How to Treat Arthritis with Niacinamide (Vitamin B-3)

[Guest guest]

http://www.doctoryourself.com/kaufman5.html

 

How to Treat Arthritis with Niacinamide (Vitamin B-3)

 

Arthritis Treatment

 

THE COMMON FORM OF JOINT DYSFUNCTION

by William Kaufman, M.D., Ph.D.

(Copyright 1949 William Kaufman. Copyright renewed

2001Charlotte Kaufman. Reprinted with permission.)

 

METHOD OF TREATMENT OF JOINT DYSFUNCTION (pages 20-29)

After completion of his physical examination, the

patient was apprised of the normal and abnormal

findings revealed by the clinical study. Where

problems other than joint dysfunction existed, these

were discussed, and appropriate therapeutic

recommendations were made. The subject of joint

dysfunction was then presented. The meaning of the

numerical value of the patient's Joint Range Index was

explained to him in terms of the Clinical

Classification of Joint Function (see page 21), and

the dynamic nature of joint dysfunction was described.

The patient was told that joint dysfunction was

reversible in time when appropriate therapy was taken.

 

All patients with joint dysfunction who elected to

accept treatment were given niacinamide in suitable

doses, either alone or in combination with other

vitamins. When indicated the appropriate vitamins were

prescribed in addition to niacinamide. The

water-soluble vitamins used were never prescribed in

aqueous solution, but as tablets or as dry powders in

capsule form. When vitamin A was used, it was usually

given in conjunction with vitamin D. Vitamin D was

always given in conjunction with vitamin A; when

vitamin D was administered in this study, the daily

dosage rarely exceeded 6,000 U.S.P.units per 24 hours

(14) (10) (38) (56) (59) (95).

 

Participation in the therapeutic program was entirely

voluntary on the part of the patient. Some patients at

the outset declined to accept treatment for their

joint dysfunction. When a patient accepted therapy for

his joint dysfunction, with each succeeding visit

after the initial one, improvement or lack of

improvement in his joint dysfunction was frankly

discussed with him. No patient was chided because he

was unwilling or unable to carry out the program of

therapy as it was originally scheduled. Thus, because

there was no “loss of face, " most patients cooperated

well and gave an accurate account of their deviations,

if any, from the suggested therapeutic program. Some

patients at the end of the first or second month of

treatment, or at a later time, felt so much improved

physically that they discontinued therapy for their

joint dysfunction, mistakenly believing, in spite of

advice to the contrary, that they were " cured, " and

required no further therapy or medical supervision.

Some of these persons, who experienced a recurrence of

their original pattern of symptoms upon premature

cessation of therapy, returned subsequently for

re-evaluation of their therapeutic needs. Other

patients, who felt that they had not benefited from

therapy for their joint dysfunction, did not continue

with treatment though objectively they responded

satisfactorily to adequate therapy, as shown by

increasing values of the Joint Range Index on serial

re-measurements.

 

Therapy was always individualized. In the therapeutic

program introduced for the treatment of joint

dysfunction, each patient served as his test object in

the bio-assay of the dosage of niacinamide necessary

to reverse his joint dysfunction. Therapy with

niacinamide (used

alone or in combination with other vitamins) was not

deemed successful unless there continuous, objective

improvement, as judged by continuously increasing

values of the Joint Range Index on consecutive

reexaminations. (When a patient subsists on a

low-protein diet, amounts of niacinamide that would

ordinarily be adequate for the treatment of his joint

dysfunction prove to be inadequate for satisfactory

improvement. In this case, the dosage of niacinamide

is continued at the same level, but the protein level

of the diet is increased to adequate levels, with

subsequent satisfactory improvement in the joint

dysfunction.) (118) (120) (172).

 

The clinical classification of joint function in terms

of the numerical values of the Joint Range Index is

listed below:

 

Clinical Classification of Joint Function

Degree of Joint Dysfunction Joint Range index

 

No joint dysfunction 96-100

Slight joint dysfunction 86-95

Moderate joint dysfunction 71-85

Severe joint dysfunction 56 -70

Extremely severe joint dysfunction 55 or less

 

For each clinical grade of joint dysfunction, the

initial dosage schedule of niacinamide suggested below

effects in time such improvement in joint dysfunction

as the writer has considered to be clinically

satisfactory. (However, since April 1947, it was found

that dosage schedules 50-100% greater than those

recommended below (particularly in the moderate,

severe and extremely severe grades of joint

dysfunction) are therapeutically superior, as judged

by the patient's clinical response.)

