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.
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