blackbird gorn

Oh, it's manageable enough. I try to avoid too many analgesics these
days anyway and it only gets bad if I've been doing a bit of awkward
work with manual or power tools. I pay for a couple of hours of that
with a few days of discomfort.
This summer's been good so far - I just downed tools a couple of months
ago and determined to have a pain-free period, which worked well. Now I
only do the small stuff which won't bring on too much aggro.
--
Dave
GS850x2 XS650 SE6a

"It's a moron working with power tools.
How much more suspenseful can you get?"
- House

 

I find that Glucosamine helps with my arthritis, but YMMV.

 

One of the problems of arthritis is that analgesics (NSAIDS) can give
temporary relief, but in practice attack the joints and make things
worse.

I fell foul of a 'healthy diet'. Having got blood-pressure problems, I
used to make myself have a huge salad lunch....I loved sweet peppers
and tomatoes, and used to pile 'em high. After about five months of
this I could hardly walk due to hip discomfort, despite being on max
dose of cod-liver oil, plus glocosamine. Biking was out as I couldn't
stand the pain in kick-starting the bike, or support the bike's weight
at e.g traffic-light stops.

After realising that foods of the solonacea family (tomatoes, sweet
peppers, aubergines, potatoes) were known arthritis agonists, I cut
out the first two from my diet. I don't eat aubergines, and have never
reacted badly to potatoes, but I don't eat that many anyway. It took
nearly a year before the hip-joint recovered, and I'm now back to
normal. But it meant *always* avoiding sweet peppers and tomatoes, in
whatever form. The latter are a bugger to avoid as they crop up in all
sorts of cooked dishes. These days, I can get away with one relapse
very infrequently - every few months, but any more than that and my
hip lets me know it!

It's a personal value judgement, but give sweet peppers and tomatoes a
miss for as long as you can. Max dose high-strength cod-liver oil, and
some glucosamine might help too. And tone down the NSAIDS if you can.

It's what works for me, and my hip-joint started playing up ~20 years
ago. YMMV....

 

Do you have a source for this "attack the joints" adverse effect? Something
peer reviewed, a Lancet article or such?

I take NSAIDs for my knee issue, in oral and gel form. I'm well aware of
potential gastrointestinal and renal issues.

My mother has arthritis. Her GP prescribes oral co-codamol and ibuprofen
gel. He doesn't like oral ibuprofen due to the gastro-risk. He's never
mentioned anything about the NSAID aggravating her joint problems.

Googling suggests your assertion is unproved
http://www.hopkins-arthritis.org/ask-the-expert/non-steroidal-anti-inflam-
012/degenerative-effects-of-long-t-442.html

For the case, I can find sites like this ambulance chaser
http://www.aws-law.com/nsaids-arthritis.asp

 

I'd be surprised. They don't protect against further damage, of
course, so it's entirely possible that one could jump to that
conclusion after a number of years.

--
_______
..'_/_|_\_'. Ace (b.rogers at ifrance.com)
\`\ | /`/
`\\ | //' BOTAFOT#3, SbS#2, UKRMMA#13, DFV#8, SKA#2, IBB#10
`\|/`
`

 

Rubbish. They don't 'attack the joints' at all. What they *do* do is
provide pain relief - which means you use the affected joint more
vigorously than the body wants you to (pain is the bodies way of saying
"don't do it"). This vigorous use leads to more damage (masked by the
painkiller) which then hurts like hell when the analgesia is removed.

And if you use a CNS-bound analgesic (like paracetamol) you also get
the 'rebound effect' where the pain signal has been ramped up because
the brain is ignoring the signal and when the paracetamol wears off the
effects of the increased signal are felt.

I've had psoriatic arthritis for about 7-8 years now. I *know* what
whole-body pain is like since it's affecting all my major joints as
well as my spine, hands and feet.

They don't seem to affect PSA. Which is fortunate since I eat quite a
lot of them (tomatos are good for diabetics - lots of complex carbs
without too many simple ones).

But make sure that you don't OD on the cod-liver oil. It's not healthy
in high-doses (too much vit. A).

And I agree with the cutting down on the NSAIDs - long experience has
taught me that overuse leads to them becoming ineffective (and in the
case of paracetamol a whole host over other things like increased
rebound pain). Things have to get *really* bad for me to take my
standard ibuprofen+codeine.

Phil.