 

While the initial dosage may be increased as

necessary during treatment, it is not decreased, even

though the Joint Range Index increases in response to

adequate therapy.

 

The vitamins were administered orally, usually in

equal doses at equal intervals during the day, and, in

severe and extremely severe joint dysfunction, during

the night when the patient would spontaneously awaken

from sleep. In slight grades of joint dysfunction, the

daily continuous ingestion of 100 mg of niacinamide

after meals and at bedtime sufficed for treatment (400

mg/24 hours). Usually adequate in moderate joint

dysfunction was the continuous ingestion of 150 mg

niacinamide administered every 3 hours for 6 daily

doses (900 mg/24 hours). In extremely severe and

severe grades of joint dysfunction, 100-150 mg

niacinamide were prescribed every hour (1500-2250

mg/24 hours), every hour and a half (1110-1650 mg./24

hours), or every two hours (800-1200 mg/24 hours),

depending on the severity of the joint dysfunction,

the more frequent schedule being used in more severe

cases (97) (51).

 

It has been found in the treatment of joint

dysfunction that the manner in which the daily dosage

of niacinamide is divided has an important bearing on

the the therapeutic results achieved; e.g., 300 mg

niacinamide given three times daily (900 mg/24 hours)

is inferior in its therapeutic action to 150 mg

niacinamide administered every 3 hours for 6 daily

doses (900 mg/24 hours). Therefore, to define the type

of therapy used, the writer routinely records the

following data: (a) the number of milligrams or units

administered per dose, and (b) the total number of

milligrams or units administered per 24 hours.

 

No untoward effects or clinical signs of toxicity were

noted when niacinamide (alone or in combination with

other vitamins) was administered on the above dosage

schedules to individuals for short or long periods of

observation. Before 1943, mild hypoglycemia had been

noted clinically in a few persons when niacinamide

exceeded certain dosage levels (97) (135) (51) (62),

but this phenomenon has not been observed since that

time.

 

" ADEQUATE " AND " OPTIMAL” DOSAGE LEVELS OF NIACINAMIDE

IN THE TREATMENT OF JOINT DYSFUNCTION

 

" Adequate " dosage of niacinamide is defined as that

clinically safe dosage of niacinamide which, when

ingested in divided doses throughout the day by a

person with joint dysfunction whose ordinary diet is

not inadequate in protein or calories, and whose

joints are not subjected to excessive mechanical joint

injury, will effect in time what the writer has

considered to be a satisfactory pattern of increasing

values of the Joint Range Index. The pattern of

recovery from joint dysfunction in response to

niacinamide therapy, and the numerical limits of

increments in the value of the Joint Range Index which

are considered to be satisfactory for the first month

of therapy and for succeeding months, are described on

page 24.

 

“Optimal” dosage of niacinamide is defined as that

clinically safe dosage niacinamide which, when

ingested in divided doses during the day by a person

with joint dysfunction, would permit the most rapid

recovery in joint function, as demonstrated by the

largest possible increments in the values of the Joint

Range Index in the shortest possible period of time.

At present, the optimal dosage of niacinamide for the

treatment of joint dysfunction has not been determined

clinically, although it is hoped to approximate such a

dosage level eventually. Since adequate dosages of

niacinamide have given clinically satisfactory results

without producing any untoward symptoms or signs of

acute or chronic toxicity, no attempt has been made in

this study to determine the optimal level of

niacinamide therapy in the treatment of the various

clinical grades of joint dysfunction.

 

However, as the higher dosage levels of niacinamide

have been cautiously explored in the past 22 months,

it has been found in severe and extremely severe joint

dysfunction that divided doses of niacinamide totaling

4 or 5 grams (4,000-5,000 mg) per 24 hours are

therapeutically superior to the lower dosage schedules

which previously had been considered adequate. Even

these higher dosage levels of niacinamide may not be

optimal for the treatment of joint dysfunction.

 

The optimal dosage of niacinamide for the treatment of

joint dysfunction, as well as the limit of human

tolerance for niacinamide, can be established only in

those medical centers equipped to provide careful

clinical supervision, and to conduct such chemical,

metabolic and clinical laboratory studies as would

reveal the earliest signs of toxicity, should these

occur with the administration of progressively higher

dosage levels of niacinamide.

