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Arthritis
Aromatherapist working with elderly clients will often be asked to treat the effects of arthritis. Even younger clients may be showing the first signs of the disease manifesting as aches and pains, repetitive strain type injuries, lower back, neck or niggling joint pain which comes and goes. There are many different types of arthritis requiring different approaches to care so it is important not to confuse the signs and symptoms.
Rheumatism
A general term used to describe any disorder causing pain in the muscles and joints.
Arthritis
A collective term used to describe inflammation of one or more joints caused by any of over 200 conditions, including rheumatic conditions and the more common conditions listed below:
Osteoarthritis
A degenerative joint disease and is the most common form of arthritis. It affects the smooth part of the cartilage attached to the ends of bones in order to help joints articulate more easily. It also affects the ends of the bones (subchondral), the membrane that encapsulates the joint, and muscles next to the joint. Osteoarthritis dries out the protective and lubricating properties of the cartilage which in turn starts to soften and crack. As a result, abnormal bone hardening can occur in the body's effort to repair itself, fluid can build up in pockets around the affected bone (subchondral cysts), and as the cartilage wears away, the bones rub together causing pain, stiffness, creaking and inflammation with eventual joint deformity. Diagnosis is made by case history, physical signs, symptoms, and X-ray of the affected joint.
Primary osteoarthritis is slowly progressive, usually occurs after middle age and affects mostly the weigh-bearing joints.
Secondary osteoarthritis can appear before middle age, is less common than primary osteoarthritis, and usually occurs due to some trauma (surgery, injury, cumulative repetitive straining on joints).
Rheumatoid arthritis
The most common arthritic disease after osteoarthritis. It affects mainly the joints of the knees, fingers, wrists, feet, ankles, shoulders, neck and hips, usually affecting both sides of the body symmetrically. It is an auto-immune disorder where the body starts to attack its own tissue and diagnosis can be achieved through a blood test and X-ray. The disease can come and go but is eventually progressive.
Rheumatic fever (acute rheumatism)
Can affect children and young adults and is the result of an infection. Symptoms include fever, rashes, joint pain, with complications which can affect the heart. Treatment is by antibiotics.
Treatments
Massage Acutely inflamed joints should not be massaged but temporary relief can be obtained by very light, fast circular brushing movements over the affected area to help interrupt pain signals and distract from the main source of pain. Deeper massage above and below an affected joint will help increase overall circulation and help distract from the pain area.
Elevating the affected limb will also help deter swelling and prevent inflammation from restricting the blood supply to the peripheral part of the affected limb.
Compress Inflammation
Essential oils recommended for arthritis pain can be applied as a light massage or on a compress or lotion. These include general pain-relieving oils which also have anti-inflammatory properties and recommendations for use with joint and muscular pain. Price et al. (1999, p235) suggests Origamum marjorana (sweet marjoram), Pelargonium graveolens (geranium), Juniperus communis (juniper), Coriandrum sativum (coriander), Melaleuca cajaputi (cajaput) (cajaput is also used as a primary ingredient for commercial muscle-rub), or Chamaemelum nobile (roman chamomile, Cymbopogen citratus, and Cymbopogen flexuosus (lemongrass), Lavender (angustifolia, intermedia), Aloysia triphylla (lemon verbena), Rosmarinus officinalis (rosemary), Pinus sylvestris (scots pine), and Cymbopgen nardus (citronella), Melaleuca viridiflora (naiouli), and for severe pain Syzygium aromaticum (clove bud), or Myristica fragrans (nutmeg). There will be other symptoms which need to be addressed when treating arthritic conditions such as depression and anxiety, depressed immune function, and possibly digestive problems associated with the side effects of conventional medication.
Infra-red heat can quickly penetrate deep tissues without the need for pressure massage. Heat stimulates blood flow, thus increasing oxygen and other immune responses to the affected area. Heat also serves to interrupt the pain pathway from the affected joint and can facilitate immediate pain relief. Infra-red heat appliances are low cost to acquire and should be part of the treatment regime of any serious practitioner. Some infra-red appliances have massage attachments which can be particularly useful to massage areas above and below the affected joint. Don't forget to take an extension lead and adaptor with you.
Medication If your client has consulted a GP about their problem, they probably will have been prescribed various anti-inflammatory medication, pain killers or even steroids. If they have not yet seen their GP, you must advise them to do so. Pain killers such as ibuprofens and aspirin are also anti-inflammatory and will help mask the pain as well as helping to reduce inflammation. They are not without side-effects however and can result in stomach irritation and long term use of steroids can decrease the body's own natural immune response which will further exacerbate the condition being treated (Theodosakis et al. 1997, p66).
Supplements supplements are not as interesting to the big pharmaceutical companies because they do not provide significant revenue from patents to make research into their use cost effective. There is 1 supplement however that is becoming more widely acknowledge as having a significant part to play in treating, and even improving arthritic conditions, namely Glucosamine sulfate.
