ARTHRITIS
DEFINITION
Arthritis means inflammation of a joint. There are more than one hundred different forms of arthritis. They are similar to each other in the symptoms they produce, which includes sore, stiff, inflamed, and painful joints. Beyond these common symptoms, the various forms of arthritis are quite different from each other. Most forms of arthritis can be subdivided into three major categories: rheumatoid (pronounced ROO-muh-toid) arthritis, osteoarthritis (pronounced OSS-tee-o-ar-THRIE-tis), and gout.
DESCRIPTION
A joint is a part of the body where two bones connect with each other. A joint consists of many structures. In the simplest form, there are two bones separated from each other by a slight gap called the joint cavity. The end of each bone is covered with cartilage, a tough, elastic material.
The space between bones is covered with a thin membrane called the synovial (pronounced si-NO-vee-uhl) membrane. The synovial membrane secretes (releases) a thin fluid called synovial fluid. The synovial fluid acts like a lubricant in the joint, helping the bones move smoothly against each other.
Arthritis usually involves some form of damage to or destruction of joint parts. In the case of rheumatoid arthritis, the synovial membrane becomes inflamed. The membrane becomes thick and stiff. It is also attacked by white blood cells, which can damage or kill tissue in the joint.
In the case of osteoarthritis, cartilage begins to break down and wear away. It is no longer able to cushion the contact of bones with each other. One bone rubs directly on the other bone. It becomes very painful to move the joint.
Rheumatoid arthritis (RA) and osteoarthritis (OA) are both common disorders. They affect both men and women of all races and ethnic background. In the United States alone, about two million people are thought to have RA. Women are three times more likely to have the condition than men. About 80 percent of patients with RA are diagnosed between the ages of thirty-five and fifty. The condition appears to run in families.
OA is one of the most common causes of disability because of limited joint movement. The condition is much more common among older people than among younger people. Somewhere between 65 and 85 percent of Americans over the age of sixty-five have the condition. Some doctors believe that everyone over the age of sixty is affected to some extent by OA. By contrast, only about 2 percent of Americans under the age of forty-five have OA.
Arthritis: Words to Know
- Autoimmune disorder:
- A condition in which the body's immune system attacks some part of the body and treats it as if it were a foreign invader.
- Cartilage:
- Tough, elastic tissue that covers and protects the ends of bones.
- Immune system:
- A network of organs, tissues, cells, and chemicals that protects the body from foreign invaders, such as bacteria and viruses.
- Joint:
- A structure holding two or more bones together.
- Synovial fluid:
- A fluid produced by the synovial membranes in a joint that lubricates the movement of the bones in the joint.
- Synovial membrane:
- A thin tissue that covers the inside surface of a joint.
CAUSES
The causes of both rheumatoid arthritis and osteoarthritis are not known. At one time, doctors believed that OA was simply a part of growing old. They thought that the body's joints just wore out over time. Today, researchers are beginning to explore specific causes for both disorders.
Rheumatoid Arthritis
Current theories suggest that RA is caused by genetic factors. That is, a person is born with the tendency to develop or not develop the condition. Then something in the environment actually sets off the disorder itself. One theory is that an infectious agent, such as a bacterium or virus, initiates the onset (beginning) of RA.
Whatever the cause, RA is an autoimmune disorder. An autoimmune disorder is a condition in which the body's immune system begins to act abnormally. The immune system is a network of organs, tissues, cells, and chemicals whose job it is to protect the body from foreign invaders, like bacteria and viruses.
At times, the immune system may become confused. It may respond to some part of the body as if it were a foreign invader. It releases its whole arsenal of weapons against that part of the body. When the immune system acts against some part of the joint, RA occurs.
Osteoarthritis
Scientists recognize two forms of OA: primary and secondary osteoarthritis. Primary OA is caused by abnormal stresses on healthy joints or by normal stresses on weakened joints. The joints most commonly affected by primary OA include the finger joints, hips and knees, the lower joints of the spine, and the big toe.
There is some evidence that primary OA is caused by genetic factors. Obesity is often a contributing factor. The heavier a person is, the greater the pressure on his or her joints. Finally, some researchers believe that primary OA may be caused by bone disease, liver problems, or other abnormal conditions in the body.
DISEASE OF KINGS
Throughout history, gout has been called the "disease of kings." The reason for this name is that gout can be caused by the over consumption of rich foods. Today, we know that gout is caused by the accumulation of uric (pronounced YER-ik) acid crystals in a joint, most often the joint of the big toe.
Uric acid is produced in the body when proteins are broken down. Proteins are a class of chemicals with many important functions in the body. Uric acid is water soluble. It usually dissolves in urine and is then excreted from the body.
Some people, however, produce an unusually large amount of uric acid. Such a tendency is thought to be caused by genetic factors. When that happens, uric acid remains in the body, circulating through the bloodstream. Eventually, it is deposited as needle-like crystals in joints. These crystals cause friction when the joint is moved. The friction causes severe pain known as gout.
Secondary OA is caused by a chronic (long-term) or sudden injury to a joint. Some factors that may contribute to the development of OA include:
- Physical trauma (shock), including sports injuries
- Repetitive stress associated with certain occupations, such as construction, assembly line work, computer keyboard operation, and hair-cutting
- Repeated episodes of gout or other forms of arthritis
- Poor posture or bone alignment caused by abnormal body development
SYMPTOMS
All forms of arthritis share certain symptoms in common. These symptoms include pain, swelling, and stiffness in the joint. These symptoms may develop slowly over time or they may begin quite suddenly. After a period of time, joints may actually become deformed. Patients may find it difficult to straighten their fingers and toes, or their hands and feet may curve outward in an abnormal way. Eventually, a patient may lose the use of a joint entirely.
