Arthritis
There are more than 100 different types of arthritis,
but all have one thing in common: they all affect joints.
Many of them also affect the areas and structures surrounding
joints. Perhaps more importantly, all types of arthritis
are painful and can interfere with your ability to
do the things that you enjoy, from cooking a meal to
playing golf.
The number of people with arthritis is staggering.
In 2005, 66 million adults in the United States — nearly
one in three — had either been diagnosed
with arthritis or were living with undiagnosed chronic
joint pain and other symptoms of arthritis. Although
the risk of some types of arthritis, such as osteoarthritis,
increases with age, more than half of those affected
by any type of arthritis are younger than 65. In fact,
arthritis is the leading cause of disability in Americans
older than 15.
It doesn’t have to be that way.
If you have arthritis, there are steps you can take,
starting today, to protect your joints, reduce pain,
and improve mobility. The exact strategy depends on the
type of arthritis you have.
Types of arthritis
Osteoarthritis is the most common type of arthritis.
It is called a degenerative joint disease because it
results from the deterioration of the bones and cartilage
that make up the joints. The second most common type
of arthritis, rheumatoid arthritis, is an inflammatory
disease that affects the lining of multiple joints,
especially in the hands and feet. Although it affects
only one-tenth as many people as osteoarthritis, rheumatoid
arthritis can be far more debilitating. The other common
rheumatic diseases — gout, pseudogout, ankylosing
spondylitis, reactive arthritis, psoriatic arthritis,
enteropathic arthritis, and infectious arthritis — are
also characterized by inflammation.
Osteoarthritis
Osteoarthritis (OA) begins in the cartilage, the smooth,
slippery tissue that covers the ends of the bones as
they come together in joints. Healthy cartilage allows
the joints to move smoothly and painlessly, but in
OA the cartilage undergoes chemical and structural
changes, then gradually wears away.
Scientists don’t fully
understand what causes OA, but they have identified
factors that increase risk. Advancing age is the most
important. Others include a family history of OA, obesity,
biomechanical abnormalities that increase stress on
joints, serious injuries, and certain repetitive activities
such as frequent knee bending. Poor nutrition may also
play a role.
Doctors can confirm a diagnosis of OA by
taking x-rays that show the typical joint space narrowing
due to loss of cartilage, accompanied eventually by
the increased density of the bones near the joint (sclerosis)
and bone spurs (osteophytes). In some cases,
blood or joint fluid tests may be needed to rule out
conditions that mimic OA. Advanced imaging techniques
are sometimes important; for example, an MRI can be
helpful when OA strikes the spine. But most people
can diagnose their own OA based on typical symptoms,
and many can treat themselves with diet, exercise,
and nonprescription medications. If these measures
don’t do the trick, doctors can provide treatments
that are usually quite effective.
Rheumatoid arthritis
Rheumatoid arthritis is a chronic autoimmune disease
in which the body’s immune system attacks healthy
tissue lining the joints. It affects about three million
Americans, and strikes two to three times more women
than men. Although the disease usually first appears
during middle age, it may occur in the 20s and 30s.
Some children develop a similar disease, called juvenile
chronic arthritis, but this is considered a separate
disorder.
The chronic inflammation of rheumatoid arthritis begins
in the synovium, where an unknown event triggers an
inflammatory reaction. As a result, synovial and other
cells produce chemicals and proteins that together
can destroy all the components of the joint (see illustration
below).

Inflammatory skin nodules at pressure points, such
as the elbow, can appear gradually or suddenly, and
may be tender and sometimes inflamed. Occasionally,
surgery is needed if these nodules become infected
or are bothersome during activity. At times, they may
also disappear spontaneously.
At advanced stages, rheumatoid arthritis can limit
a person’s ability to carry out normal daily
activities such as dressing, bathing, and walking.
Those affected this severely often experience feelings
of depression and helplessness as the disease progresses.
However, medications are now helping to slow the progression
of rheumatoid arthritis and are making a dramatic difference
in the lives of many of those who take them.
One of
the most important steps you can take if you are diagnosed
with rheumatoid arthritis is to become an active participant
in your own care. This includes working with your doctor
so that you can learn to recognize flare-ups and drug
side effects, taking medications as prescribed, and
engaging in activities to maintain joint function in
order to prevent disability. Balancing rest with activity,
dealing with the emotional impact of rheumatoid arthritis,
and using splints or assistive devices to protect your
joints against overuse are among the most helpful coping
strategies. The ultimate goals in managing rheumatoid
arthritis are to prevent or control joint damage, prevent
loss of function, and decrease pain.
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