Osteoarthritis is a degenerative joint disease which occurs when a joint wears out. It is common among the elderly and it may also occur if a joint has been injured may times. The joints most frequently affected are those of the hands, hips, knees, lower back and neck. If hips and knees are badly diseased, severe disability may result. According to specialists, victims suffer pain and may feel a grating sensation when they move. This is because the cartilage between two bones breaks down, causing those bones to rub against each other. Knobs of hardened bits of cartilage and bones can develop in the joint to cause swelling and deformity.

Rheumatoid arthritis is called "the great crippler" and most of its victims are between the ages of 20 and 40. Joints become hot, painful, red and swollen. It is commonly found in wrists and knuckles, but it may strike any joint. In extreme cases it may spread throughout the body, damaging organs and connective tissue. If untreated the diseased joints eventually stiffen in deformed positions. Inflamed tissue and other substances in a joint erode the bone and cartilage though physicians believe that rheumatoid arthritis is caused by either micro organism or the body’s attack on its own tissues (autoimmunity) or both.

The other forms of arthritis include gout, ankylosing spondylitis and septic arthritis. Gout causes swellings, mostly in the joint that connects big toe and the foot (bunion joint) and is caused by the presence of too much uric acid in the blood. Ankylosing spondylitis inflames the spinal joints and is prevalent among young men. Physical therapy and drugs are recommended. Septic arthritis is caused by bacteria, occurs mostly after a lung or skin infection, surgery of the joint, or any venereal disease.

In everybody’s mind some dark thoughts arise when arthritis is mentioned. It is painful, is it chronic? Is it disabling? Does it make a patient dependent? Does it make him semi-productive or unproductive? Those suffering from this ailments are apt to lose confidence. Frustration fills the mind after prolonged treatment and best available advice.

The earliest symptom appearing is pain in a joint often referred to as rheumatism. Generally it appears in the winter season. Afflicted people resort to heat and massage. When the pain persists they visit a doctor resort to heat and massage. When the pain persists they visit a doctor. At one time or other we have all had rheumatic pain. Patients with chronic pain agree that it is easier to suffer excruciating pain for a short time. But a chronic pain, even if it is slight and dull, which is continuous is frustrating. Many sufferers take it for granted that this pain will never leave them. This is why many await their end with eagerness, praying to God again and again to lift them up from this world. One has to live the life in this world with a hundred pains, some of the body, some of the heart and some of the mind. Hindu philosophy suggests that we suffer in this life for the bed deeds in our previous life.

Rheumatoid Arthritis
When the pain progresses slowly over a week or a week or a month, the person feels tired, with pain and malaise almost in all muscles. There is stiffness in the joints while getting up in the morning especially in the small joints of the hand. Later there is a swelling pain and tenderness in the joints. It generally involves bilateral joints, in both hands, wrists, elbows and shoulders. The main complaint of patients is that joints become stiff if they do not use them for sometime. As the pain continues the patient faces increasing difficulty in moving around, climbing stairs, opening a door, opening a jar a sewing. Such patients, gradually get depressed, lose some weight and sometimes may have low grade fever. The diagnosis for such a patient will be rheumatoid arthritis. It is a disease produced newly. Many develop crippling deformities of hands and feet and a crippling limitation of movements in certain joints and may need surgery for their correction, crutches and aids for walking and working.

Gout
The victim goes to bed and sleeps in good health. In the wee hours he gets roused by a severe pain in the big toe, more rarely in the knee, ankle or instep. The pain is like that of a dislocation and yet the parts feel as if cold water was poured over them. Then follows chill and shivers and some fever. The pain which was moderate at first becomes intense. With intensity the chill and shivers increase. You feel as if you cannot bear the weight of the clothes on your body. The night passes in torture, sleeplessness, often turning of the part affected to obtain abatement of the pain.

Gout may follow a trauma, alcohol, dietary overindulgence or a long walk. Initial attacks subside in a few days. The subsequent attacks takes longer to subside and may last days to several weeks. 62% of the patients have recurrent attack within a year, 16% after one to two years, 4% in five to ten years, 7% have no recurrent attacks at all.

More than half of the gout patients develop visible tophi and need to wear larger shoes. Tophi are formed due to deposition of sodium urate. This can also deposit in the kidney and form kidney stones.

The patient generally is in good health. It hits generally at between 30 and 60 years of age and is most common around 45 years. In women, it occurs rarely and only after menopause. It can occur following the use of oral diuretic or aggressive anti-cancer treatment.

Osteoarthritis
This condition affects persons over 50 years of age. The weight-bearing joints, mostly the knee, is involved. There is deep aching pain in the afflicted joint, morning stiffness of short duration and variable joint swelling. In many cases there is crepitous sound on movement of the knee. The diagnosis is osteoarthritis. It may occur also at a younger age following major injury or repeated small injuries or prolonged immobilization, bow legs or knock knees and can involve any joint. The disease advances over the years but rarely reaches the level of severity seen in rheumatoid arthritis. A majority of people suffer from osteoarthritis after the age of 50. This is why it is called a disease of old age.

Ankylosing Spondylitis
If you are under 40, if you have slowly increasing discomfort with increasing limitations over the spine, mostly the lower back and it persists over 3 months, you are likely to have ankylosing spondylitis. If you feel stiff in the morning and a lot better after exercise you may be suffering from it.

It was thought to be male dominated disease but now it is almost equally common in both the sexes in the west. It is more common in the white population. The sufferers develop a peculiar posture in their later years of the disease with the whole of spine bent forward allowing limited movement of the neck. They find it difficult to cross the road and walk fast.

Comes in 100 Guises
Arthritis is as common as the common cold. One out of every six patients visiting a general practitioner is a sufferer of arthritis. Ninety seven percent of all people above the age of sixty have arthritis. We all dread old age as arthritis produces crippling in most and we may have to be dependent on others for little things. It is a number one crippling disease. Although not a direct killer like cancer and heart disease, arthritis causes much pain, despair and suffering to more people than any other single disease. Arthritis is as old a disease as civilization itself. As soon as man stood on his two legs this disease crept in. There is a record of this disease for thousand of years. Egyptian mummies show symptoms. Ancient Romans built luxurious baths throughout the empire to help joints aching due to arthritis.

