Valley Health Magazine

By Pamela Freeman-Fobbs

Today, 70 million Americans are afflicted with arthritis. Arthritis and the disability it causes create huge burdens for individuals, their families and the nation. In 1995, arthritis cost more than $22 billion in direct medical costs and over $82 billion in total costs. People who suffer from prevalent forms of arthritis struggle with everyday activities like getting dressed, brushing their teeth and pouring a cup of coffee. They may even have to quit or change jobs because arthritis prevents them from being able to work.Richard Bertken, M.D., Clinical Professor of Medicine and Director of the Arthritis Clinic at University of California San Francisco, Fresno, CA/Cedar Avenue Campus, classifies rheumatoid arthritis as a public health problem because less than 15% of Americans who suffer from arthritis actually get the treatment that they need.

ARTHRITIS LINKED TO HIGHER OBESITY RATES IN BABY BOOMERS
Baby boomers are now at prime risk for arthritis. Senator Barbara A. Mikulski, member of the Subcommittee on Aging, warned in a hearing to discuss arthritis research that more than half of the people affected by arthritis are under age 65, and that as the population ages, the numbers will increase dramatically.

Dr. Bertken, also Director of Arthritis Services at the Fresno VA Medical Center, states that the average age of the onset of rheumatoid arthritis, the most common form of arthritis, is 35-40. He also says that many women in this age group manifest symptoms of osteoarthritis due to obesity. Osteoarthritis is oftentimes the result of extreme weight bearing upon the joints. "I have practiced for 30 years and I am now seeing a huge increase in the number of obese, middle-aged women experiencing pain in their knees. Gastric-bypass surgery is now being indicated for a diagnosis of osteo-arthritis," he said.Harvard Medical School researchers at Beth Israel Deaconess Medical Center discovered that baby boomers have significantly higher rates of arthritis than their parents. They concluded that this is due to baby boomers having spent more years living with obesity than the previous generation. The study found that "baby boomers got a much earlier start, and have spent more of their lives in an obese state even though they have had better access to nutrition and information about exercise for much of their lives," said Suzanne Leveille, PhD, author of the study.

WHAT YOU SHOULD KNOW ABOUT ARTHRITIS
Early arthritis symptoms can be vague and confusing, but they are important to recognize. Newly diagnosed arthritis patients quickly realize that early symptoms are just the first layer to be uncovered before a definitive diagnosis and treatment plan can be established. Early symptoms linked to arthritis usually include joint pain, joint stiffness, tenderness in and around the joint, limited range of motion in one or more joints and redness and warmth around the infected joints. In an About.com feature on arthritis, Carol Eustice, a writer and patient advocate for people living with arthritis and chronic illness, suggests a few points to keep in mind regarding the topic at hand:

• Arthritis is not a single disease. Many people speak of arthritis as if it were a single disease. There are over 100 different types of arthritis and related rheumatic conditions. It is important to obtain an accurate diagnosis regarding which type of arthritis you have, so that proper treatment can begin.
• There is no known cure for arthritis, but there are many treatment options. There are treatment options which help with managing pain, controlling arthritis symptoms and reducing joint damage or deformity.
• There are many myths and misconceptions about arthritis. It is a myth that arthritis only affects older people. Arthritis is a complex disease and cannot simply be cured by changes in one's diet, although bad diets can aggravate the condition.
• A rheumatologist is a medical doctor who specializes in treating arthritis and other rheumatic conditions. Your primary doctor can refer you to a rheumatologist or you can get an appointment through self-referral if your health insurance allows it. Evaluation by a rheumatologist is important so that you can determine your type of arthritis and start a treatment plan.
• Be patient. If you have been diagnosed with arthritis, you may have to try several treatment options before finding the most optimal treatment plan for you. There are two important points to remember about arthritis treatment. Patients vary in their response to arthritis medications or other arthritis treatments. What works for one person may not work for another. Also, to find the safest and most effective medication or combination of medications, you will have to weigh the benefits versus the risks.

TYPES OF ARTHRITIS
Dr. Bertken defines rheumatoid arthritis as an acute or chronic inflammation of the joints of the body. Common areas where people have arthritis stiffness or pain are fingers, hips, knees and shoulders.

OSTEOARTHRITIS:: mostly affects the joints—unlike other types of arthritis which may have systemic effects. The most common symptom associated with osteoarthritis is pain in the affected joint after repeated use. Joint pain is often worse later in the day. The affected joints can swell, feel warm and become stiff after prolonged inactivity. Osteoarthritis can occur with other forms of arthritis simultaneously. Bone spurs and bony
enlargements are also characteristic of osteoarthritis.

