Arthritis is a common condition, but did you know some variants may be a legacy from our Neanderthal ancestors? 

When modern humans migrated out of Africa, they interbred with Neanderthals. While this provided some benefits, research suggests we also inherited genes linked to autoimmune diseases like rheumatoid arthritis.

Pain in the joints

What exactly is arthritis? It is an inflammation of the joints and the effects thereof. Arthritis is a general term, derived from the Greek words arthro-, meaning “joint,” and -itis, meaning“inflammation.” 

Types of arthritis

There are more than 100 different types of arthritis. Some of the most common types include:

• Osteoarthritis: Wear and tear arthritis.
• Rheumatoid arthritis: Arthritis that happens when your immune system mistakenly damages your joints.
• Gout: Arthritis that causes sharp uric acid crystals to form in your joints.
• Ankylosing spondylitis: Arthritis that affects joints near your lower back.
• Psoriatic arthritis: Arthritis that affects people who have psoriasis.
• Juvenile arthritis: Arthritis in kids and teens younger than 16.

Depending on the type of arthritis, it can break down the natural tissue in joints (degeneration) or cause inflammation (swelling). Some types cause inflammation that leads to degeneration. In the case of our Neanderthal inheritance, the autoimmune types of arthritis are one of their parting gifts to us. 

How does Western medicine treat osteoarthritis and autoimmune arthritis?

The most common treatments for osteoarthritis include medication: Over-the-counter (OTC) pain relievers can help reduce pain and inflammation. Medication can be taken by mouth or applied topically to relieve pain (creams, ointments or patches you put on your skin near your affected joints). Some of the best techniques for OA sufferers is movement and usually in a warm environment. The Arthritis Foundation website has many useful suggestions. 

However, one of the greatest resources for self management when dealing with daily life and an arthritic condition is a consultation with an occupational therapist. Adaptations, simple or high tech, are introduced and if indicated, can even be fabricated by an occupational therapist. 

Adaptations are one of the best complementary interventions for all varieties of arthritis. There is surgical management when joints are severely affected and the individual’s quality of life and safety are at risk. Recent inroads to other options include the NITRO (Novel Innovations for Tissue Regeneration in Osteoarthritis) program created to support high-impact solutions to society's most challenging health problems. Its aims are to create and commercialize injectable and implantable regenerative therapies for osteoarthritis to provide an alternative to orthopedic surgery. Fingers crossed!

Conversely, the autoimmune varieties are treated with a disease-modifying anti-inflammatory drug (DMARD), or biologics. Biologics are made from living cells. They’re stronger, far more expensive, and harder to administer than conventional DMARDs. Due to their high price tag, drug companies have developed biosimilars. These drugs are similar in safety and effectiveness to already-approved biologics but have different names and should potentially cost less. 

Biosimilars are created by slightly changing the manufacturing process used for the original or reference drug. The 2020 guideline acknowledges the safety and efficacy of biosimilars and encourages their use. Yet; as of the writing of this article, health insurance companies do not yet readily approve and pay for them. 

Another option, recently out of favor because they increase susceptibility to infection and interfere with the healing process, are corticosteroids. In an effort to greatly limit their use, even as a bridge treatment, guidelines strongly recommend against long-term and short term steroid use. 

How about complementary treatment options?

Complementary implies that these options are to be considered in addition to your doctor’s interventions. In principle, they address inflammation and the severity of your body’s immune response.

Osteoarthritis, the third-most common cause of disability in the United States, is currently incurable. The College of Rheumatology and the Arthritis Foundation recommend aerobic exercise and/or strength training, weight loss (if overweight) to ameliorate effects of osteoarthritis (OA) of the knee, hip, or hand. The guidelines strongly recommend tai chi, along with other non drug approaches such as self-management programs, for managing knee and/or hip OA. Yoga is conditionally recommended for those with knee OA. Acupuncture is conditionally recommended for people with knee, hip, and/or hand OA. Massage therapy is conditionally recommended against use in people with knee and/or hand OA.

Despite extensive research, it’s still uncertain whether glucosamine and chondroitin have a meaningful impact on symptoms or joint structure in OA. The clinical practice guidelines strongly recommend against the use of glucosamine in people with hip, knee, and/or hand OA; however, the guidelines conditionally recommend chondroitin for people with hand OA. 

Topical capsaicin is conditionally recommended for people with knee OA and conditionally recommended against use in people with hand OA. 

The evidence on other natural products is too limited for any conclusions to be reached yet research suggests turmeric—particularly one of its chemical components, called curcumin—may help alleviate arthritis inflammation and pain. 

Another option is CBD. Products containing cannabidiol (CBD) may help reduce inflammation, pain, and anxiety associated with arthritis and other chronic pain conditions.

For the autoimmune types of arthritis, complementary treatments are similar to those that are suggested for OA, but psychoneuroimmunology suggests that immune function is impacted by a variety of factors that must all be considered to improve quality of life and possibly redirect the individual’s immune response.

Turmeric, ginger, valerian. These are three supplements that are thought to have anti-inflammatory properties. Curcumin has been associated with decreased inflammation in animals, ginger supplementation was associated with decreased pain and discomfort and valerian, commonly used as a sleep aid due to its relaxing properties, is helpful because poor sleep is common among RA patients.

When working with an RA population, fish oil is probably the most frequently mentioned supplement. The standard western diet contains a low proportion of omega-3 type essential fatty acids (EFAs), which are said to have anti-inflammatory properties. Gamma Linolenic Acid (GLA). Unlike EPA and DHA, GLA is an omega-6 fatty acid. It is not naturally occurring in the diet, but can be found in several plant seeds, including borage, evening primrose and black currant.

As with many supplements, however, the risk for drug interaction and side effects should be considered and discussed in detail with the managing physician. 

Living with arthritis

Aside from doing what the doctor tells you to do, arthritis makes daily living a challenge. Creativity and resourcefulness often help to overcome obstacles, yet, dear reader, we cannot all be “Inspector Gadget.” Here is a simple and helpful fix to make it easier to manipulate small handle objects or tools 

• Enlarged/adaptive handles and grips
• Hand joint stiffness and pain can limit gripping of small or thin items. Enlarged grips make it easier to hold item handles by decreasing the required bending and joint strain in the fingers. Foam tubing and pipe insulation increase handle diameter while also providing you with comfort. These can be used for kitchen cutlery, utensils, tools, as well as for handles on other items, such as mops.

There are a great number of options out there; have fun while researching. Should you, dear reader, have a need for further information, reach out. 

References

UCLA Health. (n.d.). The sprint to an osteoarthritis cure has begun. Retrieved from [https://www.uclahealth.org/news/article/osteoarthritis-cure-injectable-arpa-h#:~:text=Osteoarthritis%2C%20the%20third%2Dmost%20common,United%20States%2C%20is%20currently%20incurable](https://www.uclahealth.org/news/article/osteoarthritis-cure-injectable-arpa-h#:~:text=Osteoarthritis%2C%20the%20third%2Dmost%20common,United%20States%2C%20is%20currently%20incurable).

Arthritis Foundation. (n.d.). Healthy living resources. Retrieved from [https://www.arthritis.org/health-wellness/detail?content=healthyliving](https://www.arthritis.org/health-wellness/detail?content=healthyliving).

Arthritis Society. (n.d.). Assistive devices for pain management. Retrieved from [https://arthritis.ca/treatment/pain-management/assistive-devices-resource](https://arthritis.ca/treatment/pain-management/assistive-devices-resource).

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