Arthritis exists in more than 100 guises and at any age. A bouncing athlete, a young housewife, even a child can be affected by arthritis. The cause of arthritis in most of the cases still remains a mystery, and so its treatment. Most arthritis is incurable. We can prevent pain, arrest progression, prevent destruction of joints, crippling and loss of function with the help of real strong drugs which have side effects and sometimes create problems for the body which are worse than the disease. Rheumatoid arthritis is most puzzling. It has an erratic course. It has been described as a river that never flows the same way twice. It can appear, lie low for a number of years then flare up like a bonfire. In 7 percent cases it can just go away all by itself and never return. It may also have an unequal distribution according to sex. Rheumatoid arthritis is more common in women. A U.S. National Health Survey has revealed that it spares most unmarried women and women over 45. Generally, it does not strike widowed men. More managerial a man’s job, the less prone he is in getting rheumatoid arthritis. Their numbers have increased since the industrial revolution and in some mysterious ways it is linked to it.

Who has not been affected by arthritis! Christopher Columbus, Julius Ceaser, John Calvin, Elizabeth Tylor, James Garner, Raymond Massey, the newsman Eric Geraried, dancer Edward Villela, athlete Joe Nawath, Dick Butkus, surgeon Christain Barnard, President Ronald Reagan. So did Nehru and Mahatma Gandhi who required to have the support of two girls on both sides while walking, in his latter part of life.

The wife of former US President Henry Ford could appear on television offering a message of hope: "I am Betty Ford and like 30 million Americans I have arthritis. Arthritis means living with pain. Everyday’s activity we all take for granted becomes unbearable. But thanks to medical advances, I can now cope with my arthritis and you can find help too".

Arthritis does not spare anybody – the rich or poor, high or low, famous or not famous, we all suffer due to arthritic pain in some part of our existence. Life is said to be full of pain.

Case Histories:
One of my patients, Mrs. Jaroo Meherji, 57 years, worked as Office Superintendent in Western Railway. She was afflicted by rheumatoid arthritis for twenty years. In the last 7 years it got aggravated and affected almost all the joints. The fingers got deformed. She could not move her elbow fully, the shoulders caused pain and, and, worst of all, her knee joints, made her almost crippled. The legs used to be stiff in the morning. Gradually she had difficulty walking and had to retire prematurely. She would take a long time to get up and open the door if somebody rang the bell. It was difficult for her to climb steps. She could not sit on the pillion seat of the scooter driven by her husband. Specially, it was getting embarrassing to ask for assistance from passers-by to alight from the scooter. She still managed to do cooking, but she was slow. Needle work had become almost impossible. Her sleep was disturbed and she ate poorly. She lost weight. Rheumatoid arthritis turned a bouncing personality into almost a cripple. The body had taken the brunt but what about the mind? She was disgusted and frustrated. She had lost all hopes, except in God.

It is a disease of the whole body. With it come all symptoms of a serious illness, fever, chill, loss of appetite and body weight, pain all over the body, tiredness, sweating and stiffness in the morning and after prolonged inactivity. It is common between the ages of 25 to 50, but it can strike at any age.

During a severe attack it can erode the joints. The damage is irreversible. You may have a disfiguring nodule under the skin which may vary from the size of a pea to that of a pear. The nodule can pop out anywhere below the elbow even over a bursa or tendon. They disappear with subsiding inflammation. They become less aggressive as years go by. Only one person out of six will develop crippling deformities like bent fingers or bent elbows.

What is the cause? There is no satisfying answer to this query. One medical theory holds that somehow our body’s immune system goes haywire. Instead of fighting foreign matter like germs it attacks parts of the body. Hoards of defender cells turn traitors and march on you. They surround and digest what they believe is foreign matter and digest it. This is why it has been named auto-immune disease.

There is a common belief that damp cold climate causes it. This does not seem to be true. Many patients can predict, like a barometer, when the weather will turn foul. As soon as the clouds come in the sky, the atmospheric pressure falls, humidity goes up as it happens prior to a storm. These patients immediately find that their symptoms have worsened. If you think that by shifting to, dry and hot climate like Rajasthan’s you will improve you are making a mistake.

However women, if pregnant, get a lot of relief in their pain during pregnancy. But it resurfaces after delivery. It has therefore been thought that the cause of rheumatoid arthritis is some sort of hormonal imbalance in the body. Still we do not know it for sure. The predisposing causes for an attack of rheumatoid arthritis are many like an infection, following injury directly to the joint, weakened physical state and emotional disturbance.

Emotional disturbances also play a role. Episodes of rheumatoid arthritis can be triggered by stress, says Hans Selye, a noted authority on stress and disease. Events causing stress have special effects both physical and mental. He claims that a stressful event need not always be negative. It could be an auto accident, break up of an important relationship or even wedding of a son or purchase of a new car. Many patients will tell you that their fingers become sore three days after the review of their salary, of three days after a close family member has taken ill.

In one study, rheumatoid arthritis patients were asked to keep a life chart of the onset of their attacks. Out of 293 patients forty nine percent discovered that physical and emotional stress set of f the attacks. Arnold Fox M.D. an expert on stress and nutrition feels that it is not the event but the way you react to it. Once you know how life events affect your arthritis try to concentrate on coping with them better.

Osteoarthritis
Mrs. Asha Goyal in her mid seventies had been suffering from a stiff aching knee pain for 10 years. Her knees swells up a little after prolonged activity. In her younger years, she had been fairly active taking keen interest in gardening and social work, finding herself restricted. She is obese. She has trouble climbing stairs and getting out of a deep chair. But she has kept up her activities.

Lately she has been feeling dull and limp. She cannot raise her arms to wash properly and set her hair. She has trouble getting up in the morning and dressing up. She looks in the mirror and sighs that she is "getting old". She is depressed about her appearance and tired of her aches and pains. She does not sit outdoors so often any more.

