Who Else Wants General Information on Arthritis?
By Nathan Wei
Today there are about 70 million Americans with arthritis…that’s
one person out of every four who suffer both pain and the expense
of this crippling disease.
In one year alone, arthritis will be responsible for
over half a billion dollars in lost wages. The economic consequences
of arthritis are important to review because each year, arthritis
takes a devastating financial toll on our society.
Over the course of ten years, arthritis related work
loss has been associated with a 37% drop in income for arthritics
– all those without arthritis had a 90% rise in income over the same
period of time!
If you…a friend…or a relative has arthritis, it’s
important to know that early treatment can help sufferers continue
with their normal daily lives and remain productive members of the
community.
The term “arthritis” is derived from the Greek: “arthron”
meaning “joint” and “itis” meaning inflammation. Arthritis is a word
that describes over 100 different conditions, some involving inflammation
and others not.
Arthritis is not a single disease. It encompasses
about 100 different conditions, that affect joints and that pose unique
problems for diagnosis and treatment.
Some common types of arthritis include osteoarthritis,
rheumatoid arthritis, gout, pseudo-gout, ankylosing spondylitis, polymyalgia
rheumatica, psoriatic arthritis, Reiter’s disease, systemic lupus
erythematosus, and fibromyalgia.
Most types of arthritis involve joint inflammation.
Inflammation is the body’s natural response to injury or infection.
For an example of inflammation, take a simple scratch…your
body automatically releases chemicals that cause fluids to accumulate
and white blood cells to gather around the area of the scratch. As
your body fights foreign substances and bacteria, inflammation…redness…heat…swelling…and
pain occur at the sight of the injury.
In arthritis, unfortunately, this natural defense
mechanism goes awry. Elements from the blood designed to fight infection
and repair injury attack the body instead.
And, unless this inflammatory process is halted, it
will continue to attack the body and cause joint destruction.
So you can begin to see how treatments that just relieve
the pain associated with arthritis – but that do not reduce inflammation
– may not adequately treat this disease.
Getting proper treatment early on is important…because
proper care can help arthritis sufferers lead more active and comfortable
lives.
Yet many people with arthritis delay going to a physician.
Either they have fear about going to a doctor or they feel that nothing
can be done for arthritis. Other reasons include the notion that all
arthritis medicines are harmful or arthritis is just a normal part
of aging.
Some people try unproven remedies which also delay
proper diagnosis and treatment.
Since arthritis may evolve gradually, people often
ignore its early warning symptoms or signs. These include persistent
pain, tenderness, or swelling in one or more joints…symptoms that
should not be dismissed as signs of age.
Other warning symptoms are joint pain and stiffness…especially
when they appear in the morning.
Low back pain is one of the earliest symptoms of arthritis.
For people over the age of 60, arthritis is the most frequent cause
of low back pain.
The activity of arthritis varies unpredictably. Symptoms
are cyclic in nature and seem to come and go.
Therefore, it is important to remember that any symptoms
or signs of arthritis that last for more than six weeks – no matter
how mild – should be checked by a physician. And, if symptoms are
severe, then even waiting six weeks might be too long.
The two most common types of arthritis are osteoarthritis
and rheumatoid arthritis. Joint inflammation is involved in both.
But, these types of arthritis differ in terms of…age
of patients who are affected…the joints involved…the pattern of stiffness…and
the potential for disability.
Close to 16 million Americans have osteoarthritis
– the most common type of arthritis. Although osteoarthritis can occur
at any age, it most often begins in people in their 50’s and 60’s.
Osteoarthritis or degenerative disc disease is a disorder
of cartilage – the gristle that covers the ends of long bones. Cartilage
is made of cell called chondrocytes which sit inside a framework made
up of collagen and proteoglyens. Under normal conditions, chondrocytes
make collagen and proteoglycens – in other works – they make the framework
they sit inside. With osteoarthritis, chondrocytes behave abnormally
and begin to make destructive enzymes such as collagenasese, stromelysin
and others. These enzymes degrade cartilage…these enzymes also attract
inflammatory cells which secrete substances called cytokines which
cause further inflammation and damage to cartilage, underlying bone,
and the joint lining.
This process results in progressive pain, stiffness,
and loss of function.
Joint pain and stiffness are the most noticeable symptoms
of osteoarthritis. Morning stiffness is usually brief lasting less
than 15 minutes. Osteoarthritis usually affects weight bearing areas
particularly the neck, low back, hips and knees.
It may also affect the fingers and hands and bony
knobs may appear at the finger joints. The base of the thumb may also
be affected. The typical pattern of osteoarthritis in the hands involves
the distal and proximal interphalangeal (DIP and PIP) joints of the
fingers, and the carpometacarpal (CMC) joint of the thumb.
Osteoarthritis is considered to be a degenerative
joint disease. Along with inflammation, there is wear and tear on
the inside of the joint.
