CHAPTER ONE
Arthritis: An Introduction
Perhaps you shrugged it off the first few times you experienced it: an uncomfortable feeling in your knee, the lingering pain in your lower back when you got up in the morning, the slight change in flexibility in your hands. Maybe you have begun needing help opening jars. The stairs may be a bit more painful to climb. You hear a grating or popping sound in your lower back when you move a certain way. And the most unsettling part for you is that these symptoms are not going away. That's when it may have occurred to you: "I wonder if it's arthritis?"
You are part of a large and growing population of people of all ages who has what is generally and commonly referred to as arthritis. It is a big disease: it affects tens of millions of people, has the ability to impact every aspect of their lives, is the subject of much continuing research being conducted into its many facets, and is associated with an impressive number of conventional and alternative treatments and management options. Much has been written about it in scientific literature, on the Internet, and in books and magazines.
This chapter is an introduction to the concept of arthritis and specifically the most common type of the disease: osteoarthritis. I bring together the most relevant, up-to-date information available on osteoarthritis with the hope of helping you better manage, live with, and rise above the challenges posed by this most common of all types of arthritis.
Let's get started.
WHAT IS THIS THING CALLED ARTHRITIS?
"Arthritis" literally means "joint inflammation." Even though this describes a symptom or sign rather than a specific diagnosis, most people use the term "arthritis" to refer to any condition that affects the joints.
The word "arthritis" is tossed around generically, but in reality the term describes not a single disease but rather more than one hundred different yet somewhat similar conditions that affect the joints, tendons, and muscles. Some types of arthritis also impact the skin and other organs. Of the more than one hundred different types of arthritis, only a handful are considered to be common and one alone accounts for about 60 percent of all cases of arthritis: osteoarthritis.
When most people talk about arthritis, they are usually referring to osteoarthritis. For the 3.1 million Americans who have the "other" arthritis, the term "rheumatoid arthritis" is what comes to mind. A third type of arthritis that often does not get the respect it deserves is gout, which affects more than 3 million people. All together, these three types of arthritis directly impact the lives of an estimated 33 million people, leaving the remaining 14 million individuals affected by any of the 100-plus types of arthritis that remain.
MYTHS ABOUT ARTHRITIS
Even though arthritis has been around for millennia, there are still many misconceptions and misunderstandings about what it is and what it is not. So here are a few of the more common myths and the truth:
• Arthritis is just a name for aches and pains that affect older people. At the risk of repeating myself, I emphasize that arthritis can affect people of any age, not just older people, and it can involve much more than aches and pains. If you are experiencing any of the signs and symptoms mentioned in this chapter or in chapter 2, you should see a health-care professional to get a diagnosis so you can start a plan of treatment and avoid as much disruption to your life as possible. Chapter 4 outlines how your doctor may diagnose arthritis.
• Arthritis isn't that serious. While we don't want to be alarmist, arthritis is a serious condition: it affects about one-third of adults and nearly three hundred thousand children in the United States. About one-third of people age 18 to 64 who have arthritis have arthritis-attributable work limitations. According to the 2005 Survey of Income and Program Participation, arthritis and other rheumatic conditions have been and continue to be the most common cause of disability in the United States. The latest figure for the total costs associated with arthritis and other rheumatic conditions in the United States was $128 billion in 2003, up from $86.2 billion in 1997.
• There's no cure, so there's not much you can do about arthritis. The absence of a cure definitely does not mean you can't achieve significant improvement in symptoms using exercise and body therapies, medications, natural remedies, and medical procedures. One of the most exciting things about arthritis today is that patients are learning that they can play a significant role in their own disease management by taking advantage of conventional and alternative therapy options and networking avenues. New research findings are released regularly on innovative ways to prevent and treat many different types of arthritis. In this book I explore treatment ideas in several different categories.
OSTEOARTHRITIS
Osteoarthritis is not only the most common type of arthritis and the one with the most name recognition; it is also the type that will affect one in two people during their lifetime. If you have ever suffered a knee injury, your risk for knee osteoarthritis rises to 57 percent. Are you obese? Now your risk for knee osteoarthritis has just climbed to 60 percent.
The Centers for Disease Control estimate there are 27 million adults who have osteoarthritis, also known as degenerative joint disease, but that just represents doctor-diagnosed cases. Millions of people are likely living with undiagnosed osteoarthritis, individuals who have chosen not to seek medical care because they feel they do not need it or that they can take care of their symptoms themselves or they may not have health insurance. Perhaps you are among the 27 million or the yet-undiagnosed millions, or maybe you have a loved one with the disease. In any case, here's the story on osteoarthritis.
What Does Osteoarthritis Look Like?
