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 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.”