarthritis (1).

Modern imaging modalities demonstrate that osteoarthritis is a complex of multi-tissue pathologies. It involves Inflammation of synovium, cartilage, and subchondral bone. The changes in synovium appear before visible cartilage degeneration has occurred. The synovium lining layer thickens, and it produces inflammatory cytokines. The modern imaging modalities and synovium examination has confirmed that synovium remains inflamed in all stages of Osteoarthritis. Several studies also demonstrate that synovitis (Inflammation of synovium) causes pain and poor function. We can therefore infer that synovitis is the first stage in the development of Osteoarthritis.

A 2017 review published in ‘Arthritis Research & Therapy’ by Alexander Mathiessen and Philip G. Connaghan indicates that synovitis is essentially osteoarthritis (2).

Role of Inflammation in causing Osteoarthritis

The Inflammation of the synovium naturally affects the functions of synovium, one of which is the secretion of synovial fluid. If the synovial fluid becomes insufficient, the friction between the bones will damage the articular cartilages.

Many scientific studies demonstrate that synovitis (inflammation of synovial membrane) is the cause of pain. What seems clear is that the solution for osteoarthritis is in addressing inflammation. Reduction of Inflammation reduces pain.

The top priority in treating Osteoarthritis is pain and inflammation. Two enzymes predominantly promote inflammation. They are cyclooxygenase-2 (COX-2) and 5-Lipoxygenase (5-LO). By inhibiting the pathways of these enzymes, we can reduce pain and inflammation. The Inhibition should be only of COX-2 and not COX-1 because the latter produces prostaglandins that activate platelets and protect the lining of the stomach and intestines.

Several natural anti-inflammatory substances have been evaluated scientifically for their efficacy in alleviating pain and inflammation. They inhibit COX-2 without inhibiting COX-1. The most effective of the natural anti-inflammatory substances is Perna canaliculus – also known as Green Lipped Mussel. This species is from New Zealand.

What causes Osteoarthritis (OA)?

OA is a lifestyle inflammatory disease of the joints. It is painful and restricts free movements.

What are synovial or diarthrosis joints?

Synovial joints are the most flexible joints. A synovial membrane called synovium surrounds the joint creating a cavity.  The synovium secretes synovial fluid into the joint cavity for lubricating the joint. Examples of synovial joints are knees, hips, elbows, wrists, neck etc.

What is inflammation?

Inflammation is a protective response of the immune system to an injury or an invasion by a pathogen.

There are two types of inflammation

  • – Acute inflammation
  • – Chronic inflammation

Acute inflammation is temporary. It is a part of the immune response to achieve the following objectives:

  • – To eliminate the agent that causes injury to the cells. It does so by destroying and neutralizing the harmful agent.
  • – To remove the damaged tissue
  • – To generate a new tissue

Chronic inflammation

Chronic inflammation continues to persist because the causing agents do not disappear. This type of inflammation is a lifestyle condition, and it is associated with all chronic diseases, including arthritis.

Principal causes of chronic inflammation

  1. 1. Foods are the principal cause of inflammation.
  2. 2. Sedentary lifestyle
  3. 3. Improper sleeping habits
  4. 4. Inability to handle stress

Foods

What you eat, how you eat and when you eat can indicate the causes of chronic inflammation.

List of pro-inflammatory foods:

  • – Refined carbs
  • – Excessive sugar consumption
  • – Deep-fried foods and junk food
  • – Industrially produced foods with synthetic colors, flavors and preservatives
  • – Excessive alcohol consumption

Eating improperly can cause inflammation

  • – Eating in a hurry without completing mechanical digestion and without initiating the process of chemical digestion in the mouth
  • – Irregular eating habit
  • – Drinking water while eating (dilutes the digestive juices in the stomach, disrupting protein digestion)
  • – Viewing TV, mobile, newspapers etc. while eating; interferes with the digestive process

Eating at odd hours can cause inflammation

  • – Irregular timings; not eating when hungry or eating when not hungry
  • – Odd hour eating; midnight snacking

 [Real hunger is the body’s need for energy. Fake hunger is an addiction to a specific food.]

Other factors leading to Osteoarthritis

A sedentary lifestyle is a significant contributor

Joints do need loading and moving for the nourishment of the articular cartilages. A sedentary lifestyle can cause low-grade inflammation and bring you the misery of OA.

Poor sleeping habits lead to inflammation

Sleep is to restore your organs, tissues and cells that have slogged through the day. Not sleeping enough and sleeping at irregular hours are significant causes of inflammation.

Inability to handle stress

Stress is a causative factor in chronic inflammation. Low-grade inflammation can affect all parts of the body, including the synovium. Inflamed synovium is osteoarthritis (1), and it causes pain.

OA is preventable and reversible!

Osteoarthritis is a life spoiler. It can cause untold miseries. You must proactively make sincere efforts to free yourself from this debilitating condition.

Solution for Osteoarthritis

Osteoarthritis is a lifestyle disease. Making corrections in your lifestyle can reverse OA. Perfect Svasthya can provide you with a guideline on how to change the “Four Verticals” of lifestyle.

Lifestyle changes are also essential because they are responsible for causing Osteoarthritis (OA). Avoid eating inflammation producing foods as described above.

Include physical activities in your daily routine. Walking and Yoga are excellent. Stress can also cause inflammation. Meditation may help in managing stress.

To enjoy restorative sleep, make your dinner light and free from proteins. Maintain a gap of a minimum of 3 hours between your dinner and bedtime. Do not watch TV, cellular and computer screens at least an hour before you go to bed. All of them interfere with the production of melatonin in the brain that is essential for your quality sleep.

Movement is essential for joyful living. Do all you can to restore the wellness for your joints.

References:

  1. 1. Inflammatory synovitis in degenerative joint disease. D L Goldenberg, M S Egan, A S Cohen. J Rheumatol. Mar-Apr 1982;9(2):204-9.
  2. 2. Synovitis in osteoarthritis: current understanding with therapeutic implications. Alexander Mathiessen, Philip G Conaghan. Arthritis Res Ther. 2017 Feb 2;19(1):18. doi: 10.1186/s13075-017-1229-9.