February 3, 2005
Scottsdale rheumatologist Paul Howard doesn’t believe pharmaceuticals, by themselves, are the best way for people with arthritis to get better.
Rather, Howard sees treatment for the disease — joint inflammation affecting nearly 70 million Americans — as involving a combination of exercise, supplementation, diet and, if needed, weight loss. His patients bear out his approach.
Peggy McKee, 76, of Scottsdale first visited Howard’s office three years ago with an arthritis flare-up shortly after the death of her husband and a daughter. McKee, who suffers from rheumatoid arthritis, received a prescription for yoga. "I sometimes wonder if I still have arthritis," McKee says with a chuckle. McKee, who attends yoga class twice a week at a studio set up by Howard for arthritis patients, says the gentle form of stretching "has done wonders for me. I don’t take nearly the amount of medication I used to."
Winifred Doane, 75, received a prescription for yoga after Synvisc injections in the knee failed to help her osteoarthritis. "Yoga remade my whole life," says Doane, who attends yoga class twice a week at Arthritis Health in Scottsdale. Not only has her physical health improved, she says, but her mental well-being has, too. The Arizona State University professor emeritus is completely off medications, with the exception of glucosamine with MSM. And her bone density is back to normal after a diagnosis of osteopenia, a precursor to osteoporosis.
Ginnie Livingston, a certified yoga therapist, oversees five levels of yoga at Arthritis Health. Livingston, a faculty assistant at ASU’s College of Nursing, says the huge changes she sees yoga making in the lives of arthritis patients is inspiring. She sees yoga as a great alternative or adjunct to pharmaceuticals as it does not mask symptoms but increases balance and strength and elevates mood.
"It really improves quality of life," she says.
In addition to yoga, tai chi and warm-water aerobics (83 degrees to 88 degrees) are good forms of exercise for people with arthritis, says Dr. Randy Horwitz, medical director of the Program in Integrative Medicine, University of Arizona Medical Center in Tucson. Horwitz says interest in more "natural" treatments for the disease has picked up since the Food and Drug Administration issued an advisory regarding Vioxx, Celebrex and Bextra. Those pharmaceuticals, popular arthritis medicines made by Merck and Pfizer, contained Cox-2 selective agents that inhibit the inflammation cascade and block pain and stiffness. They also carry with them increased risk of heart attack and stroke.
Horwitz believes the positive properties of those drugs can be achieved naturally through diet. He says dietary changes are better at effecting the inflammation cascade at an earlier cellular level. Dietary changes are dictated by arthritis type, but some common recommendations include increasing intake of foods high in omega-3s, such as salmon, replacing animal protein with plant protein, and increasing fruits and vegetables. Eliminating dairy products (for some arthritis patients, not all), and cutting out processed foods and foods containing trans-fatty acids would also help. Monounsaturated fat, such as olive oil, should be the main fat source for some people with arthritis. Horwitz says it takes between six to eight weeks for dietary changes to impact arthritis.
He also recommends patients use antiinflammatory botanicals, specifically ginger and turmeric. Ginger can be found in a variety of forms including fresh root, crystallized, dried powder and tea. Turmeric, a deepyellow powder, is often used in curry dishes. Both ginger and turmeric can be purchased in capsule form at health food stores.
"People are conditioned to believe the only way to feel better is to take a pill," he says. "We (at the Program in Integrative Medicine) don’t reject conventional medicine. There are some great pharmaceuticals when it comes to chronic issues. But what we do is look for the best therapies, one that supports the whole person."
There are more than 100 types of arthritis and related conditions. The most common:
Rheumatoid arthritis is an autoimmune disease in which the joint lining becomes inflamed as part of the body’s immune system activity. Rheumatoid arthritis is one of the most serious and disabling types, affecting mostly women.
Osteoarthritis is a degenerative joint disease in which the cartilage covering the ends of the bones in the joint deteriorates, causing pain and loss of movement as bone begins to rub against bone. It is the most prevalent form of arthritis.
Gout is usually a defect in body chemistry. This painful condition, affecting mostly men, attacks small joints, especially the big toe. Gout can almost always be controlled with medication and changes in diet.
Ankylosing spondylitis affects the spine. As a result of inflammation, the bones of the spine grow together.
Juvenile arthritis is a general term for all types of arthritis that occur in children, including lupus and ankylosing spondylitis.
Systemic lupus erythematosus
(lupus) is a serious disorder that can inflame and damage joints and other connective tissues throughout the body.
Scleroderma is a disease of the body’s connective tissue that causes a thickening and hardening of the skin.
Fibromyalgia involves widespread pain that affects muscles and their attachments to the bone. It affects mostly women.
Source: Arthritis Foundation