A closer look at Arthritis

Arthritis defies stereotypes. That’s because arthritis is not a singular, specific disease: There are more than 150 different types of arthritis in existence, affecting more than 50 million Americans and counting. Cases are expected to reach 67 million by 2030, according to the Centers for Disease Control and Prevention (CDC).

Arthritis—a general term for conditions affecting the joints and surrounding tissues—is the most common cause of disability in the United States, limiting mobility for 21 million Americans. But thanks to advances in understanding and treating arthritis, many patients like are able to live full lives free of disabling pain.

The range of arthritic conditions runs the gamut from common, well-known disorders such as gout to lesser-known conditions such as ankylosing spondylitis, a form of inflammatory arthritis that mostly affects the spine. Bursitis, tendonitis and carpal tunnel syndrome also fall under the arthritis umbrella. But osteoarthritis (OA) and rheumatoid arthritis (RA) are two of the most common and potentially debilitating forms.


More than half of arthritis-related hospitalizations stem from OA. This degenerative form of “wear-and-tear” arthritis occurs as
cartilage is worn down over time. Unlike other tissue in the body, cartilage can’t regrow, and when too much cartilage is lost, symptoms of osteoarthritis—pain, stiffness and swelling—can result. Symptoms generally appear after age 40, often in the hands, hips and knees.

The most common type of arthritis, OA affects an estimated 27 million American adults. More than two-thirds of people will have degenerative joint changes by age 70. Today’s longer life spans and higher rates of obesity (a risk factor for OA) mean that stressed joints must perform longer, putting more people at risk, he says.

“There’s no substitute for a complete family history and medical exam,” says Nathan Wei, M.D., clinical director of the Arthritis Treatment Center in Frederick, Maryland. In addition to a family history and a physical examination, a doctor may use laboratory tests, X-rays and MRI tests to determine the extent of joint damage.

There’s no known cure for OA, though emerging research is paving the way for new treatments in which patients may be able to retain and even regrow cartilage in arthritic joints. But for now, common treatments include nonsteroidal anti-inflammatory pain relievers such as ibuprofen, combined with exercise and lifestyle modifications, such as weight loss to reduce joint strain.

Once frowned upon for OA patients, exercise is now viewed as essential for successful treatment. “Exercise is as important as medication,” says Wei. Low-impact forms of exercise such as swimming, resistance training and stretching are ideal.

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease that causes chronic joint inflammation and a wide range of symptoms, from pain, joint swelling and weakness to weight loss and low-grade fever. RA and OA are quite different, says Philip J. Mease, M.D., director of rheumatology research at Swedish Medical Center in Seattle: “Osteoarthritis is a more natural process [of] cartilage loss, while rheumatoid arthritis is a specific disease state caused by abnormal immune system function.”

The CDC estimates that 1.5 million adults have RA, which is two to three times more common in women. While OA is generally discovered later in life, RA is often discovered earlier, says Wei. The 30s and 40s are prime years for diagnosis.

There is no singular test for RA, so doctors use a combination of physical history and examination, blood tests and X-ray imaging to make a diagnosis. Thanks to emerging science concerning RA biomarkers— biological clues to the existence and extent of RA disease activity—sophisticated blood tests can now aid in the detection and management of RA, says Mease.

As recently as the 1980s, RA patients routinely received gold injections as a primary form of treatment. Today, the gold standard for RA treatments is disease-modifying antirheumatic drugs and biological therapies—protein-based prescription medications that fight the abnormalities that cause RA.

While RA can’t be cured, between 10 and 25 percent of RA patients reach remission. In remission, the disease is inactive and patients don’t experience symptoms, but must continue taking medication and remain under a doctor’s care. When RA is caught early, patients have a better chance of reaching remission, says Mease. “Remission doesn’t happen for everyone,” he notes. “But when it does, patients are overwhelmed by how good they feel.”



Source: CostcoConnection

Treatment of Chronic Pain


NERVE BLOCKS can relieve pain by stopping the impulses that travel along nerves in the body. The physician injects a local anesthetic along the course of the nerve or nerves associated with the pain.

SPINAL INFUSION involves the delivery of low doses of medications like morphine through a catheter inserted in the spine.

