Coping With Arthritis

Arthritis has plagued mankind for millennia. Historians have found references to forms of arthritis in Greek and Roman literature, and some even suspect cavemen suffered from it. Today it’s so widespread that one in six people and one in three families are affected by it. More than 43 million Americans of all ages are currently victims of arthritis and related conditions. Over the next 20 years, as the baby boom generation ages, the total is expected to rise to 60 million.

Frequently we ignore arthritis, calling it simply the “aches and pains” of old age. Or we self-medicate with painkillers, not bothering to seek professional treatment. But make no mistake: Arthritis is a serious, potentially crippling, and even fatal disease. The early warning signs should never be ignored.

Some Arthritis Facts

  • Women are almost twice as likely as men to suffer from arthritis. The disease becomes more prevalent after age 45. Yet it is not a disease exclusively of the elderly, for more than 300,000 children are also affected.
  • Arthritis is a costly disease: It’s the leading cause of absenteeism; more than 45 million work days are lost each year.
  • The estimated yearly cost in lost wages and medical bills is $65 billion — second only to the bill for heart disease.
  • Arthritis patients average eight visits to their doctor each year — twice as many as those suffering from other chronic illnesses like high blood pressure.
  • Approximately six million people are “self-diagnosed” and improperly “self-treated.”

What Is Arthritis?

“Arthritis” literally means “inflamed joints. “It is an umbrella term for more than 100 different forms of joint disease. However, while arthritis primarily affects the joints, it also attacks muscles and connective tissues surrounding organs. Arthritic disease stems from injuries, defects in the immune system, wear and tear on the joints, infections, or genetic predisposition. Whatever the cause, the effect is much the same in all individuals: Where bones meet in the joints, they are actually disintegrating.

Imagine a machine with well-oiled parts working smoothly, all valves pumping, all parts meshing together. Then, for some reason, one part bends, or the lubricating fluid dries up. Over a period of time, the parts begin to wear down or grind together until something gives way. For a variety of reasons, this is what happens in the joints of your arms, legs, hips, and even your back when they become arthritic. Some forms of arthritis do affect other parts of the body — skin, eyes, and various organ systems — and doctors watch for these symptoms in all patients with arthritic disease.

Many people believe that medicine’s only answer for arthritis is use of strong prescription painkillers. And so they “self-medicate,” follow “alternative diets,” or try unproven “miracle” treatments such as copper bracelets or bee stings. Because arthritis is a disease that frequently comes and goes, these non-medical cures often seem to work. In fact, their success is merely a coincidence.

Fortunately, legitimate therapy is not limited to a few potent painkillers. There are many safe and effective medications for arthritis that, when combined with physical therapy, some dietary changes, and regular exercise, can enable most patients to lead normal lives.

How Do We Treat Arthritis?

Arthritis treatment is determined by the type you have. In general, however, the front-line therapy is an analgesic like aspirin or acetaminophen or a member of a group of medications called nonsteroidal anti-inflammatory drugs, or NSAIDs. Most arthritis sufferers rely on NSAIDs for daily pain relief. While aspirin is still widely used, NSAIDs have fewer gastric side effects and are longer-acting than aspirin, so you have to take fewer pills each day. Strong anti-inflammatory medications such as corticosteroids or immunosuppressive drugs may also be used, as well as a new genetically engineered drug that blocks inflammation due to the immune-system agent called tumor necrosis factor. Another totally new class of drugs — nicknamed “COX-2 inhibitors” — promises the benefits of NSAIDs without the gastric side effects.

Here’s a rundown of treatments for each form of arthritis:

 

The Five Basic Types of Arthritis

 1. Osteoarthritis: The most common form, this disease affects 20.7 million Americans (usually over age 45).
 2. Rheumatoid Arthritis: Affects more than 2.1 million people, mostly women.
 3. Gout: More frequent among men, with an estimated 2.1 million victims.
 4. Ankylosing Spondylitis (Spinal Arthritis): and related conditions: Some 400,000 patients
 5. Systemic Lupus Erythematosus: Affects about 240,000 people, usually women.
Other, less common forms include Juvenile Rheumatoid Arthritis, Scleroderma and Arthritis Due to Infection.

 

Osteoarthritis (OA)

Most people will suffer from some form of OA as they grow older, and the joints naturally age through wear and tear. The most notable symptom, a dull aching feeling in the joints, usually appears toward the end of the day. The joints most commonly affected are in the hands, knees, fingers, spine, hips, neck, and feet. OA is a progressive disease and is not usually reversible. However, medication can relieve the symptoms.

