Arthritis in the United States: causes, treatments, and athletic participation

Arthritic conditions found within the joints of the body: their causes, treatment, current research, and what effect they have on athletic participation.

Types of Arthritis

Osteoarthritis

Rheumatoid Arthritis

Psoriatic Arthritis

Causes of Arthritis

Treatments Available

Current Research

Arthritis and Athletic Activities

Learning Outcome

Arthritis is said to be the number one cause of disability in the United States, with more individuals disabled with arthritis than by both heart disease and strokes (Lewis 2000).

Arthritis is also a disease that is plagued with misunderstanding. The Center for Disease Control warns that it is these misunderstandings that result in the disease doing so much harm (Lewis 2000).

Some of the common misunderstandings involve recognizing that there are different types of arthritis and that arthritis is not only a disease of the aged. Arthritis is also often not taken seriously enough in its early stages, preventing individuals from seeking medical help that could prevent the disease from worsening.

There is also an important link between sports, exercise and arthritis. While it is true that arthritis can be caused by sport, it is also true that exercise can prevent arthritis from developing. The link between exercise and arthritis needs to be understood so that individuals can take the correct preventative measures.

Finally, it is worthwhile to consider the extent of the problem of arthritis. It is currently estimated that over 42 million Americans suffer from arthritis, with this number expected to increase to 60 million by 2020 (Lewis 2000).

There are two major types of arthritis, rheumatoid arthritis and osteoarthritis.

Rheumatoid arthritis affects around 2.1 million Americans, about 1 per cent of the population. While it is more prevalent in people over 45, it can occur in any age group, including children (NIAMS 1998). It is reported that around 300,000 children suffer from arthritis (Lewis 2000).

Osteoarthritis is the more common type of arthritis, affecting around 21 million Americans. Osteoarthritis is associated with age, but can still be managed, treated and prevented (Lewis 2000).

The social and economic cost of arthritis is also not to be underestimated. The economic cost includes the cost of medical treatment as well as wages lost due to time taken off work. The social impact includes significant impact on quality of life, with the pain of arthritis commonly resulting in feelings of depression and anxiety (NIAMS 1998). Arthritis is also often related to problems with work and family life (NIAMS 1998).

Chapter Two: Literature Review

Types of Arthritis

While there are over 100 different types of arthritis, there are several that are more common than others. Three of these that will be discussed are osteoarthritis, rheumatoid arthritis and psoriatic arthritis.

Osteoarthritis

Osteoarthritis is the most common form of arthritis. It is also known as 'degenerative joint disease' and is basically a product of wear and tear on the joints (Lewis 2000). This means it is often seen in the elderly, though is also associated with injury and overuse.

Osteoarthritis occurs as the cartilage protecting the bone wears away. The lack of protection causes friction, inflammation then follows as the body's way of protecting itself. Osteoarthritis also often results in bone growths known as 'spurs', which cause further pain (AAOS 2000).

Osteoarthritis commonly begins with the joints of the knee, hip and hand. The knee and hip are most affected because of the weight they bare and the hands are most affected because they are used so frequently.

Osteoarthritis normally begins very gradually, often with only one or two joints affected and those only mildly. Over time, the effects increase. This slow onset is one of the reasons that osteoarthritis is often left untreated, with individuals assuming the minor pain is a product of aging. This often means that medical help is not sought until after the arthritis has done major damage.

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease, where the bodies own cells begin to attack itself and cause degeneration of the joints.

Rheumatoid arthritis occurs when the white blood cells of the immune system cause inflammation of the synovium. This inflammation causes the cells of the synovium to divide uncontrollably, with the synovium changing from a thin membrane to a thick one. This causes the joint to appear swollen. The synovial cells then continue to divide, destroying cartilage and bone as they do so. This spreads to the muscles and ligaments supporting the joint causing general weakness of the joint (NAISM 1998).

The overall effect is to cause pain in the joint and eventually deformity. Rheumatoid arthritis occurs often in the hands and feet but also in the hips, knees and elbows, with pain and swelling experienced even if the joint is not used (AAOS 2000).

One of the reasons rheumatoid arthritis is such a serious condition, is that it causes irreversible damage to the bones. Scientists believe that this damage begins in the first year that a person has the disease, making early diagnosis crucial (Lewis 2000).

Rheumatoid arthritis also commonly extends to other areas of the body. Many people develop bumps under the skin, known as rheumatoid nodules. Anaemia is also common, as is generally feeling ill. In rare occasions, people also experience heart and lung problems as well (NAISM 1998).

Another characteristic of rheumatoid arthritis is its variation. For some individuals, rheumatoid arthritis occurs for a short period and then disappears, others experience periods of flares and remissions, and others have the disease constantly. The severity of the disease also differs from moderate to severe forms (NAISM 1998). This variation between individuals causes difficulties in managing the diagnosis and the treatment of the disease.

Psoriatic Arthritis

Psoriatic arthritis is a form of arthritis experienced by around a quarter of the people with the disease psoriasis.

