Arthritis and complementary and alternative treatment

Complementary and alternative medicine or CAM became a formal and recognized body of treatment for many diseases, including the arthritides. CAM joined mainstream medicine and has been offered as part of the medical curriculum by the mid 80's.

CAM include such diverse modes  of treatment- from balneotherapy, massage, acupuncture and other physical applications to plant products as herbal concoction either applied or taken in. CAMs was reviewed in the Philippine Rheumatology Association(PRA) Recommendations for the Medical Treatment of knee osteoarthritis (OA).

Natural is not necessarily safe, so it is important for prospective users to look for seal of approval by reputable organizations (ex. Arthritis Foundation) or certifications for specific standards of manufacturing (ex. ISO). Like other treatment forms, CAMs can have side effects. We still warn against CAMs markated as a panacea. There have been reports of sideeffects to the heart, liver, kidneys and infections that arise with indiscrimate use of some of these agents.

Among the CAMs reviewed by the PRA were those with scientifically conducted trials and research for its effects on knee OA pain and function.  The following is part of the 25 recommendations published in the Philippine Compendium of Medicine, 2010.

Recommendation for Complementary and Alternative Medicine (CAM)

A. Recommended
1. Herbal preparations
The use of concentrated standardized ginger preparation is recommended for its moderate effect in the control of pain and improvement of function in knee OA. Patients should be warned of gastrointestinal adverse reactions that can occur with this preparation.
Level of evidence: Moderate

2. Acupuncture
Manual or electroacupuncture is recommended as additional therapy to achieve pain relief lasting a few weeks in patients with moderate knee pain due to OA.
The procedure must be adequate and performed by a trained and experienced acupuncturist.
Level of evidence: High

B. Insufficient Data to recommend
1. Spa or balneotherapy
There is insufficient evidence to recommend spa treatment for the control of pain and improvement of function in knee OA.
Level of evidence: Low
2. Tai Ch’i
There is insufficient evidence to recommend Tai ch’i for the control of pain and improvement of function in knee OA.
Level of evidence: Low
3. Yoga
There is insufficient data to recommend yoga to control pain and improve function in knee OA.
Level of evidence: Low
4. Herbals
There is insufficient data on comfrey, Chinese herbal recipe, Chinese pills, rose hip, devil’s claw, to recommend their use in knee OA.
5. Massage
There is insufficient evidence to recommend massage (standard Swedish) for the treatment of knee OA.
Level of evidence: Low

Arthritis in the throat (not the typical sore throat)

No, not the virus,  not strained vocal cords, not the singer's nodes on the vocal cords, but cricoarytenoiditis - what? Supercalifragilistiexpialidocious- yes, its arthritis of the joints between the two small laryngeal bones that hold the vocal cords and the larger cricoid bones of the throat, the cricoarytenoid joints.

Cricoarytenoiditis is felt as pain in the throat and hoarseness and can be part of rheumatoid arthritis, a systemic disease which causes pain and swelling in many joints of the body - wrists, fingers, ankles, knees. While rare, the condition adds to the already debilitating effects of this generalized form of arthritis.

A rheumatology clinic is the best setting for the treatment of rheumatoid arthritis. Optimum treatment will improve crycoarytenoiditis, as well as, the arthritis of the rest of the joints. Treatment is complex and consists of one or more drugs in combination - pain killers and low dose steroids as "bridge treatment" and disease modifying drugs, both synthetic and biologic. This is the best shot a patient can have to avoid disability arising from destruction of the peripheral joints as well as,  the throat joints.

Go, ask your doctor about it!

Summer and rheumatism?

It's January yet, but the sun in Manila is already threatening to be blistering hot in another month or two! Thanks to the occasional cloud cover and some cold air, we still have a very lovely weather.

Summer and rheumatism? 

from clip art

Many believe that rheumatism/ arthritis  is linked to cold weather (2nd only to the Bean Story - several posts back). Some even say that arthritis is caused by cold weather (what? so all humans living in Iceland, Canada, etc have arthritis?)

I hear these complaints more during the short cold months that the Philippines have, but surely, the same patients come any time of the year with bad arthritis, weaving stories of other causes for the pains - ate this, drank that, hexed, etc.

Truth of the matter is that, patients truly feel the tightening and pain in the joints, arms, legs and back, during the cold season. This is partly due to a phenomenon called allodynia. This is that  condition where one reacts with  pain when exposed to otherwise non-painful sources, like cold weather, draft from the airconditioner or open window and even, touch. Allodynia is commonly observed in chronic pain conditions, including rheumatism and arthritis.

During the hot months of summer, indeed, a form of rheumatic disease - lupus- can be exacerbated by exposure to sun. This condition carries with it arthritis, skin rashes ( specially on sun exposure), and even kidney, lung and brain disease. This is an uncommon condition, though among the brown and black race, this disease can be seen more often. Lupus patients are advised to:

1. avoid sun exposure or wear enough sun screen if they have to (absolutely no sun bathing!)
2. check with their rheumatologist regularly
3. comply with maintenance medications. 

Once lupus is controlled, patients can be back working, marrying and having children, etc.

Cold weather and arthritis? Not really...

Summer and arthritis? Why, yes...

Post holiday downtime, hightime for the gout!

At the start of each year,  I would expect gout arthritis patients, old and new, to rise like unwelcome spectre of the most painful of bodily retorts to dietary excesses, and come limping to the clinic. This would be followed by a week or maybe a month -long of resolve never ever to taste alcohol or the beans! This first week of 2012, one call from a patient (a doctor) came and then the week pulled off with several consults of gout patients without the gout attack and reporting a happy new year indeed!

I would like to think that after 2 decades of rheumatology practice, the returns of doing customized patient education during the clinic encounter is finally reaping some returns. However, gout patients being in so much pain with each attack, may have visited another rheumatologist, self-medicated with their favorite NSAIDs, visited the emergency room of some hospital where steroids may have doused the fire, or took steroids by themselves, or as advised by a well-meaning neighbor.

By customized patient education, I mean  giving a set or  combination of statements about the gout, its treatment and how to avoid it, as the case requires.

The first step, is to identify types of patients with gout:

(Look, these categories are not absolute or exclusive, nor are these the product of any indepth research, nor in any way intended to be derogatory. This list is anecdotal and culled from more than 20 years of observation. I suspect that these are actually patients' reactions to this severe malady, more than anything else)

1. humble and teachable (quite rare, the one with the best prognosis)
2. wife/ mother dependent
3. officemate/neighbor dependent
4. pseudo-doctor
5. late disease (nodes and masses stud the elbows, knees, and feet, kidneys and intestines bad)
6. one- consult patient
7. the returning one- consult patient
8. confused

First visit: all patients receive the complete set of educational instructions  and memorize their medications, and no looking to the caregiver, please...

2nd to the 5th consultation and still with recurrent attacks:  patients slowly fall into any item in the above list, so instructions are delivered "differently" per category, emphasized, and patient is required to write instructions down.

5th visit onwards: not to lose hope, patient still comes back, so, reiterate important points, use the" I agree, but..." or, "you are doing excellently, but..." approach, let him write down and read back instructions in the clinic, recruit wife or family members to help remind patient...

The single call received this week, is a looking up for an optimistic 2012-  could the patients attending this clinic have licked the gout? I will have to wait though, for the rest of January 2012. I'm keeping my fingers crossed!