INFLAMMATORY ARTHRITIS TREATMENT

Outcomes in inflammatory arthritis have greatly improved with use of the modern disease-modifying anti-rheumatic drugs (DMARDs).

They are potentially toxic and should not be relied on without nutritional, herbal and energy medicine support.


The inflammatory process in general

You will have experienced inflammation many times. Acne, insect bites and sprained joints all involve inflammation. An inflamed body part is often swollen, painful, hot and red.

One type of inflammatory arthritis is gout. People who have this are painfully aware of these features. An attack of acute gout is so painful that a person sometimes cannot even stand the bedclothes touching the part.

The inflammation process is an essential part of fighting germs which manage to get past our first line of defense and invade our body. It is also involved in the healing of injuries.

In these circumstances, it is mostly short lived and should mostly be left alone and not treated.

You can rest or splint the inflamed part. Bacteria can be attacked with antibiotic.

The inflammation itself can also be treated, and this is very useful in some circumstances¹, but this needs careful consideration by your doctor.

Inflammation is always uncomfortable. It can be valuable or damaging.


Inflammation in your knee joint.

The knee is often swollen, painful and a little warmer when it has inflammatory arthritis.

The swelling is above the knee cap.It may be caused by excess synovial fluid  in the joint cavity, or by the swollen inflamed joint tissues themselves.

knee swelling

Swelling on the inside of the knee, lower down, is not due to knee arthritis³ usually. It is more likely to be caused by trouble in the Lumbar spine. This is produced by changes in the nerve supply to little blood vessels, rather than inflammation produced by the immune system.

Just to complicate matters, this same neurological process can cause increased fluid in your knee joint, but it is usually a very small effusion in this case.



Swelling right in front of your kneecap, is pre-patellar bursitis. The bursa here is to allow our skin to move freely over the kneecap. It can become inflamed because of injury or diseases such as gout and food intolerance.


An example of anti inflammatory treatment is the use of cortisone injection into an infected knee joint, at the same time as giving intravenous antibiotics. This reduces the damage to the joint caused by the germs, but mediated by the inflammation.


Inflammation is mediated by your immune system.

There are many diseases which are largely disturbances of the immune system and manifest as inflammation which is not obviously useful and is at very least distinctly inconvenient.

Rheumatoid arthritis and Crohn’s disease are two examples, involving joints and intestine respectively. The swelling and pain in these conditions appears to serve no useful purpose.

This is called autoimmunity, where the immune system is damaging our body. It indicates a disturbance of the immune system and so it is not uncommon for different organs or tissues to be affected. An example is that Sjogren's syndrome occurs in approximately 20% of people with rheumatoid.



Benefits and limitations of modern drug treatment

A large part of the treatment usually advised will be aimed at reducing the inflammation ("modifying the disease process.)

bDMARDS are the ants pants, but horrendously expensive and only by injection. Methotrexate, leflunomide, salazopyrine, plaquenil and low dose prednisolone are often effective and much cheaper.

This is a link to a very good site by a specialist in the field of inflammatory arthritis. As a result of modern drug based treatment inflammatory arthritis should no longer cripple people.



As always, however, it is best to also work out what is causing the problem and deal with that as well.



The following analogy will show the deficiency of relying exclusively on the first mentioned approach.

You’re driving along in your car and a red light on the dashboard flashes. It’s the oil light. What do you do? You would probably stop at the next gas station.

Would you... buy a small spray can of paint, and carefully spray over the red light, then happily drive off down the highway?

I’m sure you wouldn’t. You would at least top up the oil, and as soon as possible find out if you are leaking and from where.

That is exactly what is being done, however, when the only treatment is aimed at reducing inflammation and not seeking the cause.



Rheumatoid arthritis needs early diagnosis, careful followup

This disease can cause irreparable damage before it is recognized, especially in the small joints of your forefoot.

Any persistently painful, swollen joint is a good reason for a checkup. The problem in the foot is that the swelling may not be very obvious.

Symmetrical joint involvement and prolongued morning stiffness are good indicators.

X-rays of both hands and feet may show early bone erosion of the metatarsal heads (ball of foot) especially. Blood tests may show inflammation or positive "specific" tests² for rheumatoid. None of these is likely to make the diagnosis, or make it early enough.

It is a clinical diagnosis, based on your story and the clinicians examination of your joints.


Assessment of the disease activity on follow up, needs to include your opinion, blood test results and the doctors findings - all three together.



Ankylosing spondylitis is commonly undiagnosed for years.

This often starts in the teens, back pain developing gradually. It is three times more common in  males.

It is inflammatory type pain, worse at night and not improving with rest.

It feels better with exercise.

Associated conditions can be Crohn's disease and eye inflammations.


When anti inflammatory treatment is often not needed

Degenerative arthritis (osteoarthritis) of the knee can have episodes of joint inflammation too, following injury usually.

Simple analgesics, temporary rest, muscle stretching and strengthening exercises will often suffice here.

Notes and references for inflammatory arthritis page

1. As an example, cortisone has been shown to reduce the risk of scar within an infected kidney. See...http://pediatrics.aappublications.org/content/early/2011/08/11/peds.2010-0297

2. The RA test is positive in 10% of the healthy population, so a positive result is more likely to be from a healthy person than a person with rheumatiod (which is less common, even if the test is positive more often in them.)

A high proportion of a small number is still just a small number.

3. Robert Maigne MD, in his textbook "Orthopedic Medicine A New Approach to Vertebral Manipulations" pages 45-46, calls it pseudoinflammatory edema and cellulalgia...

"It is common to note areas of infiltration of the skin in radicular neuralgia. The cutaneous and subcutaneous tissue appears to be infiltrated so that skin-rolling maneuver gives the impression of the skin being thicker on one side than on the other side (of the body.) In addition, this maneuver elicits a rough sensation and sometimes reveales the presence of small nodules which are extremely tender (formerly known as fibrositic nodules.)

The “cellulalgia” has a distribution in strips with preferential localized zones: supraspinal fossa of the scapular region, the lateral aspect of the shoulder, at the level of the deltoid insertion, the lateral aspect of the lower part of the arm, the sacral region, the buttocks, the lateral aspect of the thigh, the external aspect of the lower leg, the medial aspect of the knee, etc. These areas of “cellulalgia” which appear with neuralgia can also disappear when the neuralgia disappears. But sometimes they outlast the disappearance of the neuralgia, causing a persistent pain whose authenticity is doubtful up to the day when it will vanish under the influence of a few sessions of massage.”



Dealing with possible causes of your inflammatory arthritis


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Synovial fluid is the normally small amount of liquid which lubricates the gristle covering the bones of the joint.

"Biological disease modifying antirheumatic drugs" (bDMARDS) are monoclonal antibodies against key immune system molecules, to block their action and reduce inflammation.

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