Coping with Arthritis

by Food and Drug Administration (FDA)

It may begin as a slight morning stiffness. For the lucky person with arthritis, that's as far as it goes. But for millions of others, arthritis can become a disabling, even crippling, disease. Roman Emperor Diocletian exempted citizens with severe arthritis from paying taxes, no doubt realizing that the disease itself can be taxing enough.

One in seven Americans — nearly 40 million — have some form of arthritis. That number will climb as the baby boomers age. By 2020, about 60 million Americans will have arthritis, according to The National Arthritis Data Workgroup of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The disease is physical, but also exacts a mental, emotional and economic toll.

"Chronic illness impacts a person's entire lifestyle — work, family and recreation," says Gail Wright, Ph.D., a rehabilitation psychologist at the University of Missouri, Columbia. To improve quality of life, doctors and health educators increasingly advise combining drug treatment with education, social support, and moderate forms of exercise.

Arthritis means joint inflammation. In a normal joint, where two bones meet, the ends are coated with cartilage, a smooth, slippery cushion that protects the bone and reduces friction during movement. A tough capsule lined with synovial membrane seals the joint and produces a lubricating fluid. Ligaments surround and support each joint, connecting the bones and preventing excessive movement. Muscles attach to bone by tendons on each side of a joint. Inflammation can affect any of these tissues.

Inflammation is a complex process that causes swelling, redness, warmth, and pain. It's the body's natural response to injury and plays an important role in healing and fighting infection. Joint injury can be caused by trauma or by the wear and tear of aging. But in many forms of arthritis, injury is caused by the uncontrolled inflammation of autoimmune disease, in which the immune system attacks the body's own tissues. In severe cases, all joint tissues, even bone, can be damaged.

The general term arthritis includes over 100 kinds of rheumatic diseases, most of which last for life. Rheumatic diseases are those affecting joints, muscle, and connective tissue, which makes up or supports various structures of the body, including tendons, cartilage, blood vessels, and internal organs. The Food and Drug Administration has approved a wide variety of drugs to treat the many forms of arthritis.

The most common type of arthritis is osteoarthritis, affecting more than 16 million Americans. This degenerative joint disease is common in people over 65, but may appear decades earlier. It begins when cartilage breaks down, sometimes eroding entirely to leave a bone-on-bone joint in extreme cases. Any joint can be affected, but the feet, knees, hips, and fingers are most common. It may appear in one or two joints and spread no further. Painful and knobby bone growths in the fingers are common, but usually not crippling. The disease is often mild, but can be quite severe.

Second most common is rheumatoid arthritis, which affects 2.5 million Americans. It can strike at any age, but usually appears between ages 20 and 50. The hands are most commonly affected, but it can affect most joints of the body. Inflammation begins in the synovial lining and can spread to the entire joint. Highly variable and difficult to control, the disease can severely deform joints. Some people become bedridden. Others continue to run marathons.

An autoimmune disease affecting the whole body, rheumatoid arthritis can also cause weakness, fatigue, loss of appetite, muscle pain, and weight loss. Blood tests may reveal anemia and the presence of an antibody called rheumatoid factor (RF). However, some people with RF never develop rheumatoid arthritis, and some people with the disease never have RF. In about one in six, the disease becomes severe and can shorten life. Researchers hope to find ways to predict which patients should be treated more aggressively.

Two Most Common Forms of Arthritis

Compare the appearance of a normal joint with these two most common forms of arthritis.

Normal Joint: In a normal joint (where two bones come together), the muscle, bursa and tendon support the bone and aid movement. The synovial membrane (an inner lining) releases a slippery fluid into the joint space. Cartilage covers the bone ends, absorbing shocks and keeping the bones from rubbing together when the joint moves.

Osteoarthritis: In osteoarthritis, cartilage breaks down and the bones rub together. The joint then loses shape and alignment. Bone ends thicken, forming spurs (bony growths). Bits of cartilage or bone float in the joint space.

Rheumatoid Arthritis: In rheumatoid arthritis, inflammation accompanies thickening of the synovial membrane or joint lining, causing the whole joint to look swollen due to swelling in the joint capsule. The inflamed joint lining enters and damages bone and cartilage, and inflammatory cells release an enzyme that gradually digests bone and cartilage. Space between joints diminishes, and the joint loses shape and alignment.

About the Author

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