Arthritis and rheumatism

Dr Peter Fisher discusses his approach to this common, painful and potentially crippling group of conditions

Arthritis and rheumatism are among the commonest forms of chronic  disease and, with an aging population, are set to become commoner still.  Strictly speaking, arthritis means disease of the joints, while  rheumatism is disease of the soft connective tissues which support and  move the joints. In fact, the distinction is often artificial, since  many of these conditions affect both the joints and connective tissues.

Osteoarthritis, the commonest of these conditions, is basically “wear  and tear” of the joints. The root of the problem is wearing out of the  cartilage, the tough, slippery “gristle”, which allows the ends of the  bone to slide smoothly over each other and absorbs shocks. The joint  becomes stiff and painful, and may creak as it is moved.

As the cartilage wears down, the bones on either side of the joint  may react by forming small bony outgrowths called osteophytes. One of  the sites where bony nodes can easily be seen is the last joint of the  fingers. Spondylosis is a similar problem affecting the spine; here the  main problem is degeneration of the disks which separate the vertebrae.

As one would expect with a degenerative condition the prevalence of osteoarthritis increases with age, it affects nine per cent of the total  population but around 70 per cent of the over-70s. It is the commonest  of all rheumatological conditions, and indeed probably the commonest of  all chronic diseases, because many sufferers live with it for many  years. Not surprisingly it tends to affect weight-bearing joints (eg low  back, hips and knees). Joint injuries or overuse (for instance heavy  physical work or professional sport) predispose to osteoarthritis later  in life. Overweight is another important factor.

The other two main groups of arthritis and rheumatism are  inflammatory arthritis, of which the commonest form is rheumatoid  arthritis, and soft tissue rheumatism. Rheumatoid arthritis affects  about one person in a hundred; it is nearly three times commoner in  women than men (for unknown reasons). Its cause, too, remains  frustratingly elusive. It tends to come on at an earlier age than  osteoarthritis (typically in the 30s to 50s) and is more aggressive,  running a more rapid course: about a third of sufferers are seriously  disabled within ten years, although it is very variable. It particularly  affects the small joints, especially of the hands and feet, causing a  typical hand deformity where the fingers slant sideways. But it can  affect almost any joint in the body, and also cause nodules under the  skin and eye problems. There are many other forms of inflammatory  arthritis, some of them associated with infections.

The final group is true rheumatism, affecting the soft connective  tissues rather then the joints themselves. There are many forms, some  with picturesque names. They include enthesopathies which affect the  point at which tendons connect to the bones – the best known of these  are tennis elbow, affecting the outer side of the elbow, and golfer’s  elbow, which affects the inner side. Capsulitis – inflammation of the  capsule of tissues that surround the joint – most commonly affects the  shoulder, and may lead to a stiff “frozen” shoulder. Some of the more  amusing names are reserved for bursitis – inflammation of the bursae,  cushioning pads which overlie many joints. These include Housemaid’s  Knee (also known as Clergyman’s Knee), from too much kneeling. But my  favourite is Weaver’s Bottom – so called because it used to affect  weavers who had to shuffle up and down long benches to tend their looms!

The most common form of soft tissue rheumatism, however, is  fibromyalgia (which used to be known as fibrositis). It affects about  two per cent of people and is much commoner in women than men. It is a  controversial condition; some believe that fibromyalgia and chronic  fatigue syndrome (ME) are varieties of the same condition, certainly  there are similarities. The typical features are widespread  musculoskeletal pain and aching with tender points at several specific  locations. It is frequently associated with poor sleep and fatigue as  well as other problems including migraine and irritable bowel syndrome.

There are many problems with current conventional treatment of arthritis and rheumatism. For instance, although osteoarthritis rarely,  if ever, killed anyone, a group of drugs often used in its treatment,  the non-steroidal anti-inflammatory agents (NSAIDs), including aspirin,  Ibuprofen and Voltarol among many others, certainly has. There are some  12,000 hospital admissions and 2,000 deaths from these drugs every year  in the UK alone. Although the new generation of NSAIDs is safer, they  are only glorified painkillers, which do not affect the basic disease  process. Similarly for rheumatoid arthritis, a range of powerful drugs  is available but all of these have long and alarming lists of side  effects.

The homeopathic approach

In treating someone suffering from arthritis and rheumatism with  homeopathy, just as with any other condition, I look at the person as a  whole. In practice this means starting by looking at what exactly the  problem is: pain, stiffness, sleep disturbance, limitation of particular  activities, or what? Where is it? How long has it been a problem, and  what has been the evolution? “Evolution” means where did it start and  what has happened since – has it moved, if so, in any particular  pattern? Does it come and go, any pattern to that? Did anything seem to  trigger it off in the first place?

Then the modalities – simply any factor which makes the problem worse  or better: for instance hot or cold applications, bandaging or support,  the weather etc. Here it is important to know what is normal: for  instance it is usual for an acutely inflamed, swollen, tender joint to  be relieved by cold applications. But in homeopathy exceptions to the  rule are of particular interest.