 

DESCRIPTION OF JOINT DYSFUNCTION AND ITS TREATMENT FOR

THE PATIENT

 

Since the cooperation of the patient is a

prerequisite for the successful therapy of joint

dysfunction, it was found desirable and necessary

before treatment of joint dysfunction was instituted

to discuss with the patient his various clinical

problems (including the dynamic nature of joint

dysfunction, and its response to niacinamide

treatment, and the dynamic nature of certain

complicating syndromes, and their appropriate

treatment), and the therapeutic goals. During the

course of therapy, it may become necessary to review

and amplify this discussion for the benefit of the

patient as various clinical problems arise.

 

Joint dysfunction is the articular aspect of a

generalized, usually slowly progressive metabolic

disorder which is corrected in time by adequate

niacinamide therapy. Since the retrograde changes in

tissue structure and function which characterize this

disorder occur insidiously over a period of years,

many of its symptoms and signs are incorrectly

attributed by laymen and physicians alike to the

so-called " normal " aging process. But

these retrograde changes in morphology and function of

bodily tissues are usually

reversible in time when adequate levels of niacinamide

are supplied continuously to bodily tissues. The

patient who takes continuously adequate amounts of

niacinamide experiences, in addition to improvement in

joint function, an improvement in his general health.

 

Theoretically, optimal nutrition must be

continuously available to bodily tissues to ensure the

best possible structure and function of tissues (104)

(108). While we do not know what constitutes optimal

nutrition, it has been demonstrated empirically that

even persons eating a good or excellent diet according

to present-day standards exhibit measurable impairment

in ranges of joint movement which tends to be more

severe with increasing age (see page 153). It has also

been demonstrated that when such persons supplement

their good or excellent diets with adequate amounts of

niacinamide, there is, in time, measurable improvement

in ranges of joint movement, regardless of the

patients' ages. In general, the extent of recovery

from joint dysfunction of any given degree of severity

depends largely on the duration of adequate

niacinamide therapy (see pages 187 and 188).

 

With the ingestion of adequate amounts of

niacinamide continuously for a sufficient period of

time, a patient whose ordinary diet is not inadequate

in protein or calories, whose joints are not subjected

to excessive mechanical trauma, will recover from

joint dysfunction at the satisfactory rate of 6.0 to

12.0 Joint Range Index units, or better, in the first

month of therapy, and 0.5 to 1.0 Joint Range Index

unit, or better, for each month of therapy thereafter,

until a Joint Range Index of 96-100 is reached.

(Rarely, when a patient has one or more ankylosed

joints, he may have no appreciable active or passive

movement of these ankylosed joints, even after two

years of adequate niacinamide therapy, although his

other joints recover the full ranges of movement in

response to such therapy. In such cases, the Joint

Range Index cannot reach 96-100; e.g., when one wrist

is ankylosed and has not shown increased movement in

response to niacinamide therapy, the maximum Joint

Range Index attainable is 90.9; and when both wrists

are ankylosed, the maximal Joint Range Index

attainable is 81.8.)

 

In general, the more severe and more chronic the

patient's joint dysfunction, the slower is the rate of

recovery in response to adequate niacinamide therapy,

and the slower his subjective appreciation of

improvement. The rate of recovery for each patient

must be established empirically from serial

determinations of the Joint Range Index. In order to

ensure a continuously satisfactory rate of recovery

from joint dysfunction, the physician must re-examine

the patient at intervals during the course of

niacinamide therapy. Whenever a patient taking the

amounts of niacinamide prescribed by the physician,

and eating a good or excellent diet, fails to make

satisfactory improvement in his Joint Range Index, in

the absence of excessive mechanical joint injury the

niacinamide schedule must be revised upward to that

level which permits satisfactory improvement. Failure

of the patient to take niacinamide as directed will

result in failure to improve at a satisfactory rate.

 

When a patient has joint dysfunction associated with

obvious arthritic deformities, he is told that the

physician cannot predict whether or not in his case

articular deformities will resolve with adequate

niacinamide therapy. However, in response to adequate

niacinamide therapy for a sufficient period of time,

other patients have shown partial or complete

resolution of their arthritic joint deformities. Some

patients with arthritic deformities show resolution of

some of their joint deformities, but not of others.

Only careful observation of the patient's deformities

on serial re-examinations will indicate whether or not

his deformities are resolving in response toadequate

niacinamide therapy. In most instances, the rate of

resolution of the deformities will be slow, if it

occurs at all.

