Arthritis could probably be called the scourge of our existence, particularly in the U.S. where dietary factors have a strong impact on this disease. Just to give an idea of the scope of this disease, there are 50 million U.S. adults who are being treated for arthritis, and 10 percent have physical limitations relating to arthritis. The prevalence of this disease is increasing and will continue, becoming the most common cause of disability. It will have a huge, significant impact on the cost of medical care and individual productivity in this country in the future. More than thirty percent of American adults have arthritis, and nearly two-thirds of these patients are under 65 years old.
What causes arthritis and how is it best treated? The cause is said to be inflammation, similar to the reactive tissue found around a skin acne pustule or a boil. The tissue thickens, becomes red and tender, and can evolve into a chronic type of inflammation leading to swelling and stiffness around a joint. Because there are different kinds of arthritis, it is also good to note that there are different causes.
Osteoarthritis is the most prevalent type of arthritis. It involves degenerative changes to the surface of the joint, which then rubs against the other joint surface, causing pain and even a squeaking sound. Osteoarthritis involves the hands, knees, and feet and even the hips. Treatment options include an improved diet, NSAIDS to reduce inflammation, and prescription medications, such as cortisone. Salicylate creams can be applied to the joints for relief of pain and stiffness. Surgery is the last resort but is becoming more frequently performed.
Rheumatoid arthritis affects only a small portion of the total number of arthritic patients and is diminishing in occurrence. The average age for rheumatoid arthritis is in the mid-60s, and it is more common in women. Gouty arthritis affects about 3 million people in the U.S. and it seems to be on the rise. It is more prevalent in older men and is clearly related to diet intake. Juvenile arthritis affects about a third of a million children up to age 17 and can be caused by multiple factors, including Lyme disease, Crohn’s disease, psoriasis, and sarcoidosis.
As mentioned, dietary intake is one of the most important factors to consider when thinking about either the origin of the arthritis or the treatment. Gouty arthritis, for example, is affected by high uric acid levels, which is secondary to a high protein diet. A diet which is low in alcohol and lower in protein can lower blood uric acid levels and lessen the number of gout attacks.
Excess body weight can also be a factor in arthritis. If you have a sore joint, such as a knee or hip, and add a 20 pound pack to your back and walk around for a couple of hours, you will see that it makes a difference. Take this extra weight off you’ll experience a considerable reduction in the symptoms of the arthritis both in terms of pain, fatigue, and swelling of joints.
Arthritis of the spine as well as the hips and knees are commonly affected by excess body weight. Additionally, if you have arthritis and you are already overweight or obese, then you are not able to exercise as much to help you lose weight so that you can ease this burden of the joints. In other words, the more weight, the more likely the arthritis will cause disability for a person. It may be said in general that eating less food and eating a balanced carbohydrate-protein-fat diet can decrease symptoms of arthritis by reducing the swelling and can also enhance movement of these diseased joints by reducing inflammation.
Maintaining and or reducing your weight, staying on a well-balanced diet, and adding anti-inflammatory medication may help as well. If you are taking anti-inflammatories or NSAIDS for your arthritis and continue to eat more and continue to gain weight, then you can still expect your disease to progress rapidly to greater severity and more disability. It is said that wheat products can cause edema in the joint, and this results in more swelling and pain. Sugar, salt, red meat, and caffeine are also possible offenders in causing more difficulty and pain.
Inflammation is said to be the cause of arthritis, heart disease, cancer, and even Alzheimer’s disease. Inflammation is related to certain hormones in our bodies called prostaglandens, some of which are pro-inflammatory and some anti-inflammatory. Factors which influence inflammation include ingestion of omega 3s which are special oils that reduce inflammation. On the other hand, omega 6 oils, which have been hydrogenated, really tend to aggravate the inflammatory process. Too many carbohydrates cause a higher long-term insulin level, and in particular wheat products, such as breads, baked goods, bagels, etc. are big offenders in this as well. By reducing these in your diet, your insulin levels are reduced, and therefore the anti-inflammatory hormones become more dominant and improve the inflammation.
If you consider the impact arthritis will ultimately have on our country’s health care costs, it will seem staggering to you. If you assume that many of the 60 million Americans who will have arthritis in the next 5 to 10 years will have to have joints replaced, you can understand the cost impact. This is a burden that has not been seen in our medical history but has become so common that nearly everyone with this debilitating arthritis has this procedure. The procedures are expensive, and they contribute to the high cost of medical and surgical care in this country.
In summary, stay with a good balanced low-calorie diet, get exercise but don’t overdo it, and take anti-inflammatory, NSAIDS when you need to for mild to moderate joint pain. Newer treatments, include surgical and medical modalities, are making the lives of some arthritics who are constantly suffering much better. With joint replacement, stem cell therapy, PRP therapy, and anti-inflammatory meds, there is a full menu of treatment options available for these patients.
Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.