This causes damage to the cartilage (the substance
that forms the surface of the joints and works as a shock absorber).
As the cartilage wears thin, the underlying bone is damaged. This
process results in progressive pain, stiffness, and loss of function.
Osteoarthritis does not need to be disabling and with
the proper medical care can be managed easily.
Rheumatoid arthritis is the other most common type
of arthritis. It is more common in women and affects 7 million Americans…or
one out of every five arthritis patients. It may affect any age group,
although onset is most common in middle age.
Rheumatoid arthritis is usually characterized by heat,
swelling, and pain in multiple joints in both the right and left sides
of the body, including the hands, wrists, elbows, hips, knees, ankles,
and feet. Spinal involvement also occurs on occasion.
The typical pattern of rheumatoid arthritis in the
hands involves the proximal interphalangeal (PIP) joints, the metacarpal
phalangeal (MCP) joints, the wrists, and the elbows.
Unlike osteoarthritis, rheumatoid arthritis can affect
the entire body. People with this disease may feel sick all over…tire
easily…lose their appetite…and lose weight.
In rheumatoid arthritis, the tissue that surrounds
and nourishes the joints is attacked by the body’s immune system.
The body mistakenly perceives its own tissue as foreign, and it reacts
by sending special white blood cells and toxic chemicals called cytokines
to destroy the foreign material. (The cytokine abnormalities that
cause the damage in rheumatoid arthritis are different from the abnormalities
seen in osteoarthritis.) This process of white cell migration and
cytokine release damages the joint.
Although we do not know the cause of rheumatoid arthritis,
researchers are investigating several possibilities.
Another interesting point about rheumatoid arthritis
is that this disease can affect the internal organs including the
lungs, skin, blood vessels, spleen, heart, and muscles.
If rheumatoid arthritis is not well controlled it
can damage the joints irreversibly and cause serious disability.
To diagnose rheumatoid arthritis, the rheumatologist
establishes the presence of joint pain and inflammation lasting at
least six weeks and then looks for signs of the course of the disease
that are characteristic for rheumatoid arthritis.
There are also blood tests that aid in the diagnosis
of rheumatoid arthritis.
Patients with rheumatoid arthritis have a series of
flare-ups followed by a period where there are mild or no symptoms.
Usually, the pain and disability of rheumatoid arthritis progresses
gradually.
Morning stiffness generally lasts longer than half
an hour and may last several hours depending on the severity of the
condition.
Most forms of arthritis persist for the patient’s
lifetime. Medication cannot usually reverse the bone and soft tissue
damage caused by arthritis.
However, new methods of measuring inflammation and
its response to medication and other treatments offer valuable information
to physicians…and can help to evaluate the arthritis sufferer’s discomfort.
Magnetic resonance imaging is one such technique.
This method using the effects that strong magnets have on water molecules
to provide exquisite images of the interior of the body. MRI has been
used to diagnose and also assess the degree of damage within joints
of patients suffering from arthritis. It is also helpful for evaluating
the effect of new drugs.
Although there is no cure for arthritis, proper treatment
can help tremendously. The goal of arthritis treatment is to relieve
the pain and stiffness due to the progressive destruction caused by
inflammation, and to maintain or increase freedom of movement.
Among the advancements that have taken place in the
medical treatment of arthritis are various disease-modifying medications
that not only relieve symptoms but also help slow down the progression
of disease.
Other advances include various cartilage sparing drugs,
cartilage growing drugs, and also biologic remedies. These drugs act
by blocking the destructive effects of enzymes such as metalloproteases
in osteoarthritis and cytokines in rheumatoid arthritis. By targeting
specific processes, relief of symptoms and healing of damage can take
place with presumably fewer side effects.
What can you do if you think you have arthritis?
First, you can consult your doctor. This is important
because medical issues are complicated and your doctor, who understands
your health needs, can prescribe the best treatment for you.
The type of doctor who can best evaluate arthritis
is called a rheumatologist. These are physicians who have completed
four years of medical school, three years of internal medicine residency,
and three years of rheumatology fellowship.
While arthritis can be a serious disease that can
progress and cause disability, science has come up with some new answers
for arthritis sufferers. It is now up to the arthritis sufferer to
recognize early warning signs and symptoms and to see a rheumatologist.
With proper medical care, the course of this crippling disease may
change and people can help to be returned to fully active lives –
without pain and crippling disability.
Dr. Wei (pronounced “way”) is a board-certified
rheumatologist and Clinical Director of the nationally respected Arthritis
and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor
of Medicine at the University of Maryland School of Medicine and has
served as a consultant to the Arthritis Branch of the National Institutes
of Health. He is a Fellow of the American College of Rheumatology
and the American College of Physicians. For more information on arthritis
and related conditions, go to: http://www.arthritis-treatment-and-relief.com
