Joints are vulnerable to wear and tear and also to chronic inflammatory and immunological disease. There are herbal approaches that have shown they can work.

Arthritis

Can we find different approaches to conventional anti-inflammatory medicines for arthritic pain and disability? The best prospects may be from looking at underlying causes and processes that are amenable to herbal action.

Orientation

Arthritis means ‘inflammation of the joints’ and is an umbrella term for many different conditions marked by joint pain and damage. Joints are engineering miracles but still tend to wear through life and are increasingly likely to be troublesome as the years roll by: this is not a modern problem, nor confined to humans. Optimum joint health seems to average around 50 years: longer life span is a challenge. Weight and stress are the main burdens, and keeping joints mobile is generally a good thing: swimming may be the ideal exercise. ‘Wear and tear’ is associated with the most common type of arthritis, osteoarthritis. This is however an active disease of the joints as well, associated with local inflammatory activities involving the microcirculation and even insulin resistance.

Oher types of arthritis have wider more systemic inflammatory, usually immunological causes. They include rheumatoid arthritis, ankylosing spondylitis, Sjögren’s syndrome, polymyalgia rheumatica, lupus erythematosus, Reiter’s syndrome and psoriatic arthropathy. Not all blood or antibody tests are clear and some individual joint problems are described as ‘rheumatoid like’. All should be approached as a body-wide immunological and chronic inflammatory problems, rather than just a joint condition.

Joints may also be harmed by uric acid deposits, following build up of this metabolite in the blood. This can lead to an extremely painful arthritis called gout.

Joints are lined by a tough tissue called cartilage, designed to survive interrupted blood flow and pressure. Early arthritic inflammation, whether local or systemic, initially has transient effects, that might include swelling and pain in the surrounding tissues and perhaps in cushioning fluid-filled sacs called bursae. If persistent this could then lead to provocation of the cells that produce cartilage, (chondrocytes), with subsequent spillover to affect the nearby bone-producing cells, (osteocytes). This is when inflammation leads to joint damage. The first aim of treatment for arthritis is to prevent this by catching the inflammatory changes early.

There is another category of joint and muscle pain in which an inflammatory backdrop is exacerbated by heightened responses throughout the system. Fibromyalgia is a syndrome marked by widespread musculoskeletal pain and symptoms such as fatigue, upset sleep, digestive problems and psychological distress.  It is diagnosed on the basis of multiple tender points on the body and high pain scale scores. Investigative findings include exaggerated pain and sensory processing in the central nervous system, possibly linked with disturbances in neurochemical transmission (such as raised levels of substance P), and with changes in hypothalamic control of hormone systems in the body. Because of the particular nature of this syndrome it may be more effective to manage it herbally not as a joint disease at all, but as evidence of a wider disruption in hormonal and other internal controls, requiring various calming tonic and adaptogenic herbs, as well as a wider convalescent regimen.

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