 

It cannot be predicted whether or not a given joint

that appears to be completely ankylosed clinically

will recover any degree of movement. It has been

observed many times that joints appearing to be

clinically ankylosed prior to therapy tend to have

partial or complete recovery of movement in response

to adequate niacinamide therapy, although some

ankylosed joints have not shown any degree of movement

as a result of therapy during an observation period of

several years. In response to adequate niacinamide

therapy over a sufficient period of time some patients

have partial or complete recovery of movement in some

of their ankylosed joints, but not in others. Only

careful observation of the ranges of joint movement on

serial re-examinations will demonstrate whether or not

a given ankylosed joint can recover any degree of

movement in response to adequate niacinamide therapy.

 

In general, in the absence of complicating factors,

the higher the patient's Joint Range Index rises in

response to adequate niacinamide therapy, the fewer

articular symptoms he will have; and the better he

will feel. However, even though the Joint Range Index

increases satisfactorily in response to adequate

niacinamide therapy, the patient may not feel well

because of complicating syndromes which are not on the

basis of aniacinamidosis. Careful clinical study is

necessary in order to establish the etiology of

whatever complicating syndromes may be present and,

with appropriate therapy, the patient is likely to

become free from articular symptoms and to feel well.

However, at any time symptoms of bodily discomfort may

recur which must be studied and given appropriate

treatment as promptly as possible, if the patient is

to feel well again. While the patient may obtain

temporary relief from articular and other symptoms

through the use of analgesics, narcotics, sedatives,

antihistaminics and local anesthetics, only adequate

treatment of joint dysfunction and the complicating

syndromes is likely to give more lasting benefits.

 

In order to assess the effects of niacinamide

therapy on joint dysfunction and on the patient's

general status, the patient is usually re-studied one

month after continuous niacinamide therapy has been

instituted. If good progress in recovery from joint

dysfunction is noted at that time, he is reexamined in

two months, and thereafter every three to six months.

For the most part, this schedule of re-examination is

found to be satisfactory for the supervision of the

therapeutic program of patients presenting the chronic

problems of joint dysfunction, although when the

individual's problems are of unusual complexity, or

when intercurrent problems arise, the time interval

between visits is shortened.

 

When a patient with joint dysfunction fails to make

the anticipated progress in response to niacinamide

therapy, he is asked if he has taken the medication as

prescribed; if not, he is urged to do so. (When a

patient has taken multiple vitamin capsules as

prescribed and has not made satisfactory improvement

in his Joint Range Index in response to such therapy,

the druggist is asked how the vitamin powders were

compounded. The clinical effectiveness of niacinamide

seems to be lessened when niacinamide is mixed with

ascorbic acid by vigorous trituration, since this

favors inter-molecular reactions between niacinamide

and ascorbic acid in the dry powder state. The

occurrence of such inter-molecular reactions between

niacinamide and ascorbic acid is hindered by the

preliminary admixture of each dry powder separately

with a small amount of calcium stearate (0.2%) before

the final admixture by sieving.)

 

It is always emphasized that the patient must take

his medication continuously as prescribed until such

time as the supervising physician may decide, on the

basis of objective clinical evidence, that it is

necessary to increase the level of niacinamide therapy

in order to produce continuously satisfactory

improvement in the Joint Range Index.

 

However, certain factors other than the ingestion

of inadequate amounts of niacinamide may tend to

depress the Joint Range Index. These include (a)

transient or persistent mechanical joint injury

resulting from unusual or physical exertion (see page

79) or from psychogenically sustained hypertonia of

somatic muscle (see page 115), (b) rapid and excessive

gain in weight to obesity levels, © excessive

ingestion of alcohol, (d) inadequate dietary protein.

When any of these factors is operative, it is of

limited value to increase the amounts of niacinamide

taken by the patient in an effort to effect

satisfactory improvement in the Joint Range Index.

Instead, treatment should be directed toward

lessening the degree of mechanical joint injury,

reducing the patient's weight to the normal range,

interdicting alcohol, and increasing the protein

intake to adequate levels, respectively.

 

When indicated, the physician describes for the

patient four complicating syndromes frequently

coexisting with joint dysfunction, and their treatment

(see page 76). Most of the articular and non-articular

symptoms of a patient with joint dysfunction which are

not corrected by niacininide therapy usually originate

as part of these four complicating syndromes. When the

patient understands the etiologic basis of his

symptoms, he will not have anxiety concerning the

meaning of symptoms which would otherwise seem

mysterious and alarming. The patient with joint

dysfunction who has one or more of these complicating

syndromes is told that he will not feel well unless

joint dysfunction and these coexisting syndromes are

correctly identified and successfully treated, and

that in order to accomplish this, his active

participation in the clinical investigation and

therapeutic program is required.

