Gout is a form of inflammatory arthritis. In gout, crystals of uric acid is deposited in and around the joints. For this deposit of urate to occur, the circulating level of uric acid in the blood must be higher than normal.

Gout has been recorded through the centuries. Hippocrates wrote about it and urate crystals were found in the big toe of an Egyptian mummy.

Gout is more prevalent in males and high in affluent societies. This may be a dietary factor. In the old days the rich ate the expensive red meat while the poor could only afford grain. Guess who developed gout?
Acute gout is rare in pre-menopausal women and it is predominantly a male disease up to the age of 50. It usually starts after 30 years of age and more commonly between 40 and 50 in males. In women the first attack is usually between 50-60 years.

The first attack of gout is usually in the big toe and this is called Podagra. 70-90% of first attacks present this way.

Pain often develops at night and within a few hours the pain level can escalate to severe and throbbing. The big toe will become red, hot, swollen and very tender to the touch. This acute attack will resolve spontaneously but can take weeks. Medical intervention often shorten this episode.

After this first attack your doctor is not likely to start you off on long term medication because you may not get another attack for years. On the other hand, you could have another attack in days.

Dr. Phil Hariram,

Arthritis Guide.

Magnets were discovered in China and Greece. In China it was used in fortune telling and as a guide to building. By 1200 AD they were used in ships as compasses. Ever since, sailors and navigators have used compasses and the earth’s magnetic field to guide them in their journeys, whether on land or at sea.

Legends have it that Magnes, the Greek shepherd discovered the magnetic properties of lodestone when his iron staff was stuck to the lodestone and he was unable to dislodge it. Another legend has it that magnets were discovered in Magnesia, a place in Turkey.

Traditional Chinese Medicine which dates back to 2600 BC used magnetic stones on certain areas of the body to correct imbalance. The Vedas, dating back to 1500 BC, mentioned the use of lodestone in healing. The dead were buried with the head facing north to create harmony between the body and the earth.

Thales, a Greek philosopher, described the magnetic effects of lodestone in the seventh century BC. When St. Augustine arrived in Britain in the sixth century, he noted that lodestone was being used.

Compasses were developed where the lodestone was suspended by a piece of string, then later by a piece of wood in water. This was subsequently replaced by the dry suspension magnets.

In 1269, Pierre de Maricourt mapped the magnetic field around the lodestone. William Gilbert in the sixteenth century recognised the two poles, north and south. He also described the healing properties of magnets. Gilbert realised that iron rods left in a north south direction in alignment with the earth’s magnetic field, became weakly magnetised after 20 years. He suggested that lightning could magnetise iron. He also found that if a blacksmith heated an iron rod, and cooled with the rod lying in a north south direction, it becomes magnetised if the blacksmith hammered it while it is cooling.

The horseshoe magnet was developed by bending a straight iron magnet into the shape of a horseshoe. With the north and south poles so near to each other, the power of the magnet was doubled.

Iron magnets were heavy. Lightweight powerful magnets were soon developed. In the eighteenth century, carbon steel magnets were developed. It retained its magnetism better than beaten iron.

The first alloy containing magnet was developed in the early twentieth century and contained cobalt, tungsten, molybdenum or chromium. The next development was in the 1930s when iron was alloyed with aluminium, nickel and cobalt. These magnets were called Alnico magnets. These magnets were still metal based and therefore heavy to use.

In 1980s, magnets incorporating cobalt and samarium were used. They were the rare earth magnets. They were lighter and were used in industry. They were, however, expensive. In 1983, magnets using iron, boron and neodymium were produced. They were called Neodymium Magnets. They are very difficult to demagnetise and will remain magnetised for several decades. The process by which neodymium magnets were developed is called sintering. High temperature and pressure are applied to the powdered metals. This, however, means the magnets are brittle but this can be overcome by using a strong metal casing. A Neodymium magnet of say 8000 gauss weighs 20 gm while the comparable strength Alnico magnet weighs 90kg.

