Clinical Features

The term 'arthritis' simply means the presence of pain and inflammation (heat, swelling, redness) in a joint. Joint pain without inflammation is 'arthral-gia', and may be due to disease within the joint or in the surrounding soft tissues, ligaments, and tendons. Degenerative arthritis such as OA is generally a disease of the large weight-bearing joints of the lower extremities, such as the knees and hips. In addition, OA commonly strikes the distal interpha-langeal (DIP) and first carpometacarpal joints of the hands, especially in women. The affected joints have pain on motion, mild swelling, and sometimes intra-articular effusions or swelling. As the disease progresses, bony overgrowth becomes clinically apparent, coinciding with the development of osteophytes on radiographic examination. These osteophytes, together with loss of joint space, are the radiographic hallmarks of OA, and reflect new bone formation at the joint margins. Over time, the range of motion in the joint is restricted, first by pain, later by loss of joint space, and finally by the osteophytes. Treatment of OA is essentially symptomatic, using analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and limit the intra-articular inflammation. However, this treatment is seldom completely satisfactory, and progression of the disease is usually seen. Joint replacement surgery has revolutionized the care of end-stage OA, allowing return of function of joints that are otherwise immobile.

In inflammatory arthritis the situation is quite different. Rheumatoid arthritis is a symmetric, additive polyarthritis involving up to several dozen small joints of the hands, wrists, and feet, often with involvement of the knees, hips and ankles, and sometimes the elbows, shoulders and cervical spine. There is pain, swelling, and warmth in the affected joints and stiffness upon awakening or after prolonged immobility that can last for several hours. Unlike OA, in RA there is evidence of whole-body inflammation with activation of the acute-phase response. This leads to suppression of albumin gene expression and upregulation of the production of acute-phase proteins such as C reactive protein, transferrin, and fibrinogen. In addition, there is suppression of serum iron, increased zinc, and increased

Table 1 Examples of drug side effects on nutritional status

Effect

Drugs

Appetite increased

Alcohol, insulin, steroids, thyroid

hormone, sulfonylureas, some

psychoactive drugs, antihistamines

Appetite

Bulk agents (methylcellulose, guar

decreased

gum), glucagon, indometacin,

morphine, cyclophosphamide, digitalis

Malabsorption

Neomycin, kanamycin, chlortetracycline,

phenindione, p-aminosalicylic acid,

indometacin, methotrexate

Hyperglycemia

Narcotic analgesics, phenothiazines,

thiazide diuretics, probenecid,

phenytoin, coumarin

Hypoglycemia

Sulfonamides, aspirin, phenacetin,

p-blockers, monoamine oxidase

inhibitors, phenylbutazone,

barbiturates

Plasma lipids

Aspirin and p-aminosalicylic acid,

reduced

L-asparaginase, chlortetracycline,

colchicine, dextrans, fenfluramine,

glucagon, phenindione,

sulfinpyrazone, trifluperidol

Plasma lipids

Oral contraceptives (estrogen-

increased

progestogen type), adrenal

corticosteroids, chlorpromazine,

ethanol, thiouracil, growth hormone,

vitamin D

Protein

Tetracycline, chloramphenicol

metabolism

decreased

From The Merck Manual of Diagnosis and Therapy, Edition 17, p. 22, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.

From The Merck Manual of Diagnosis and Therapy, Edition 17, p. 22, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.

whole-body protein breakdown and resting metabolic rate. Treatment begins with rest, physical therapy, and use of NSAIDs to reduce pain. Low-dose oral corticosteroids, equivalent to 5-10mgday_1 of prednisone, are often necessary to control symptoms. However, these therapies do not alter the natural history of the disease. The best chance of doing so rests with the so-called 'slow-acting anti-rheumatic drugs' (SAARDs), such as methotrexate, TNF-a inhibitors, and other medications that have been shown to prevent erosions. It should be noted that some of these medications may also affect the nutritional status of individuals with RA via either altered appetite, blood sugar, plasma lipids, absorption, or protein metabolism (Table 1).

Treating Rheumatoid Arthritis With Herbs Spices Roots

Treating Rheumatoid Arthritis With Herbs Spices Roots

Did You Know That Herbs and Spices Have Been Used to Treat Rheumatoid Arthritis Successfully for Thousands of Years Do you suffer with rheumatoid arthritis Would you like to know which herbs and spices naturally reduce inflammation and pain 'Treating Rheumatoid Arthritis with Herbs, Spices and Roots' is a short report which shows you where to start.

Get My Free Ebook


Post a comment