It rarely draws sympathy of friends and relations. The knees and the back may ache terribly but your friends will shrug and say: "What do you expect? You are getting old" You start getting depressed emotionally because it hurts to do so many tasks you never had to think twice about doing before. Eventually some people may get such bad osteoarthritis that they may come to view a flight of stairs as equivalent to climbing Mt. Everest.

With osteoarthritis there are a lot of ups and downs. Typically you may wake up feeling stiff. It requires 15 minutes to half an hour for the pain to ease. As the day progresses you feel better till early afternoon. After that it starts deteriorating again and you may feel miserable by the evening. Sometimes when pain is less you may do some active housework like washing windows or digging in the garden. After a vigorous exercise the sore joints will hurt even more. You may get some swelling over it. If you sit for long and try to get up you will feel stiff.

You may feel a cracking or grinding sound in the arthritic joint but this is not serious. Many complain that they had some injury in the joint before the pain started. If you are worried and tensed up about pain it gets aggravated. If you rest and relax you feel much better.

Gout
Mr. Kashinath, a young dynamic businessman, has done well in business. Recently he branched out into another industry. People think his success results from sincerity and friendliness. He is regular in attending business conferences twice a year which last sometimes for 5 days, gives business launches and treats potential clients to good food and had drinks. At the end of the week two things always result Mr. Kashinath gets lots of friends and orders and one case of gout, that is himself. In olden times gout used to be a disease of royalty and it is best exemplified by Henry VIII who ate drank and married too often. But, to our misfortune, gout has shifted from royalty to ordinary mortals. It is a disease caused by inborn error in metabolism. Though the basis of the disease is inherited, it can be controlled to a great extent by diet and a proper life style. If you have gout that means that either your body is producing too much uric acid or producing normal quantity but which the body is not able to excrete sufficiently. Gout is caused by excessive accumulation of uric acid in the body. This stage is called Hyper Uricemia. Obesity and alcohol intake are associated with gout. The attack can last from 5 to 10 days during which time the toe gets swollen and becomes dusky red. Inside the joint the urate crystals have started a chemical reaction in the joint fluid that results in inflammation. The cells of the body’s defence system rush to the joint creating more congestion. After the attack the joint returns to normal. Even in the 18th century, most people knew that rich diet and gout were inter-related. Since 1960, we know for sure that alcohol consumption gives rise to gout though it was doubted for a long time. At the clinical Research Centre of University Hospital Pittsburgh, USA, an experiment with six men and one woman was carried out to see the effect of purine rich diet and alcohol on gout. Gerald Rodnan M.D. placed patient on purine free diet to stabilize the urate level in their blood. These patients were given large evening meals containing 2 to 5 gms. of purine. First the meals were eaten without wine and spirit the patient’s uric acid level rose somewhat. When alcohol was added to the meal the urate level rose sharply. In some cases it almost doubled from the previous level. Six of the seven patients had an acute attack of gout within the next four days. High purine foods are likely to induce gout. They are organ meats (brains, liver, kidney, hearts) meat extract, mince meat, sardines, herring, asparagus and mushrooms. They contain purine ranging from 150 to 1000 mgm for every 3 ½ ounce serving but still can contribute to gout. They are dry beans and pea, lentils, meats, poultry, fish cauliflower, spinach, seafoods, yeast etc. Limit these foods to three ounces serving five days a week.The patients should be careful throughout life, and avoid excessive alcohol, high calorie diet and tension.

Ankylosing Spondylitis A leading surgeon in Gorakhpur, U.P., started having stiffness in his spine since the age of 40. It started from the lower back and gradually spread to the whole spine as far as the neck. Gradually he began stooping somewhat and his bent went on increasing. His neck movement became limited. Now he finds difficulty in crossing the road and prefers to take assistance.

25 years after the disease he still continues doing his surgery jobs. He takes on only few jobs due to the limitation of his movement, but he hardly complained of pain now. This condition is called Bamboo Spine an appropriate nickname as the spinal joints become stiff and limited in movements as the disease progresses. Ultimately turning the spine, skull, ribs and hips into one long bone that cannot bend. Hence the name.

The disease can start when one is 15 or 20 years of age. In the beginning the disease is not traumatic. It comes and goes, the pain starting in the lower back lasting for a few days. Then it completely disappears. Frequent attacks last longer. You feel more stiff. There is a feeling of being better after exercise. Slowly, the disease moves up the spine. Some joints in the arm or leg occasionally get inflamed. Appetite is lost and so is the weight. You may develop low grade fever. There is a feeling of pain and stiffness when getting out of bed in the morning. It is usually not diagnosed until about the age of 40. Generally the sacroiliac joint – that is the joint in the lower back gets affected first. Fibrosis develops in these joints. They gradually lose their movement and ultimately may get completely fused: Initially, this disease is painful, now ever once the fusion has taken place there is no more pain. When the spine and ribs have become fused deep breathing becomes difficult because of limited chest expansion.

It is 8 times more common it is generally associated with small joint pains of hands and toes. Most sufferers live a normal active life and do not miss many working days. The spine will become rigid in the position in which it has become ankylosed and the patient should cooperate in the programme to prevent persisting spinal deformity. He must sleep on a hard bed and with a low pillow and try to keep his spine as straight as possible. The disease normally becomes inactive 10-15 years after it has started and in more than half the cases it does not spread beyond the lower back.

If there is a sore or stiff joint which persists for a month or two, you ought to see a doctor. He will see it for movement, feel for heat, prod it for swelling and listen for any grinding or creaking noises. Before he makes a diagnosis he may like to take a few tests. These may include X-ray, Erythrocyte, Sedimentation Rate, Rheumatoid factor test and HLA-B 27 for Ankylosing Spondylitis

1. X-rays are a common took in diagnosing osteoarthritis. They will show the wear and tear of the bone and bone spurs that develop during the course of osteoarthritis. We can find the narrowing of the joint space which indicates that the cartilage protecting the end of the bones has begun to wear away. In ankylosing spondilytis we find reduced joint space in sacroiliac joint and it may get almost fused in advanced stages. Degeneration and erosion of the joints can be seen in rheumatoid arthritis and gout. Punched out lesion is characteristic of gout. Because X-rays expose to dangerous radiation, avoid them if possible. Often a doctor can tell as much about the joint by physically examining it.