 

TYPICAL IMPROVEMENT IN MOBILITY OF A SINGIE JOINT IN

RESPONSE TO LEVELS OF NIACINAMIDE THERAPY USED PRIOR

TO APRIL 1947

 

In serial determinations of the mobility of single

joints in response to levels of niacinamide therapy

used prior to April 1947, it was found that

niacinamide-induced recovery of full joint mobility

was an orderly process. (Since April 1947, when higher

dosage schedules of niacinamide were introduced (see

page 21), there has been a marked reduction in the

incidence of articular pain and discomfort upon

maximal passive movement of the moveable joints during

various stages of recovery from joint dysfunction.)

 

There is described below typical improvement in

joint mobility, as illustrated by several sequential

stages occurring during niacinamide-induced recovery

of full mobility of the metacarpophalangeal (knuckle)

joint.

 

(Figure 14 is a schematic representation of maximal

passive extension of the meta-carpophalangeal joint at

four successive stages (a) (b) © (d), during the

course of niacinamide-induced recovery of full joint

mobility. The line touched by the head of the arrow in

(a) (b) © (d) indicates the upper limit of painless

extension. The shaded angle in (b) and © indicates

the range of painful passive extension.)

 

Figure 14(a). On the initial examination before

niacinamide therapy was instituted, the

metacarpophalangeal joint of the forefinger of the

right hand could be extended passively to 30% of the

full range of extension for this joint. No pain or

discomfort was experienced by the patient during this

maneuver. The examiner noted the presence of palpatory

resistance from the initiation of the movement of

passive extension of this metacarpophalangeal joint,

and this resistance progressively increased as the

joint was extended from the range of 0% to 30% of the

maximal extension; the palpatory resistance at the end

of the movement was graded as firm. When at the 30%

level of passive extension a small increase of force

in the direction of extension caused no further

extension of this joint, 30% of the full range of

extension was taken as the upper limit of maximum

passive extension of this metacarpophalangeal joint.

 

Figure 14 (b). At the end of one month of

continuous, adequate niacinamide therapy, maximal

passive extension of this metacarpophalangeal joint

increased to 60% of the full range of extension. No

pain or discomfort was experienced by the patient when

the metacarpophalangeal joint was extended from 0% to

40% of the full range of extension. The patient

experienced localized joint pain, often severe, as the

joint was passively extended from 40% to 60% of the

full range of extension. The examiner's palpatory

sensation indicated that movement of the joint in

passive extension was free from 0% to 40%, and that

there was soft, yielding resistance which

progressively increased as the finger was extended at

the metacarpophalangeal joint from 40% to 60% of the

full range of movement. When a further small increase

of the extending force did not increase the degree of

extension, 60% of the full range of extension was

taken as the upper limit of passive extension of this

metacarpophalangeal joint. The palpatory resistance at

the end of the movement of extension was rubbery.

 

Figure 14 ©.After months of continuous, adequate

therapy with niacinamide, maximal passive extension of

the metacarpophalangeal joint reached 100%; i.e., the

full range of movement. Passive extension of the

metacarpophalangeal joint from 0% to 85% was without

pain or discomfort; passive extension from 85% to 100%

was painful. The examiner's palpatory sensation

indicated that the movement of this joint was free

from 0% to 85%, and that there was soft resistance,

which increased progressively with increasing

extension of the metacarpophalangeal joint from the

level of 85% to 100%. A small additional force in the

direction of extension when the 100% level was reached

did not cause further extension of this joint. The

palpatory resistance at the end of the full range of

movement (100%) was rubbery.

 

Figure 14(d). With a longer period of continuous,

adequate niacinamide therapy, it was possible to

achieve full, free and painless extension of this

metacarpophalangeal joint to the level of 100%. Slight

additional palpatory force in the direction of

extension with the joint fully extended did not

increase the amount of movement beyond the full range

of extension; i.e., the 100% level. The examiner's

palpatory sensation indicated that the movement of

extension was free from 0% to 100% of full extension,

that the resistance met at the end of this movement

was firm, and that the patient experienced no pain

from this maneuver.