Glucosamine Sulfate is a cartilage-building nutritional supplement that helps rebuild damaged joints, tendons, cartilage and soft tissue. Unlike pharmaceutical products that offer only symptomatic relief, glucosamine sulphate helps not only to reduce pain and inflammation, but also directly combats osteoarthritis by aiding normal repair and regeneration of ligaments, tendons, joint and bones and helping improve connective tissue elasticity and cushioning. For a report on glucosamine and other articles, go to the Arthritis Resource Centre.
In short-term controlled trials, glucosamine has been reported to be effective in relieving pain and increasing range of motion in patients with osteoarthritis (McCarty 1994). One four-week double-blind trial in 252 patients with osteoarthritis of the knee found oral glucosamine sulfate 500 mg three times a day more effective than placebo in relieving symptoms (Noack 1994). Another four-week double-blind trial in 200 patients with osteoarthritis of the knee found 500 mg of glucosamine sulfate as effective in relieving symptoms as ibuprofen 400 mg three times a day from the second week onward (Muller-Fassbender 1994). In a double-blind eight week study in 40 patients with osteoarthritis, glucosamine sulfate 500 mg three times a day orally was as effective as ibuprofen 400 mg three times a day in relieving pain after the first two weeks, and by the end of the trial was more effective (Vas 1982). In all reports, the drug was generally well tolerated. Gastrointestinal discomfort and nausea have been reported, but the incidence was no higher than with placebo.
Glucosamine is available in pharmacies and health food stores and is sometimes combined with chondroitin sulfate, a glycosaminoglycan that has been reported to maintain viscosity in joints, stimulate cartilage repair mechanisms and inhibit enzymes that break down cartilage (Pipitone 1991).
Side effects There are very few side effects with either of the above supplements and Glucosamine and chondroitin have been used for over 20 years in Europe without any complication. They can also be used with other supplements without fear of adverse interaction. Please look at my research page.
Dosage Recommended dosage varies (the Arthritis Information Centre recommends 1250 mg daily. The general view (supported by Theodosakis (1997, p53) is an initial dose of at least 1200 mg Glucosamine sulphate. Aspirin can supplement treatment for the first week if necessary to help reduce inflammation and relieve pain.
Not all glucosamine products are the same quality. Some are intended for animal pet consumption. Products that contain human grade glucosamine are much more likely to be of high quality and in a purer form and the the liquid preparations seem to be better tolerated for faster absorption and less minor gastric upsets in the stomach.
Arthritis Fact sheet
Glucosamine Fact
Sheet
Arthritis Resource Centre - a commercial site offering pharmaceutical
grade glucosamine
Jane Ellwood
September 2000
References
McCarty M F (1994) The neglect of glucosamine as a treatment for osteoarthritis: A personal perspective. Medical Hypotheses 42:323Muller-Fassbender H (1994) Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage 2:6
Noack W (1994) Osteoarthritis Cartilage 2:5
Pipitone V R (1991) Chondroprotection with chondroitin sulfate. Drugs Experimental and Clinical Research 17:3
Theodosakis J,. Adderly B, Fox B (1997) The Arthritis Cure London: Century Books
Vas A L (1982) Double-blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulphate in the management of osteoarthritis of the knee is outpatients. Current Medical Research and Opinion 8: 145
Further information
American College of Rheumatology website: http://www.rheumatology.org/patients/hotline/970127.html
Arthritis Foundation website: http://www.arthritis.org/resource/statements/glucosamine.asp
Basleer C (1992) International Journal of Tissue Reaction 14:23.
Duke, J. A., Ph.D. (1997). The Green Pharmacy. Rodale Press, Penn.
DietNet - lots of information on nutrition and diet and their effect on health and illness
Edmonds SE; Winyard PG; Guo R; Kidd B; Merry P; Langrish-Smith A; Hansen C; Ramm S; Blake DR (1997). Putative analgesic activity of repeated oral doses of vitamin E in the treatment of rheumatoid arthritis. Ann Rheum Dis (England), 56 (11) p649-55.
Encyclopaedia of Health Concerns trials
McAlindon TM, LaValley MP, Gulin JP, Felson DM (2000). Glucosamine and Chondroitin Sulfate for Treatment of Osteoarthritis: A Systematic Quality Assessment and Meta-analysis. JAMA; 283:1469-1475
National Institute for Arthritis and Musculoskeletal and Skin Diseases
National Center for Complementary and Alternative Medicine website
NIH Office of Dietary Supplements website
Nutrition News Focus website
Peirce, A (1999) The American Pharmaceutical Association Practical Guide to Natural Medicines. William Morrow and Co., New York.
Qiu GX, Gao SN, Giacovelli G, Rovati L, Setnikar I Arzneimittel-Forschung (1998). Efficacy and Safety of Glucosamine Sulfate Versus Ibuprofen in Patients With Knee Osteoarthritis at Medscape
Setnikar I (1991) Antiarthritic effects of glucosamine sulfate studied in animal models. Arzneimittelforschung 41:542
Somer, E., M.A., R.D. (1995). The Essential Guide to Vitamins and Minerals. 2nd edition, HarperCollins, New York
Towheed TE, Tassos PA (2000). Glucosamine and Chondroitin for Treating Symptoms of Osteoarthritis JAMA;283:1483-4.