Imagine you are looking at the ends of the bones that form a joint. The two ends are cushioned by cartilage, like a piece of firm elastic or rubber that allows the joint to move smoothly and efficiently. Now picture the rubbery cartilage deteriorating, breaking away bit by bit, which allows the bone ends to rub against each other. Tiny pieces of bone or cartilage break off and float in the space between the bones and around the joint, causing irritation and pain.
The rubbing bones and cartilage can cause other changes, including the development of bony growths called spurs that can cause additional irritation. When the shape of the joint is altered, it can no longer function smoothly. The lining of the joint, called the synovium, becomes inflamed and causes proteins called cytokines to appear and damage the cartilage even further. The overall result is pain, stiffness, reduced function, and limited mobility: you have osteoarthritis.
Osteoarthritis can affect people of any age, but it is more common among older adults. Generally, women are more prone to the disease than are men, but among adults younger than 55 men are more likely to develop osteoarthritis.
Signs and Symptoms
One-third of people older than 65 have X-ray evidence of knee osteoarthritis, and 70 percent of people older than 70 have X-ray evidence of osteoarthritis in general. The good news is that just because you show signs of osteoarthritis does not automatically mean you will experience the symptoms of the disease. In fact, only about 50 percent of people who show signs of the disease actually have symptoms. Those symptoms are:
• Pain in one or more joints during or after movement (the joints most often affected are the knees, hips, fingers, lower spine, and neck)
• Stiffness in a joint that is most obvious after a period of inactivity and which lasts no more than 30 minutes
• Tenderness in a joint when you apply light pressure
• Grating or popping sensation you can hear and/or feel when you move the joint
• Development of bone spurs around the affected joint
• Muscle atrophy around the affected joint(s) caused by inactivity
• In knee osteoarthritis, pain exacerbated when moving the knee, pain when standing up, pain when using the stairs, weakening thigh muscles, and a knee that locks or catches
• In hip osteoarthritis pain in the groin, buttocks, or inner thigh and an obvious limp
• In osteoarthritis in the fingers, enlarged joints, painful and swollen finger joints, nodes on the finger joints, and manual dexterity difficulties
• In osteoarthritis of the feet, as pain and tenderness in the big toe (tight shoes and high heels can provoke pain)
• In osteoarthritis of the spine, bone spurs, which occur when disks in the back deteriorate, and pressure on nerves in the spinal cord that causes pain that radiates to the neck, arm, lower back, legs, and/or shoulder
Symptoms of osteoarthritis tend to develop gradually and get worse over time.
DID YOU KNOW?
Knee osteoarthritis is a leading cause of disability in the United States. Approximately 9 million adults were diagnosed with knee osteoarthritis in 2005, and more than half of those affected are older than 65. (American Academy of Orthopaedic Surgeons)
Causes and Risk Factors
What causes osteoarthritis? That's a good question. Even though there is archaeological evidence that arthritis existed millennia ago and despite decades of research, no one has come up with a simple answer to this question. No expert has yet identified why certain joints are affected by osteoarthritis or what causes the cartilage damage that is the trigger for the characteristic wear and tear of the disease.
Although the natural course of aging can contribute to the breakdown in the joints and cause osteoarthritis, not all older people develop the disease. Therefore, experts have identified risk factors for osteoarthritis. These factors fall into two general categories: those over which you have no control and those that you may be able to change or control. The first five risk factors are in the latter category.
• Age. Although osteoarthritis can affect people of any age, the risk of developing the disease increases with age. Fifty percent of people older than 65 have osteoarthritis in at least one joint.
• Ethnicity. Caucasians have a greater risk of developing osteoarthritis than Asians. African-American women have more knee osteoarthritis and less hand disease than do Caucasian women.
• Gender. Among people younger than 45, more men have the disease; among those 55 and older, women are affected more.
• Family history. Having a close family member with some form of arthritis increases your risk of getting the disease.
• Medical history. Your chances of developing osteoarthritis increase if you have a history of joint injury, joint surgery, joint infection, Paget's disease, a pituitary disorder, gout or pseudogout, congenital weakness or defect in a joint, or hemochromatosis (excess iron disease).
• Weakness. Weak thigh muscles increase the risk of developing osteoarthritis of the knee.
• Overweight/obesity. Excess weight places increased stress on weight-bearing joints and is a risk for arthritis. Sixty percent of people who are obese are at risk for developing knee osteoarthritis.
• Joint trauma. Injury to a joint may increase your chances of developing arthritis in that joint.
• Infection. An infection in a joint can result in arthritis in that joint.
• Repetitive motion. A job, hobby, or sport that involves repetitive motions may increase the risk of arthritis in the affected joints. For example, baseball pitchers and carpenters may develop motion-related arthritis.
While the risk factors and causes presented here are commonly associated with conventional medicine, other medical models, including Eastern practices such as Ayurvedic medicine and Chinese Traditional Medicine, and naturopathy, bring several other risk factors and causes to the table.
