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In search of the perfect arthritis treatment.

The next time you are nursing an aching, arthritic joint, give a nod to your Neanderthal ancestors. They probably spent many a morning nursing their joints as well. In fact, arthritis has been around for several million years - even the bones of prehistoric animals indicate signs of the disease. After all that time, you'd think we would have the disease licked. Unfortunately, few arthritis treatments have managed to survive thousands of years of testing, and no treatment has provided the total answer. But along the way, there have been some memorable experiments.

The earliest known treatment of disease - arthritis included - dates back 20,000 years to Cro-Magnon man. Cave drawings indicate that Cro-Magnons enlisted one tribesman as their healer and treated illness with dances, sorcery, magic and other appeals to the spirits. They most likely did not distinguish arthritis from other painful conditions and used similar treatments for many illnesses.

Spirituality remained the basis of the healer's role for millennia, but it did not preclude the development of other treatments. In Assyro-Babylonia, center of ancient civilization as far back as 4000 B.C., herbs and drugs originally used for supernatural reasons were adopted for medical use. Ancient American Indian societies also used herbal remedies, although their primary treatment for arthritis was the steam house, a primitive version of the modern sauna. An Imbalance of Humors

The ancient Greeks introduced a new approach to medicine, regarding it as a discipline separate from philosophy, religion and magic. And they were quite familiar with arthritis: As early as 400 B.C., Hippocrates used the word "arthritis" to describe gout and other rheumatic diseases. He even attributed a cause to the disease, suggesting it resulted from an imbalance in a person's bodily fluids. But that was nothing unusual - nearly all diseases in ancient Greece were attributed to such an imbalance. The reason? Humoral theory, a theory of medicine that suggested the body is made up of four basic fluids - blood, phlegm, black bile and yellow bile all of which should be in perfect harmony.

Humoral theory postulated that the four fluids could fall out of balance, causing illness. Following this reasoning, one would treat an illness by attempting to restore the healthy balance of the fluids.

"There was only one disease in ancient Greece - your humors were messed up," says james Whorton, Ph.D., professor of medical history and ethics at the University of Washington in Seattle. "And when there was an imbalance of fluids, there was one way to set it right again - that was to rid the body of the bad fluid. Treatments often involved bleeding patients and giving drugs to induce sweating, vomiting and urination. Active removal of fluids from the body was the core of treatment from the Roman period onward."

There were some slight variations in treatment depending on the patient's complaint. If a patient complained of arthritis pain in his foot, for example, a physician would likely remove the fluid directly from the foot using one of several unappealing techniques. Leeches were one method of sucking blood from an area; cupping," a mechanical technique used to suction blood, was another. Sometimes the physician would rub chemicals on an area to cause it to blister and thereby remove fluids. (And you thought you hated visiting the doctor!)

The Greek humoral theory generally ruled medical thinking until the 1600s, although the Middle Ages (A.D. 476 - approximately 1450) brought a return of supernatural beliefs as well. One important development during this period was the discovery of an effective treatment for gout in the fifth century. Physicians began using colchicum, an extract from a crocus-like plant, with excellent results. It is likely that the extract was first used by classical physicians to induce the purging of fluids, and its effectiveness in treating gout was discovered later.

Well into the Middle Ages there were frequent references to the use of colchicum to treat both acute and chronic gout. Then, with the emergence of the Renaissance (c.14001600), all mention of the extract as a treatment for gout disappeared. It was not mentioned again for 400 years.

According to physician and historian W.S.C. Copeman, the disappearance of colchicum was a case of Renaissance philosophy influencing medical treatments. Renaissance physicians, eager to return to classical scholarship, shunned treatments developed during medieval times.

"This is a strange page in medical history," Dr. Copeman comments in his book, A Short History of the Gout and other Rheumatic Diseases. "Colchicum was well studied and had been known as an effective remedy for certain painful and common affections of the joints. ... Then came the Renaissance and the dominance of scholars who, with all this written and practical evidence before them, chose to see none of it - their learning seemed like a bandage round their eyes." Renaissance physicians instead returned to the classical remedies that had long been practiced for gout: bleeding and purging. The Scientific Revolution

The humoral theory of medicine finally lost favor in the 1600s, thanks to Copernicus and other gifted scientists. When Copernicus suggested that the sun, not Earth, was at the center of the universe, he set into motion a scientific revolution that spilled over into the medical arena. "Copernicus, and later, Newton, raised all sorts of scientific questions," says Whorton. "As a result, there was a reaction against ancient science. Most of the ancient ideas about medicine got tossed aside."