Most experts say that surgery is a treatment of last resort. For many patients surgery can magically cure their pain, but, the risks are high. Surgery can destroy other sensations in the body or become the source of new pain.

IMPLANTED DRUG DELIVERY SYSTEMS are used for patients with very resistant pain. These systems are expensive but offer a more convenient, portable and efficient way to take medications.

IMPLANTED DORSAL COLUMN STIMULATOR is a device that allows a patient to stimulate spinal nerves with mild doses of electricity, producing relief by short-circuiting pain impulses. This method is being used to treat pain caused by nerve damage and angina.

JOINT REPLACEMENT is the surgical replacement of a joint with a prosthesis. This procedure can be a successful treatment for rheumatoid arthritis and osteoarthritis.

SYMPATHETIC BLOCKS cut some of the sympathetic nerves, reducing pain for some patients.

ABLATIVE SURGERY cuts one or more sensory nerves and blocks sensation from the parts of the body affected by that nerve.


PHYSICAL THERAPY helps patients with chronic pain to improve flexibility, strength, endurance and conditioning thereby reducing the disability caused by chronic pain. Techniques include postural correction for patients with back pain, hot and cold therapy, ultrasound and massage.

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) uses mild electrical impulses delivered to the skin by hand held device. It is a popular method of relieving joint and muscle pain. TENS works by increasing endorphins and stimulating the nerve fibers, altering the balance of painful stimuli entering the spinal cord. It can be worn in a pocket and transmits an electrical impulse through electrodes taped to the body in the area of pain.

Total Knee Replacement Surgery Improves Function, Reduces Long-Term Costs

Total knee replacement (TKA) dramatically improves a patient’s quality of life and significantly reduces his/her long-term treatment costs, according to a new study.

Total knee replacement is performed on people who have severe functional limitations due to traumatic injury, a systemic disorder, or osteoarthritis, a condition which destroys cartilage and joints.

More than 194,000 TKAs are done each year in the United States, and the number is expected to increase as the population ages.

Orthopaedic researchers compared the long-term cost-effectiveness of total knee replacement surgery to that of medical management (nonoperative strategy) for treatment of severe osteoarthritis of the knee, over the remaining lifetime of the patient.

“For both strategies, we calculated the patient’s estimated average time in various functional outcome states and the total direct health care costs over his/her remaining lifetime,” said Dr. Gottlob.

The four functional states are:

the person is completely able to carry on all their usual activities

the person has some discomfort or limited motion in the knee but otherwise is able to perform usual activities

the person can do little or no regular work; little or no self-care

the person is incapacitated, primarily bedridden, or wheelchair-bound, with little or no ability for self-care

Results of the study shows that patients treated nonoperatively with anti-inflammatory medications and/or supportive devices (cane, walker) would spend all of their time in the two worse functional outcome states-unable to work or incapacitated, said Dr. Gottlob.

In contrast, total knee replacement patients would spend most of their time able to perform their everyday activities.

The costs of the TKA strategy include total hospital costs (operating room costs, implant costs, nursing unit costs), physician charges, medication costs and acute rehabilitation costs, he said. “A patient gets twice as many quality years with a total knee replacement than without the surgery,” said Dr. Gottlob.

“Total knee replacement surgery is a cost-saving procedure, even for people in their 70s, 80s and 90s. These results are especially relevant for health care decision makers who wish to allocate resources, in part, on the basis of cost-effectiveness.”

Source: Ivanhoe


The American Cancer Society estimates diet is linked to about one-third of all cancers. They say eating more fruits and vegetables can help. Recent research suggests produce may also play a protective role in osteoarthritis.

Carrots have them. So do Brussels sprouts. Antioxidants are nutrients found in orange and red produce and green leafy vegetables. They’re known to fight heart disease and some cancers. Now they’re linked to a reduced risk for osteoarthritis.

In a new study, Dr. Joanne Jordan at the University of North Carolina, Chapel Hill, found caucasians with high levels of antioxidants in their blood have less osteoarthritis. This did not hold true for African-Americans. “Why would this be different? We don’t know why, but it is something that bears further research,” she says.

