Coping with Arthritis in Its Many Forms
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
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
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.
Ups and Downs
With so many kinds of arthritis, which can appear and
progress unpredictably, diagnosis and treatment can be trying for both
physician and patient. Diagnosis depends on integrating a host of factors,
including the possibility that a person may have two forms of the disease.
The normal ups and downs of chronic, painful disease further
complicate matters. "Just about any painful condition will wax and wane on
its own," says rheumatologist Dennis Boulware, M.D., University of Alabama,
A worsening or reappearance of the disease is called a
flare. Remissions bring welcome relief, but can also obscure whether symptoms
decreased on their own or due to treatment.
Proper treatment depends on correct diagnosis of the
specific disease, and varies with severity and location, as well as from person
to person. But treatment need not wait for a final diagnosis because initial
treatment options, such as anti-inflammatory drugs and exercise, are similar
for many forms of the disease. Treatment should begin early to reduce joint