| Article provided by: Colorado HealthSite
Used with permission.
This article contains information on arthritis including:
Arthritis Forms and Management Options, Rheumatoid Arthritis,
Osteoarthritis, Scleroderma, Sjogren's Syndrome, Reiter's
Syndrome, Polymyalgia Rheumatica, Gout, Ankylosing Spondylitis,
Juvenile Arthritis, Lyme Disease, Coping with Arthritis, and
even Joint Replacement.
Its Forms and Management Options
Arthritis is among the oldest known afflictions of human
beings. It has been found in the mummies of Egypt and in skeletons
in excavations of other ancient civilizations.
The word -arthritis- literally means joint inflammation,
but it is often used more broadly to indicate any of the more
than 100 so called rheumatic diseases. Such disorders can
affect not only the joints but other connective tissues of
the body. These include important supporting structures, such
as muscles, tendons, and ligaments, as well as the protective
coverings of internal organs.
The rheumatic diseases vary greatly from person to person
and from one disease to another. Their effects vary from a
slight pain, stiffness, and swelling to crippling and disability.
Therapies range from a warm bath and massage, to changes in
lifestyle, to combinations of antiarthritic drugs or surgery.
Today, about 15% of Americans-some 37 million-are afflicted
with arthritis or a related disorder. Although medical science
has not yet found a cure for all forms of arthritis, scientists
have achieved major advances in understanding these diseases
and in controlling and preventing them.
Arthritis and related musculoskeletal disorders cost the
nation an estimated $31 billion annually in medical expenditures
and associated economic losses, according to the National
Arthritis Data Workgroup convened by the National Institute
of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
The Workgroup projects that by the year 2000, these disorders
will account for over $95 billion of the nation's health costs.
Because a large percentage of those with arthritis and related
disorders are 65 years of age or older, much of this economic
burden falls on public resources such as Medicare and Medicaid.
However, no measure of economic impact can adequately represent
the personal and social burden of arthritis.
As scientific knowledge about the rheumatic diseases has
grown, their complexity has become more apparent. In fact,
authorities now list more than 100 different disorders that
fall under the heading of the rheumatic diseases. Each is
a distinct disease with different causes and different prospects
for recovery. Several of the most common disorders are discussed
below.
Rheumatoid Arthritis
Rheumatoid Arthritis (RA) is the most difficult of the rheumatic
diseases to control and can do the most damage to the joints.
According to the Arthritis Foundation, in 1988 it affected
over 2.1 million people in the United States, two-thirds of
whom are women. The condition generally starts between the
ages of 20 and 50, although it can begin at any age.
RA usually affects many joints, most commonly the small joints
of the hands. The affected, joints become inflamed. painful,
and swollen, and later deformed. In addition, there may be
general symptoms such as weakness, fatigue and loss of appetite.
The disease tends to be both chronic and irregular; it can
be severely disabling. It can flare up suddenly, and just
as quickly go into remission. Emotional stress appears to
play a role. While stress is not a direct cause of rheumatoid
arthritis, it can hasten progression of the disease and make
it worse.
Although it is not possible today to cure rheumatoid arthritis,
it is possible for patients to cope successfully with their
affliction with the help of their physicians and other specialists.
The prime objective of treatment is prevention of joint destruction.
The possibility of having a remission of the disease makes
it important that all efforts be made to prevent joint destruction
during the active stage. Once damage has occurred, it may
be irreversible.
Since rheumatoid arthritis is usually chronic and may last
a lifetime, physicians try to avoid the use of toxic drugs
as far as possible. The patient is usually started on large
doses of aspirin, which is the most reliable and least toxic
of all antiarthritic drugs. It is most likely to provide sustained
control of symptoms at the lowest risk of undesirable side
effects.
Two new therapies are currently being investigated by NIAMS
grantees. Dr. Jon Levine, University of California, San Francisco,
has discovered that a substance found in the nervous system
may play an important role in promoting the inflammatory component
of arthritis. To determine whether inhibiting this substance
could reduce this problem, the researchers gave 24 patients
with active RA either a placebo or a drug called quanethidine
(a regional nerve blocker). After 14 days, the researchers
found that quanethidine decreased the patients' pain and increased
their finger-pinch strength, whereas those who were given
the placebo had no appreciable change.
In another study designed to develop new therapies for RA,
Dr. David Trentham and associates at Beth Israel Hospital,
Boston, found that patients given the immunosuppressive drug
cyclosporin A - used by organ transplant recipients - had
significantly less pain and joint swelling. The researchers
reported that cyclosporin A is clinically effective in patients
with RA that does not respond to other treatment, but its
therapeutic value is limited by its toxicity for the kidney
and elsewhere. Lower doses of the drug may reduce its toxicity.
Other drug therapies that are sometimes used include chloroquine,
gold and gold compounds, penicillamine, immunosuppressives,
and corticosteroids. These treatments have quite serious side
effects, however, and are used only when the rheumatoid arthritis
cannot be controlled with more conservative measures.
Besides medications, doctors usually recommend a balance
of rest and exercise. Rest can mean having the patient lie
down when tired, or it can mean resting swollen, painful joints.
A prescribed plan of physical activity generally involves
regular, gentle, and slowly progressive exercises.
Osteoarthritis
The most common form of arthritis, afflicting more than 16
million Americans, is degenerative joint disease, or osteoarthritis
(OA). OA primarily affects cartilage - the protective material
that covers and cushions the ends of the bones - causing it
to fray, wear, ulcerate, and in extreme cases, to disappear
entirely, leaving a bone-on-bone joint. At the edges of the
joint, bony spurs may form. Disability results most often
from disease in the weight-bearing joints (knees, hips, and
spine).
Older people are the most frequent victims of osteoarthritis.
Excessive or unusual wear of the joints is an important contributing
factor and results from overweight, poor posture, injury,
strain from one's occupation or recreation, or a combination
of these factors. The most common symptoms are pain and stiffness.
Pain is usually experienced when joints are used, especially
finger joints and those that bear the body's weight. Enlargement
of the fingers at the last joint often occurs. Such enlargements
are common and are called Heberden's nodes. Although permanent,
these nodes seldom lead, to disability.
The same general methods of treatment and care that are used
for rheumatoid arthritis are equally effective in treatment
of osteoarthritis. Drug therapy is not nearly as important,
although painkillers and anti-inflammatory agents are helpful
in some people. Surgical correction of deformed weight-bearing
joints, especially hips, has been effective in helping many
osteoarthritis patients to walk again without pain.
Scleroderma
Scleroderma is characterized by excessive deposits of collagen
(a structureal protein) in the skin and various other organs
such as the heart, kidneys, lungs, and gastrointestinal tract.
These deposits can cause thickening and hardening of the affected
organs. The disease often begins with Raynaud's phenomenon,
blanching and cooling of fingers and toes on exposure to cold
or during emotional episodes, Raynaud's phenomenon, which
occurs in about 5% of the population, results from abnormal
changes in the small blood vessels of the hands and feet that
prevent the blood from flowing properly.
Sjogren's Syndrome
Sjogren's syndrome is marked by dryness of the eyes and mouth,
caused by the destruction of the lymph glands that secrete
tears and saliva. It may be a primary disease, or it may be
secondary to certain rheumatic diseases, such as rheumatoid
arthritis, lupus, and scleroderma. Patients with this disease
may also be at increased risk for developing lymphomas, as
well as inflammatory blood vessel disease and nervous system
dysfunction. Sjogren's syndrome is common in women but not
well recognized in men.
More
Types of Arthritis
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