Forty million Americans have osteoarthritis. Experts predict in 20 years the number will jump to 60 million. Joe Weissman has osteoarthritis now. “The biggest problem I have is walking down stairs,” he says.

Dr. Jordan says, “If we could come up with something as simple as a dietary intervention to either prevent developing osteoarthritis or prevent it from getting worse — becoming disabling and painful — then we can make a significant impact to the public health.”

Dr. Jordan is conducting more studies to determine the role of antioxidants in arthritis. Vitamin E, beta carotene, lutein and lycopene were the antioxidants Dr. Jordan found in high levels most often in those subjects who did not have arthritis.

Gelatin For Joint Pain

Gelatin in concentrated amounts may have a positive effect on joint pain and stiffness in athletes, according to a study conducted at Ball State University by Dr. David Pearson, coordinator of the university’s Human Performance Laboratory.

“There has been some use of gelatin combined with vitamin C and calcium in Europe for osteoarthritis patients,” explains Pearson. “Based on that research, we determined to find out if athletes who have chronic knee pain that is unrelated to arthritis would benefit from gelatin supplementation.”

The experiment involved 20 athletes, men and women in several sports, all of whom reported knee pain. They were divided into two groups, one of which was given concentrated gelatin (NutraJoint) in orange juice and the other a placebo that looked, smelled and tasted the same. Ball State researchers pre-measured and packaged the substances for both groups to ensure compliance. Both groups were given three separate tests for pain before the study. Then they took the supplements for eight weeks and were tested again.

“We found an overwhelming difference in the amount of force the gelatin group was able to exert on the bad knee, and we also found that they reported a significant decrease in knee pain,” says Pearson. “But we were not looking for a cure, a healing mechanism or a cause-effect relationship. The study simply revealed that those who took the gelatin showed improvement in the amount of pain they experienced and in the amount of force they could withstand without pain.”

Pearson adds that gelatin contains high amounts of proline and glycine, two amino acids that are used for forming cartilage. He speculates that concentrated amounts of gelatin may help enhance the formation of building blocks for joint health. He also thinks that the results may be encouraging to older adults suffering from joint pain.

Pearson cautions that eating gelatin alone is of little benefit, and that the concentration of gelatin used in the study was greater than that found in common desserts. It should be noted that the Ball State study involved a small number of subjects, is not yet published in a scientific journal, and remains to be replicated by other researchers.

Pearson concludes, “Athletes are constantly pounding their knees, and they are sidelined because of joint health more than anything else. Gelatin is just a food. It’s not more drug therapy, and there are zero side effects. It’s worth the time and the science to investigate it further.” Pearson and his associates are conducting a similar study to investigate gelatin’s effect on shoulder pain.

Acupuncture help patients with arthritis of the knee

The ancient Chinese therapy of acupuncture can help those suffering from arthritis of the knee, according to new research. The study is the largest clinical trial on acupuncture reported to date.

More than 20 million Americans suffer from osteoarthritis. It’s one of the most frequent causes of physical disability in adults.

The current study was led by researchers from the University of Maryland School of Medicine in Baltimore. The multi-location trial included 570 patients ages 50 or older with osteoarthritis of the knee. Participants were placed in three groups. One hundred and ninety patients received acupuncture, 191 underwent sham acupuncture, and 189 followed a self-help course to manager their condition. The patients all received their standard medical care from their physicians.

Acupuncture involves inserting thin needles into specific body points to stimulate the body and improve health. In the sham acupuncture group, the needles were taped to the skin, so the patient would feel some sensation, but the needles were not inserted.

Study authors report by the eighth week of the study, the patients receiving acupuncture showed an increase in function of their knee. By week 14, the patients in the acupuncture group had a decrease in pain compared to the other two groups. Specifically, the patients receiving acupuncture reported a 40-percent decrease in pain and a 40-percent increase in function.

Lead researcher Brian Berman, M.D., says, “This trial … establishes that acupuncture is an effective complement to conventional arthritis treatment and can be successfully employed as part of a multidisciplinary approach to treating the symptoms of osteoarthritis.”

SOURCE: Annals of Internal Medicine, 2004;141:901-911