Wednesday, July 25, 2018

Wisdom Wednesday: Rheumatoid Arthritis or Osteoarthritis?

Rheumatoid Arthritis is an autoimmune disease, a result of the immune system attacking the tissues that line the body’s joints. This causes pain, swelling, and stiffness in the joints and the pain is often symmetrical. It is more common in women and those who are middle aged, but it can happen to anyone.

Osteoarthritis happens over time. It is the most common form of arthritis, and it usually occurs in older people. The protective cartilage on the ends of your bones wear down as you age, making it difficult to move. It usually affects one side of the body. Osteoarthritis can damage any joint in your body, though it most commonly affects joints in your hands, knees, hips and spine.

My Take:
This article is fairly accurate but is an example of the type of health care reporting that has replaced reporting on new research.

Rheumatoid Arthritis (RA) effects women nine times more often than men. It tends to be bilateral and symmetrical. If you left elbow is affected, sooner or later, so will the right, but maybe not with the same intensity. It is typically diagnosed in a woman’s mid-to-late 30’s. But has been going on for years. I don’t consider that middle age but maybe that’s because I’m in my sixties.

There are reliable blood tests for RA including the ANA (antinuclear antibodies), RA factor, and SED rate. However, the diagnosis is based as much on symptoms as lab work. On occasion, the diagnosis is based on x-ray findings but by the time you see the damage on x-ray, the disease is quite advanced.

Osteoarthritis (OA) is the result of wear and tear on a joint over time. So, the joints that get the most use typically show the most damage. The base of the thumb on your dominant hand is the most likely joint for osteoarthritis.

The current theory on the mechanism of osteoarthritis is more complex that just a wearing down of the protective cartilage over time. It is thought that micro trauma (or a single severe traumatic injury) damages the blood supply to the end of the bone. The gradual loss of blood supply causes the cartilage to erode.

Nutritional support for these two diseases has some common threads. Both will typically respond favorably to omega-3 fatty acid supplementation. However, osteoarthritis often responds better as prostaglandin inflammation is primary inflammatory response. In RA, leukotrienes and cytokines are more prevalent. So, Turmeric or Curcumin work better for OA while Boswellia and ginger can be effective for mild cases of RA. Classic RA generally requires the use of Echinacea, St. John’s Wort or some other immune modulator to reduce symptoms.

Clinically, I include autoimmune disease in my differential diagnosis when patients test for both leukotriene and cytokine inflammation, especially if both ginger and Boswellia test as ineffective using the QA (Quintessential Applications) protocol. The reverse is also true – when a patient has been previously diagnosed with RA and ginger is effective at reducing their inflammation, I suspect the diagnosis is wrong.

Bottom Line:
Differentiation of rheumatoid and osteoarthritis is an important clinical consideration. Especially in light of the fact that physicians are more often wrong about the diagnosis then right. The medications used in both conditions have serious side effects, more so with RA than OA, and should be used judiciously and accurately, when needed.

Source: July 21, 2018 National Institutes of Health

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