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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