2. Erythrocyte Sedimentation Rate. This test is done most commonly in all arthritic cases. The blood is drawn from the patient and put into a test tube. The solid cells of the blood settle down and separate from liquid serum in which they float – separate into layers. The distance that the cells settle in one hour is the sedimentation rate. A high "sed rate" means onset of inflammation. By periodic tests, a doctor can tell whether the inflammation in the joint is getting better or worse.

   In the case of osteoarthritis it is usually normal and in case of rheumatoid arthritis it is usually high. It is elevated in most cases of ankylosing spondylitis but may be normal in few cases. It is also raised in gout.

3. Rheumatoid factor test. This is done only in rheumatoid arthritis. It is positive in most of the cases. This factor is something the body’s immune system produces to fight off rheumatoid disease.

Uric Acid
This test is positive in gout Uric acid levels are higher than normal levels. Normal values for non-vegetarians are usually higher than vegetarians. Somehow it has been seen that arthritis is more common among non-vegetarians especially those who take non-vegetarian in their meals and very few vegetables or salads or none at all.

HLA-B27
This test is of some significance in case of ankylosing spondylitis. It is positive in 95% cases of white people suffering from it. It is an expensive test and not necessary.

Joint Fluid
A needle is inserted in the sore joint and a few drops of joint fluid (synovial fluid) are drawn out. It tells a lot about the disease of the joint. In osteoarthritis it is clear and sticky. If it contains crystals of uric acid it is most likely gout.

Drugs
"The art of medicine consists of amusing the patient while nature cures the diseases". (Voltaire) When there is a severe aching knee which persists for several weeks, you may need to consult a rheumatologist. He may decide you have osteoarthritis. He prescribes aspirin. You feel annoyed and probably cheated. Your knee is hurting badly and you are asked to take the common aspirin.

Yes, aspirin is preferred for arthritis. In case of osteoarthritis it kills the pain but in rheumatoid arthritis when taken in right doses reduces the inflammation. When taken at regular intervals it enters the blood stream and reaches all parts of the body, reducing swelling in the joints and helping the inflammation to subside. People with rheumatoid arthritis often take 10-12 or 15 tablets a day, under doctor’s supervision, because it can cause some severe side effects. This drug so commonly used by all form of aches and pains in the body is available in different combinations under different brand names.

The most common side effects are gastrointestinal problems. You may get a sour stomach, nausea, vomiting and even ulcers. The most serious of all is gastric or intestinal bleeding if you are taking them in high doses. Quite a few times the side effects are diagnosed late and may be fatal.

Even the coated aspirin has similar effect, though advertisements will not say it. If you drink alcohol with aspirin there is twice more chance for you to get ulcers. Alcohol increases the ulcer causing potential of aspirin. It may cause noises in the ear followed by loss of hearing.

Aspirin or similar anti-inflammatory drugs play havoc with nutrition. Even in small doses, aspirin can cause to excrete 3 times more vitamin C in the urine. Routine use can lead to folate deficiency which is one of the vitamin B complex vitamins. In one study of 51 patients with rheumatoid arthritis, 71 percent had a low level of folate in blood. It also prevents blood from clotting.

The common practice of taking aspirin for colds is not right. Aspirin, in fact, prevents the body from fighting off colds, by blocking the effect of interferon a substance normally produced in the bodies.

Scientists at Duke University and Burroughs-Welcome Research Laboratories indicated that interferon cannot do its work of fighting viruses when aspirin is present. These scientists worry that taking aspirin for cold may allow the number of cold viruses to multiply more rapidly. Taking aspirin may you more vulnerable to an entire host of virus caused diseases.

New Arthritis Drugs

If aspirin is dangerous what can be done to relieve pain? There are many new drugs flooding the market – they are called non steroidal antiinflammatory drugs. They are mild pain relievers and fight inflammation.

The grand daddy of this group is Indocin (Indomethacin) which was introduced in 1963. It is effective in rheumatoid arthritis, osteoarthritis, ankylosing spondylitis and gout. It is not recommended to children under 14 years, pregnant and nursing mothers, patients who have peptic ulcer and gastritis, and patients who are allergic to this drug. Doctors generally agree that it is not any more effective than aspirin. It does however have more serious side effects than aspirin. In fact 35 to 50 per cent of people who take it develop bizarre symptoms such as total loss of appetite, nausea abdominal pain, painful ulceration of upper gastrointestinal tract which sometimes perforates leading to haemorrhage and anaemia. It can cause hepatitis, jaundice or servere bone marrow depression. Medical literature cautions: "drug not to be used routinely"

There are many more entrants in the market like Brufen, Ibuprofen, Naprosyn (naproxen), Nalfon (fenoprofen) and tolmetin. They are all non steroidal anti inflammatory drugs. They are taken orally and absorbed directly into the blood stream within one hour. Though they have similar effect but are chemically different, some people react better to one than the other. Usually after a week you will be able to assess whether any of these drugs is going to harm your stomach.

Brufen and Ibuprofen were introduced in 1960. They are weak but effective anti-inflammatory drugs. They pass in the joint fluid and remains long after the amount in blood stream has diminished. They are supposed to have less side effects than aspirin. Still 15% patients produce severe symptoms, severe enough to cause them to discontinue. They may report thinning or loss of hair.

It is easier to live with Naprosyn (naproxen) than aspirin. Twice a day, it is effective in rheumatoid arthritis and ankylosing spondylitis. It gives a lesser side effect than aspirin. Butazolidine (phenylbutazone) is effective in osteoarthritis, ankylosing spondylitis and gout. It depresses bone marrow. It is advised for those taking this drug to have a regular blood count done. It causes irritation of the stomach and can produce ulcers. It causes sodium and fluid retention in the body. It must not be administered in cardiac cases and dermatitis. It can cause jaundice, blured vision, asthma attacks. As many as 45 percent of people will develop side effects. Tandril (oxyphenbutazone) is closely related to this drug and is equally dangerous.

