The most common cause of joint pain in the United States is osteoarthritis, followed by other inflammatory joint diseases including rheumatoid arthritis and gout.
Although there are reliable lab tests, otherwise known as biomarkers, for rheumatoid and gout, currently there is not a test specific to the most common condition leading to joint pain in our country.
Radiographic, or x-ray, findings and grading systems have been developed as the default test to look at the structure of the joint, and to then quantify the severity of the disease. The severity on grading than becomes a suggestion of how likely it is that you are being affected by what is seen on the x-ray.
Sounds similar to the example of your genetics being solely responsible for what becomes of you in time. You already learned that this is not completely true anymore, as much of what becomes of you is firmly in your control. You have the ability, to a significant degree, to illuminate the path of health that you follow.
X-ray technology no question was a major accomplishment in medicine. We could now look into (or more correctly through) your body to see structural problems that clinically we knew were there, but couldn’t see. However, there is so much more happening at the cellular and tissue level of the joint that can not be quantified or seen by a single snapshot, or x-ray, of the joint. The x-ray tells us very little about the biology, physiology, or what I will refer to as the chemistry in the joint. It is the chemistry that may be largely responsible for the joint pain making you miserable.
Don’t take this the wrong way. What is seen on your x-rays will certainly guide my treatment. If there are already radiographic findings of significant damage, this tells me that the chemistry has also been significantly altered, and the potential for destructive degenerative aging within the joint is much greater. It tells me we must be aggressive with your treatment to prevent further destruction putting you on a near certain path that will lead to surgery or joint replacement at some point in your life.
So let’s take a deeper look at the chemistry of your joints, to understand why we will need more information than an x-ray in order to uncover the root cause of your joint pain. It is this chemistry that is unique to you, and cannot be altered with generic treatment of symptoms.
If we take knee joint osteoarthritis as an example, all of the articular tissues including the cartilage, subchondral bone (SCB), or bone beneath the cartilage, synovium (lining of the joint), intra-articular fat, meniscus, ligaments, and surrounding and supportive muscles can be affected by the pathology associated with the disease. It has long been known that the failure of these individual tissues can cause pain, but we now know that the “crosstalk” between the tissues is even more likely to be an even bigger factor in disease progression and pain.1
This “cross-talk” is very complex, and nerds like me find it fascinating. You will want to understand this as well, and I will help you, because there in this chemical crosstalk we will find the factors that we can identify and treat.
The treatment approach I use will greatly and positively influence what will become of your joints in time. I will prove this to you.
First, in complete disclosure, I have to inform you that this is not an approach by which your symptoms are treated, i.e. the current “treatment” of osteoarthritis. That approach has not changed dramatically in several decades. There have been some advancements over the years in regards to the medications used to treat the symptoms – with the focus being to reduce (but not eliminate) potential side effects – but not much else has changed.
Before I go on, do you remember Vioxx?
This was an “arthritis medication” approved by the Food and Drug Administration (FDA) in 1999. It was released to the public with great fan-fare as a medication that could treat the inflammatory symptoms associated with osteoarthritis. I like many other physicians at that the time, began prescribing this medication, as well as a couple other similar medications released shortly thereafter, to many of our patients. And are patients confirmed just how great this drug was working for their symptoms.
It also had the added benefit that it was more selective to not inhibit an enzyme (cyclooxygenase, or COX-1) important for protection of the gut lining. Prior to this, all synthetically produced, over the counter and prescription anti-inflammatory medications were non-selective anti-inflammatories. This means that not only would they inhibit the COX-2 enzyme, known to mediate the synthesis of inflammatory chemicals associated with inflammation and pain, but also they would also unfortunately target the COX-1 enzyme.
This was very problematic.
Although these medications might help dramatically with symptoms, patients had to deal with varying degrees of stomach upset and other GI side effects. The most significant side effect being formation of stomach or small intestine bleeding ulcers, and at times these bleeds could (and still do) lead to death.
[In fact, it is estimated annually that at least 100,000 patients in the U.S. alone are hospitalized with serious GI side effects, and 20,000 deaths are directly related to anti-inflammatory medication use.]
At that time worldwide, more than 80 million people were taking this medication, and it was hailed as “the miracle drug” physicians were waiting for to more safely treat the symptoms of disease without a true cure.
On September 30th, 2004, just 5 years after the release of this “miracle drug”, the parent pharmaceutical company, Merck, voluntarily withdrew the drug from the market. The reason behind this was concerns that the drug could be contributing to increased risk of heart attack and stroke when taken for extended periods of time. And since nearly every patient was taking this medication over extended periods for chronic pain related to osteoarthritis, this potential side effect could impact millions of patients over time.
On the surface, this sounded very noble, as at the time this was the most widely utilized drug to ever be removed from the market. In just one year prior to the drug being removed from the market, the company turned sales revenue of $2.5 billion in the United States alone.
The nobility of the drug company for taking this incredible financial hit was short-lived. The novelty of this drug, as the “cure for arthritis” was also forever tarnished when information became public that the company had withheld case reports of side effects being experienced with the medication. This information was withheld from prescribing physicians and the millions patients taking daily doses of this medication. Over five years on the market FDA analysts estimated that this drug directly contributed to between 88,000 and 139,000 heart attacks, 30-40% of which were fatal. 2
Adding to the insult, additional information brought forward in 2009 showed that the author of 21 studies showing how effective this drug was for pain, had actually fabricated his data.3
I remember this time distinctly as this outright fraud, coupled with corporate greed at the expense of patients, shook the scientific foundation of medicine. I believe this was also a tipping point for the healthcare consumer. They began to more seriously question their health care providers, including me. I had no problem with this. I actually welcomed this approach, as I was trained to look at the patient-doctor relationship as a collaborative partnership.
The far-reaching effects from this pharmaceutical fiasco I believe also began to erode some element of trust in the medical system. This I saw unraveling in front of me with my patients, as well as what was seen in the news over the ensuing years, were mounting questions about the role of Big Pharma.
Were they driven by honest intentions to deliver better health through scientific discovery and pharmaceutical advancements, or were they driven by max profits at the expense of patients?
Medicine, and the view from both sides of the examination table, was forever changed, for patients and healthcare providers.
For me, it led down a path of discovery. To seek out and structure any and all treatments with the capacity to enhance and harness the healing capacity of your body – without the potential for commonly accepted or potentially catastrophic side effects.
My approach built over years of training, thousands of hours of research, and thousands of patient interactions is what I will share with you in these emails over the coming year.
This is not a “treat the symptoms” approach.
This is not a “pop a pill quick fix” approach.
This is not a “rail against Big Pharma” approach.
This instead is a comprehensive system of treatment that you deserve that seeks to treat the root cause of the structural failure and chemical cross-talk contributing to your joint pain.
The focus will be safe and sustainable treatments that are health enhancing with known side benefits, not potential side effects.
It is a system and a lifestyle to restore and regenerate the health of your body, and at the same time, the health of your joints.
To your best health in the coming year,we
- Loeser RF, Goldring SR, Scanzello CR, Goldring MB. Osteoarthritis: a disease of the joint as an organ. Arthritis Rheum 2012;64(6):1697-1707.
- Congress Questions Vioxx, FDA. PBS NewsHour. 11-18-2004.
- Winstein, Keith J. “Top Scientist Fabricated Data in Studies, Hospital Says.” March 11, 2009.