I then move on to the rest of “homeopathic” histories, I integrate  the two. Sometimes the conventional part of the history can give a vital  clue. For instance, a woman came to consult me with extra-articular  manifestations of rheumatoid arthritis. When I asked if anything seemed  to have triggered the problem, she said she couldn’t think of anything.  But when I enquired into the social background it turned out she had  been through a messy divorce, including a court battle for custody of  the children, which she eventually won. The onset of her illness  coincided almost to the day with the end of the custody case. I was  amazed that she did not make the connection. It was clear that this was a  topic she didn’t want to discuss. Translated into the quaint 19th  century language of some homeopathic books this is “aggravated by  consolation”. It was this that gave me the first clue to the homeopathic  medicine, Sepia, to which she had an excellent response. This was an  example of “not what they say, but how they say it”.

Then to complete the history, the “mentals” and “generals”. The  mentals include how the patient reacts to and copes (or fails to cope)  with their problems, and the so-called “constitutional” features: is  this a strong-willed and assertive person, or the opposite? Tidy and  organised or untidy? And so forth. Then the generals, for instance does  this person feel the cold excessively, prefer the morning or the  evening? I then examine the patient, again this not just a matter of  good medical practice, but can give important clues to possible  homeopathic treatment. For instance warm, swollen joints may suggest the  medicines Apis or Bryonia; stiff contracted joints Causticum or  Formica.


Some cases of arthritis and rheumatism treated with homeopathy

Mrs KS is an Asian woman, aged 39 when she first consulted me in  April 1993. She had been diagnosed as suffering from rheumatoid  arthritis about 18 months earlier. She worked in a supermarket, and  although she had had some pain and swelling in her knuckle and finger  joints for a couple of years before the diagnosis was made, this had  never really bothered her until she started to work on checkout. (This  was in the days before bar code scanners, so checkout involved a lot of  keyboard work!) Within weeks of starting on checkout, she developed  severe pain and swelling in many of her finger and knuckle joints. She  was taken off checkout, but this lead to only slight improvement. Her GP  referred her to the rheumatologist at the local hospital, and the  diagnosis of rheumatoid arthritis was made, confirmed by blood tests.  She had had several conventional treatments, which either did not help,  or caused side effects.

Her GP was sympathetic and referred her to me at the RLHH. The basic  features were typical of rheumatoid arthritis, but on talking to her a  number of idiosyncratic characteristics came out. Although the problem  had started in the hands, it had since involved a number of other  joints, but unusually, the arthritis moved unpredictably from joint to  joint. A knee, say, would be painful and swollen for a couple of weeks,  then settle down by itself, only to flare up elsewhere. Her arthritis  was definitely worse before her monthly period and it became clear she  was quite depressed about the situation: she became weepy, on discussing  it. But unlike the patient mentioned earlier, was quite willing to talk  about her feelings, and seemed to feel better for doing so.

These features gave me a “tripod”, the traditional basis for a sound  homeopathic prescription: one typical local, mental and general feature.  I prescribed Pulsatilla. I saw her again a couple of months later and  was pleased to hear that she was feeling much better in herself, more  cheerful, and felt that her joints were better. She had reduced the  painkillers (which upset her stomach) and was taking them on an “as  required” basis. There have been some ups and downs since, and I have  prescribed some other medicines, but always come back to Pulsatilla. The  blood tests have steadily improved, and x-rays shown no further  deterioration. She still works in the supermarket, but is now a manager.  I continue to see her once or twice a year, but she now has virtually  no trouble from the arthritis and takes only homeopathic treatment and  nutritional supplements for it.

Miss AQ, 73, is a colourful and artistic character: a ballet dancer  since her teens, she had risen to prima ballerina in a major company,  and later taught ballet for many years. She came to me complaining of  pain in various joints, particularly the knees. She had had numerous  injuries and strains to her joints, especially feet and knees, during  her career. On many occasions she had danced despite injury. She had had  several operations on her knee cartilages. On examination, I found her  to be extremely supple, able to touch the floor with the palms of her  hands with straight legs. She had large nodes on her fingers.
It was clear that she had osteoarthritis relating to overuse and injury.  She had been advised to have her knee joints replaced, but was  reluctant to do so, because she felt that the previous knee operations  had done more harm than good in the long run.

I was interested by her extreme flexibility; it seemed that this was  not solely due to her professional training. As a child her mother had  taken her to the doctor for “growing pains”, and the doctor said she had  sway-back knees, and she had been “double-jointed”, able to bend her  thumbs right back to her forearms. On this basis I prescribed Calcarea  fluorica, and Symphytum, Rhus tox and Ledum cream to be rubbed into the  joints. She came back a couple of months later, saying that the pains in  her joints were under good control, the cream gave several hours relief  when she needed it. She probably will need to have her knee joints  replaced eventually, but for the time being she finds her symptoms quite  tolerable.

Dr Peter Fisher, (1950 – 2018) was director of research  at the Royal London Hospital for Integrated Medicine and served as  homeopathic physician to Her Majesty, Queen Elizabeth ll for 17 years.  An Honorary Consultant Rheumatologist at Kings College Hospital and  President of the Faculty of Homeopathy, Dr Fisher also chaired the World  Health Organisation's working group on homeopathy and served on their  Expert Advisory Panel on Traditional and Complementary Medicine.