Colchicine
Gout responds quickly to this drug. Inflammation and pain subside quickly. It can produce nausea, diarrohea, can suppress bone marrow and produce anaemia, leucopenia and thrombocytopenia. It can cause liver cell damage. Not to be given to a patient suffering from liver or kidney disease.

Probenecid
It is a uricosuric agent. It helps to reduce uric acid in blood and is usually prescribed to those suffering from gout. Once started it has to be taken life long. It should be accompanied by weight reduction, low fat diet and complete absence from alcohol. Probenecid helps to block the reabsorption of uric in the kidney and thus more uric acid passes out in the urine. It has side effects like vomiting, skin rash, drug fever. Urate stones may get formed in the kidney and cause severe colic.

Allopurinol
It acts by inhibiting the enzyme xanthine oxide which prevents the final step in the production of uric acid. It can produce gastric irritation, dermatitis, blood dyscrasias and is toxic to liver.

Corticosteroids
These are "miracle" drugs, but most dangerous of them all. When first introduced in 1950 they were thought to be the greatest boon of all time for patients with rheumatoid arthritis. When the people were first given this drug their symptoms disappeared overnight. The patients who were confined to chair or bed suddenly were up and about. Their limbs moved and spirits soared. To millions of people with arthritis around the world, cortisone held out great promise that at last an effective remedy for the disease had been found. Unfortunately, in the next few years the drug showed that it was a much dangerous as wonderful. It soon became evident that the remedy was worse than the disease.

Doctors found that patients got side effects which were serious. They developed stomach ulcers, loss of muscle tone and became moon faced. Hair grew on the faces of women taking them. Bones became less dense and fragile (osteoporosis). There was difficulty for a wound to get healed. It also led to cataract, high blood pressure, greater appetite, emotional depression, even psychosis.

The other drugs which produce a welcome relief from pain and inflammation and also terrible side effects are prednisolone, decadron, hydrocartisone etc. These drugs even suppress the immune system of the body. The body becomes less capable of fighting infection. An immune system is essential for our survival.

Overenthusiastic and new doctors tend to overprescribe cortisone. This drug when essential should be taken in minimum doses. Switch on to some milder drug or reduce the doses. It must not be stopped immediately, but doses reduced gradually and then stopped. After taking steroids for sometime, the adrenal gland shuts down. If you stop suddenly the body will not be able to reduce the dose and space it.

A random injection of cortisone directly into a painful joint does not produce dreadful side effects. Because of its very brief stay in the body the drug not have much chance to do a lot of damage. Keep in mind, applying ice often produces the same relief.

Gold
Sometimes gold is given orally or by injection in arthritis. Unlike steroids or aspirin the beneficial effect does not appear for weeks even for months. Injections are painful and can have serious side effects. Most common is soreness in the mouth, skin rashes or even a plastic anaemia and kidney damage.

Penicillamine
Like gold it takes several months to work. The side effects of penicillamine are explosive vomiting, loss of taste, sore mucous membrane, excretion of protein in urine, bone marrow problem in some cases a serious disease like myasthenia gravis.

Chloroquin
This is the drug actually used to treat malaria, but in can also be used to treat chronic active rheumatoid arthritis. Taken over a long period it can produce some unwanted symptoms like skin rashes, hair loss or even retinopathy which may result in blindness. Arthritis is a disease which will last for a lifetime. All the medicines used are merely pain relieving and inflammation reducing drugs to be used for years if not life long. The innocent looking tablets are not innocent at all. They give relief in symptoms but do damage to the body. Doctors always balance the two, if disease is too severe and symptoms must be relieved the drug is given inspite of the fact that they know that the drug does harm to the body and many a time the harm is greater than the benefit derived. With the above knowledge of drugs and their side effects we know that it is better to avoid drugs or take them in minimum doses and for the shortest duration to avoid the dreaded side effects.

The most important thing of all is that the treatment must do no harm. So it becomes more important to know what we should do to avoid medicine and what are the alternative methods to get relief or cure. The cure is accomplished by the healing power inherent in the body, itself. One of the most important things to help the body to help itself is food. Wrong food can produce disease and the right food can cure it. Make food, your medicine, Hypocrates said.

During the World Wars I and II acute gouty arthritis was less common in Europe. When dietary proteins again became plentiful the disease returned. In Japan gouty arthritis was rare but now it is competing with Europe, with an increase in the consumption of proteins. Arthritis seems to be more common among people who consume a rich diet.

Most doctors honestly and firmly believe that what you eat absolutely has no effect on arthritis. Yet people who switch on to a milder vegetarian diet are known to find relief. Some doctors have come forward with explanations how certain specific diets may really help almost every one with arthritis.

Amazing effect of low fat diet
Two doctors at Wayne State University in Detroit Michigan made a remarkable discovery while working with obese patients on low fat diet. Two of the group had active rheumatoid arthritis. After just five days on special diet their symptoms of arthritis disappeared and did not return as long as they remained on diet.

"Now I do not believe this diet affects the basic underlying rheumatoid diseases", says Dr. Lawrence Power, co-developer of the diet. However, the body needs fat to produce the intermediary products like prostaglandius that fuel inflammation. You take away the fuel and you take away the inflammation.

Dr. Power and his colleague Dr. Charles P.Lucas have had encouraging results with this diet. It all began with one patient who had arthritis for a long time. Her condition which was critical mostly in hands, cleared up on this diet. After a while she returned to her work routine. The symptoms reappeared, when her diet included fat. Later Dr. Power and Dr. Lucas borrowed 6 patients from a rheumatologist and got the same astonishing result. They are confident that ninety per cent of the patients on special diet will improve.

