Rheumatoid Arthritis

There's no doubt now that I am suffering from rheumatoid arthritis but not osteoarthritis which is characterised by degeneration of the cartilage of certain joints. My wrists, hands, shoulders, feet and sometimes other parts of my body are being attacked by my immune system to varying degrees, causing stiffness and pain.

The condition was definitely triggered by my fall about three months ago because prior to that I only had sporadic pain in my right shoulder and nowhere else. I'm not too troubled at the moment. The soreness and swelling in my left foot has subsided. There was one night when my wrists were causing me considerable discomfort. Ironically, this had been caused by finger exercises that I had been doing to ameliorate the stiffness in my fingers.

I have been walking between 2km and 4km a day, sometimes more, but I notice my knees are weaker than they used to be and sometimes hurt when I'm walking up stairs. I definitely need to resume by leg band exercises and squats. I just have to accept that the arthritis is not going away anytime soon. The more I can find out about the condition and how to manage it the better. This post was prompted by this YouTube video and is where the screenshot came from.

The body's decline creeps like a vine.

Day to day, the changes can be imperceptible.

You adapt. 

Then something happens that finally makes it clear

That things are no longer the same.

My condition is certainly not severe at the moment. There is no redness and swelling of the joints of my hands and certainly no deformities. Maybe that will come later. Maybe it won't. One thing is incontrovertible. My body is in decline. The price one pays for longevity. Fortunately, my mind seems largely intact. Let's hope that continues.

Monitoring My Exercise And Diet

My resting pulse rate is 63 beats per minute and, with light clothing on, I weigh 70.9 kilograms. I've been walking regularly of a morning, at a fairly brisk pace, and covering about 2.2 kilometers. However, yesterday (Saturday 14th July) I had a not so good day. My right shoulder joint had been hurting in the night and I woke up feeling stiff in my fingers with my ankle causing discomfort as well. I also felt discomfort in my chest when getting out of bed.

Today, Sunday, I feel a lot better comparatively speaking. I wonder if it's diet-related. Yesterday I had my usual toast in the morning following by pasta at two different times of the day plus a couple of pastries in between. On the Thursday and Friday prior my bad Saturday I'd two eggs with mayonnaise on toast, even though I'd been advised to eat only the whites of the eggs and not the yolks. Could this have triggered my subsequent discomfort?

I did some very brief and mild isometric exercises for my arms on either Thursday or Friday. Could this have triggered the discomfort behind my sternum? It's hard to say and thus it's probably a good idea to monitor my intake of food and drink as well as the amount of exercise that I undertake. Should I start another Airtable database or should I record the information using some other software, perhaps a spreadsheet? Before deciding, I should carry my phone with me whenever I leave the house so that any distances that I walk can be recorded. My daily walk around the block is about 2.2 kilometres.

For the moment I've opened a fresh document in Google Docs and will begin recording there. I'll see how that goes. I'm rather averse to phone apps or other online methods of monitoring diet and exercise. A simple pedometer is sufficient for recording distance walked.

Recrudescence

A recrudescence is defined as the recurrence of an undesirable condition and that's certainly a word that applies to me at the moment. For a while there, I thought that my stiff fingers, weak wrists and dodgy left ankle were on the mend and that the discomfort caused by my thymoma was largely in abeyance. However, the last few days have seen a rise in finger stiffness and a noticeable uptick in thymoma-related discomfort. My ankle remains tender but then again I've been walking fairly regularly of a morning so that's to be unexpected. Overall, my mobility and ease of movement have declined and I tend to dodder about the house being particularly careful when negotiating any stairs.

While on a walk, I can generally stride about as I did in the old days but with the constant awareness that all is not right with my left ankle. Apart from the morning walks, I'm engaging in very little physical activity around the house. I found my old resistance band that was fashioned from pantyhose but have yet to make use of it. One can only speculate on the cause of this decline and what the dire consequences might be if I were I to suffer another fall. I've spent no time at all on introspection designed to discover what remedial action is necessary on my part to stem and perhaps reverse this decline.

I've adhered to my a significant reduction in my intake of fried foods, assisted by use of an air fryer. This is a healthy choice of course but I don't whether it's sufficient in itself to turn things around. I need to look deeper into the underlying causes, both physical and psychological. To this end, I decided to take another Etorvel (Etoricoxib) tablet. I still had four tablets left following my tooth extraction. It was 2:30am at the time of ingestion and this gave me about four hours before my morning walk to monitor the changes in my physical condition.

If there's a noticeable reduction in my finger stiffness, ankle soreness and general restricted mobility, then my problem is definitely of an inflammatory origin. The body is attacking itself. I've written about the effects of this drug in my recent post titled Tooth Extraction. As I said in that post, it's not a drug that you'd want to take in the long term given its side effects but this one off experiment should prove useful. So how is the experiment progressing?

• After about half an hour, the physical effects are quite noticeable. I feel quite flushed and I'm sure my blood pressure is elevated. My brain is not working all that well. I don't feel like concentrating on anything too taxing. I have an inclination to listen to some music which I'm doing. My fingers still feel stiff so not much change there.
  
  
• After about an hour, there is a noticeable reduction in finger stiffness and wrist weakness and overall a general feeling of well-being. I'm continuing to enjoy the music.
  
  
• After about an hour and a half, the flushed feeling has subsided and my mental faculties have returned. The general improvement in my fingers and wrists remain but has far from disappeared entirely. I'm definitely moving more freely and am feeling far less stiff as I walk about.
  
  
• About three and a half hours later, I went for my morning walk and felt particularly strong with my ankle giving me very little trouble. It would be good if I always felt like this but I have the drug to thank in part this time.

What conclusions are we draw then from this little experiment? It would seem that the drug is working as it's supposed to:

Etoricoxib works by selectively inhibiting an enzyme called cyclooxygenase-2 (COX-2). COX-2 plays a role in the production of prostaglandins, which contribute to pain, inflammation, and fever. By blocking COX-2, Etoricoxib helps reduce these symptoms.

The question is why is my body continuing to produce prostaglandins that cause pain and inflammation. As Google's Gemini explained:

Prostaglandins are major contributors to the inflammatory response. They trigger processes like: 

• Increased blood flow to the injured area
• Increased permeability of blood vessels, allowing white blood cells to migrate and fight infection
• Pain perception by sensitizing nerve endings

 This process is what led to my DOMS but the problem is that the process never stopped.

ADDENDUM:

A day later and I'm still feeling very good. I have very little stiffness, my ankle is not troubling me and even the discomfort from my thymoma is greatly reduced. It will be interesting to see how long this feeling of well-being will last. Doubtless, the production of prostaglandins is still being inhibited by the Etoricoxib.