Joint Problems

Dr Janet Gray on some of the painful conditions that can benefit from homeopathy 

In general practice, I was frequently consulted by people with problems  with their joints. In any one surgery, I would quite likely see two or  three such patients, whose problems could vary from a simple joint  sprain to severe deformity due to rheumatoid arthritis.

In between these extremes come the many patients who have developed  pain in a particular joint, which does not resolve with simple measures.  It is important, first of all, to find out the “agenda” of the patient,  or else one can find that the patient goes out dissatisfied, whatever  you do. One of the most frequent worries of patients with joint pains is  that they are getting arthritis. I can remember several patients  consulting me over the years with fairly trivial joint problems, and I  could not understand their apparent over-reaction until I discovered the  underlying worry. Often a parent or close relative would have suffered  from severe, incapacitating arthritis, and the patient was terrified  that this was the first sign. They were envisaging ending up in a  wheelchair in the near future. Very often it was possible to dispel  these fears completely by close examination of the joint or by x-ray.  Once the patient was reassured that the symptoms were not those of  arthritis, they no longer worried about the slight discomfort.

What is arthritis ? 

The word comes from the Greek arthros, meaning joint, and itis,  meaning inflammation. So arthritis simply means inflammation of the  joint. It is, therefore, an incomplete diagnosis, and this is where the  problems arise. There are many different forms of arthritis, and each  has a different clinical course and prognosis. So when a patient says to  me, “Of course, my mother had arthritis.” I have to try to find out  what sort she had, and whether it is likely to be hereditary.

Osteoarthritis (OA) 

This is the most common form of arthritis. It is caused by the  degeneration of the cartilage that covers the ends of the bones, where  they “articulate” with other bones. When the cartilage wears away, there  is bone grating on bone, which is obviously very painful, and limits  the mobility of the joint. In addition, projections of bone, called  osteophytes, grow out around the joint, causing swelling and sometimes  trapping nerves.

OA was not thought to be hereditary but recent research has changed  the thinking about this, and it is now thought that OA can cluster in  families. It is not a generally progressive disease, so the patient can  be reassured that it will not usually spread to involve other joints. It  was previously thought that it was only a mechanical degeneration of  the joint due to wear-and-tear, because it is usually seen in joints  that have been over-used, or previously injured, but the recognition of  genetic factors has introduced the idea that it is an active disease  process.

Most elderly people suffer from OA of the knees as they get older,  particularly if they are overweight, which is not surprising, because  the knees have transported all the body’s weight for many years. It is  worse in people who have spent a long time on their knees, for example  carpenters, cleaners, and also in runners and footballers.

OA of the hip also occurs in athletes, especially gymnasts and  dancers, who have over-stretched the joint. Before the days of hip  replacement it was a common cause of elderly people being bent over a  zimmer frame, walking slowly in extreme pain. Nowadays, although we  complain about the waiting lists, OA of both hip and knee can be  corrected by replacement surgery.

Other joints can also be affected by OA, for example the base of the  thumb in hairdressers, because of continual use of scissors, the base of  the big toe in policeman and traffic wardens, who are on their feet all  day long. OA of the shoulders is a particular problem, as it is not so  amenable to surgery, so is difficult to treat. It is very painful and so  can cause big problems for those who have to do a lot of heavy lifting.  However it is now clear that OA only develops in people with a genetic  predisposition despite years of over-straining of that joint.

The joints affected by OA become stiff and painful, often creaking or  grinding when being moved. There may be some swelling, but the joint is  not usually hot or inflamed. The range of movement becomes less and  less, restricting function, which is further restricted by the pain.  Diagnosis is by clinical examination and x-ray. There are no changes in  blood tests.

Rheumatoid arthritis (RA)

On the other hand, RA is a condition that definitely runs in  families, and does have a progressive course, sufferers sometimes ending  up with crippling disease of many joints.

It is an auto-immune disease, which means that the body is attacking  its own joints. The reason for this is uncertain, but some researchers  think the disease may be started by a viral infection.

The onset of RA is sometimes very acute, accompanied by an acute  febrile illness, involving redness and swelling of one or more joints.  When the fever settles, the joint remains painful and swollen, and other  joints often become affected. Sometimes the disease seems to jump from  joint to joint, with one clearing up and another being affected  immediately (known as palindromic arthritis).

