Monday, 29 June 2009

Arthritis and gum disease?

If you went to see your general practitioner and started talking simultaneously about having painful bleeding gums and arthritic knees, what do you think their response would be?
Are they the laid-back type who might ask you about your general health and suggest a multi-vitamin supplement with glucosamine? Or maybe they politely stifle a laugh and try to reassure you that this is a pure coincidence.
If you persisted in telling them you believed the two things were linked - maybe you had some jaw pain with the inflamed gums as the same time as the knee pain - how would they respond? Their body posture might become more defensive and they may lean seriously over the desk in a way which reassures you who the medical expert is.
If they agreed to treat both symptoms, it is likely you would walk out of the consulting room with two separate prescriptions; one for the mouth, the other for the knee pain.
Unfortunately most of our doctors are not scientists. And of course none of them have time to spend examining medical research journals - there are far to many of them. So they won't have read the Journal of Periodontology 2009, Volume 80, No.4.
There is a direct link between treating gum disease and improving Rheumatoid Arthritis, a joint study by periodontology, rheumatology and epidemiology specialists have concluded. They have given clear evidence to back up similar recent studies revealing this possibility.
Surprisingly, arthritis patients who received dental hygiene treatments, such as scale removal, and also advice on maintaining their oral health, subsequently found their arthritic symptoms reduced significantly.
The positive results were the same even between those on standard medical treatment for RA and those receiving the cutting-edge anti-tumor necrosis factor-alpha treatment. Who would have thought going to the hygienist regularly would keep arthritis at bay?
From looking at the abstract of this research it is not clear why such a link might be made. But all those gleaming TV ads for dental products show one thing - there is money to be had for research in to those nasty bacteria which cause dental disease.
Conversely there is not much money around for investigating a bacterial cause for arthritis.
Would a drug company spend money on investigating something with possibly wide-ranging epidemiological causes? I don't think they would rush to innovate and develop new drug patents for what could be a non-specific target market.
This area of research faces 'multiple challenges' according to a study in Current Opinion in Rheumatology (Epidemiologic approaches to infection and immunity: the case of reactive arthritis: Rohekar, Sherry; Pope, Janet). The Canadian researchers were aware of the 'significant evidence that infection and arthritis are linked' and reviewed all the current studies relating to the specific condition Reactive Arthritis (ReA).
Connections to ReA have been established from outbreaks of gastroenteritis and from other, less obvious, bacterial infections. The nastier the infection, the greater the risk of getting ReA apparently.
More careful epidemiological studies are going to be necessary, the researchers concluded, particularly as higher rates of self-reported cases of arthritis have been discovered in the population than first thought.
So, if you have a set of symptoms that seem completely unrelated, push for your doctor to take a holistic view - and book a visit to the hygienist just in case!

Friday, 12 June 2009

A modern parable for the chronically ill

A security guard is sitting at his desk, a couple of token CCTV screens in front of him. In this very quiet building the security desk is tucked to one side, away from the gaze of people passing by.
Not much happens so it is unsurprising that occasionally the bored security guard puts his feet up and nods off.
On one of these occasions some brazen robbers take advantage of his nap and creep past the desk. They invade the inner office and tie up the staff.
They steal everything they can get their hands on and get access to the valuables in the safe - but the security guard is none the wiser.

Once the robbers have stolen everything and decided to set up their own illegal business there, they are a bit hungry. They call up a pizza firm and a bakery and impersonate the office manager to order some take-aways.
The pizzas and doughnuts arrive, but the security guard doesn't think this is suspicious and lets the delivery men deliver to the inner office.
The robbers are enjoying their new crime base and the free facilities but eventually get fed up with having to fool the security guard outside in the lobby. So they devise a way of sealing up the security guard's mouth.
Once they have attacked him, he is forced to remain at his desk as if he is on guard, but all he can do is shriek and groan through his sealed mouth. Now the security guard is aware of what’s happening but unable to tell anyone.

He is a conscientious guy so he decides to risk contacting the main security centre to call for help. But at the other end of the phone line the operator is alarmed and confused to receive several calls and hear nothing but a terrible moaning sound.
The security centre operators become quite distressed when the muffled screeches are repeated over and over again as the security guard keeps phoning.
Eventually the controller of the security centre takes a decision to stop these calls that are distressing his staff so much. He sends round a telephone engineer to the nearest exchange.

Soon the telephone line to the office security guard has been cut and they are no longer troubled by the awful calls.
They assume that the office staff and valuables are safe but the security centre has in fact let the robbers get away with the crime. The business originally operating from that sleepy office is now totally wiped out.

Have you noticed how modern Western medicine is devoted to describing what your main symptoms are and then prescribing specific medication to reduce or stop each symptom?
But consider the word ‘symptom’. When we experience pain or joint aches or digestive problems, what are these symptoms of?
Our bodies are complex organisms able to send us messages to tell us that something is wrong. If we remove these messages – these symptoms – then we don’t know anything dangerous is happening.
The security guards in our body are called Vitamin D Receptors. These form the major part of the body’s innate immune system. This is different from the adaptive immune system which moves to destroy any bacterial or viral ‘robbers’.
In our nice clean society the Vitamin D Receptors get sleepy because they don’t have much danger to look out for. But there are some very clever bacterial ‘robbers’ out there who know how to get past them.
Around one hundred of them can fit inside one human cell. They also produce a ‘slime’ which eventually can coat the Vitamin D Receptors and stop them communicating.

If your body seems to be sending you alarming and painful messages – symptoms - then it may be better for your long term health to listen to them, rather than cut them off at source with medication.
For that you don’t need a specialist. You need to have a holistic view of how the body works. In the past this may have been an area left to ‘alternative’ medicine but now some scientists are beginning to uncover how the body works as a whole mesh of complex metabolisms.
Why not make some further investigations to help yourself out of chronic illness and back in to health?