Arthritis is the leading cause of disability in the U.S. In 1998, arthritis and other rheumatic conditions affected 43 million people - a number that is expected to climb to 60 million by 2020 as the "baby boom" generation ages. That's almost 20 percent of the population.
Arthritis conditions don't usually cause death, but they do worsen health-related quality of life. Arthritis is the leading cause of disability in the United States, limiting the everyday activities of more than 7 million Americans. Arthritis results in 39 million physician visits and almost 2.5 million hospitalizations each year.
Findings on the impact of arthritis by the Centers for Disease Control and Prevention (CDC) show people with arthritis have worse health-related quality of life than people without it, regardless of sex, age or education level. From 1996-98, the CDC interviewed more than 32,000 people in 11 states about:
- Their general self-rated health.
- The frequency of days in which their physical health was not good.
- The frequency of days in which their mental health was not good.
- The frequency of days in which their usual activities were limited.
Overall, the CDC found about 29 percent of people with arthritis. Doctors had diagnosed most of these people (75 percent). Others had symptoms of pain, aching, stiffness or swelling in or around a joint on most days for at least a month.
People with arthritis reported having fair or poor health about three times more often than did people without arthritis. The CDC says "unhealthy days" are days in which physical and/or mental health was not good. Among arthritis sufferers, the most unhealthy days were experienced by women, younger people, and people with less than a college education. For people with less education, unhealthy days may reflect less access to health care or more physical labor, the CDC says. Depression is common in people with all types of arthritis, especially rheumatoid.
Prevailing myths have portrayed arthritis
as an inevitable part of aging that can only be endured. But the CDC says there
are effective interventions that are available to prevent or reduce arthritis-related
pain and disability. These include early diagnosis and appropriate management,
including weight control, physical activity, physical and occupational therapy
and joint replacement, when necessary.
Joints and cartilage
A joint is where the ends of two or more bones meet. For example, a bone of the lower leg, called the shin or tibia and the thighbone, called the femur, meet to form the knee joint. The hip is a ball and socket joint. It is formed by the upper end of the thighbone-the ball-fitting into the socket-part of the pelvis called the acetabulum.
The bone ends of a joint are covered with a smooth material called cartilage. The cartilage cushions the bone and allows the joint to move easily without pain. The joint is enclosed by a fibrous envelope called the synovium which produces a fluid that helps to reduce friction and wear in a joint. Ligaments connect the bones and keep the joint stable. Muscles and tendons power the joint and enable it to move.
Inflammation is one of the body's normal reactions to injury or disease. In an injured or diseased joint, this results in swelling, pain, and stiffness. Inflammation is usually temporary, but in arthritic joints, it may cause long-lasting or permanent disability.
There are more than 100 different types of arthritis. This web site has pages which describe in symptoms, care and treatment of the following:
- Osteoarthritis (OA)
- Rheumatoid arthritis (RA)
- Arthritis of the thumb (CMC arthritis)
- Arthritis of the hand
- Arthritis of the wrist
The most common type of arthritis is osteoarthritis. It is seen in many people as they age, although it may begin when they are younger as a result of injury or overuse. All joints may be more affected if they are used extensively in work or sports, or if they have been damaged from fractures or other injuries. Read more about osteoarthritis.
In osteoarthritis, the cartilage covering the bone ends gradually wears away. In many cases, bone growths called "spurs" can develop in osteoarthritic joints. The joint inflammation causes pain and swelling. Continued use of the joint produces pain. Some relief may be possible through rest or modified activity.
Rheumatoid arthritis is a long-lasting disease that can affect many parts of the body, including the joints. In rheumatoid arthritis, the joint lining swells, invading surrounding tissues, and producing chemical substances that attack and destroy the joint surface. This commonly occurs in joints in the hands and feet. Larger joints such as hips, knees, and elbows also may be involved. Swelling, pain, and stiffness are usually present even when the joint is not used. Rheumatoid arthritis can affect people of all ages, even children. However, more than 70 percent of people with this disease are over 30 years old. Many joints of the body may be involved at the same time. Read more about rheumatoid arthritis.
Making a diagnosis of arthritis often includes evaluating symptoms, a physical examination, and X-rays, which are important to show the extent of damage to the joint. Blood tests and other laboratory tests may help to determine the type of arthritis.
The goals of treatment are to provide pain relief, increase motion, and improve strength. There are several kinds of treatment:
Many over-the-counter medications, including aspirin, ibuprofen, and naproxen (common anti-inflammatory drugs) may be used to effectively control pain and inflammation in arthritis. Acetaminophen (Tylenol) may be used to effectively control pain. Prescription medications also are available if over-the-counter medications are not effective. The physician chooses a medication by taking into account the type of arthritis, its severity, and the patient's general physical health. Patients with ulcers, asthma, kidney, or liver disease may not be able to safely take anti-inflammatory medications. Injections of liquid cortisone directly into the joint may temporarily help to relieve pain and swelling. It is important to know, however, that repeated frequent injections into the same joint can damage the joint and have undesirable side effects.
Canes, crutches, walkers, or splints may help relieve the stress and strain on arthritic joints. Learning methods of performing daily activities that are the less stressful to painful joints also may be helpful. Certain exercises and physical therapy (such as heat treatments) may be used to decrease stiffness and to strengthen the weakened muscles around the joint.
In general, surgery for arthritis can be effective at pain relief when other methods of nonsurgical treatment have failed. The physician and patient will choose the type of surgery by taking into account the type of arthritis, its severity, and the patient's physical condition. Surgical procedures include:
- removal of the diseased or damaged joint lining;
- realignment of the joints;
- total joint replacement; and
- fusion of the bone ends of a joint to prevent joint motion and relieve joint pain.
Wear and tear arthritis is very common at the base of the thumb. Pain localized to the base of the thumb, particularly with use, is a very common early symptom. Early disease can be treated with anti-inflammatory medication, steroid injections into the joint, or splinting.
As the wear and deformity progress, surgery is frequently required. There are many procedures to relieve pain and improve function.
Heberden nodes are "bumps" which occur at the last joint of the finger or thumb due to wear and tear arthritis (osteoarthritis). As the joints deteriorate, small bone spurs form over the back of the joints and make them appear "lumpy." Since most Heberden nodes are not painful and seldom interfere with function, no specific treatment is usually required. Patients with pain can be treated with anti-inflammatory medications. All patients should continue moving their hands; disuse frequently results in stiffness.
At present, most types of arthritis cannot be cured. Researchers continue to make progress in finding the underlying causes for the major types of arthritis. In most cases, persons with arthritis can continue to perform normal activities of daily living. Exercise programs, anti-inflammatory drugs, and weight reduction for obese persons are common measures to reduce pain, stiffness, and improve function.
In persons with severe cases of arthritis, surgery can often provide dramatic pain relief and restore lost joint function. Some types of arthritis, such as rheumatoid arthritis, are often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and hand surgeon.
Dr. Concannon is a medical doctor with extensive training in the diagnosis and nonsurgical and surgical treatment of the hand, including bones, joints, ligaments, tendons, muscles and nerves.