More frequently the onset is insidious, presenting with pain in the  small joints of the fingers or toes. These joints swell and become  deformed, ending up with the typical rheumatoid picture of ulnar  deviation. Other joints are also affected, commonly shoulders, knees,  ankles and elbows.

This is the form of arthritis that everyone dreads, but fortunately  there are now more effective early drug interventions that can prevent  the crippling deformities. They can, however, cause major side-effects.  The use of homeopathy can reduce the need for such drugs, or at least  reduce the dosage needed.

RA is diagnosed by blood tests and x-rays, and the progress of the disease can also be monitored with blood tests.

Psoriatic arthritis

This is very similar to rheumatoid arthritis, but is seen in  patients who suffer from the skin disease, psoriasis. The blood tests  for RA are negative, so the diagnosis is clinical.

Ankylosing spondylitis

This is a most unpleasant form of arthritis which predominantly hits  young men between the age of 20 and 40. It is hereditary, and can be  diagnosed by a blood test to detect a particular antigen called HLA-B27,  and is again an auto­immune disease.

It mainly attacks the large sacro-iliac joints in the lower back, and  if not treated can cause fusion of the joints, causing the patient to  become bent over and fixed.

The mainstay of treatment, apart from drugs, is physiotherapy to keep the back supple.

Gout 

Gout is caused by an excess of uric acid in the blood, which  deposits itself in the joints. This is not due to over-indulgence in  wines and port, as was previously thought! The uric acid crystals set up  inflammatory reactions in the joints, causing extreme pain, tenderness,  swelling, redness and heat. It usually affects the big toe, but can  affect other joints.

It is treated conventionally with drugs to lower the uric acid level  in the blood, but homeopathic treatment can also be very successful.

Septic arthritis 

Other joint problems can be caused by infections and these are very  serious. They have to be treated promptly with intra-venous antibiotics  or else permanent damage will occur. The worst sort is tuberculous  arthritis, not seen nearly so much these days but unfortunately showing a  resurgence.

Homeopathic treatment 

Although it is absolutely necessary to make an accurate diagnosis of the  type of arthritis for the general management of the patient, from a  homeopathic point of view it is the symptoms that are important.

So, if a patient is suffering from joint pains, worse on waking in  the morning with great stiffness; better on limbering up after a while;  better for a hot bath or shower; generally better in the hot dry  weather, and worse in the cold and damp; worse on over-activity, but  stiffens quickly on resting – that patient will require Rhus  toxicodendron whatever the pathology, especially if the patient is  restless, and unable to stay in bed because of the pain. Ruta graveolens  has identical modalities to Rhus toxicodendron, but has more a  predilection to tendons and ligaments, rather than joints. However it  can be useful for arthritis, particularly of the knees, where Rhus  toxicodenron has been seemingly well indicated but has failed to act.

If, however, the sufferer prefers the cold weather, and the joints  are so painful that they dare not move them, even splinting them to keep  them still, they will require Bryonia.

The symptoms of gout are often characterised by an exquisite  sensitivity to touch, such that the patient cannot bear even the  bedclothes on the affected limb. The joint is red, hot, shiny and  swollen, and the pain is agony, stinging in nature and much worse for  the heat. This fits the remedy, Apis mellifica, but if the modalities  were identical with the exception of being worse for cold, Colchicum  would be the remedy. Belladonna is appropriate when the onset is  extremely sudden, the pain is throbbing or bursting in character, and  the patient cannot bear being jarred in the slightest.

Rhododendron is suitable for those people who are “human barometers”.  They are very sensitive to the approach of a storm, and will be able to  tell from their joints that the weather is going to change. In  particular they are worse from a change to cold, damp weather. Their  joint pains tend to improve immediately on moving, and are better from  warmth. They tend to shift about.

Ledum is good for chilly people, but who prefer cold applications on  their painful joints. Their pains often start in the small joints of the  feet, and then move upwards.

With Phytolacca, the pains are described as like electric shocks,  shooting along the limbs. A strange symptom is that one foot is usually  colder than the other.

