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Friday, July 3, 2009

What is Arthritis?

Dr. Holly Atkinson, Internal Medicine

Arthritis is a group of conditions that typically involve inflammation and pain in the joints. Arthritis typically develops where two or more bones meet, although it can affect other tissues in the body. Arthritis can lead to joint weakness and physical deformities that can interfere with even the most basic daily activities. Arthritis pain varies considerably in severity. It may come and go, which is called episodic pain, or it may be chronic, meaning you’ll feel it all the time.

How Does Arthritis Happen?

In most cases, arthritis is a natural part of aging, and develops over a lifetime of the use of our joints. In healthy joints, the ends of the bones are protected by cartilage, which is a tough smooth tissue that cushions the ends and allows them to glide smoothly across one another. The whole joint is surrounded by synovial fluid, which lubricates and delivers nutrients to the cartilage. Osteoarthritis, the most common form of arthritis, develops when the cartilage wears away and the bone ends are left unprotected. They may rub together every time you move, which can cause pain. The edges of the joints may also develop dense spots and bumps called spurs. The ligaments, which are cord-like tissues that connect the bones to other structures around them, may also thicken, preventing movement.

Types of Arthritis

There are more than a hundred types of arthritis. Some of the more common types are as follows:

Osteoarthritis. This is by far the most common form of arthritis and caused by long-time use of the joint and surrounding tissue.

Arthritis Caused By Inflammation. Inflammation is part of the body’s natural healing process. But once the inflammatory process starts and doesn’t stop, cartilage and other tissues surrounding and connecting your bones are attacked. This leads to swelling, throbbing pain and sometimes deformities.

  • Rheumatoid Arthritis, or RA. The inflammation of rheumatoid arthritis starts after the immune system turns on itself and attacks the body. It is not known why the body does this. It’s a called systemic condition, meaning that it affects tissue throughout the body, including the respiratory system, skin, blood vessels, nerves and eyes.
  • Gout. This type of arthritis develops as a result in a defect in body chemistry. People with gout form tiny, needle-shaped crystals in the joints, causing inflammation. That inflammation triggers attacks of severe pain that lasts from one to two weeks. Gout usually affects the toes, but can also occur in the feet, the hands and the wrists. During an attack, the area affected becomes swollen, hot and extremely tender. Gout usually affects men.
  • Ankylosing Spondylitis. This is a condition that mostly affects the spine. Inflammation causes the bones of the spine to grow together.
  • Lupus. This is a serious disorder in which blood vessels throughout the body are inflamed.
  • Scleroderma. This is a disease of the body’s connective tissue that causes a thickening and hardening of the skin.
  • Juvenile Arthritis. This can develop as early as infancy, and is a general term for all types of arthritis that occur in children.

Coping With Arthritis

The treatments for arthritis vary according to which type you have, which joints are affected, the intensity of the pain and how it affects your daily life. There is no cure for arthritis, but there are many things you can do to cope with the condition.

Lifestyle Choices

  • Practice Good Posture. This will help keep your bones and joints aligned. Walking is an easy way to improve posture.
  • Watch Your Weight. Your body weight has a large impact on the amount of stress on your muscles and bones. Excess fat cells also release chemicals that trigger inflammation.
  • Exercise. Activity will help to keep your weight under control, but don’t overdo it. If your body starts to hurt, you should stop. Swimming and the stationary bike are two great options since they are easier on the joints than weight-bearing exercises like walking or dancing.
  • Keep Moving & Stretch. To reduce stiffness, try to avoid sitting or standing in the same position for long periods of time. When writing or using your hands, give your hands a rest every 10 to 15 minutes. On long car trips, get out of the car. Stretch and move around at least once an hour. And when you’re picking up an object, bend your knees and squat while keeping your back straight.

Medication Options

Your doctor may suggest or prescribe medications to ease the pain and inflammation if lifestyle changes don’t help. These options include:

  • NSAIDs or Nonsteroidal Anti-Inflammatory Drugs. These target the enzyme active in joint inflammation and work to relieve pain. They are available over- the-counter. Examples include aspirin, ibuprofen and naproxen.
  • Cox 2 Inhibitors. These are a prescription class of NSAIDs. These newer drugs are easier on your stomach, but may have side effects on your heart. Speak to your doctor about these risks.
  • DMARDs or Disease Modifying Anti-Rheumatic Drugs. If these are taken early enough, they can limit the amount of joint damage that occurs in rheumatic arthritis. They work to slow down the disease and prevent permanent joint damage. Because it can take weeks before they start to work, they’re often taken with NSAIDs or corticosteroids. Other forms of DMARDs include immunosuppresants and Tumor Necrosis Factor or TNF-blockers. Immunosuppressants act on your immune system to blunt the immune response, which drives the inflammatory process. However, by blunting the immune system, these drugs also leave you susceptible to infection.

There are several other new drugs recently approved by the FDA. Ask your doctor about the benefits and risks of these newer medications.

Other Treatment Options

  • Blood Filtering. This type of treatment removes the antibodies that can contribute to inflammation and pain.
  • Surgery. More severe cases of arthritis may require surgery that removes the joint lining, such as Arthroscopy and Synovectomy. A total joint replacement may also be recommended.
  • Complementary Approaches. Relaxation techniques like hypnosis, deep breathing and muscle relaxation may help ease arthritis pain. Many people also find relief through acupuncture, gentle forms of yoga and Tai Chi.
  • Dietary Supplements. Glucosamine and Chondroitin, the building blocks of cartilage, are popular supplements among people suffering from mild forms of arthritis. Studies have shown that some people with mild arthritis get some relief, with others experience no benefit.

While arthritis is a long term condition, there is much that you can do to live an active life. Work closely with your doctor to find the right combination of treatments for you.

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