by James J. Patterson, MD
Orthopaedic Institute of Ohio
Our joints move freely and painlessly due to a specialized coating called articular cartilage. This cartilage lowers the friction during movement and cushions the joints reducing the stress of motion. Damage or loss of this cartilage increases friction leading to arthritis.
Arthritis is a Greek word applied to over 100 different diseases that affect our joints. It literally means “joint (arthros) inflammation (itis)”. These diseases attack our joint cartilage, breaking it down. The most common arthritis diagnoses are osteoarthritis and rheumatoid arthritis. Treatment is focused on reducing the inflammation in the joint.
Over 10% of our population suffers from osteoarthritis (OA). Usually OA presents itself as localized pain to a joint that is aggravated with activity. As the disease progresses in the joint, the pain can be more global. Swelling can become common after activity. As OA enters its final stages, stiffness and deformities develop escalating the pain.
Early treatment for OA includes activity modification, weight reduction, and stretching exercises to maintain joint motion. As the disease progresses so does the pain. Early pain remedies include aspirin, Tylenol and ibuprofen. These are later substituted with more powerful anti-inflammatory drugs or even oral steroids for short courses. Joint injections of steroids or “lubricants” can also relieve pain. Finally, surgery is the last option for treatment. Arthroscopy or “scoping” the diseased joint can ease pain and return function for a short period of time. Ultimately joint replacement is necessary for eradication of the disease and long term pain relief.
Rheumatoid arthritis (RA) is the second leading cause of arthritis. This is an autoimmune disease where your body recognizes its own cartilage as “bad” and starts to digest it. It is familial in nature and can attack early on (Juvenile) or later in life (adult onset). RA affects 1% of Americans and can be severely debilitating. Usually RA presents itself as early swelling with global joint involvement and multiple joint involvements. It can be detected by laboratory blood tests. Progression can be rapid depending on the aggressive nature of the patient’s RA and the treatment.
Early treatment for RA is the same as that for OA. These include rest, over the counter medications and activity modification. More powerful antiinflammatories and steroid medications are introduced early on in the treatment of RA. Ultimately, specific RA medications including plaquenil, methotrexate or embril are necessary to slow the RA progression and treat the symptoms. Injections are commonplace and are used judiciously to lessen the amount of medications taken. Joint irrigation with arthroscopy can help prolong the course, but eventually joint replacement is necessary to relieve suffering and correct deformity.
Arthritis is virtually inevitable as our population continues to age. The fastest growing segment of population in America is people over the age of 80. Unfortunately, this translates to higher rates of arthritis. Treatments have improved over the years, but they have not kept pace with the growing demands of our more active octogenarians. Prevention will likely decrease this epidemic in the future. These include long term weight reduction, continued physical activity such as walking, swimming and biking, and stretching to keep the joints mobile and the muscles and tendons strong and supportive.