Dulcamara is for a person who is extremely sensitive to the damp. It  is said that even watercress makes their joints ache! They are better  for walking, and are restless, with shooting, tearing pains,  particularly of their hips.

Kalmia latifolia is very good for shoulders, when there are shooting,  tearing pains, worse for movement, and worse at night. The odd  characteristic of this remedy is that the pains move from central to the  periphery, and from the upper to the lower part of the body, whereas  Lac caninum has pains that move from side to side, and is particularly  good for hips.

Guaiacum is a lesser-known medicine, but should not be forgotten for pain in the thumb joints, improved by cold applications.

Cause & effect 

So far, we have concentrated on the joint symptoms in guiding us to the  right medicine, and this is called local prescribing, whereby low  potencies are used frequently. I often use this method in general  practice where there is not a lot of time to glean more information, and  achieve very good results. It is particularly useful when patients have  been taking conventional medicines, such as anti-inflammatories, and  have been suffering from gastric side-effects, and are looking for an  alternative approach.

However, there are other approaches which can give more deep-seated  results. It is important when prescribing homeopathically for any  condition to consider the aetiology. For example, I had a patient in her  late 50s who had been suffering from RA for about ten years, and  conventional medicine had failed to halt the progression of the disease.  When I took her history she told me that her joints first flared up  immediately after her husband had died – but her rheumatologist told her  that it was nothing to do with it. I prescribed Natrum muriaticum with  this information, and her disease progression slowed right down.

Constitutional prescribing

Another approach is the constitutional or totality approach, whereby  the whole of the patient’s make-up is taken into consideration. I  remember a woman, aged 65, who came to me privately who was in agony  with joint pains. These pains would flit about – sometimes in her elbow,  making it impossible to raise a fork to her mouth, sometimes in her  ankles, making walking difficult, and then moving to her shoulders. She  had been diagnosed with palindromic arthritis, and when she came to me  her blood tests showed a high level of inflammation. She was on high  doses of four different drugs, but she was still suffering. Her joints  were very stiff in the mornings and gradually eased up with movement.  They were better for heat, and she was very restless, with the pain  driving her out of bed. I gave her Rhus tox, which seemed to fit, but it  produced no improvement whatsoever. I then questioned her more closely  and found that she was very changeable in mood, emotional and weepy, and  liked being the centre of attention (she was a professional singer).  She craved fresh air and had to have the bedroom window open. She was  clearly a constitutional Pulsatilla, and when I prescribed this, the  result was remarkable. Her pain and swelling subsided and, to her  rheumatologist’s amazement, her blood tests returned to normal. From  time to time she would return to me for repeat doses of Pulsatilla,  which kept her well.

Causticum is another useful joint medicine that works best when used  constitutionally. I had a patient, now aged 62, whose RA had started  after the birth of her second child. Her main problem was her hands,  because her fingers were stiff, swollen and difficult to use. She  noticed that, unusually, her joints were much better when it was  raining, but were worse in the cold, dry weather.

She was a rather irritable person, but very sympathetic and  emotional. She tended to get very involved in “causes”, especially those  to do with the environment.

I gave her Causticum and the swelling and stiffness in her fingers resolved, enabling her to peel the potatoes again.

The future

More and more powerful drugs are being developed by pharmaceutical  companies to modify the progress of arthritic disease, but  rheumatologists constantly have to juggle the dangers of the disease  with the dangers of the drugs used to treat it. Homeopathic doctors are  lucky – our medicines are gentle, have no side-effects, and treat the  whole person. Our homeopathic hospitals see a high proportion of  musculo-skeletal problems, and a recent audit from the Bristol  Homeopathic Hospital showed a 70 per cent rate of improvement.

I am not claiming that homeopathy can cure every case of rheumatoid  arthritis, or stop the deterioration in an osteoarthritic joint, but I  do feel that we have a valuable complementary form of medicine that can  certainly help to arrest the disease, or at least modify it so that  lower doses or less powerful drugs can be used to treat it.

Certainly, during my years working in general practice, I would not  have been without my armamentarium of homeopathic medicines.

Janet Gray MA MB BCh FFHom MRCGP DRCOG was a GP for over 25 years  and used homeopathy in her Bristol practice.