PSORIATIC ARTHRITIS: is a type of arthritis associated with psoriasis (a skin condition characterized by red, patchy, raised or scaly areas) and chronic joint symptoms. The symptoms of psoriasis and joint inflammations often develop separately. Symptoms associated with psoriatic arthritis vary in how they occur (symmetrical or asymmetrical) and what joints are affected. Any joint in the body can be affected. When psoriasis causes pitting and thickening or discolored fingernails, the joints nearest the fingertips are likely to become arthritic.

ANKYLOSING SPONDYLITIS: is commonly associated with inflammations that starts at the lower spine or sacroiliac joints. The earliest symptoms are often chronic pain and stiffness in the lower back region and hips. Typical ankylosing pain in the back worsens following rest or inactivity. As symptoms of pain and stiffness progress up the spine to the neck, possibly including the rib cage area, bones may fuse.

LUPUS: can affect the joints, skin, kidneys, lungs, heart, nervous system and other organs of the body. It is not uncommon for symptoms associated with lupus to resemble symptoms associated with other types of arthritis and rheumatic disease, making lupus difficult to diagnose. A butterfly-shaped rash appearing on the cheeks and over the bridge of the nose (malar rash) is one of the distinguishing characteristics of lupus.

GOUT: is considered one of the most intensely painful types of arthritis. Gout is characterized by the sudden onset of severe pain, tenderness, warmth, redness and swelling from inflammation of the affected joint. Gout usually affects a single joint, most often the big toe. The knee, ankle, foot, hand, wrist and elbow may also be affected. Shoulders, hips and spine are rarely affected by gout. Often the first gout attack occurs at night.

There are other types of arthritis and joint inflammation conditions to consider as well: Fibromyalgia, Sjogren's Syndrome, scleroderma, reactive arthritis, carpal tunnel syndrome, lyme disease, pseudo gout, Raynaud's Phenomenon, polymyositis and tendonitis. The process of identifying a specific type of arthritis is not always quick or easy. Individual symptoms and symptom patterns can make diagnosing arthritis tricky. Being aware of and tracking early symptoms is a definite advantage in detection and diagnosis.

LIVING WITH ARTHRITIS
There is often a financial impact associated with chronic arthritis. Arthritis and related rheumatic conditions are recognized as the leading cause of disability in the United States. Medical expenses and lost wages can be crippling to families whose breadwinner suffers from arthritis.Arthritis can cause functional limitations that interfere with activities of daily living. The Center for Disease Control stated that approximately 41% of adults with doctor-diagnosed arthritis report activity limitations. Some of the most crippling limitations are also the ones most often taken for granted. Daily activities such as bending, stooping, walking and climbing stairs. Consequently, cleaning, cooking, personal hygiene and other daily activities are often affected. The physical limitations imposed by arthritis in addition to living with chronic pain, can have emotional consequences. Many emotions are stirred by living with chronic pain. Anger, resentment, depression, isolation and fear are just a few. It is important for you and your family to be patient and understanding of the emotional toll arthritis can have on loved ones or those close to you.

ALTERNATIVE TREATMENTS
In a small 2001 study, acupuncture reduced pain by a third in 73% of patients, and more than half reported at least a 50% improvement in pain. Patients also reduced their use of pain medications.

Balneotherapy, also known as hydrotherapy or spa therapy, is an ancient form of therapy that involves baths to sooth pain. Some arthritis patients have reported relief using such baths.

The National Institute of Health is currently conducting clinical trials to examine whether relaxation response, tai chi, stress management and cognitive-behavioral therapy can help patients with rheumatoid arthritis feel better.

SURGICAL OPTIONS
Dr. Bertken views knee and hip replacement as a major breakthrough for those suffering from these areas of targeted arthritis. Other surgical options tend to be far more tenuous and unproven.

EXERCISE THOSE AILING JOINTS
A healthy lifestyle and good habits may positively impact the course of arthritis. Regular exercise, maintaining a healthy weight, minimal stress, being a non-smoker and getting restful sleep are all parts of better living with arthritis. Individuals who want to stay healthy and mitigate the potentially debilitating effects of arthritis should speak with their physician and design a personalized exercise regimen. Balance and endurance exercises, strength training and stretching have all been credited for pain relief in some arthritis patients.

UNTIL THE NEXT STEP
As Americans age, one thing's for sure: the buying power and influence in our society will demand a better understanding of arthritis. Until medical science is able to provide a reliable cure, the best form of treatment remains physician-approved physical exercise, proper nutrition, rest, a stress-free lifestyle and the care of a rheumatologist.