In the nineteenth century, Hans Christian Oersted, professor of physics at Copenhagen discovered that an electric current developed a magnetic field. In 1830s Michael Faraday and Joseph Henry independently discovered that a magnetic field produced electricity.

James Clerk Maxwell, a British physicist developed the Cork Screw Rule for calculating the direction of electrical flow when an object is moved in a magnetic field. In 1820 Andre Marie produced a mathematical relationship between electricity and the strength of the magnetic field.

Franz Anton Mesmer was the eponymous Viennese psychiatrist who developed the theory of animal magnetism. In his magnetic seances, Mesmer placed individuals in a magnetic tub, and made them relax. He then touched them, sending them into a trance. When they woke up, they were cured.

Pierre Curie discovered that magnets lose their magnetism above a specific temperature. This is now known as the Curie point. Edward Purcell & Flix Bloch developed a way to measure the magnetic field of nuclei. This led to the development of the MRI (Magnetic Resonance Imaging) scan.

In the 1960-1970 superconductors were developed. Magnets were cooled to absolute zero. These magnets can generate fields up to 200,000 gauss. It is used today in nuclear research.
Dr. Phil Hariram.

Arthritis Guide.

There are many arthritic patients and sufferers in pain that use magnets. Some are very certain that the magnets they are using are a great help.

There are no large controlled clinical trials to evaluate the benefits of magnets on arthritis.

Doctors in general do not think they work to relieve pain in arthritis. There are, however, amazing anecdotal evidence. There are stories that seem too good to be true.

A friend of mind, Steve, has severe back problems. He has a prolapsed intervertebral disc.
He could not stand for long and often made his journey to the toilet on all fours. After a MRI scan and other tests, his orthopaedic Surgeon told him he needed surgery.

A friend introduced him to magnotherapy. He placed a powerful booster magnet directly over the prolapsed disc. Within a week he was up and about. Today he wears a magnetic bracelet and although his disc is still out, he can do most things with care.

Experts think that a magnet placed over an artery will improve the oxygen carrying capacity of blood. This encourages faster healing. This theory is used in horse racing. Injured horses are fitted with magnets to speed up recovery and get them back on the track in the quickest time possible.

The most recent trial results showed that there was no real benefit from using a magnetic bracelets. The only benefits were placebo effect. The proponents argue that the improvements in animals confirm the benefits are not just placebo. They site circumstances where animals have made significant improvements after a magnet was fitted. A dog that needed to be lifted up unto the back of the car was able to leap in after having a magnetic collar, and many more similar stories.

Magnets are safe to use. The drugs that are used to help control pain and stiffness in arthritis come with risks. Often with magnets from a reputable company you get your money back within a specified time. If it does not work send it back.

The new alloy deodymium magnets retain their magnetic properties for 100 years. So one magnet will last a like time as long as you do not lose it.

Trial Results.

Here is a brief summary of a trial result published in the British Medical Journal (BMJ).

Randomized controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee.

Tim Harlow, Colin Greaves, Adrian White, Liz Brown, Anna Hart, Edzard Ernst

BMJ 2004;329 (18 December), doi:10.1136/bmj.329.7480.0-b

Abstract

Objective: To determine the effectiveness of commercially available magnetic bracelets for pain control in osteoarthritis of the hip and knee.

Design: Randomized, placebo controlled trial with three parallel groups.

Setting: Five rural general practices.

Participants: 194 men and women aged 45-80 years with osteoarthritis of the hip or knee.

Intervention: Wearing a standard strength static bipolar magnetic bracelet, a weak magnetic bracelet, or a non-magnetic (dummy) bracelet for 12 weeks.

Main outcome measures: Change in the Western Ontario and McMaster Universities osteoarthritis lower limb pain scale  (WOMAC A) after 12 weeks, with the primary comparison between the standard and dummy groups. Secondary outcomes included changes in WOMAC B and C scales and a visual analogue scale for pain.

