CAUSES AND REMEDIES OF ARTHRITIS

SAIMA IBRAHIM (Saima_virgo1@hotmail.com)
Aug 10 - 16, 2009

The term 'arthritis' simply refers to an inflammation of the body joints. Arthritis is the major cause of disability and chronic pain. There are now more than 100 known types of arthritis including osteoarthritis (OA), rheumatoid arthritis (RA), fibromyalgia, lupus, and gout.

- OSTEOARTHRITIS (OA)

Osteoarthritis is the most common form of arthritis. It develops when cartilage (the smooth covering over the bones in your joints), starts to break down, usually as a result of aging, trauma, or increased wear and tear. As it worsens, OA can cause bone-on-bone friction. There are several patterns of joint involvement in OA, most of which involve only a few joints. The most common pattern involves the major weight-bearing joints such as the hips, knees or lower spine. Most forms of OA become symptomatic after age 50.

OA of the hands is a distinct subtype of OA, and very common in women. This type of arthritis can often begin when a woman is in her 20's or 30's. Unlike the gradual onset of other types of OA, this type can begin suddenly and can be quite painful. This is progressive and causes classic deformities of the fingers with enlarged joints.

- RHEUMATOID ARTHRITIS(RA):

Rheumatoid arthritis (RA) is a systemic autoimmune disease in which immune cells attack and inflame the membranes around various joints. RA is three to four times common in women than in men.

Resulting symptoms are inflamed, swollen, painful, and/or deformed joints. RA is generally symmetric and affects many joints simultaneously. RA can also affect the connective tissues of the body and other organs such as the lungs, heart or nervous system.

Although arthritis is a disease of aging, infants can be affected from birth with a form of RA called Juvenile Rheumatoid Arthritis (JRA).This is a much more serious and complicated form of RA, which affects approximately 300,000 children in the US; JRA is one of the most prevalent chronic illnesses among youngsters, affecting more children than juvenile diabetes or cerebral palsy.

Unlike rheumatoid arthritis, which affects joints symmetrically, OA can often affect only one knee or one hand. The joints most affected by OA are the spine, fingers, toes, knees, and hips. Less commonly affected are the shoulder, TMJ, ankle, wrist, and sacroiliac.

In OA, the cartilage wears down, and the joints don't have a cushion. So when bone touches bone, it equals "Ouch!"

The pain usually increases with more use of the joint. So pain is minimal at the beginning of the day but increases as the day goes on. Though pain is not bad after waking up, there is often stiffness-- a 'gelling' that lasts usually less than 30 minutes. So 'rise and shine' is more like, 'rise and oooh'.

The number one risk factor for OA is age. Getting older is great in many ways, but the joints can start to become arthritic. The average age of onset for OA is 40. About 80 percent of folks over 55 years old have OA, and after the age of 65 it's about 97 percent.

Women seem to be affected by OA about 2.6 times more than men, and their OA progresses faster. Obesity is the biggest modifiable risk factor for OA. More weight means more stress on the joints, especially the hips and knees.

- OTHER TYPES OF ARTHRITIS:

Certain types of infection (such as Lyme disease and syphilis) are known to cause a persistent arthritis. Successful treatment of the infection itself does not always eliminate the residual arthritis, which can mimic OA, RA, or a mixed form. Other autoimmune diseases such as systemic lupus erythematosus (SLE) also cause arthritis and fibromyalgia has many similar symptoms.

In women, these symptoms may often flare up with menses. Some other types are: spondyloarthritis, psoriatic arthritis, ankylosing spondylitis, scleroderma, bursitis, tendonitis, myofascial pain, carpal tunnel syndrome, infectious arthritis, polymyalgia rheumatica, dermatomyositis, and Reiter's Syndrome to name only a few.

DIAGNOSIS

How do you know if you have arthritis? See your physician sooner rather than later; don't just try to treat yourself. Your symptomatic and long-term treatment may be much more successful if begun early. The diagnosis is primarily based on clinical findings, including pain, pattern of joint involvement, joint enlargements, and specific joint deformities. Your doctor will probably recommend x-rays to identify the extent of the damage and certain blood tests to rule out other conditions or to help identify the specific type of arthritis.

