Early detection of arthritis is key to controlling aches
Disease comes in many forms
The aches and pains of arthritis are usually associated with getting older, but it can hit at any time, from age 1 on up.
Understanding arthritis and its many forms is more important than ever, because researchers have made some breakthroughs in recent years. Some of the treatment, though, depends on quick action.
The development of new medications for rheumatoid arthritis and pediatric arthritis can slow and even stop the disease from progressing, but the effectiveness of the drugs is fully realized only if patients start treatment in a matter of months from the onset of the disease.
There are some promising new surgical developments for osteoarthritis in early, limited stages, too.
Patients with any kind of arthritis can help themselves by being alert to the earliest symptoms and taking action before this progressive condition becomes disabling, experts say.
That’s why it’s important to check with your doctor about any pain in a joint that is present for more than a month or is getting worse in adults, or unexplained fevers, weight loss or persistent joint swelling in children.
About 46.4 million adults in the United States had been diagnosed with some form of arthritis as of 2007, making it the No. 1 cause of disability, according to the Centers for Disease Control and Prevention.
It ensues when there is an inflammation of the tissue that lines the joints, manifested by swelling, stiffness, redness, heat and pain.
If unchecked, that inflammation can damage the cartilage that protects the surface of the bones. Cartilage is the cushion that allows for smooth and pain-free movement at the joints where the bones meet. When the cartilage decreases or is gone, it can lead to bone pushing on bone, which can in turn lead to permanent damage.
Rheumatologists can usually determine what type of arthritis you have through your medical history, physical exams, imaging and blood tests.
Here’s a guide to some of the most common forms and treatment options:
Osteoarthritis
What it is: A degenerative joint disease associated with aging, although it also can develop years after an injury to a joint has apparently healed. Our joints try to repair the damage that occurs to the cartilage that lines them. Arthritis results when the repair process can’t keep up with the damage.
First symptoms: Pain when the joint is used or later in the day after a person has been up and walking. Sometimes patients can have knees give out on them or lock up. Often the joints have bony bumps on the sides, but are not usually hot and swollen.
First treatments: Lifestyle changes. Losing even 10 to 20 pounds can make a big difference by reducing pressure on the joints. Consider requesting a prescription for a physical therapist to teach you exercises, such as low-impact aerobic activity, range-of-motion exercises, aquatic exercises and strength training tailored to you that improve muscle and bone strength. Braces can be used to provide external stability to the knee joint, too.
Medications: Prescription nonsteroidal anti-inflammatory drugs monitored by a doctor and anti-inflammatory over-the-counter pain relievers. You also can ask your doctor about glucosamine and chondroitin sulfate, which may reduce symptoms in about 40 percent of patients but have not been shown to repair cartilage or affect inflammation.
Each medication has potential side effects, so be sure to check with your doctor.
Other options: Surgeries, considered a last resort, may include arthroscopic surgery to remove debris or repair torn cartilage or the more extreme joint replacement.
New developments: For those with a small defect in the cartilage, Dr. Charles Toulson, orthopedic surgeon and medical director of the Baylor Plano Joint Replacement Center, describes a relatively new option called DeNovo NT that uses juvenile cartilage from donors because a child’s cartilage, unlike an adult’s, can regenerate. Also, a less invasive surgical option for the hip allows an orthopedic surgeon to go between muscles, instead of cutting them. This can speed recovery from months to weeks.
Rheumatoid arthritis
What it is: An autoimmune disorder that occurs when the body’s defense system doesn’t work properly. It causes inflamed joints, affecting the knuckles of the hands, the wrists, the knees and feet and also may affect internal organs and systems. It may cause fevers and leave the patient feeling sick or tired.
Symptoms: Swollen and painful joints that may be stiff for hours in the morning
Treatments: Prescription medications.
New developments: Anti-inflammatory medicines that target the immune system. Some of these are pills, but the newest medicines are given as injections, either in the doctor’s office or at home like insulin. These drugs have been shown to nearly stop the damage that occurs in the joints.
Concerns: All of the drugs for rheumatoid arthritis work by affecting the immune system, which makes people prone to infection. Patients should be under a doctor’s close supervision. The medications also can be expensive, ranging from $15,000 to $30,000 a year.
Pediatric arthritis
What it is: An inflammation and stiffness of joints that lasts more than six weeks. As with adult rheumatoid arthritis, the current theory is that it is an autoimmune disease in which the body attacks its own tissues, causing inflammation and damage. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children may be able to go into remission. The disease can affect bone development.
Who is affected: Children 16 and younger; the peak of onset is between the ages of 1 and 4.
Symptoms: Unexplained fevers, weight loss, persistent joint swelling, problems with some kind of function that may lead to walking with a limp, trouble holding a pen or pushing buttons. Unlike with adults, joint pain does not necessarily indicate arthritis in children.
Treatment: While there is no cure, many of the new medications developed for adult rheumatoid arthritis can bring remission if the diagnosis and treatment begin early. Cortisone or steroids injected in a single swollen knee can also be effective. Physical therapy, regular eye exams to detect early changes of eye inflammations, exercise, weight control and adequate rest are also recommended.
Concerns: Patients need to be carefully monitored, particularly by pediatric rheumatologists, as some medications recently have been associated with cancerous lymphomas.