Nathan Pritikin, the inventor of a diet for the obese watched the improvement in many patients having rheumatoid arthritis, some of them had severe pain in fingers and their arthritis had lasted sometimes for 35 years. He was surprised at the recovery made by an 81-year-old lady with severe deformities in her fingers. Her arthritis in the knee was also bad and she could not walk. After one year of this diet at the age of 85 ½ years she entered Senior Olympics and won two gold medals.

Unlike Dr. Power, Pritikin believes that his diet strikes at the disease itself and not just the inflammation. He claims that "the disease is not the misery. Fat and salt are the primary causes with fat the major factor. On a low fat diet, the blood has substantially better circulation. Fat coats the red blood cells so that they cannot get through the small blood vessels. This limited circulation lowers oxygen levels and indirectly destroys certain cells of immune system, and powerful enzymes then leak into the joint. The result is rheumatoid arthritis". Salt, Pritikin explains causes the tissues to become flooded with water which also lessens circulation".

Pritikin says it works on 90 per cent of the people who have arthritis in their hands, fingers and wrists and 50 per cent of all people who have arthritis in their knees and hips. "May be we get it too late after serious joint damage has already occurred," he said. You will know fairly soon if the diet is working. Most people begin to improve in one or two weeks and feel better in two to six weeks.

"It is not a matter of being overweight, but eating too much fat", he warns. Dr. Power also agrees that we love food which is moist, rich and buttery "but we never meant to eat fat the way we do- we were meant to eat it as it is found naturally in whole food". Look at this way. You would have to eat a lot of corn to get one table spoon of corn oil. It is important to adjust your thought about food so that when you are hungry you want an apple instead of a samosa.

Thus if you follow Dr. Power’s line of reasoning you would stop eating fried foods, butter, cheese, whole milk, red meat, pork, most nuts and seeds, cakes and pastries etc. Instead you will prefer cereals, grains, skimmed milk, fruits, salads, vegetables and fish. You will sense the intensity of your arthritic pain going down. It would have nourished you well, aided digestion, unclogged the arteries and slimmed the body. Surely there is no harm trying it.

Allergy and Arthritis
Food allergy plays a great role in rheumatoid arthritis. 80% of people with rheumatoid arthritis are allergic to certain foods. Dr. Marshal Mandell, Connecticut, allergist admits: "Allergic reactions aggravate and perpetuate the swelling, redness, pain and limitation of movement. I am convinced that allergic reactions are the underlying cause of many cases of this form of arthritis. Allergy also plays a role in childhood arthritis and osteoarthritis." Dr. Mandell along with Dr. Anthony Conte, completed a study on 40 patients with arthritis that revealed their arthritis symptoms along with other important chronic ailments were caused by reaction to food frequently eaten or exposure to something in the environment they are allergic to.

"We investigated the relationship between arthritis and allergy in 40 volunteers with arthritis by means of double blind study, where neither the patient nor the doctor knew which substances were being tested on whom. We tested the volunteers for allergies with specially prepared solution of food, house dust, molds, tobacco smoke and petrochemicals. Eighty six percent had symptoms of arthritis – their usually chronic joint and muscle complaints provoked by these allergens (substances that cause allergic reactions), the method of testing we employed was one that actually reproduced the volunteers familiar symptoms. Most had no idea that allergies might be a very important factor in their illness", Dr. Mandell explained.

He adds: "The body’s response to an allergen is complex and can involve arthritis, nervous system disorders, respiratory ailments, gastrointestinal and urinary tract disorders even eye problems. My clinical experience indicates that at least 70 per cent of the general population (about 150 million people) in U.S.A. suffer from some form of internal allergy that is unsuspected, unrecognised, undiagnosed and therefore uncorrectly treated. Each human being has a biologic uniqueness which is going to determine which substances will or will not cause health problems in a particular person. Much depends upon the duration or amount of exposure to allergen, exposure to indoor and outdoor pollution, chemical additives, a personal nutritional state and so on. Some people will react to only one or two substances, others will respond to more than a dozen and some individuals may be allergic to almost every food they eat".

According to Dr. Mandell arthritis could be related to allergy if there is strong family history of allergy, a personal history of allergy or if arthritis improves during fast or illness when you lose appetite. You should also suspect as a culprit if the arthritis gets worse on a certain day of the week, during a particular season, at a particular location, during home activity, after certain meals, after taking an alcoholic beverage or after an obvious chemical exposure.

If you think your arthritis is related to allergy, keep a careful record of your personal observations, noting when the arthritis got worse or what food and other substances you have been exposed to that could have provoked the attack. These observations provide valuable clues to determine the particular offending substance.

Armed with this information you can set about eliminating these problems substances from your life. Unfortunately some of the foods most likely to cause a problem are old favourites that will be missed. "But you do not have to avoid these foods for ever", says Dr. Mandell. After the arthritis is under control, you will be able to eat many of these food items again without any problem, perhaps once every five or seven days.

After staying on your own individualised allergy – arthritis – diet with great success, you may have a flare up. Why? Dr. Mandell suggests that perhaps the diet relied too heavily on a certain food creating a new allergic sensitivity because of an overexposure to a trouble maker. Should this happen do not feel that the entire effort has been wasted. Instead calmly determine which foods might be causing the problem and eliminate them.

Dr. Mandell is not alone in his conviction that there is connection between allergy and arthritis. In England, 20 out of 22 patients with rheumatoid arthritis who followed allergy free diet found improvement in less than 3 weeks. Of the group 7 were sensitive to grain, 8 to nuts and seeds, 7 to cheese, 5 to eggs, 4 each to milk and beef and one each to chicken, fish, potato, onion and liver.

Dr. James Braly, Head of Optimum Health Laboratories in Encino has developed an allergy free diet that has helped several arthritic patients. Dr. Braly used to new and controversial method to find out a patient’s allergy. He has helped several athletes and actor James Coburn of his severe arthritic pain. He calls this test as "cytotoxic food allergy test". A blood sample is centrifused to remove the plasma and white cells. Next, tiny groups of these cells are mingled with individual food concentrates. In theory, if a person is allergic to certain food, this white blood cells should change shape or even rupture after several hours contact with that food sample concentrate.

