What is Arthritis?

Arthritis is the general name for a joint complaint. It comes from the latin “arthr-”, meaning joint, and “-itis” meaning inflammation.

If you’d like to see a Flourish patient testimonial from someone with OA in both knees, click here (it’s the third video down).

Not all arthritis is the same

There are actually over 100 different types of arthritis – far too many to go into detail about here – but they fall under 2 simple categories.

Inflammatory Arthritis/Rheumatic Diseases happens when the immune system attacks something in the joint, whether that’s the cartilage, the bone, the joint lining or other parts of the joint. It is characterised by redness and swelling, which often happens in flare-ups, and will affect lots of joints around the body and other areas of the body.

Osteoarthritis happens when there is an irregular surface in the joint. This means the joint cannot glide through its movements like it used to and often becomes stiff. This is by far the most common type of arthritis, especially in those over 50, and is what most people mean when they say they have “a bit of wear and tear”. This is the type of arthritis I’ll be addressing in the rest of this article.

(If you want to read more about inflammatory arthritis, stay tuned for another article coming soon.)

What is Osteoarthritis (OA)?

It’s a joint condition characterised by stiffness, mild swelling and pain. It happens mostly commonly in the weight-bearing joints, such as knees and hips, but also joints that get a lot of use, like the hands. On examination, it’s often found that the muscles that travel across the joint have become tighter and weaker.

When we see OA on an xray, this is what is looks like:

  • The normal space between 2 bones in a joint is narrower than it should be. This is because the layer of cartilage (which you can’t see on an x-ray, so it just looks like empty space) which would allow the joint to glide freely has become thinner
  • The surface of the bone looks bumpy instead of smooth, giving the appearance that is has been worn away
  • There is less fluid in the joint than there would usually be

There isn’t a cure for osteoarthritis, since it essentially occurs in response to everyday living, but there are lots of strategies that can be used to reduce the symptoms and many of these are incredibly effective and easy to do.

Why is OA painful?

So here’s the interesting thing. OA isn’t painful at all. None of the changes associated with OA that we see on an x-ray actually cause pain in and of themselves. In fact, many people don’t even know they have OA because the don’t experience any pain or stiffness at all.

There are cases where the OA can become very severe and cause pain in other structures (for example, if the extra bone deposits started pushing on a nerve or a tendon) or if eburnation – bone rubbing directly on bone – occurs in the joint then this can also be painful. In cases like these a joint replacement is often recommended. However, when a clinician sees evidence of OA on an x-ray or another scan, it doesn’t automatically mean that it will be painful or symptomatic.

It’s not wear and tear, it’s wear and repair

When viewed on an x-ray, OA gives the appearance of a bumpy and irregular surface, and so many people assume that the bone is gradually being worn away over time. But in fact what we are seeing on the x-ray is MORE bone being deposited onto the joint surface, not less. The bumpy surface we see is actually the site of extra bone growth, which is taking place to make the bone stronger in an area where the body feels it needs building up.

In response to force or load through a particular joint, cells called osteoblasts become more active. It’s the osteoblasts’ job to deposit calcium and other minerals into the structure of the bone to increase its density and strength.

In the same way, the cartilage within the joint is capable of regrowing and, although this is a slow process, even a small amount of regrowth can reduce the symptoms of OA.

The body is adaptable

In OA, the body is simply adapting to the stresses and stimuli of everyday life, and most of the time that is beneficial. It’s also true to say that if we change those stresses and stimuli we can halt – or sometimes even reverse – the changes in the joint that we see in OA.

Here are my top tips for managing OA:

  1. Exercise – research shows that exercise prescribed by a professional (such as a physical therapist, chiropractor or physiotherapist) is more effective than medication for managing pain and stiffness in arthritis.
  2. Manage your weight – putting extra weight through your joints will accelerate the process of wear and make it harder for your immune system to keep up with the healing process
  3. Increase your intake of GAGs – glycosaminoglycans (GAGs) are the building blocks of new cartilage, and you can find them in bony oily fish like sardines and mackerel. They are also available in tablet form, in supplements like Glucosamine and Celadrin.
  4. Get a good night’s sleep and deal with unresolved stress – both stress and poor sleep will slow down your body’s healing processes, but a good night of rest for your joints will help take the load off
  5. Don’t smoke – this stunts blood flow to everywhere in the body, including your joints, which need good blood flow to repair. Smoking increases your risk of developing many different kinds of arthritis.

Acupuncture has also been shown to be beneficial for reducing pain associated with OA, and for helping with the tension and weakness that develops in the surrounding muscles. Here at Flourish we treat many patients with OA and get great results! To see a patient testimonial, click here.

Stress and the Ageing Process (Part 2)

Last time we learned that our DNA is protected by structures called telomeres, and that stress can cause these telomeres to shorten. This causes the cells to reduce their activity to a bare minimum to keep the cells alive. Injuries don’t heal as quickly, cells don’t replenish as quickly, our immune system reduces in activity and we are more vulnerable to disease. Our ageing process has been accelerated due to stress.

I also told you about another exciting piece of research where Professor Blackburn sent Group A – The Stress Group away for a week-long relaxation retreat and looked at their DNA again afterwards. And, would you believe it – their DNA was longer again! How did that happen?