 

As I said in my previous post they don't attack the joints at all. What
they do do is encourage you to put more loading on an already damaged
joint since the pain signal is masked by the painkiller. And it's the
loading that does the damage.

Phil.

 

I don't have access to The Lancet, so can't help there. The book that
I'm sure contains the allegation, if not the references, is crated up
and stored at my Mother-in-Law's - not a happy place to visit. A web
search for a review of the book doesn't mention its references. So at
the moment I'm stymied on providing a direct reference.

Slightly indirect evidence is that there are web references to NSAIDS
inhibiting the effects of naturally-produced anti-inflammatory
prostaglandins, and thus increasing joint pain from that source.

http://www.merck.com/mmpe/sec04/ch034/ch034b.html

"NSAIDs inhibit cyclooxygenase (COX) enzymes and thus decrease
production of prostaglandins. Some prostaglandins under COX-1 control
have important effects in many parts of the body (ie, they protect
gastric mucosa and inhibit platelet adhesiveness). Other
prostaglandins are induced by inflammation and are produced by COX-2.
Selective COX-2 inhibitors, also called coxibs, seem to have efficacy
comparable to nonselective NSAIDs and are less likely to cause GI
toxicity; however, they do not seem less likely to cause renal
toxicity."

[This article also suggests not taking two different NSAIDS at the
same time]

In that article, this comes out through clenched teeth:

"Substituting ?-3 fatty acids (in fish oils) for dietary ?-6 fatty
acids (in meats) may partially relieve symptoms by transiently
decreasing production of inflammatory prostaglandins."

....and yet the body's pathways to producing anti-inflammatory
prostaglandin I and III, as well as the inflammatory prostaglandin II,
is clinically proven; references in said book, I recall seeing them
specifically mentioned.

I also found this, which hints at research having been done:

"Fish oil

Unlike diet and vitamins, fish oil has been scientifically tested
against drug therapy. One study, carried out by L Skoldtsam at Kalmar
Hospital in Sweden, concluded that 10g of fish oil a day had similar
anti inflammatory qualities as NSAIDs. Another, by C S Lau of
Ninewells Hospital, Dundee, discovered in a double blind placebo study
that patients on the fish oil could reduce their NSAID requirements
without suffering any deterioration. However, it should be noted that
high doses of fish oil can lead to changes in white blood cell counts
and cause excess bleeding in the brain. "

ISTM that the key to joint condition is inflammation and its control.
The body produces pro-inflammatory Prostaglandin II, I think from red
meat or fats, and it can produce anti-inflammatory prostaglandin I and
II from e.g omega-3 and omega-6 oils. I am certain as I can be that
these are clinically proved. But the reference above says that
COX-type NSAIDS reduce prostaglandins (context suggests I and III) and
produces others (context suggests II).

I've only quoted one article in some detail,and I suspect it is
carefully written - they are in the business of making and selling
NSAIDS, after all. But even so, buried in there are references to the
pathways by which NSAIDS can negatively affect arthritic joints.

I'd like to come up witha single article with it all in, but doubt if
there is one.

I suspect many doctors don't know of this, or offer the only way
forward that they've got. i've never known a doctor refer a patient to
a nutritionist or dietician, and yet these apects can offer positive
benefits - even the Merck reference above says so, in a hedgeds-about
way (that doesn't seem to be referenced).

The problem here as I see it is that the Dietary Supplements vs The
Pharma Industry is almost a one-sided game, as there are huge profits
made by the one, and not a lot of money to be made by the other. this
is rather similar to the tobacco industry sixty years ago, where they
engaged the best scientific researchers in order to know what the
health problems were, knowing that 'the opposition' had no money and
no facilites to counter the smooth claims of the industry.
Fortunately, information is easier to come by these days - but that
makes the job of processing it harder.

I'm sorry I can't come up with a direct reference, but what is quoted
above suggests there is a known pathway by which NSAIDS can cause
joint problems.

 

Please see my reply to wessie, where I've tried to show that
prostaglandins can have postive or negative effects on the inflamed
state of the joint, depending on which prostaglandins are involved.

I don't doubt it.

I take the max dose, and a recent blood-test (unrelated) showed a
normal white cell count (as well as everything else being OK)

I'd agree with cutting down on NSAIDS if that's possible, but if
avoiding red meat, tomatoes, and sweet peppers, and taking cod-liver
oil might tip the balance in favour of a better outcome.