In "Muscle and Fitness" magazine, he adds" "Within a few weeks of eliminating allergic foods from your diet you notice some drastic changes in your physical and psychological well being. One immediate result is a marked weight loss. Some patients lose upto 10 to 15 lbs. in two to three weeks. This is primarily water that is flushed from the system once the allergy induced inflammation has abated.

He recommends that " a person with arthritis should stop alcohol, stop caffeine, stop tobacco, stop refined sugar, and excess fat, stop food allergens and learn to deal more effectively with mental stress. Moreover I find that exercise is extremely important in treating arthritis. Certain foods called night shades (solonaceae) of a family of foods has been linked with arthritis and rheumatic pain. Norman F. Childers, a retired professor of Horticulture feels that the members of this family commonly used in daily food are tomato, white potato, egg plant, tobacco and all pepper except black (a different family).

The allergic problem that results from eating these foods is a toxic problem, a kind of slow poisoning since 5 to 10 per cent of people are sensitive to these foods. He discovered the relationship between night shades and joint pain on his own, after he stopped eating tomatoes for a time and noticed improvement in his pain and aches in his joints and neck pain. Although he is not a doctor he plunged into medical research by launching a nationwide survey involving thousands of volunteers. Eventually he published a book called A Diet To All Arthritics. The diet is not as easy to follow as it looks because traces of these forbidden fruits are found in many processed foods.

It must be followed for 3 months and often six to nine months before results are observed. If you want to try a diet to relieve your arthritis where do you begin? First make some careful choices. Say, if you have allergies you may try Dr. Mandell’s approach. If you are eating too many fatty foods try Pritikin’s diet and if you can get through a day without tomatoes and potatoes try Mr. Childer’s approach.

There are many health farms spread all over the world. More people are getting attracted to them for an alternative method after prolonged medication. Having known the limitations of medication and its severe side effects or developed allergy to these medicines they seek new options. Some of these health farms are old , new ones are coming up in larger numbers. How do reputed, well established health farms treat their arthritis patients? The stress is on diet but other physical treatments like water treatment, exercise and relaxation are also added to the routine.

Vita Nora an extremely well located health farm in Sweden, has a 3-storeyed villa on the steep slope of Kulla hill overlooking the sea, a narrow strip of sea which separates Sweden from Denmark. It accommodates only 50 patients. The dining table is huge and placed in a room with a breathtaking view of the sea. Salads of different types, buttermilk, cottage cheese, baked and boiled potatoes, vegetable soup and protein-rich assortments made from soyabean.

Their arthritis patients are given raw foods which includes fruits, salads, sprouted beans, nuts. A small portion of cooked food would include boiled or baked potatoes and vegetables soup with a small quantity of butter milk, curd from skimmed milk. Butter and ghee are drastically cut down. Generally, non-vegetarian foods are avoided. Even a small portion of fish or meat is given with a lot of boiled vegetables and salads. At their farm they grow fruits using organic manure and using minimum insecticides. Today, "to grow more food" we are using much larger quantities of fertilizers and deadly insecticides. A small quantity of these chemicals often enter the food grains, which is not healthy for our bodies.

The world famous Bircher-Benner Clinic, in Switzerland, excludes all cooked food during the first phase of treatment for the first one or two weeks. The diet is chiefly of raw nuts, sprouted grains, fruits, salads and small quantity of milk. After the second week foods are added like soups, boiled vegetables, potato boiled or roasted and whole wheat bread. Then comes milk, butter milk, curd and small amounts of cheese. Refined food like sugar, white flour are avoided as also overcooked, canned or frozen foods. The food should be easy to digest and provide nutrients for the repair.

The patients are not allowed to smoke, imbibe alcohol or coffee. In general they avoid all animal foods like meat, fish, eggs, milk, butter and cheese. In chronic cases needing a more vigorous treatment, they are advised to undertake a small fast. The fast is normally short and is followed by a special cleansing diet. If need be, these fasts can be repeated. In a few healthy people they can be prolonged for a week or ten days.

I have been treating patients of arthritis in our Health Farm at Gorakhpur and also at the clinic in Bombay. In gorakhpur we keep indoor patients. It is much easier to regulate the diet in a health farm and also carry it through as group therapy. At gorakhpur, we generally give one seasonal fruit (say of 250 gms) for breakfast. At 12 noon the patients get a whole wheat chapati, 2 green vegetables, salads and a small quantity of curd. In the afternoon one glass of carrot or sweetlime juice. The food at lunch is similar to that given for dinner. Nuts, resins or whole pulse sprouts can be added at breakfast. The patients also get water treatment, are advised to do walking and exercises as much as their health permits. Many mild cases respond to this treatment. Sugar, white flour, tobacco, alcohol and coffee are completely avoided.

In a few obstinate cases fasting is prescribed. These are short fasts which last 3, 5 or 7 days. Gradually they are brought to normal diet. I have observed that a patient who had taken steroids for a prolonged period was difficult to treat. Steroids are known to suppress the immune system of the body. Health farming depends more in activating the immune system.

In a majority of cases cutting down sugar to one teaspoonful a day and adding a lot of salads and fruits is good enough. In early cases two months are enough. In chronic cases the diet should continue for a longer period, may be 6 months or one year. Little milk or curd can be added to make the food more palatable and nutritious. Cut down on alcohol, cigarettes and coffee as much as you can.

Patients with higher ESR, Uric Acid or blood sugar levels take longer to respond. When a patient is put on the prescribed eliminative diet the elevated ESR, uric acid and blood sugar level tend to fall. If these tests are repeated after one or two months a marked difference can be noted. Diet is important, though medical science cannot still conclusively decide what role it plays in arthritis. It is a little tricky and needs to be adjusted individually. Some foods to which patients are allergic should be eliminated. A careful study of a person’s response to a particular diet will need to be studied before discovering the optimum diet for an individual.