Unfortunately, there was no equal to Copernicus in the medical world, and although literally dozens of new medical theories were introduced, none proved any more successful than the humoral theory. In fact, many of the theories still led to the same classic treatment: purging. "It is ironic that with all the new theories, as far as the patient could tell there hadn't been any change," Whorton comments. "The treatments were the same as they had been for centuries."

Well, almost the same. The good news for those with gout was the reemergence and renewed popularity of colchicum. By the beginning of the 19th century, the kings of both England and France were successfully treated with the extract, adding to its acceptance. The active ingredient of colchicum, colchicine, is still used today in the treatment of gout.

Another new treatment for arthritis in the 1700s was "taking the waters" - 18th century 'argon for soaking in hot springs. Members of the upper class would travel to places like Bath, England, to soak in the spas. Like many other treatments, hot springs were used for nearly every condition," Whorton says. "For most people the visits were more social than medical, but it was taken seriously as a medicine. People with rheumatoid arthritis and gout took the waters more than other people if they could afford it."

Hot springs fell out of favor during the morally strict Victorian era due to the seemingly indulgent nature of the spa environment. Today, with the advent of the hot tub, people with arthritis are once again discovering the beneficial effects of taking the waters." (For a roundup of present-day hot springs resorts in the U.S., see page 52.)

Other arthritis treatments during this period included generic pain medications, most notably opium. Although today opium seems exotic and dangerous, it was the standard pain reliever from the 1600s through the 1800s. "People used it like we use aspirin today," says Whorton. "There were no controls over it. You'd walk to the corner store and pick up Laudanum - a solution of opium and wine."

Although opium in its crude form is not strongly addictive, morphine opium's primary pain-killing ingredient - is extremely addicting. Morphine was isolated from opium early in the 19rh century, and several decades later the first hypodermic needle was introduced. As a result, morphine addiction became rampant, especially among people with chronic, painful diseases like arthritis. Recurring Themes in Treating Arthritis

As if to prove the old adage that "timing is everything," aspirin was introduced just as concern about morphine addiction was building to a peak. At the turn of the century, aspirin became the analgesic of choice for people with arthritis, although it was not until the 1950s that its anti-inflammatory properties were recognized and that physicians recommended it specifically for arthritis.

Interestingly, the active ingredient in aspirin - salicylate - can be traced back nearly three millennia. Although it is now produced chemically, a natural form of this ingredient is found in the bark of the willow tree and had been used by primitive tribes and later civilizations as a traditional household remedy for the treatment of rheumatic diseases.

Just as salicylate has been used to treat arthritis throughout medical history, the promotion of unproven remedies has been closely tied to the disease for generations. Arthritis is particularly prone to unproven treatments because the on-again/off-again nature of the disease invites speculation as to the "miracle cure" that might have caused any improvement. The popularity of specific unproven remedies for arthritis has changed over time, but the basic ingredient remains the same: mystery.

"Quacks look for anything that is mysterious, clearly powerful, difficult to harness, and not understood yet - a force of nature, for example," says Whorton. In the 1700s, with the discovery of static electricity, metal devices were sold to give a shock to the afflicted joint. In the 1800s the same idea was introduced using newly recognized electrical currents. Early in this century the "mystery" was radiation, and elaborate instruments with glowing tubes were sold to zap the disease. (For a first-hand look at today's unproven remedies for arthritis, see page 30.)

Glowing tubes notwithstanding, the 20th century has brought an array of effective treatments for arthritis. Cortisone, nonsteroidal anti-inflammatory drugs (NSAIDs), gold shots, anti-malarial drugs, and immunosuppressive medications all were developed in this century. Past treatments, such as salicylate and warm-water soaks, have been resurrected in new forms. Still the search for the perfect treatment continues.

As we near the beginning of the 21st century, sophisticated machinery and computers are raising arthritis treatment to levels undreamed of only a few years ago. Today some physicians can custom design artificial joints to exactly match a patient's own joints - all on a computer screen. Certain surgical procedures can be accomplished by inserting a pencil-thin telescope through a tiny incision and then projecting a picture of the joint onto a television screen. Procedures that were rare and dangerous only a decade ago are now considered routine and safe.

Progress in arthritis treatment continues at a dizzying pace. Considering how far we've come to get here, who knows what may lie ahead? Nancy joseph is an editor and freelance writer in Seattle.
COPYRIGHT 1992 Arthritis Foundation, Inc.
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Author:Joseph, Nancy
Publication:Arthritis Today
Date:Jan 1, 1992
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