The Many Faces of Arthritis

It Strikes Even the Young

We tend to think of ailments like arthritis as coming part and parcel with age, and might react with an unsurprised, knowing nod upon hearing of an elderly friend or relative who has been diagnosed with arthritis. For sure, arthritis is a malady that would likely garner a spot on any list of age-related health woes, but it can occur at any age – even in infancy. The good news is, there are steps we can take to lessen our chances of becoming arthritic or at least reduce symptoms, whether we are in our teenage years or an octogenarian.

There are more than 100 varieties of arthritis, with some being so rare that a doctor might never see them in his or her lifetime, says Hoke H. Shirley, MD, a rheumatologist at Concord Orthopaedics and Concord Hospital. "But there are probably 15 or 20 [types] that are pretty common," he says.

Arthritis disorders result when cartilage – the tissue that lines joints and provides a cushion between bones – breaks down for one reason or another. An injury might damage cartilage, for example, the heavy load of obesity might wear out cartilage, or an immune system gone haywire could destroy cartilage. Some forms of arthritis can be systemic, and affect parts of the body beyond joints. Types of arthritis are classified as inflammatory or non-inflammatory, but overall, osteoarthritis is the most prevalent form, says Shirley. Osteoarthritis typically results from wear and tear of the joints or from injury, but genetic susceptibility may also play a role.

Rheumatoid arthritis is another common arthritis disorder, an autoimmune disease not fully understood but believed to be triggered by a combination of genes and environmental factors. In cases of rheumatoid arthritis, "the body essentially attacks itself" by destroying a membrane that lines the joints, leading to pain, inflammation and sometimes deformity, says Kim Kennedy, RN, coordinator of Community Health Education at Catholic Medical Center.

Another form of arthritis is recognized for its presence in the young: juvenile arthritis, an umbrella term that refers to instances of arthritis in children ages 16 and younger, sometimes occurs at a young age due to obesity, which "puts tremendous strain on joints," or a severe sports injury, Kennedy says. The cause often remains unknown, however.

Hallmark arthritis symptoms – pain, stiffness and swelling – can range from mild to debilitating, making even simple daily tasks like tying shoes or brushing teeth difficult for some, impossible for others. "It can be crippling for some people. Some patients end up in a wheelchair because of arthritis," Kennedy says.

Symptoms can also vary in terms of constancy. Sufferers of non-inflammatory, degenerative osteoarthritis usually experience pain with activity, Shirley says. Standing on or flexing their arthritic knee or ankle, for example, hurts. When they rest, the joint feels better. Individuals with inflammatory disorders, in contrast, often feel pain even during inactivity, "so the arthritis limits them at all times," Shirley says.

Easing the pain

At least partly because doctors cannot always pinpoint the origins of arthritis, a cure in many cases remains elusive. In such instances, arthritis becomes a chronic condition and treatment focuses on managing symptoms. But for some patients who are stuck with arthritis for the long haul, the future has brightened considerably. Within the last 10 to 15 years, "there's been an explosion, a great accelerated development" of medications for certain types of inflammatory disorders, including rheumatoid arthritis, that have contributed "quantum leaps" to doctors' ability to control those disorders, Shirley says. "If we use those medicines assertively … we can stop the disorder from progressing and destroying the joints and also stop the disorder from limiting the functional status and the quality of life [of people] better than we ever have in the past, by far," Shirley says. Unfortunately, the medications do not apply to all forms of arthritis, do not actually "cure" the disorders and require lifetime use. In most instances "you can't ever stop the medication," Shirley says.

Degenerative arthritis disorder treatments, including those for osteoarthritis, have not experienced similar advancements. Degenerative conditions present a particularly formidable challenge because they tend to become symptomatic only after progressing about 80 percent along in their course, Shirley says. So, by the time many osteoarthritis sufferers experience symptoms, "salvage" procedures such as joint replacement surgery are often the best treatment option, he says. Joint replacement surgery has greatly reduced the disability of many arthritis patients, however, and has enabled many to regain significant function and quality of life, he says.

Playing the odds

Your lifestyle can go a long way toward influencing your odds of developing arthritis, or easing symptoms if they already exist. Number one on the to-do list? Shed extra pounds if you've got them. Losing excess weight will not only lower your risk of developing arthritis, it will, of course, benefit your health in numerous other ways.

Next in line should be muscle strengthening. Working the muscles around joints such as the knee can decrease pain and increase gait stability, allowing many patients to use their problematic joint and do more than they had previously been capable of, which is vitally important because a painful joint can lead to a cascade of worsening problems as the patient avoids using the joint and muscle tone declines. "If you just go to bed, for example, and don't move any of your muscles, you will lose three percent of your muscle mass a day. Muscles deteriorate extremely rapidly," Shirley says.

Incorporating or eliminating specific foods in your diet can also affect arthritis disorders. Scientific data shows that fish oils can help osteoarthritis, for instance, Shirley says. "They work very similar to anti-inflammatory drugs physiologically," he says. Tweaking intake of cherry juice and dairy products can also benefit some individuals; they have been shown to lessen the risk associated with gout, a type of arthritis.

Unfortunately, maintaining a healthy weight and diet and exercising as you should won't provide any anti-arthritis guarantees, but will at least stack the deck in your favor. NH