| Introduction to Arthritis |
| Symptoms of Arthritis |
| Treatment Options |
| The Outlook for the Future |
| Frequently Asked Questions |
| Links & Contacts |
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Email AlertsJoin our email group to receive updated information on this topic. One in seven Americans suffers from arthritis, an umbrella term for a collection of some 100 disorders that affect the areas in and around the joints. Arthritis can produce pain, loss of movement, and inflammation in the joints. It can also affect muscles and connective tissues in the body, such as tendons, ligaments, and cartilage, and even whole body. Because it can be disabling--even crippling--arthritis can take a psychological as well as a physical toll on a person, leading to depression and anger.
About six million Americans have diagnosed themselves as having arthritis, but haven't seen a doctor for treatment. That may be because, as the Arthritis Foundation recently found in a survey of arthritis sufferers, they mistakenly believe there is little that can be done to help their disease and improve their quality of life. While arthritis is a chronic disease--meaning you'll typically have it for the rest of your life once you get it--doctors have developed many drug and nondrug treatments for various forms of the disease. What causes arthritis?The cause of most forms of arthritis isn't known. It's believed that many are a result of a combination of factors. For instance, increasing age, a family history of the disease, overuse or abuse of a particular joint, injury, being overweight, and other diseases may all contribute to the development of OA. And doctors think that RA may be an inherited disease that is triggered by a virus, bacteria, use of a medication, or excessive stress. Likewise, they believe that ankylosing spondylitis and SLE run in families. Physicians have a better handle on gout, which is caused by rising levels of uric acid in the blood. This occurs as a result of a metabolic disorder. Gout runs in families, and is seen more commonly in those who are overweight, drink alcohol, have higher blood pressure, or are taking certain medications. Who is affected?
One in seven Americans--40 million people--suffers from arthritis. By the year 2020, it's expected that number will rise to around 60 million Americans--or one in five people. Arthritis is the number one cause of disability in the United States, according to the Arthritis Foundation, and limits the ability of 7 million Americans to dress themselves, walk, climb stairs, or get in and out of bed. Together, the various forms of arthritis primarily affect people over the age of 45, and especially those over the age of 65. But it also strikes about 8.4 million young adults and 285,000 children. And more women than men have the disease: About two-thirds of arthritis sufferers are female.
Osteoarthritis (OA)Typically, the symptoms of OA creep up on you slowly. A particular joint may feel achy and sore, especially while or after you’ve been using it for a while. Aching and soreness may also occur after you’ve been inactive for an extended period of time, such as when you’re sleeping. The pain, stiffness, and soreness often get worse with time. You may also experience less range of motion and more stiffness in the affected joint, and you may hear a grating sound when you move, which indicates that the cartilage in your joint has worn away and the bones are rubbing against each other. Rheumatoid arthritis (RA)RA initially causes pain, stiffness, tenderness, and swelling in certain joints. It may also produce fatigue and aching in the morning and after you’ve been still for a long time. As the disease gets worse, it may cause muscle pain, and you may lose the ability to use a certain joint. RA may also permanently damage a joint; that is why it is sometimes called a crippling disease. Inflammation in other body organs may occur, along with a lessening of appetite, weight loss, fever, and extreme fatigue. Lumps--called rheumatoid nodules--may develop over joint areas that receive pressure such as knuckles of the hand. GoutThis disorder typically comes on fast and without warning. It usually starts in the big toe, and then may move to the finger, foot, ankle, elbow, wrist, or knee. The joints become hot, swollen, and very painful and tender to the touch, and the skin over the joint may take on a red or purple, shiny appearance. Ankylosing spondylitisTypically, this disorder first shows up as constant pain and stiffness in the hip and lower back that continue for more than 3 months. Systemic lupus erythematosus (SLE)
SLE causes chronic inflammation in one organ or joint or many organs and joints throughout the body. Symptoms can be different for each person affected, but most suffer from achy joints and frequent fevers. Skin rashes, anemia, kidney problems, pain in the chest on deep breathing, sun sensitivity, and hair loss are also common. The most tell-tale sign of lupus is a distinctive butterfly-shaped rash that comes and goes across the nose and cheeks. Lupus patients can alternate between periods when they're very ill--even requiring hospitalization--and long periods when the disease is in remission. Lupus tends to get worse with time and was once even considered to be a fatal disease. But because of advances in diagnosis and treatment, that is no longer true; today, most patients have a normal life expectancy. Clinical diagnosisYour medical and family history and your physical examination will lead your doctor to diagnose arthritis. He or she may also order some tests, such as x-rays to determine if a joint has already been damaged, a joint aspiration (where fluid is drawn from a joint with a needle), or blood tests.
What do doctors recommend?Although most forms of arthritis are permanent and chronic, there are many steps you can take to relieve the pain, improve your mobility, and reduce inflammation and joint damage. Because there are so many forms of the disease, and because each form can cause different problems, it is essential that a treatment plan be tailored to your specific diagnosis and your medical and lifestyle needs. This treatment regimen will probably include both drug and nondrug recommendations, and perhaps even surgery. Try to be patient while you're experimenting with different remedies; it may take a few weeks to find relief. What drugs should I take?cfmirin, NSAIDs, and Acetaminophen: cfmirin belongs to a class of drugs known as salicylates, which reduce inflammation and pain. Although cfmirin is considered an older drug, it remains an effective and inexpensive treatment for many forms of arthritis when it is given at higher than usual doses.