Treatment for OA usually starts with a mild drug such as acetaminophen (Tylenol) or aspirin taken every four to six hours as needed. As the disease progresses, symptoms become more severe, and a COX-2 inhibitor or a traditional NSAID may be substituted. The available COX-2 inhibitors are celecoxib (Celebrex) and valdecoxib (Bextra). Likely choices among the NSAIDs include ibuprofen (Motrin), indomethacin (Indocin), meloxicam (Mobic), or naproxen (Naprosyn).

If OA pain becomes especially severe, a doctor will sometimes prescribe a short course of narcotic pain relievers such as Tylenol with Codeine. When joints become inflamed, injections of corticosteroids such as cortisone or prednisone can be effective.

Finally, a real exercise program — swimming, golf, walking, tennis, range-of-motion exercises (such as stretching) — is as valuable as medication in keeping joints flexible and mobile. Weight loss to relieve extra stress on joints is also vital to OA care.

Rheumatoid Arthritis (RA)

Between the ages of 30 and 50, eight times as many women as men develop this crippling form of arthritis. Although we don’t know why it develops, researchers suspect that victims have a genetic predisposition.

Unlike OA, RA symptoms are more pronounced in the morning — the joints and muscles tend to stiffen up overnight as you sleep. RA patients may develop swelling in the joints; and this may lead to deformities and, ultimately, total immobility. RA patients may also develop such related symptoms as fever, fatigue, and loss of appetite.

Drug treatment of RA begins with the same types of medications used for OA: aspirin, Celebrex, NSAIDs, and, occasionally, steroids. If these drugs fail to control joint inflammation, other, more potent medications are prescribed. Although we don’t know why, an antimalarial drug called hydroxychloroquine (Plaquenil) is known to reduce RA inflammation. While the drug seems to work well, it has potentially serious side effects that can cause vision problems, so careful monitoring by your physician and eye doctor is important. Gold salts, injected on a weekly or biweekly basis, or taken orally once or twice a day can reduce joint inflammation, but, again, serious side effects make them impractical for many patients. Another drug — penicillamine (Depen or Cuprimine) — works much like gold salts in reducing symptoms and retarding disease in severe cases of RA, and may cause fewer side effects.

Researchers today are exploring the role that immunosuppressive drugs can play in the treatment of RA. Azathioprine (Imuran) and cyclosporine (Neoral) are approved for use in RA cases. Methotrexate (Rheumatrex) is now frequently prescribed as well, and your doctor can try the new drug anakinra (Kineret) if other drugs prove inadequate.

Most immunosuppressive drugs are extremely potent and are usually reserved for very serious cases where all else has failed. However, some drugs that work through the immune system may help a larger group of patients. One, called leflunomide (Arava), not only relieves the symptoms of RA but also staves off the joint damage that accompanies the disease. Another, a genetically engineered drug called etanercept (Enbrel), works on just one element of the immune system, the naturally occurring protein called tumor necrosis factor (TNF). By blocking the inflammatory effects of TNF, Enbrel provides significant relief to a majority of patients with moderate to severe RA.

Like other forms of arthritis, RA should be treated by both medication and physical therapy, which can help restore some of the lost joint function. Surgical procedures such as hip and knee replacements have enabled many patients to return to a more fully functional lifestyle.

Gout

Gout, one of the most painful forms of arthritis, is found primarily in men. While we can’t cure it, we do have several highly effective treatments to control it. The symptoms of gout are often centered in the big toe, causing it to become swollen and extremely painful; but any joint may be affected. Pain usually occurs when the body is unable to eliminate uric acid, a waste product normally in the blood. If your body produces too much uric acid, or your kidneys aren’t working properly to excrete it, an acute gout attack can follow.

Through the ages gout was known as the “disease of kings” because it was believed that a rich (man’s) diet caused the disease. This myth is partially true. Diets high in purines (organ meats, fish eggs, sardines, anchovies, beer, and wine) can aggravate gout — but only in people who have trouble dealing with uric acid. Likewise, eliminating these foods may help reduce chances of an attack, but won’t cure the underlying cause. Alcohol, too, can cause an attack or make one worse. Your diet and drinking habits should be fully discussed with your doctor when you begin treatment.

In general, gout is controlled or prevented by a number of specific medications that reduce the inflammation caused by the crystal-like deposits of uric acid that form in the toe, or other areas, and precipitate an attack.

Colchicine, a drug developed from the crocus plant, is among the best known anti-gout drugs. It provides quick relief during a gout attack and is also used preventively. In addition, there are two types of second-line treatment: Drugs that lower uric acid levels by increasing output, such as probenecid and sulfinpyrazone (Anturane), and drugs like allopurinol (Zyloprim) that prevent uric acid production. These medications are often supplemented with NSAIDs during acute attacks.

 

How Arthritis Disables the Joints

Normal joint: Where two bones meet, our bodies normally provide a simple and effective lubricating system. Ligaments binding the bones together form a capsule within which a thin membrane called the synovium exudes a fluid lubricant. For good measure, the ends of both bones are cushioned by a smooth layer of cartilage.

