Saturday, March 26, 2016

Inflammation in Early Ostoearthritis: It's Not Your Imagination

After my “Ghost in the Machine” post, I received a link to an interesting paper (published in Therapeutic Advances in Musculoskeletal Disease only a few years ago). It isn’t a meta-study, but more a state-of-what-we-know summary.

First, you have to understand a little background. The prevailing paradigm is that rheumatoid arthritis is the inflammatory arthritis. The immune system goes beserk in an RA patient, and a blood test shows high levels of inflammatory markers, such as C-reactive protein.

Now, contrast that with the traditional understanding of osteoarthritis: It too causes havoc in a knee joint, but it’s a “wear and tear arthritis” and noninflammatory. And so, when I asked my doctor if my knee pain might be implicated in inflammation elsewhere in my body, he more or less scoffed.

That paradigm is now shifting, it appears, so if you’re one of those knee pain sufferers who is wondering about an onset of other aches and sorenesses, you’re not crazy. Medical thinking may be just slow to catch up with what we’ve long suspected: there probably is a ghost in the machine when someone has chronic, low-grade inflammation.

But I may be crossing a bridge too far (at least for this paper). Let’s look at what it actually says, using a few snippets:
Although rheumatoid arthritis is clearly associated with higher levels of inflammation, osteoarthritis is by no means a “noninflammatory condition.”
No surprise to most of us. But what’s more:
Inflammation is present in osteoarthritic joints well before the development of significant radiographic change . . . Cartilage breakdown products in synovial fluid as well as microfissures in articular cartilage are present long before any degeneration can be noted using current MRI technology or gross arthroscopic visualization.
Translation: Inflammation and other bad stuff is going on in your joints WELL BEFORE you can see anything on an X-ray or an MRI. So if you go to your doctor with burning, aching knees, and he says (after studying your X-rays and MRI), “Well, they look fine,” don’t be fooled. That doesn’t mean they are fine.
The development of chronic inflammation in OA following joint trauma or overuse can be understood as a vicious, self-perpetuating cycle of local tissue damage, inflammation, and repair, such that the osteoarthritic joint has been likened to a chronic wound.
This is IMPORTANT. Note the operative phrase “vicious, self-perpetuating cycle.” This is the cycle you somehow have to break. I had a sense of this when I quit my job and devoted myself to the full-time pursuit of healing my bad knees. To me, I was fast running out of time and needed to take a dramatic step to get on top of my chronic inflammation.
These studies, demonstrating significant synovial inflammation in early osteoarthritis, suggest a window of opportunity may exist in which disease-modifying interventions targeting inflammatory processes might be the most efficacious for the prevention and treatment of osteoarthritis.
Okay, this is the part I’m somewhat tepid about, but I understand the authors’ proclivity for a solution that comes in a neat little pill (that some pharmaceutical company can charge $800 a month for). I would modify their conclusion somewhat, saying instead that there’s a window of opportunity to subdue that inflammation. You may benefit most from a drug (but be careful, as some will degrade cartilage and what’s more encourage you to do things that are too taxing for your weak joints). Or you may need a tonic that’s free: the proper amount of easy, appropriate motion, and the ability to keep your knees in non-stressful positions.

For more, please check out the study. The second half dives deep into the weeds, flinging about terms that I expect most of us will struggle to comprehend, as the authors look at particular pathways of inflammation. If you have an appetite for such, go for it. Mine is somewhat limited, I confess. :)

Saturday, March 12, 2016

Open Comment Forum, Dive In!

Today I’m going to do something different. Today I’m going to turn the mike around, so to speak. I’m going to let all of you “talk amongst yourselves” (I’m sure some of you remember the original context for that phrase!)

A while ago, someone suggested doing this, so people could share and help each other. It made perfect sense to me.

Before we begin, I think there are four things we all share:

(1) We believe there is good reason to be optimistic about the prospect of damaged cartilage healing, or at least improving.

(2) We accept this will probably take a long time (maybe years).

(3) We believe that getting better requires movement.

(4) We believe “envelope of function” is the best framework for understanding and dealing with knee pain.

Okay, that’s it. You can start talking now. Since it might be useful to have a subject, I’ll throw one out there (but feel free to ignore or modify): What are some things you’ve done that have helped you with your knee pain?