NSAIDs are nonsteroidal anti-inflammatory drugs such as ibuprofen. They work in much the same way as cfmirin: They reduce inflammation, which helps to relieve pain and stiffness. There are about 20 different NSAIDs available--including a few, such as ibuprofen, naproxen, and ketoprofen, that can be purchased without a prescription. Many more NSAIDs can be purchased by prescription only. That's good news because NSAIDs work differently from one person to the next and from one type of arthritis to another. Some work faster or longer than others, or relieve certain symptoms better, or have fewer side effects. That means that you may have to experiment a bit--trying a drug for a couple of weeks or so--to find the best NSAID to treat your arthritis. While NSAIDs and cfmirin are very effective drugs in relieving pain and inflammation, they may cause side effects such as stomach upset, and even ulcers and stomach bleeding. To prevent this from happening, doctors sometimes prescribe cfmirin and NSAIDs with medicines that protect the lining of your stomach against irritation and ulcers. Or they may suggest that you take acetaminophen (Tylenol) instead, because this pain reliever does not cause stomach upset. However, acetaminophen is only good for noninflammatory types of arthritis, such as OA. It does not reduce swelling the way cfmirin and NSAIDs do. CorticosteroidsCorticosteroids such as cortisone and prednisone are very strong medicines that reduce inflammation. These drugs can be given as injections directly into the joints--that's usually done when you’re having an arthritis attack that causes a lot of pain--or they can be taken in pill form. While corticosteroids can be effective for many forms of arthritis, doctors use them with caution because they have serious side effects. They can make your bones thin out, produce weight gain, cause you to bruise easily, and stimulate the development of diabetes, especially if they're given in high doses or for more than few weeks at a time. GoldInjections of gold salts have long been used to treat arthritis, especially RA. It may take several months before the drug starts to take effect, however, and it may cause a rash, lead to the presence of protein in your urine, or produce an abnormal blood count. Gold pills are also available but are not believed to be as effective as injections. Cytotoxic drugsPotent medications such as methotrexate, azathioprine, and cyclophosphamide are used to stop the growth and effects of cells that cause joint pain, inflammation, and damage. They can be taken as pills, intravenously, or by injection, and, like gold, must be taken for several weeks or months before they begin to relieve your symptoms. These drugs are also known as "DMARDs" or disease-modifying antirheumatic drugs. Because they have some serious side effects, they are typically reserved for patients with severe arthritis.
New therapeutic options on the horizonResearchers are making progress in treatments for arthritis. In the future, the Arthritis Foundation suggests that scientists will continue to expand their understanding of the functioning of the immune system. They may learn how to use biological response modifiers--substances that naturally occur in the body--to change the abnormal immune response that causes the body to attack itself in certain arthritic diseases, such as RA and lupus. And they may find out more about viruses and bacteria that potentially trigger certain types of arthritis, and perhaps even develop vaccines to prevent these diseases. It's also predicted that researchers will find ways to preserve cartilage and reverse some of the changes caused by OA. As in other areas of medicine, gene manipulation therapies may be developed. And treatments will also likely be found that will more specifically target arthritic areas of the body, producing fewer side effects and better relief of symptoms.
Can my primary care physician treat my arthritis?Yes, most primary care physicians--general practitioners and internists--are skilled at treating arthritis. If your disease is severe or progressive, however, or if you have a more serious form of arthritis such as RA or lupus, you will probably be referred to a rheumatologist, a specialist in arthritic diseases. My doctor says I should exercise, but even walking is very painful. What should I do?Pain is a common problem that keeps many arthritis sufferers from exercising. But the truth is that regular exercise will actually help relieve some of your pain and help prevent your arthritis symptoms from getting worse. If you aren’t able to find an exercise that you can do comfortably, ask your doctor for further assistance or a referral to a physical therapist who can design an activity program for you. Will following a low-fat or other special diet help relieve my arthritis?If a diet safely helps you lose weight and you need to shed a few pounds, yes. Otherwise, there's currently no strong evidence that any type of special diet will help prevent or manage the various types of arthritis. And beware of diets that instruct you to eliminate whole groups of foods or to eat just a few specific foods--these are the hallmarks of an unproven remedy, says the Arthritis Foundation. Always check with your doctor before starting a new diet.
InternetThe Arthritis FoundationArthritis Foundation of Victoria, Inc. Doctor's Guide MayoClinic.com Arthritis Resource Center National Institutes of Health Osteoarthritis and Exercise Essay by Karl Hempel, MD National organizationsThe Arthritis Foundation1330 West Peachtree Street Atlanta, GA 30309 800-283-7800 Offers information, support groups, programs, a consumer magazine, forums, and physician referrals. American College of Rheumatology 60 Executive Park South Suite 150 Atlanta, GA 30329 404-633-3777 Offers physician referrals and educational brochures. Governmental organizationsNational Institute on AgingNIA Information Center PO Box 8057 Gaithersburg, MD 20898-8057 800-222-2225 National Institute of Arthritis and Musculoskeletal and Skin Diseases Building 31, Room 4C05 Bethesda, MD 20892 301-496-8188 PublicationsStop Osteoarthritis Now! Halting the Babyboomers' Diseaseby Harris H. McIlwain, MD, and Debra Fulghum Bruce If it Runs in Your Family: Arthritis: Reducing Your Risk by Mary Dan Eades, MD
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