 

And you are aware that cooling the joint will also decrease
prostaglandins? Which is why applying ice-packs reduces swelling.

Which is why I was always taught to use heat/cold therapy - heat
increases the prostoglandins (and helps carry white blood cells to the
area of damage by vasodilation) and cold (reduces inflammation and
ramps down prostoglandin production). But *always* finish with cold
because longer-term production of prostoglandin is harmful to the
injury since they also inhibit platelet action.

Also in immune-error conditions (like psoriatic arthritis) you *do*
want to suppress prostoglandin production since that tends to minimise
the damage that the bodies own immune system is doing to the joint.

Since overdosing on vit. A. doesn't affect your white bloodcell count I
wouldn't use that as an indicator. Overdose of vitamin A ca (bizarrely)
lead to oseoporosis and problems with joints..

None of those have any effect whatsoever on psoriatic arthritis.

Phil.

 

There are two types of prostaglandin; inflammatory and
anti-inflammatory. The procedure you mention above would surely only
be effective if the heat brought the anti-inflammatory type to bear,
and the cold suppresed the pro-inflammatory type. This might happen, I
just haven't seen anything published about it.

Which prostaglandins is it of benefit to suppress, pro-, anti-, or
both?

It might do, depending on exactly which prostaglandin acts in which
manner.

 

There's 3 actually (according to pikiwedia). And which of the COX[1]
enzymes get blocked by the NSAID depends on the type of NSAID -
undifferentiated NSAIDS like ibuprofen or asprin block all 3 COX types
(which is why they can harm the stomach - one of the COX enzymes is
also responsible for helping to produce the mucus lining of the
stomach). Newer COX-2 inhibitors supposedly reduce the likelyhood of
this happening.

[1] Prostaglandins are the end-result of COX enzyme metabolism. NSAIDS
work by blocking this COX enzyme to a lesser or greater degree.
Ibuprofen (which I take) blocks all 3 COX enzymes. So there are hundreds
of different varieties of prostaglandin but they are all produced by
one of the 3 COX enzymes. Which is why they say that there are 3
'types' - one the prostaglanins produced by COX-1, one by COX-2 etc.

Whichever is produced by the COX-2 method (they are responsible for
mediating pain and inflammation). Which is why the COX-2 inhibitors
like Vioxx or vadecoxib are used instead (I was on vioxx for a while
until it got discontinued because of an increased heart-attack risk).

Empirically I can tell you it doesn't. Since the pain levels from PSA
don't vary between periods when I eat tomatos and when I don't.

Ditto for red meat (I don't eat peppers - I don't like the taste).

Phil.

 

At least you had a go.

The supplement v pharmacology disinformation battle is why I'm rather
sceptical about many claims. The sellers of supplements have created a
whole new pseudo-science that is reminiscent of those shampoo adverts from
the 1990s.

 

You're welcome. If I can find the book, I'll come back with the
references, I'm equally interested in following this up.

Interestingly, I've had a number of recent changes to my medication
for high blood-pressure. The original combination of beta-blockers and
thiazides was found to be implicated in causing the onset of diabetes.
The beta-blocker was dumped in favour of a calcium-channel blocker.
That worked for a couple of years, until it started turning me bright
pink and failing to reduce my BP. That was dumped in favour of a
different calcium-channel blocker.

I found after a few months on the new stuff that I was suffering a
raft of side-effects, some caused discomfort, others caused all sorts
of quietly-irritating probems. I only realised the scale of the
problem when under doctors orders I came off them for a short period.

My god, within a couple of days I could taste food again, my energy
levels were astronomic, other side-effects began to fade away,
including a mysterious tingly-numb left arm and fingers. Best of all,
my BP stayed down, mostly.

Yesterday, I saw the doc again and gave him the results. He wanted to
put me back on beta-blockers, FHS, which I resisted. Finally, he
prescribed the last shot in his locker, an alpha-blocker.

Frankly, I don't like the look of this, so I resolved to carry on for
now with something I'd alread started a few weeks ago: change of diet
and 'lifestyle'. Last night my BP had fallen to 135/74, a figure I've
never seen in the whole of my adult life - in which I used to have
annual medicals as part of my job, so I have a long history of knowing
my BP.

This morning I trimmed over a 100' of 6' high hedge, top, and both
sides, using a 400W electric trimmer, after which my BP was 145/86,
still low by historical standards.