Osteoarthritis: In this form of arthritis, trouble begins when the protective cushion of cartilage between the bones slowly degenerates. As it disappears, the synovium and the ends of the bones thicken within the joint, leading to the aching stiffness that characterizes the disease.

Rheumatoid arthritis: The culprit here is the synovium, which for unknown reasons becomes swollen and inflamed, leading to irreversible damage to the joint’s capsule and protective cartilage. Eventually the unprotected ends of the bones themselves begin to erode.

 

Ankylosing Spondylitis (AS)

Ankylosing spondylitis (AS), or spinal arthritis, literally means “fused spine,” since its basic symptom is an inability to bend the spinal column. Primarily afflicting men, this form of arthritis usually causes severe pain where the base of the spine connects to the pelvis. During the course of the disease, inflammation actually destroys the flexible joints in the lower spine. A certain genetic marker called HLA B-27 signals an increased risk of AS. Patients first experience pain in the lower back and buttocks, fever, and fatigue. Later, they may develop a stooped-over posture. Inflammation of the eyes and valvular heart disease may also occur.

The good news is that most cases of AS are relatively mild and can be treated with NSAIDs and a regular physical therapy program.

Systemic Lupus Erythematosus (SLE or Lupus)

Though not itself a form of arthritis, lupus is linked to arthritis in more than half the cases. Its victims are teenage girls and young women more often than men. While it is treatable, no cure has been found for this largely hereditary and possibly fatal disease. A less serious form of lupus is discoid lupus erythematosus (DLE).

The main symptom of SLE is inflammation of internal connective tissue. DLE, on the other hand, causes a circular rash on the face or skin. Although we don’t know why either form occurs, lupus is classified as an immune system disorder. It can cause the body to attack its own organs, including the kidneys, causing high blood pressure and kidney failure; the lungs, causing pleurisy; or even the central nervous system, causing problems ranging from headache to psychosis. The symptoms wax and wane, reappearing with differing degrees of severity.

Once diagnosed, usually through blood tests or a skin biopsy, lupus is treated mainly by reducing its symptoms. NSAIDs, antimalarial drugs, and steroids are frequently used. Immunosuppressive drugs are prescribed for difficult cases. Because sunlight can make lupus symptoms worse in many cases, sunblock or sunscreen should always be worn.

While lupus is a serious, life-threatening disease, patient survival rates have steadily improved over the last decade, due to more effective treatment of related kidney disease and other problems.

Other Arthritic Disease

Progressive Systemic Sclerosis, better known as Scleroderma, is a relatively rare disease that causes thickening of the skin and, like lupus, can affect connective tissue in internal organs. While there is no cure, its symptoms are often relieved by high blood pressure medications like vasodilators (see Chapter 2), steroids, and immunosuppressive drugs.

Juvenile Rheumatoid Arthritis is also known as Still’s Disease, monarticular juvenile arthritis, or polyarticular juvenile arthritis. This disease, which afflicts children and adolescents, usually has symptoms — aching and swollen joints — similar to other forms of arthritis. Treatment includes pain relief with NSAIDs and analgesics. Steroids and other drugs used to treat adult RA may be needed in some juvenile cases.

Infectious arthritis is the name given to arthritis-like symptoms that often occur after severe infections such as Lyme disease or gonorrhea, and viral illnesses such as measles, chickenpox, and mumps. Symptoms usually disappear with treatment of the primary infection by antibiotics or other appropriate drugs.

Living with Arthritis

Many arthritis victims will suffer for prolonged periods, even the rest of their lives. Often simple skills like dressing, eating, and bathing must be relearned. To make life easier, there are many assistive devices that can be installed in the home, such as “grab bars” to help a person get in and out of the bathtub, and other aids such as large-button phones. Any physical therapist or rehabilitation specialist can make a visit to your home to help determine your needs. Often simply removing dangerous electrical cords or other impediments can prevent the falls and other accidents that damage fragile joints. In general, proper use of medications, exercise, rest, and a good diet will do the most to relieve arthritis symptoms.

Over the past three decades, research breakthroughs have helped reduce the suffering of many afflicted with arthritis. We have learned that certain gene patterns mean a susceptibility to arthritis, making early detection possible. There is now evidence that a genetic marker for osteoarthritis may exist. Researchers are closer to understanding which cells trigger the autoimmune forms of arthritis such as lupus, and what these forms may have in common with other diseases such as diabetes and multiple sclerosis. Even the drugs we take for granted today were the result of years of research. And now on the horizon is a new class of medicines called leumedins which block inflamed cells from reaching the joints.

Source: From the PDR® Family Guide to Prescription Drugs™

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