Results: Mean pain scores were reduced more in the standard magnet group than in the dummy group (mean difference 1.3 points, 95% confidence interval 0.05 to 2.55). Self reported blinding status did not affect the results. The scores for secondary outcome measures were consistent with the WOMAC A scores.

Conclusion Pain from osteoarthritis of the hip and knee decreases when wearing magnetic bracelets. It is uncertain whether this response is due to specific or non-specific (placebo) effects.

Dr. Phil Hariram,

Arthritis Guide.

At the American College of Rheumatology Congress, reassuring information was released on repeat treatment of rheumatoid arthritis by MabThera or Rituxan (rituxmab). Further improvement of quality of life was achieved by a second course of rituximab.

Professor Keystone, University of Toronto, Canada said, “With further analyses, we are able to evaluate just what MabThera can deliver with subsequent treatment courses for patients who have an inadequate response or intolerance to one or more TNF(Tumour Necrotic Factor) inhibitors. Patients are telling us they feel better and their quality of like has improved significantly. This is supported by clinical outcomes.”

156 patients who had poor response to Tumour Necrotic Factor inhibitors were given MabThera. The second course showed further improvement of rheumatoid activity and remission.

Rituximab is a monoclonal antiboby that specifically acts on B-cells. B-cells are important in the inflammatory process of rheumatoid arthritis.

Rituximab was approved by the FDA in 1997 for the treatment of B-cell non-Hodgkin Lymphoma.

Adverse effects were reported to be fever, nausea, headache, weakness and chills.

There has been reports of serious side effects on infusion treatment with this drug. The manufacturer, Genentech Inc. reported 70 cases of serious infusion reactions in 12,000 to 14,000 patients on rituximab.

Dr. Phil Hariram.

Arthritis Guide.

Cervical spondylosis is a degenerative condition of the cervical spine.

Thirty five percent of us have had neck pain at some time or other but in most of us the pain was transient and disappeared in time. In some cases, however, this is not the case.

Movement of the neck is a complicated process involving the bones of the cervical spine, ligaments and muscles. It is not surprising that the neck is susceptible to injury and pain.

X-ray confirms the bony problem resulting in pain but a curious finding is that 80% of patients with no symptoms had abnormalities on x-ray, and it is not unusual to see x-ray abnormalities in the neck in the over 30s.

A common cause of neck pain is cervical spondylitis. This is like arthritis of the spine in the neck. Bony growth develops on the vertebral bodies. They are called osteophytes and the moving joints may become involved. There may also be intervertebral disc degeneration.

Progressive arthritis might lead to pressure on the nerves and the artery (the vertebro-basilar artery). This can lead to problems with swallowing, visual problems and vertigo.

With cervical spondylitis, pain is present. There may also be referred pain in the face and chest. There may be restriction of movement, pain on movement of the neck and stiffness.

Cervical spondylosis is more common in the lower cervical vertebrae but can be in the upper spine. In this case a patient can develop headache mainly in the back of the head (Occipital).

Dr. Phil Hariram.

This form of arthritis treatment is increasing in popularity and more health food shops are stocking their shelves with alternative treatment for arthritis. There are many reasons why sufferers are turning to this form of treatment.

Conventional medicine is not providing the expected benefits patients want. Ideally I would expect for arthritis a drug that will work effectively to control pain, stiffness and swelling without any concerns about side effects. In reality the picture is different.

Patients are concerned about the potential side effects. Drugs that work well for pain control for years, are suddenly withdrawn because of serious side effects and makes a sufferer suspicious of conventional drugs. Some drugs are re-introduced on the proviso that the benefits outweigh the risk.

Some analgesics have addictive potentials. NSAIDs can cause gastric bleeds and the newer COX2 inhibitors can cause heart problems.

There is nothing wrong with complimentary medicine but be well informed before you use them.