The length of the telomeres is held in a careful balance by two opposing processes. On one hand, each time a cell divides the telomeres get shorter. On the other hand, an enzyme called telomerase adds extra bits on to the end of the DNA to restore some of the telomere. In a normal cell under normal conditions, the balance will be tipped slightly towards cell divisions, so that each time a cell divides the telomere will get shorter and the enzyme will add on almost all of what was lost, but not quite all. Overall, this makes the telomere only a little shorter.

However, when a person gets stressed their stress hormones (adrenaline and cortisol) completely knock out the activity of the enzyme telomerase. This means that each time a cell divides, there’s no enzyme there to add on what was lost and so the telomeres get shorter and shorter much more quickly.

This explains what happened in Professor Blackburn’s research, for which she won the Nobel Prize. People who were under long-term stress, and had no telomerase working in their cells, were sent on a relaxation week. During that week, their telomerase levels rose so much that, for a short time, the balance was slightly tipped towards their telomeres getting longer.

So what are the implications for us?

We know that stress affects health in a wide range of ways, even down to the DNA in our cells. Of course, not all stressful situations can be completely avoided but Dr Albert Ellis, who developed Cognitive Behavioural Therapy (CBT) once said “man is not disturbed by events, but of the view he takes of them”.

More and more research is showing the positive benefits of reducing stress in day to day life, and developing a mindful, positive attitude. In fact, one study has showed that belonging to a faith-based community (features of which are a strong support network and a positive frame of mind during stressful situations) can increase your life expectancy by 4-14years!

Here are some practical tips to help:

  • Cliched as it may sound, it helps to talk. If you have a close friend or relative who would be able to listen and support you, arrange to meet up and talk it through.
  • Counselling may also help, if you need someone to listen and give professional advice
  • Many online or app versions of CBT (Cognitive Behavioural Therapy) are now available
  • Research has shown that belonging to a faith-based community can increase your lifespan by between 4-14years and can also increase quality of life. It’s thought that this is due to the combination of a strong support network and regular prayer or meditation.
  • Learning a relaxation technique such as mindfulness or anchoring can be helpful in the midst of a stressful situation, to keep you calm.
  • If you feel you may have anxiety or depression, then having a chat with your GP about medication may be helpful. Having said that, research has recently shown that regular aerobic exercise is more effective for combating mild depression and anxiety than any prescription medication, and has many other health benefits too.

Stress and the Ageing Process (Part 1)

Have you ever wondered how people like Tony Blair or David Cameron, enter the office of Prime Minister looking so fresh faced and optimistic, only to leave a few years later looking old, tired and haggard?

I was fortunate enough to meet Nobel Prize Winner Elizabeth Blackburn and discuss her research with her. Professor Blackburn studies a very specific part of our DNA – an area called the telomere. Her most recent research has focussed on the effect of stress on this part of our DNA.

But firstly, what is a telomere exactly?

Our DNA isn’t just in one big clump in our cells. It’s arranged into 23 pairs of individual strands called chromosomes, and on the end of these chromosomes is the telomere. It acts as a little cap on the tail ends of our DNA to protect it from damage and stop it accidentally unwinding or fraying at the edges.

At the beginning of its life, telomeres are quite long and sturdy. However, scientists have found that every time a cell divides the telomere gets a bit shorter and weaker, and so less able to protect our DNA. As we get older and older our telomeres get shorter and shorter, which makes our DNA more vulnerable to damage. And if our DNA is damaged, our bodies don’t function as well as they should.

When our telomeres get short, our cells notice this and know that they only have a limited number of divisions left before they run out of telomeres. To deal with this, they reduce their activity and only do the bare minimum to keep the cell alive as long as possible. For example, a cell on your scalp might notice its telomeres are getting short and reduce its activity to the bare minimum to keep the cell alive – it might keep producing hair, but that hair might be thinner, weaker and have less pigment in it, making it dull or grey.

This, in a nutshell, is the ageing process. When our telomeres are short and our cells have reduced their activity: injuries don’t heal as quickly, hair and skin cells don’t replenish as well as they used to, our immune systems slow down and our internal organs are more vulnerable to disease.

So, how does stress affect our DNA?

Professor Blackburn’s research shows the dramatic effect of long-term stress on the state of our DNA. She took a group of people who had been caring for a sick spouse or parent for at least 3 years. We’ll call them Group A – The Stress Group. She then created another group of people who were the same in every other respect (age, gender, social background and education) but were not under long-term stress. This is Group B – The Relaxed Group. She then looked at the telomeres of these groups, and the results were striking.

Group A had significantly shorter telomeres than Group B. And remember, the people in each group had matching ages, so this was purely down to the influence of stress and not age. When she looked closer at Group A, she also noticed that the longer the person had been caring for their sick relative, the shorter their telomeres were. So not only does stress affect the length of your telomeres, but the longer you are under stress the shorter they get. In terms of the ageing process, it means your cells get older quicker!

This is part of the answer to the question I posed earlier: why do people in stressful situations tend to look older than they are? One reason is that their cells have shifted down a gear, and aren’t repairing and healing like they used to. The ageing process has been accelerated through stress.

However, it’s not all bad news. Luckily for us Professor Blackburn didn’t leave it there. She sent Group A – The Stress Group, away for a week-long relaxation retreat and looked at their DNA again afterwards. And, would you believe it – their DNA was longer again!

How did that happen?

Come back next week to find out!

 

Summary:

Stress has lots of wide reaching implications for our health, even down to our individual cells. When we’re stressed our DNA is less protected, cells are less active and this causes the ageing process to speed up.