The moral of this tale? I guess it's that as consumers of medical
care, we aren't always playing with a full deck of information.
Doctors have medications they prefer to prescribe, the pharma and
supplements industries have their own axes to grind. Somehow, we have
to find our own way through this. As a former research scientist, I
look upon things with a sceptical eye, but when I find something, e.g
cod-liver oil, that works for me, or medication that doesn't, I'll
accommodate that into the least-pertubing approach that I can see to
dealing with the problem. Sadly, not all areas of interest are
researched in a disinterested manner, and so an authoritative sort of
proof of efficacy of one thing or another might be hard to find.

Apologies for the long post.

 

Phil Launchbury wrote:

The problem is that dietary changes can take a long time to work
through - nearly a year for me after my tomato-and-peppers overload,
so any experimental change is going toneed to be a longer-term thing
rather than a day-to-day variation.

I've replied separately to wessie regarding a medication vs
diet-and-'lifestyle'(ugh) approach to a problem with high
blood-pressure, but similar things could be said re arthritis.

 

This mirrors my experience as a BP mong.

Similarly, my GP followed NICE guidelines and took me off the single tablet
a day (beta blocker plus thiazide).

First try: Istin - swollen ankles [1]
2nd try: ACE inhibitor - caused Angioedema [1]
3rd try: losartan plus thiazide
Final try: losartan, thiazide plus alpha blocker

This final combination seems to work. It's a bloody good job that drugs are
free in Wales.

I've tried the change of lifestyle thing. I never last more than about 2
weeks before resorting back to type.

[1] likely to be something genetic as my mum & sister had similar reactions

 

What the NICE guidelines fail to take into account is that everyone is
different..

When I gained my sugar-mongness I was put on the whole raft of stuff
(statins, BP reducers, anti-diabetic tablets) because "that's what
diabetics have". The fact that my BP was absolutely normal (120/80) and
my triglycerides & cholesterols were on the low side of normal disn't
seem to matter.

And I (surprise surprise) reacted badly to the BP reducing meds and the
statins.

And given that the NICE guidelines change every 6 months the GPs
!should! take them with a pinch of salt. But it's easier (and less
risky legally) to follow NICE.

Fortunately the GP practice owner is a pragmatic realist in these
things. Once I'd escalated my problem to him it got sorted ASAP.

Phil.

 

My oldest brother reacts badly to soya (or anything with soy-derived
compunds in like thickeners) with a lifespan of about 6 weeks on the
effect. So when I did my exclusion diet it was for periods of 8 weeks
starting with a base of fish and rice (I got *really* bored with fish
by the end of it! And fortunately it was while I still had a
fully-functioning glucose mechanism so I could tolerate large
quantities of rice) with gradual adding back in of stuff to test the
effect. In total it took well over a year before being back on a full
diet.

And nothing made any difference..

If only it were standard arthritis. It isn't - its a form of psoriasis
that attacks the synovial membrane round the joints.

http://en.wikipedia.org/wiki/Psoriatic_arthritis

I have the symmetric variety. Pre-treatment I was walking with a stick.
And (unless the increased dosage of sulphasalazine works or I move onto
something else) I'll be back there again fairly soon.

Phil.

 

Although the beta blocker link to diabetes is well proven

My blood sugar has reacted positively to the new drug regime. I was
heading towards type2 but a reversal seems to have taken place

GPs are expected to keep up with current research and act accordingly.
Following NICE guidance is part of that regime. New research is being
done all of the time. Should NICE ignore new findings just because they
contradict current best practice?

My GP is also pragmatic. He accepts that some of his patients are
capable of understanding elementary pharmacology. He's also very up to
date on current best practice and new drugs as a) he teaches post
graduates to become GPs at Cardiff Uni and b) sits on a number of
medication related panels e.g. All Wales Prescribing Advisory Group

 

Had to look that one up. Not nice...

I'm highly interested to hear about combination No. 3, as it
essentially represents my doctor's last shot before reverting to
something previously tried but dumped for one reason or another aka
making one ill.

ATM I'm on your No. 2, which I've been on since the start of all this
about eight years ago.

It's very early days here, but if it keeps up its current promise, I
might be able to avoid combination No. 3.

I also find a half-bottle of Australian red can bring down the BP
too...about as effectively as medication.

Is that free in Wales too ;-)

Ah, genetics....I think that's why all the males in the family here
seem to die of exploding heads aka stroke or heart attack.

Thanks for the very interesting info.