Sep 1, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I am smiling. Well, really grimacing. I am grimacing with my green, lumpy kale smoothie. Family vacations are harder than you'd think and Karma is a, well let's say I'm not always impressed with her sense of humor. My dad, turned 70 this year, so the four Dauphin Shewfelts (and Sheldon the dog), my parents from Pinawa and my sister and husband from Langley, BC met at a lodge south of Canmore in the Rockies. It was beautiful, but our plan each day was a hike. They lasted from 3 to 6 hours. They were multiple kilometers long and we had to climb 1000-2000 feet per hike. My triathlete sister thankfully stayed with the group and didn't chide us for being slow too often. This was the most exercise I can ever remember getting on a vacation. The food back at the lodge was very nice, but it was geared towards adults. I give Eric credit that he tried everything including the cold peach soup, the hot chickpea puree and the kale. But he did make the biggest face at the kale. And we made fun of him a bit. Karma has a good memory, though.

In the mornings after hiking, everything hurt. I don't have arthritis, but I felt like I did. My mom does have arthritis in her knees, so I was very impressed that she hiked every day. What is arthritis? Arthritis means inflammation of the joint. As the Arthritis Society points out, arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus. We are going to talk about the two most common types of arthritis: osteoarthritis and rheumatoid arthritis. Osteoarthritis (OA) is a complicated disease, but at its simplest, it is when the cartilage in a joint wears out and bone rubs on bone. Rheumatoid arthritis (RA) is an autoimmune disease condition in which the bodys own immune system attacks the lining of the joints.

If the joint wears out in osteoarthritis, what is a normal joint like? In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction. As cartilage wears down, bits can break off and go into the soft tissue around the joint and cause pain. I was surprised to learn that cartilage itself doesnt have any nerve endings, so it doesnt feel any pain. The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they werent designed to because of the cartilage break down. When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs.

What symptoms might I have with osteoarthritis? Pain, stiffness and swelling around a joint that lasts longer than 2 weeks. Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes. Although there can be swelling around the joint in OA, it is usually less than that expected in rheumatoid arthritis. The joints usually affected are the hips, knees and spine. Finger and thumbs joints may also be involved.

Rheumatoid arthritis (RA) is an autoimmune disease condition in which the bodys own immune system attacks the lining of the joints. The first symptom a patient might notice is pain in the hand or foot joints but can also affect other joints. Unlike osteoarthritis, in rheumatoid arthritis, morning stiffness usually lasts longer than 30 minutes. The pain of RA can be in 3 or more joints at the same time. (Often osteoarthritis effects only one joint like a knee.) The pain from RA can last all night long. The pain from RA can be symmetrical on both sides of the body. That means, for example, both your wrists are sore. Other symptoms a person might experience include fatigue, dry eyes, dry mouth, fever and/or chills. RA can cause the immune system to attack other internal organs like the eyes, lungs and heart.

Treatment for both types of arthritis often starts with non-steroidal anti-inflammatory drugs or NSAIDS like ibuprofen, diclofenac or naproxen. These medications can work well for the pain and inflammation but have side effects like stomach upset, risk of ulcers, and risk of increasing blood pressure. In osteoarthritis sometimes synovial fluid replacements can be injected directly into the joint and help lubricate it. It can be effective. It is used most often on knees and it is expensive. In rheumatoid arthritis the bodys own immune system is attacking the joints. The most common medication to calm the immune attack in mild RA is hydroxychloroquine and is generally well tolerated. For moderate RA, methotrexate once a week is very common and seems to work very well. Because these drug must modify the immune system, they can take 6 weeks to 6 months to work.

My daughter, the new Co-op store and Karma conspired against me. Emily actually enjoyed the kale we ate on vacation. My sister told Emily that she made kale chips by covering them with olive oil, spices and cooking them on a cookie sheet. Emilys version turned out okay. Then Emily found a kale smoothie recipe in the new Coop flyer. She went to Coop and bought the kale, hemp seeds, bananas, coconut water and other super-foods in the recipe. They all went in the blender. And we are back to me posing for a kale smoothie pic. Emily wanted to send her Auntie Michelle the picture. Now, I have to drink the green, lumpy goo. Karma, I'm really sorry I made fun of Eric for making faces at the veggies he didn't like. I guess I've run out of excuses. And it tastes like....bananas. Phewww...

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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