Patients with RA often report other symptoms also. These symptoms include increased fatigue, loss of appetite and weight loss, and, sometimes, fever. RA may also be accompanied by the development of rheumatoid nodules. Rheumatoid nodules are bumps that appear under the skin, in tissue covering the lungs and chest, or in the brain and spinal cord. These nodules can cause serious complications, including shortness of breath, poor blood circulation, gangrene (tissue decay), and damage to nerves.
DIAGNOSIS
Rheumatoid arthritis and osteoarthritis are usually both diagnosed based on a patient's history. This history typically includes an increasing occurrence of pain and stiffness in joints. The doctor can also examine the patient's affected joint for swelling, limitations on movement, pain, and a cracking sound that is sometimes heard with a damaged joint.
There are no blood tests that strongly confirm the presence of arthritis. Many tests that can be used for RA are also positive for other disorders. One test measures the amount of a chemical known as rheumatic factor in a patient's blood. Rheumatic factor is produced by the immune system when it attacks a joint. It is found in about 66 percent of patients with RA. But it is also found in 10 to 20 percent of healthy people over the age of sixty.
A good diagnosis for OA can sometimes be obtained from X rays or other imaging techniques. An X-ray photograph may show changes in the space between bones in a joint, indicating the presence of OA.
TREATMENT
The first line of treatment for most forms of arthritis is medication to reduce inflammation, swelling, and pain. Aspirin, acetaminophen (pronounced uh-see-tuh-MIN-uh-fuhn, trade name Tylenol), and ibuprofen (pronounced i-byoo-PRO-fuhn, trade names Advil, Motrin) are all effective in this regard. In fact, people with mild cases of arthritis can often control their condition satisfactorily simply with one of these drugs.
In more severe cases of arthritis, stronger medications may be required. The most common of these is one of the corticosteroids (pronounced KOR-ti-ko-steer-oids). The corticosteroids are very effective in the treatment of pain, swelling, and inflammation. However, they have some serious long-term side effects and should be used only when milder medications are not effective.
A variety of other medications have been used against arthritis also. These drugs include gold compounds, D-penicillamine (pronounced pen-i-SIL-uhmeen), and sulfasalazine (pronounced SULL-fuh-SAL-uh-zeen). Medications used to treat malaria can also be helpful. These drugs have potentially dangerous side effects and should be used with caution.
Rest and supportive devices may also be important in the treatment of arthritis. When the pain becomes too great, patients may be advised to take to their bed and stay there until they experience relief. They may also be provided with various protective measures, such as neck braces and collars, crutches, canes, hip braces, and knee supports.
Physical therapy can also be an important component of treatment programs. Physical therapists can teach patients how to exercise their affected joints. Exercise may reduce the rate at which the joints are worsening. It may increase the patient's balance, flexibility, and range of motion. Physical therapy can also consist of massage, moist hot packs, and soaking in a hot tub.
In the most severe cases, surgery may be required. Some surgical techniques that can be used include:
- Replacement of a damaged joint
- Fusion (joining together) of spinal bones
- Scraping or removing damaged bone from a joint
- Removal of a bone chip to allow realignment of a joint
Alternative Treatment
Some types of food intolerance may contribute to both RA and OA. Patients should try to find out the foods to which they are allergic and eliminate those foods from their diets. In general, nutritionists recommend a diet high in fiber and complex carbohydrates (starches) and low in fats and refined foods.
Some food supplements have been found to be effective in treating arthritis. One substance that is commonly recommended is a combination of glucosamine (pronounced gloo-KO-suh-meen) and chondroitin (pronounced kon-DRO-i-tin) sulfate. This product is thought to help repair cartilage. Other nutritional supplements that have been suggested include vitamins A, B, C, and E, and the minerals selenium and zinc.
Traditional Chinese medicine emphasizes the use of various herbs for the treatment of arthritis. These herbs include turmeric, ginger, feverfew, devil's claw, Chinese thoroughwax, licorice, lobelia, and cramp bark.
Naturopathic treatment may include hydrotherapy (water therapy), diathermy (deep-heat therapy), nutritional supplements, and various herbs.
PROGNOSIS
About 15 percent of patients with RA experience their symptoms for only a short period of time. The symptoms then disappear with no long-term effects. For other patients, however, the symptoms never disappear and become progressively worse over time. In general, patients with RA have a shorter lifespan by three to seven years than individuals without the disorder.
Osteoarthritis is a progressive disorder without a permanent cure. The rate of progression can sometimes be slowed. Factors that may help in reducing the disorder's progress include weight loss, exercise, surgical treatment, and some alternative therapies.
PREVENTION
There is no known way to prevent arthritis. The most that can be hoped for is to slow or prevent its progress.
FOR MORE INFORMATION
Books
Aaseng, Nathan. Autoimmune Diseases. New York: Franklin Watts, 1995.
Schlotzhauer, M. Living with Rheumatoid Arthritis. Baltimore: Johns Hopkins University Press, 1993.
Shenkman, John. Living with Arthritis. New York: Franklin Watts, 1990.
Theodosakis, Jason, et al. The Arthritis Cure. New York: St. Martin's Press, 1997.
Organizations
American College of Rheumatology. 60 Executive Park South, Suite 150, Atlanta, GA 30329. (404) 633–1870. http://www.rheumatology.org.
Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (404) 872–7100. http://www.arthritis.org.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.nih.gov/niams.
Web sites
"Arthritis." [Online] http://arthritis.miningco.com (accessed on June 20, 1999).