I have used acupuncture on my patients with pain. The only serious risk from acupuncture is a punctured lung. If your acupuncturist sticks a needle on your chest wall for arthritic pain, then question his credibility.

I have used acupuncture for backache and I have had some amazing results. One day I will post these individual results but I can reassure you that everyone with backache who had acupuncture from me had some improvement.

There are a wide range of complimentary therapies available. They include homeopathy, herbal medicine and Traditional Chinese Medicine. Then there are treatments such as massage, aromatherapy and reflexology.

If you are looking for a way to control pain, stiffness or other problems with arthritis, you could waste a lot of time and money looking for a solution.

Please make an informed decision on what you want to do. My blog will give you information but it is up to you to decide what treatment option to go for.

Dr. Phil Hariram,

Arthritis Guide.

Winter poses a few problems for patients with arthritis especially arthritis of the hips and knees. Your driveway, the pavements and the roads are often wet and slippery. Early morning frost or ice on the road is also a problem. There is a risk of slipping and falling.

In addition the cold weather may increase stiffness and pain. I live in England and although it is not that cold here, it is very damp. Many arthritic patients have increased pain and stiffness and a few who go off to warmer climate such as Spain admits that their pains and stiffness are a lot less.

Although there is no concrete evidence that weather has an impact on the symptoms of arthritis, anecdotal evidence is different.

Dr.Hollander did a trial to assess the effect of temperature, humidity and atmospheric pressure on arthritis. He found that there was more joint pain and stiffness in high humidity and lower pressure. Weather only affects the symptoms. It does not have any affect on the disease itself.

Elderly arthritic patients who have moved to Florida will tell you that their arthritis feels better. The facts really is that they are having fewer symptoms.

If you can move to warmer drier climate that is fine. For various reasons not all of us can. I personally prefer to stay where I am. So in winter make sure you are kept warm. You may be inclined to do less in winter. Remember exercise is good for your joints and muscles. Inactivity may increase your pain and stiffness. You do not need to go outdoors to exercise. There are lots of exercises you can do indoors. If you like walking but you are worried about the risk of slipping and falling, get an exercise bike.

Remember that in winter there is less sunshine and your body will not manufacture enough Vitamin D to keep your bone strong. Make sure your consume foods rich in Vitamin D or if necessary take a supplement.

Dr.Phil Hariram.

Arthritis Treatment.

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When the level of uric acid in the blood is too high, gout can develop. It was known as the patrician’s malady in the past because it was considered a disease of over indulgence amongst the wealthy.

High purine diet can affect gout and red meat is high in purine. The rich ate red meat while the poor could only afford grain.
Gout is predominantly a male disease up to the age of 50. It usually start around age 30 and the highest incidence is between 40 and 50 years. In pre-menopausal women, it is rare.

Gout can be classified as primary and secondary. In primary gout the body either produces too much uric acid or it cannot excrete it effectively to maintain a normal blood level. These patients benefit significantly from dietary changes.

Secondary gout develops as a result of other factors. Some medical conditions can raise uric acid level and trigger gout. These include renal disease and myeloproliferative disorders. In leukaemia, the imbalance is due to excessive production of uric acid, and in renal disease the excretion of uric acid is impeded.

Drugs can affect blood uric acid levels. These include diuretics especially thiazide diuretics, aspirin and cytotoxic drugs. Gout is also linked to obesity and alcohol.

Hippocrates wrote about gout as a disease of males and post-menopausal women and urate crystals were found in the big toe of an Egyptian mummy.
Acute gout often develops during the night. 70-90% of acute gout develops in the big toe and typically affects the first metatarso-phalangeal joint. This is called podagra. Within hours the pain becomes severe and throbbing. The big toe swells up and can feel hot.

It is extremely painful to the touch and even the touch of the bed sheath can induce excruciating pain. The acute episode resolves on its own but can take over a week. Medication can shorten this time.

