The Burden of Arthritis

According to the Centers for Disease Control and Prevention (CDC), self-reported doctor-diagnosed arthritis collectively affects nearly 43 million Americans--or about 1 in 5 adults.

Another 23 million have chronic musculoskeletal symptoms that suggest they, too, may have arthritis. This makes arthritis one of the most common illnesses in the United States and a leading cause of disability.

As the population ages, the CDC says that the number of Americans affected will increase dramatically.

"People ignore arthritis both as public and personal health problems because it doesn't kill you," says Capt. Charles G. Helmick, M.D., a medical epidemiologist at the CDC. "But what they don't realize is that, as people work and live longer, arthritis can affect their quality of life and lead to limitations in activities and work and eventually disability."

link to long descriptionArthritis limits everyday activities for 8 million Americans, according to statistics compiled by the CDC. Each year, arthritis results in 750,000 hospitalizations and 36 million outpatient visits. In 1997, medical care for arthritis cost over $51 billion.

The disease affects people of all ages. Nearly two-thirds of those with arthritis are younger than 65. Arthritis may affect people of all racial and ethnic groups. It is more common among women and older Americans.

Arthritis symptoms include joint pain, stiffness, inflammation, and limited movement of joints. When a joint is inflamed, it may be swollen, tender, red, or warm to the touch. In a healthy joint, the ends of the bones are covered by cartilage, a spongy material that allows almost frictionless motion between bones.

In fact, Birbara says the amount of heat produced when bones normally meet is less than when two pieces of ice are rubbed together. The joints are enclosed in a capsule and lined with tissue called the synovium. This lining releases a slippery, lubricating fluid that helps the joint move smoothly and easily. Muscles and tendons support the joint and help it move.

With arthritis, the cartilage may be damaged or worn away by degenerative processes or by inflammation, making movement painful and difficult. If left undiagnosed and untreated, arthritis may progress to cause irreversible damage to the joints.

Some rheumatic diseases are systemic, meaning they can affect the whole body. Diseases such as systemic lupus erythematosus (SLE) can cause arthritis as well as damage to virtually any bodily organ or system, including the heart, lungs, kidneys, blood vessels, skin, and brain, and may result in debilitating, and often life-threatening, complications.

According to the Arthritis Foundation, the most common form of the disease--osteoarthritis (OA)--affects about 21 million people in the United States. Also called "degenerative joint disease," OA is caused by the breakdown of cartilage and bones from the wear and tear of life, resulting in pain and stiffness.

OA usually affects weight-bearing joints such as the knees and hips, but an inherited form commonly affects the hands and spine. Pain and stiffness are the earliest symptoms in OA, which affects both men and women and usually occurs after age 45.

Other risk factors include joint trauma, obesity, and repetitive joint use. In most cases, OA can be detected by X-rays. Treatments include medications, education, physical activity or exercise, heat or cold, joint protection, pacing activities, weight loss if overweight, self-care skills, and sometimes surgery.

Shirley has the second most common type--rheumatoid arthritis (RA)--an autoimmune disease that occurs when the body's immune system mistakenly attacks the synovium and can lead to damage of both cartilage and the adjacent bone. RA may affect any joint but most commonly starts with inflammation in the hands and feet.

While the cause remains elusive, doctors suspect that genetic factors are important in RA. Recent studies have begun to tease out those specific genetic characteristics that make a person susceptible to developing RA. However, the inherited trait alone does not appear to fully account for the development of the illness. Researchers think this trait, along with some other unknown factor--probably in the environment--triggers the disease.

But RA can be difficult to diagnose early because it may begin gradually with subtle symptoms that usually wax and wane. According to the Arthritis Foundation, this form of arthritis affects more than 2 million people in the United States and is more common in women than men.

Ironically, even when the disease appears to be relatively inactive--as measured by the patient's pain, swelling, and stiffness--joint deterioration is likely to be progressing.

In early disease, most of the disability that patients experience is due to inflammation. In later disease, however, it is the loss of joint integrity that creates disability. This often necessitates surgical joint reconstruction or replacement procedures.

Treatments for RA also include medications, exercise, rest, joint protection, and self-care skills.

Managing Arthritis and Rheumatic Conditions

For years, the pain and inflammation of arthritis have been treated using medications, local steroid injections, and joint replacement--all with varying success. Seldom did the therapies make the pain go away completely or for very long, nor did they affect the underlying joint damage.

Today's researchers are working to improve diagnostic tools and develop treatments to forestall joint erosion.

Even people whose joints are already damaged by arthritis can benefit from the knowledge generated by today's research. Patients should consult with their doctors to determine which treatments are the most appropriate for their conditions.

Most arthritis medications fall into three categories: those that relieve pain; those that reduce inflammation or the body process that causes swelling, warmth, and redness; and those that slow the disease process and limit further damage to the joints--so-called disease-modifying agents.

Pain relievers such as Tylenol (acetaminophen) and NSAIDs such as Motrin (ibuprofen) are used to reduce the pain caused by many rheumatic conditions. NSAIDs have the added benefit of decreasing the inflammation associated with arthritis.

But a common side effect of NSAIDs is stomach irritation, which can often be reduced by changing the dosage or medication. Even acetaminophen has risks when taken in large doses, Kweder says.

Before safety concerns about Vioxx, Celebrex, and Bextra emerged in December 2004, these newer COX-2 NSAIDs were used primarily to reduce gastrointestinal side effects and offered an additional option for treatment.

Depending on the type of arthritis, a person may use a disease-modifying anti-rheumatic drug (DMARD). This category includes several unrelated medications that are intended to slow or stop disease progress and prevent disability and discomfort. DMARDs include Rheumatrex (methotrexate), Azulfidine (sulfasalazine), and Arava (leflunomide).

Someone diagnosed with RA today is likely to be prescribed a DMARD fairly early in the course of the disease, as doctors have found that starting these drugs early can help prevent irreparable joint damage that might otherwise occur.

Corticosteroids, such as prednisone, cortisone, methylprednisolone, and hydrocortisone, are used to treat many rheumatic conditions because they decrease inflammation and suppress the immune system.

The dosage of these medications will vary depending on the diagnosis and the patient. Corticosteroids can be given by mouth or by direct injection into a joint or tendon sheath.

For Shirley, any minor relief he experienced over the 25 years was due to injections of corticosteroid preparations into his joints.

The injections would relieve his pain, stiffness, and swelling temporarily. Unfortunately, corticosteroids given orally and for prolonged periods and at higher doses may carry side effects such as brittle bones, cataracts, elevated blood sugar, and an increased susceptibility to infections throughout the body.