Close to 16 million Americans have osteoarthritis – the most common
type of arthritis. Although osteoarthritis can occur at any age, it most
often begins in people in their 50’s and 60’s.
Osteoarthritis or degenerative disc disease is a disorder of cartilage
– the gristle that covers the ends of long bones. Cartilage is made of
cell called chondrocytes which sit inside a framework made up of collagen
and proteoglyens. Under normal conditions, chondrocytes make collagen and
proteoglycens – in other words – they make the framework they sit inside.
With osteoarthritis, chondrocytes behave abnormally and begin to make
destructive enzymes such as collagenasese, stromelysin and others. These
enzymes degrade cartilage…these enzymes also attract inflammatory cells
which secrete substances called cytokines which cause further inflammation
and damage to cartilage, underlying bone, and the joint lining.
This process results in progressive pain, stiffness, and loss of
function.
Joint pain and stiffness are the most noticeable symptoms of
osteoarthritis. Morning stiffness is usually brief lasting less than 15
minutes. Osteoarthritis usually affects weight bearing areas particularly
the neck, low back, hips and knees.
It may also affect the fingers and hands and bony knobs may appear at
the finger joints. The base of the thumb may also be affected. The typical
pattern of osteoarthritis in the hands involves the distal and proximal
interphalangeal (DIP and PIP) joints of the fingers, and the
carpometacarpal (CMC) joint of the thumb.
Osteoarthritis is considered to be a degenerative joint disease. Along
with inflammation, there is wear and tear on the inside of the joint.
This causes damage to the cartilage (the substance that forms the
surface of the joints and works as a shock absorber). As the cartilage
wears thin, the underlying bone is damaged. This process results in
progressive pain, stiffness, and loss of function.
Osteoarthritis does not need to be disabling and with the proper
medical care can be managed easily.
Source: Nathan Wei
Dr. Wei (pronounced “way”) is a board-certified
rheumatologist and Clinical Director of the nationally respected Arthritis
and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor
of Medicine at the University of Maryland School of Medicine and has
served as a consultant to the Arthritis Branch of the National Institutes
of Health.
Rheumatoid arthritis is the other most common type of arthritis. It is
more common in women and affects 7 million Americans…or one out of every
five arthritis patients. It may affect any age group, although onset is
most common in middle age.
Rheumatoid arthritis is usually characterized by heat, swelling, and
pain in multiple joints in both the right and left sides of the body,
including the hands, wrists, elbows, hips, knees, ankles, and feet. Spinal
involvement also occurs on occasion.
The typical pattern of rheumatoid arthritis in the hands involves the
proximal interphalangeal (PIP) joints, the metacarpal phalangeal (MCP)
joints, the wrists, and the elbows.
Unlike osteoarthritis, rheumatoid arthritis can affect the entire body.
People with this disease may feel sick all over…tire easily…lose their
appetite…and lose weight.
In rheumatoid arthritis, the tissue that surrounds and nourishes the
joints is attacked by the body’s immune system. The body mistakenly
perceives its own tissue as foreign, and it reacts by sending special
white blood cells and toxic chemicals called cytokines to destroy the
foreign material. (The cytokine abnormalities that cause the damage in
rheumatoid arthritis are different from the abnormalities seen in
osteoarthritis.) This process of white cell migration and cytokine release
damages the joint.
Although we do not know the cause of rheumatoid arthritis, researchers
are investigating several possibilities.
Another interesting point about rheumatoid arthritis is that this
disease can affect the internal organs including the lungs, skin, blood
vessels, spleen, heart, and muscles.
If rheumatoid arthritis is not well controlled it can damage the joints
irreversibly and cause serious disability.
To diagnose rheumatoid arthritis, the rheumatologist establishes the
presence of joint pain and inflammation lasting at least six weeks and
then looks for signs of the course of the disease that are characteristic
for rheumatoid arthritis.
There are also blood tests that aid in the diagnosis of rheumatoid
arthritis.
Patients with rheumatoid arthritis have a series of flare-ups followed
by a period where there are mild or no symptoms. Usually, the pain and
disability of rheumatoid arthritis progresses gradually.
Morning stiffness generally lasts longer than half an hour and may last
several hours depending on the severity of the condition.
Although there is no cure for arthritis, proper treatment can help
tremendously. The goal of arthritis treatment is to relieve the pain and
stiffness due to the progressive destruction caused by inflammation, and
to maintain or increase freedom of movement.
Among the advancements that have taken place in the medical treatment
of arthritis are various disease-modifying medications that not only
relieve symptoms but also help slow down the progression of disease.
Other advances include various cartilage sparing drugs, cartilage
growing drugs, and also biologic remedies. These drugs act by blocking the
destructive effects of enzymes such as metalloproteases in osteoarthritis
and cytokines in rheumatoid arthritis. By targeting specific processes,
relief of symptoms and healing of damage can take place with presumably
fewer side effects.
Source: Nathan Wei
Dr. Wei (pronounced “way”) is a board-certified
rheumatologist and Clinical Director of the nationally respected Arthritis
and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor
of Medicine at the University of Maryland School of Medicine and has
served as a consultant to the Arthritis Branch of the National Institutes
of Health.
