Arthritis is the nation’s number one chronic disease, affecting over one in seven Americans, or nearly 41 million people. The most common form of arthritis, osteoarthritis, can be identified in the knees of one third of all persons by the age of thirty and affects nearly everyone by the age of sixty. Although often considered an ailment of the elderly, experts who know better call arthritis everybody’s disease. It haunts the athletically active regardless of age and is av real problem for a quarter of a million children under the age of sixteen.
Many individuals have “silent” arthritis, that is, they do not suffer the pain, limitation of motion, joint instability, and deformity that are the hallmarks of this disease. Still, about one third to one half of all people with arthritis have a condition serious enough to consult a doctor about their symptoms. The good news is that only a small percentage of this group have severe pain and disability. The bad news is that many people ignore early symptoms or delay effective countermeasures, thus aggravating the problem and sometimes causing permanent crippling. It may seem ludicrous, but it is true: The average individual with arthritis waits four years after symptoms develop before seeking medical help! By then a lot of damage has already taken place.
WHAT IS ARTHRITIS?
Although the pain of arthritis may be new to you, it’s one of the oldest identifiable diseases on earth. While Adam’s bones probably began creaking shortly after he took up residence outside of Eden, he was not the disease’s first victim. A giant dinosaur named Diplodocus Longus holds that honor. Today man’s aching joints are joined by those of birds, amphibians, reptiles, and mammals. The animals that are spared tend to have cartilaginous skeletons instead of bony skeletons, which means sharks have never experienced arthritis but porpoises have. So it appears that arthritis developed at the same time that bone did during the course ‘of evolution. One might expect, with this kind of long-term experience, that we should by now have a clear understanding of this disease, but in fact arthritis is still poorly understood and the source of many misconceptions. Part of the problem is that arthritis is a word that is used to label about 100 conditions that involve aches and pains in joints and connective tissue. The “big three” are osteoarthritis, rheumatoid arthritis, and gout.
Osteoarthritis (OA)
We discussed cartilage earlier and explained how it is a tough, elastic tissue that acts as a shock absorber and keeps the bones from rubbing against each other. In osteoarthritis (OA) there is a gradual wearing away of this cartilage, which leads to discomfort, pain, stiffness, grating, and, sometimes, deformity. The pain is often localized to only one or a few joints. Classically, the pain of OA occurs with movement and is relieved by rest; however, many OA patients will experience some degree of achy pain when they resume activity following a period of rest. Pain may also be worse at the end of the day.
Factors contributing to OA include repetitive stress and injury, heredity, and too much weight. An estimated 30 million Americans nuller from osteoarthritis, with the greatest incidence among the older population.
The list of specific causes is long: an improperly repaired meniscal tear or the removal of a meniscus, a fracture, bowlegs or knock knees, any abnormal development of the hip, prolonged immobililallon, overuse of a joint that is not entirely normal, chronic inflammation or infection, and most rheumatic diseases, which means that osteoarthritis may actually be caused by rheumatoid arthritis. Certain diseases may also predispose one to OA, including diabetes and hypothyroidism.
One of the most important lessons we’ve leamed in recent years regarding OA is that it is not a natural process of aging, nor is it necessarily a consequence of wear and tear. Consider, for example, that a whale, which spends its life supported in water in a total non-weight-bearing state, may have extensive OA while landlocked humans show no correlation between lifelong, weight-bearing physical activity and joint deterioration--even jogging does not lead to OA.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis is a puzzle to researchers. RA is an inflammatory disease that is characterized by attacks on healthy tissue. The disease begins when the synovium (the thin membranes lining the body’s joints) become inflamed. This inflammation may spread and destroy cartilage or weaken ligaments. RA is the most destructive form of arthritis. Whereas most forms of arthritis affect only a few joints, RA can cause damage throughout the body. It may even invade other body tissue, such as the heart or lungs. RA tends to be symmetrical, that is, joints on both sides of the body will often be involved. (However, one knee may be more severely diseased than the other.)
The effects of RA differ from person to person, but they often begin as mild symptoms that come and go before becoming chronic. Early in the disease process people feel tired, sore, achy, and stiff. The joints stiffen, then swell, and later become tender, making full motion difficult and painful. The knees, hands, and feet are the most commonly involved joints. Symptoms are generally most noticeable after long periods of inactivity, such as in the morning.
The most crippling effects of RA are seen in about one of very six RA patients. These people will experience severe aches, pains, and badly damaged joints. If the hands are severely affected, the fingers may become crooked and deformed so that movement is difficult. Rheumatoid arthritis (RA), often occurs in younger individuals and even children. Unlike OA, which tends to be seen more often in men, women have the leading edge for rheumatoid arthritis. Of the six million Americans suffering from RA, three out of four are
women between the ages of twenty and fifty.
Gout
Gout is the result of inflammation of the joints produced by an excess of uric acid. Usually, uric acid circulates in the blood as a by-product of normal metabolism and gets whisked away through the kidneys. Gout patients, however, either produce too much uric acid or the kidneys can’t process and remove it properly. Either way, the end result is a uric acid buildup in the form of needlesharp crystals of monosodium urate in the joints.
The damaging mechanism of gout is a combination of erosion and inflammation. Those crystals are deposited in the cartilage and synovium, which we just defined as the starting spot of RA. This causes acute and chronic inflammation and, over time, an erosion of the cartilage and the underlying bone.
Gout is far more common than most people think. Nearly two million people in the United States suffer from it, 95 percent of whom are men. Acute gouty arthritis usually appears without warning, often at night, and may follow overindulgence in food or alcohol, fatigue, and emotional distress. The pain is not easily ignored and is often described as throbbing, crushing, or excruciating. lt may be so severe that even the pressure of a thin bed sheet can not be tolerated. The inflammation often resembles an acute infection: there is swelling, warmth, redness, and extreme tenderness. Although the classic location for gout is generally considered to be the big toe, it also commonly affects the knee, instep, ankle, wrist, and elbow.
The first attack of gout may last only a few days, but if left untreated, subsequent attacks may last for weeks. While gout is generally asymmetrical, that is, limited to one foot and not the other or one knee and not the other, the onset is rapid compared to osteoarthritis. lt’s even easier to distinguish gout from rheumatoid arthritis since RA is more likely to be symmetrical, more gradual in onset, and more likely to last longer for each acute attack.
Systemic Lupus Erythematosus (Lupus)
We’ll briefly mention one other common rheumatoid disorder that may affect the knees, systemic lupus erythematosus. Called SLE or lupus for short, this is another rheumatic disease that affects many more women than men. It is mild for many patients but it can lead to serious problems, including damage to the skin, joints, and intemal organs.
There is no known cure for lupus, but the treatment program can help reduce pain and inflammation and prevent serious joint damage from occurring. The treatment includes medication, heat or cold treatments, exercises, rest, joint protection, and, because of a sensitivity to sunlight, which often accompanies this disease, avoiding sun exposure.
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