In Ayurvedic medicine, arthritis is attributed to toxins, which are produced by a poor digestive system. These toxins are said to circulate throughout the body and then settle in weak areas, which in many cases include the joints. Ayurvedic treatments for arthritis reflect this approach to the disease and include nutritional and herbal remedies that focus on preventing the accumulation of toxins as well as their elimination.
In Traditional Chinese Medicine (TCM), arthritis is associated with a disruption in the flow of the life force, of qi (chi). To restore this energy flow in the body and thus relieve symptoms of arthritis, TCM therapies employ both acupuncture and herbal remedies, which are discussed in later chapters.
The naturopathic approach to arthritis considers nutritional risk factors and causes. An imbalance of bacteria in the gastrointestinal tract is proposed as one contributing cause; certain foods are also believed to contribute to inflammation. (I discuss the role of diet in chapter 10.) Therefore, naturopathic treatment options take these factors into consideration.
SPOTLIGHT ON RESEARCH
If your knees face outward, you may be at an increased risk for osteoarthritis. This condition is known as varus alignment, and while it resembles bowleggedness, it is not as extreme. According to an August 2010 study released by the U.S. National Institutes of Health and published in the journal Annals of the Rheumatic Diseases, people with varus alignment were nearly 1.5 times more likely to develop osteoarthritis than individuals who have a straight-legged stance. The authors of the study note that about 70 percent of the force transmitted to a healthy knee while walking is focused on the inside of the knee. Therefore, if the knee is facing outward, there is greater stress on the inside of the knee, which may increase the risk of osteoarthritis.
Preventing Osteoarthritis
Whether you want to prevent osteoarthritis or you already have the condition but want to help prevent any further damage, here are some suggestions from the Arthritis Foundation. The earlier you start these preventive measures the better, so encourage any young people you know to start now!
• Achieve and maintain ideal body weight. Any excess weight places unnecessary and harmful stress on your joints.
• Keep moving! Exercise to strengthen the muscles around joints and to help prevent deterioration of cartilage in the joints. I discuss different physical exercises and activities in chapter 7.
• Pay attention to posture. Proper posture protects the joints from excessive or abnormal pressure. If you have poor posture, you may favor one side of the body or one leg, for example, and place undue stress on the opposite side or the other leg.
• Spice it up. Doing the same exercise routine every day not only is boring; it also places repetitive stress on the same joints, which can lead to osteoarthritis. Strength training should be alternated with different aerobic activities.
• Remember that pain is not gain. Joint pain is a sign that you have overstressed your joint(s). Rest and perhaps some tender loving care (ice, elevation, massage) may be in order as well.
• Follow safety precautions. Injuries can lead to osteoarthritis. Wear the proper shoes for your chosen activity, don helmets, wrist pads, and knee protectors when appropriate, and make sure your equipment is always in good operating condition. Do not take unnecessary chances when participating in activities that could lead to injury.
Diagnosis and Treatment
I cover both diagnosis and treatment in much more detail in subsequent chapters, but here is an introduction. Diagnosis of osteoarthritis typically begins with a medical history, a physical examination, and X-rays to determine if there is any joint damage. Bony enlargements of the joints caused by bone spur formation are a sign of osteoarthritis, so your physician will look for nodes (called Heberden's and Bouchard's nodes) on your hands and bunions on your feet.
Although there are no blood tests that diagnose osteoarthritis (see chapter 4), your doctor may do them to exclude other diseases that can cause secondary osteoarthritis (other diseases or conditions that explain the presence of osteoarthritis, such as an injury, congenital abnormality, or another form of arthritis). He or she may also perform arthrocentesis to exclude other causes. This procedure allows the clinician to analyze the fluid in your joint, and it can also provide relief from pain and swelling as well. (A detailed explanation of diagnostic procedures and techniques is provided in chapter 4.)
Treatment of osteoarthritis focuses on relieving and managing symptoms, improving and conserving mobility, and preserving joint function. These goals can be achieved using both over-the-counter and prescription medications (e.g., nonsteroidal anti-inflammatory drugs, painkillers), both oral and topical; injections of corticosteroids or viscosupplementation; lifestyle changes such as weight control, exercise, and diet; herbal and nutritional remedies; physical therapy; and body and energy therapies. Often individuals find that combining two or more of these approaches is most helpful. Surgery is considered a last resort and may include joint replacement. All of these options are discussed in detail in part 2.
BOTTOM LINE
Millions of Americans get up each day to face the challenges of living with osteoarthritis. The first step to living life to the fullest with this disease is to understand what it is, what it can do to your body, and how you can prevent and manage the signs and symptoms to minimize the negative impact they can have on your life.
Copyright © 2011 by Lynn Sonberg Book Associates