Take this list with you when you consult your physician.

- You have joint discomfort or swelling.
- You have unexplained fatigue.
- You notice a change in your fine motor skills with your hands.
- You notice difficulty writing.
- You have a sudden unexplained limp or difficulty walking.
- You have repeated bouts of tendonitis.
- You have visual changes.

The pill may trigger lupus in some women. Certain women may be prone to develop lupus when they start taking combined oral contraceptives.

Systemic lupus erythematosus (SLE) is an autoimmune disorder in which the immune system mistakenly attacks normal tissue. The condition can vary widely in severity, manifesting as a skin rash and arthritis or leading to damage to the kidneys, heart, lungs and brain to varying degrees

The increased risk of developing lupus in connection with starting on the pill appears to be greatest in the first 3 months of use, and with first- and second-generation contraceptives containing higher doses of estrogen.

TREATMENT OF ARTHRITIS

Arthritis is a chronic disease and requires long-term management and follow-ups. Arthritis therapy focuses on reducing the symptoms (especially pain and decreased mobility) as well as slowing the progression of the inflammation of arthritis.

NON-PRESCRIPTION MEDICATIONS:

First line medications include analgesics (painkillers) such as acetaminophen (e.g. Tylenol) or one of the many non-steroidal anti-inflammatory agents (NSAIDs, e.g. Motrin.. or Advil or Aleve). Most drug stores also carry generic ibuprofen or acetaminophen, which are just as effective and much less costly.

There are enteric coated versions of most of the NSAIDs and aspirins (acetaminophen is not irritating to the stomach); these may reduce the incidence of gastrointestinal complications.

PRESCRIPTION MEDICATIONS:

- CELEBREX: (Celecoxib Capsules) Celebrex was recently approved as the first COX-2 inhibitor for the relief of the signs and symptoms of OA, and of RA in adults. It treats both the pain and inflammation of arthritis.

The most common side-effects for Celebrex are indigestion, diarrhea, and abdominal pain. In rare cases, problems such as bleeding can occur without warning. This medicine should not be taken by patients with asthma or allergic reactions to aspirin, arthritis medications or certain sulfa drugs.

- ENBREL (ETANERCEPT): for the treatment of moderate to severe RA in adults and children called 'biologic response modifiers'. It greatly reduces pain and duration of morning stiffness as well as to reduce the number of swollen and tender joints, thus enabling patients to resume their normal daily activities.

Enbrel acts by supplementing the body's natural process of regulating levels of tumor necrosis factor (TNF), a protein know to be integrally involved in the RA disease process. Enbrel effectively prevents the TNF from working, making it inactive, and thereby reducing the inflammatory process.

CORTICOSTEROIDS: most potent anti-inflammatory agents,

METHOTREXATE: used as second line therapy by many rheumatologists for RA because of its relatively rapid onset of action (4-6 weeks) and oral administration.

EXTERNAL RISK FACTORS:

Environmental pollutants, including cigarette smoke, have been shown to raise the risk, and this suggests that other factors that increase inflammation, like car and truck exhaust, may also be associated with the disease.

After controlling for age, cigarette smoking, oral contraceptive use and many other variables, researchers found that the women who lived within 55 yards of a large road had a 31 percent increased risk for rheumatoid arthritis compared with those living 220 or more yards away.

LIVING NEAR MAJOR ROAD MAY BOOST RHEUMATOID ARTHRITIS RISK

People exposed to high levels of traffic pollution have an increased risk of rheumatoid arthritis, a new study suggests.

Researchers measure the distance between each woman's home and the nearest major roadways. The results showed that women who lived within 50 meters (164 feet) of interstates or primary, multi-lane roads were 31 percent more likely to develop rheumatoid arthritis (RA) than those who lived more than 200 meters (656 feet) from a major roadway. Women who lived within 50 meters of the largest roadways had a 63 percent increased risk.

"Even after accounting for the effects of age, race, sex, socioeconomic status and cigarette smoking, the increased risk for women located near major roads remains substantially higher."