Since the introduction in 1951 of probenacid and allopurinol in 1963, chronic gout is rare apart from non-compliant sufferers. Before these drugs were introduced chronic gout caused severe distress. Acute gout was frequent and severe. In addition urate crystals separated out into other joints, kidneys and other organs leading to polyarthritis, kidney stones, heart disease and tophi.

Diet and weight loss has an important role in gout management. A low intake of purine can reduce blood urate level by up to 20%. Foods high in purine are meat especially liver and other organ meat, sausages and other processed meat, seafood, milk, eggs and certain beans. Alcohol increases the possibility of gout. Beer is the worse culprit. It contains guanosine. This chemical is converted by the gut flora into uric acid.

Today, with screening and tests done regularly and even for insurance purpose, we are seeing a group of individuals with high uric acid without any signs of gout.

These people need to be monitored. Once all potential factors that can influence gout are eliminated or reduced and diet and weight loss in place, if the uric acid level remains high, then maintenance therapy in the form of allopurinol is recommended to keep the blood uric acid level within the normal range. This stops urate crystals separating out into important parts of the body.

Dr. Phil Hariram

Arthritis Treatment.

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Patients with Rheumatoid Arthritis should benefit from the new range of drugs called Tumour Necrotic Factor Inhibitors (Anti-TNF).

Tests on three of these new drugs slowed progression and reduced symptoms by up to 50%.

Research at the Medical University of Vienna, Austria, has shown that these three drugs are most effective in combination with the standard treatment, methotrexate.

In their published article, the team said, “The emerging agents show that a new era has started in the treatment of Rheumatoid Arthritis.”  UK expert, Paul Emery said, “They are strikingly effective and they work  on different targets from the existing drugs. That’s the joy of it.”

The three drugs in the trial are MabThera (rituximab), Orenca (abatacept), and tocilizumab.

These drugs are, however, not cheap. It is estimated that it will add around £250 million to the NHS drug bill.

Rheumatoid Arthritis is a debilitating joint disease and develops when the immune system attacks the joints causing destruction, stiffness and pain. It is estimated that there are about 400,000 rheumatoid arthritis patients in the UK.

Orenca was the first drug to target T cell in blood and tissue. Other Anti-TNF drugs are Enbrel (etanercept) and Remicade (inifliximab).

As these drugs affect the immune system, there is a higher risk of infections. They can cause headaches, fevers and increase blood cholesterol.

Ailsa BOSWORTH of the National Rheumatoid Arthritis Society said, “It means that we have some choice, and that’s very important if you are 22 and facing a lifetime of the Disease.”

Dr. Phil Hariram.

Arthritis Treatment.

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The main feature of GERD is chest pain. This pain is easy to recognise if it is just heartburn. GERD, however, can produce a deep pain that radiates into the back or side. This pain is not easy to differentiate from pain of cardiac origin.

In heart pain (angina pectoris), the pain is a tightness across the chest and feels like a weight or a heavy pressure inside the chest. It can feel like the chest is being squeezed or crushed. You may notice a degree of breathlessness.

GERD pain, however, is sharp like a knife cutting through. It can come in waves like colic and shoots across the chest and worsen when the chest is pressed or you move position. This is not the case in angina. Unlike angina the chest pain from GERD can be persistent.

The heart is on the left side of the chest and angina pain often radiates into the jaw and left arm. The pain is usually in the central chest or to the left. It is rarely on the right hand side of the chest. Esophageal pain is almost always central.

Heart pain tends to develop following exercise and  goes away following rest. On the odd occasions, however, certain exercises can increase intra-abdominal pressure and trigger chest pain due to acid reflux but this is not common. Acid reflux pain is relieved by antacids. Heart pain is not.

If your pain goes away while still exercising it is not likely to be angina. If rest is the only way you get relief, then angina is likely.

If you suspect your chest pain is due to your heart, seek medical advice as soon as possible.

Dr. Phil Hariram.