Water Treatment
Water forms the major portion of the body, with each of the hundred trillion cells filled and bathed with it. It is the basis of our blood and our tears. Humanity has recognised some what mystical qualities in water and they realise that it does more than simply quench thirst.

Doctors and health professionals abroad recommend water therapy. It is economical, effective, has no hidden side effects and it works.Hydrotherapy, apart from its pain relieving quality, can also prevent deformity and improve joint function. However this treatment does not work like a miracle drug. Two hot water treatments and you are cured is really not true. Hydrotherapy needs some time and committed effort. The experience is pleasant and rewarding and, actually, you will look forward for each treatment.

Hydrotherapy is being used in a big way. In hospitals abroad they use a contraption known as Hubbard Fank, shaped like the figure eight, with pulleys straps and levers that lower the patient in and out of water. The treatment is simple and can be done in comfort at home. There is no need to buy special equipment. All you need is two buckets, two basins, or a bath tub.

Fill up the bath tub with hot water. With a special thermometer measure the water temperature. Keep the water temperature a little higher than the body temperature say between 100-102F. It should never be higher than 104F. Otherwise the body will not be able to throw out enough of its own heat. This can give rise to hyperthermia – a kind of under water heat prostration.

It would be nice to fill the tub each day with some marvellous elixir like that from a mineral spring or a hot spring spread all over India like the one in Vajreshwari near Bombay, or Sohna (Gurgaon) near Delhi. But most of us cannot afford to get this spring water. Instead use just whatever comes out of the tap.Once in the bath tub plan to stay there for 20-30 minutes.

When the body is submerged in water, it loses weight as much water as it displaces. If you displace 45 litres, the weight is around 40 kgs. Like astronauts circling the globe you will be relatively free from gravity. The limbs can float, the joints can be moved more freely than while lying in bed. It will be a nice feeling to know that the old joints can still work. It will heighten you spirits. A rheumatologist advised his patients. "Exercise your lower back, knees, hips, ankle and wrists. There may not be enough space in your bath tub to move your shoulders or elbows".

At the spa in Baden Baden, West Germany, they have tiny jets of carbon dioxide that shoots into the tub through tiny pin holes. The carbon dioxide gathered gives a special tingling sensation to the body. There is no need to go to Baden Baden. Any health club can provide these facilities in a tub fitted with a whirlpool.

The exercise in the bathtub will pay rich dividends. You will feel that your joints are opening up, the pain is reducing and the muscles getting toned up. The flexibility will increase almost every day. You will be able to perform these motions once you thought impossible. You will feel a lot better in a week to 10 days.

You can try these in a swimming pool too. With hydro-gymnastics, you can work your entire body. It will gain a large range of health benefits like preventing muscle wasting. It will tone up muscle strength, balance and co-ordination. You can swim if you know swimming, wear a swim belt if you like. You need a willing partner to support your back and hips so that you can make circles with the legs and arms or to hold you by shoulders so that you can do spine stretches. The idea behind moving around and having fun is fruitful. But do not overdo, ask your doctor if you are in doubt.

Baggie Therapy for pain
The new and latest breakthrough is by doctors at the German town Philadelphia, Pennsylvania, who have found that the arthritis pain can be killed with a baggie full of ice. For those who do not help through the usual heat treatment this might be the answer.

At this clinic, 24 patients applied this treatment to sore knees, three times a day for 4 weeks and all agreed they had experienced improvement. They had no pain. The movement was free and there was muscle strength. Those who undertook this treatment could stand up faster, sleep better and best of all could cut down their doses of medicine to half.

This is the treatment, in a nutshell. Using 2 large baggies, you fill each of them with six cubes of ice and half a litre of water. Put one on top of the sore knee and one below. Wrap it with a towel and keep it for 20 minutes. Do it three times a day at evenly spaced intervals. You may feel uncomfortable for a little while. This feeling lasts for 5 minutes then anaesthetic effects set in. At the end of the treatment you feel great. The German town patient, used baggies only on one knee even if they had arthritis in both the knees. Even though it was applied to only one knee, patients said it made both knees feel better. Peter D.Utsinger, who headed the research team says this unexpected benefit may not be just the power of suggestion, but something purely physical. This is why one of several effects produced by the cold therapy is an upsurge in the body’s level of endorphines. These are the natural chemicals that circulate in the body and actually numb pain. It is quite possible that endorphines relieve pain in both legs and convincingly anywhere else in the body.

Exercise
Exercise is one of the most important therapies. It helps to regain flexibility and strength. Exercising, with the onset of arthritis, can be really painful. Should one exercise if there is pain? Pain in the nature’s way of telling us to stop doing something harmful. Sure the old saying is generally true, but not absolutely true in the case of arthritis. The arthritic joints you must keep moving, preferably through the full range, to prevent them from freezing up and to prevent muscles from wasting. Many a time these motions hurt but most doctors will agree that you must move the arthritic joint. Push it just a little past the point of discomfort during the work out. If the pain persists over two hours after you have finished the exercise it will mean you have pushed a little too hard. Reduce the pressure when you do it the next time. You will be surprised as the days and weeks pass by. Keep on exercising, the range of your joint movements will go on increasing slowly but surely.

The movement and pain are inversely related. As you increase the movement, the pain keeps on reducing. The cartilage in the joints does not have its own blood supply and for it there is only one way to get the nourishment and that is through synorial fluid and the only way synorial fluid can enter the joint is by doing exercises. Without movement the synovial membrane gradually adheres to the joint cartilage, eventually it obscures the synovial fluid reaching the joints. The cartilage cannot survive without nutrition for long and it degenerates.

Exercises are not only good for you, but they are (or soon will be) a source of real fun. There are a lot of items to choose from yoga, dancing, stretching, sports or just plain movements. This will depend more on your personality than the type of arthritis you are suffering from. The aim is to improve flexibility, increase the strength of the muscles surrounding the joint, so that you do not need the external support and you increase your endurance.

A word of caution. Do not use painkillers when you are exercising. They too easily mask the pain, so that you unwittingly damage the joint by pushing it too fast or too hard.