Psoriasis is defined as "a chronic skin disease in which itchy scaly red patches form on the elbows, knees, legs, scalp, and other parts of the body" (Martin 2000, p. 523).

Psoriatic arthritis occurs in combination with psoriasis and typically involves the joints of the fingers and toes. Another dangerous form is psoriatic spondylitis, which involved the joints of the spine, typically of the lower back.

Causes of Arthritis

Rheumatoid arthritis is thought to be caused by a combination of genetic and environmental factors.

Scientists have found that certain genes cause a predisposition to rheumatoid arthritis, with individuals with certain genes more likely to have the disease. At the same time, some individuals with the genes do not experience arthritis, while other without the genes do. This leads to the conclusion that genes are involved, but environmental factors are also important (NIAMS 1998).

It is thought that an environmental agent triggers arthritis in those predisposed to it. The agent involved is not known, but it is thought that there may be a virus or bacteria involved (NIAMS 1998).

Other research suggests that arthritis may be caused by hormonal factors, with hormones or changes in hormones causing arthritis in those predisposed to it (NIAMS 1998).

Treatments Available

There are a range of treatments available for arthritis.

A ical pain relievers are used for mild arthritis. These include various creams, gels and sprays that are applied to the joint experiencing pain. These are designed to reduce pain and inflammation experienced only mildly or infrequently.

Antidepressants are used to treat the chronic pain associated with more severe forms of arthritis. These antidepressants also treat depression that often accompanies chronic forms of the disease (MFMER 2002).

Injections of corticosteroids directly into the joint are also used to give long-term pain relief. These injections give pain relief for four to six months (MFMER 2002).

Non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin and ibuprofen are also commonly used. These drugs reduce the swelling and ease the pain associated with arthritis. NSAIDs have however, been linked to gastrointestinal bleeding and ulcers. A new type known as COX-2 inhibitors have been successful in treating arthritis without the stomach irritation (Lewis 2000).

Another common treatment uses disease-modifying anti-rheumatic drugs (DMARDs) that slow inflammation. DMARDs are often used early in treatment to slow the disease and prevent damage to the joints (Lewis 2000).

For severe arthritis, joint replacement is also used as a treatment, where the joint is removed and replaced with a plastic or metal prosthesis. This is commonly used for hip replacements but can also be used for arthritis of the knee, shoulder, elbow, finger or ankle (MFMER 2002).

Other surgical procedures include fusing of the joint, where the bones are fused. This stops the pain but means that the joint has no flexibility (MFMER 2002).

Two non-drug alternatives known as Hyalgan and Synvisc were approved for use in 1997. These products are viscous solutions of a lubricant found naturally in the joints. These products are injected directly into the joint to increase the synovial fluid present. This treatment is currently used for osteoarthritis of the knee (Lewis 2000).

Enbrel is a relatively new drug that is used to treat rheumatoid arthritis. It is taken twice a week by injection and decreases pain and swelling. Enbrel has been effective in patients that have not responded to any other treatment and is also suitable for children with rheumatoid arthritis (Lewis 2000).

Arava is a new oral treatment that is used to slow the onset of rheumatoid arthritis. This drug is not able to stop the progress, but can slow the effects (Lewis 2000).

Another non-drug treatment used for severe rheumatoid arthritis uses a device known as the Prosorba column. In the treatment, the patient's blood is removed, the plasma separated from the blood cells and the plasma passed through the column. This filters the blood and is thought to remove damaging proteins (Lewis 2000).

Current Research

New therapies for the treatment of rheumatoid arthritis increasingly focus on understanding the causes of the disease.

There is a focus on understanding the genetic factors involved and identifying the genes that cause individuals to be predisposed to arthritis. One major project is known as the North American Rheumatoid Arthritis Consortium. The consortium is made up of twelve research centers that will collect genetic information from around 1000 families with a history of arthritis. This information will be used in various studies that attempt to understand the genetic factors involved (NIAMS 1998).

There is also a significant amount of research that focuses on understanding the processes of arthritis. This includes understanding the immune system, the inflammatory process and the cells, hormones and chemicals of the body involved. There are suggestions that this could eventually lead to a vaccine for rheumatoid arthritis as well as offering a range of new treatments (Arthritis Foundation 2002).

There is also some evidence that viruses or bacteria may be a trigger for arthritis. There is currently a significant amount of research attempting to determine what this trigger may be and how it may work (NIAMS 1998). This is thought to have potential in preventing the disease.

Arthritis and Athletic Activities

There are several links between arthritis and athletic activities. Arthritis can be a product of sporting injuries, athletic activities can also prevent arthritis and athletic activities can also be used in the treatment of arthritis.

Arthritis can be caused by sporting injuries or by overuse of the joints through exercise. Sporting injuries and overuse can both result in osteoarthritis, with the osteoarthritis usually taking years after the original injury to develop (The Arthritis & Glucosamine Resource Center 2002).

Athletic activities are also important in preventing arthritis, with exercise strengthening muscles and bones and increasing flexibility. This involves three types of exercise. Range-of-motion exercises stretch the joint and assist in maintaining full mobility. Strengthening exercises strengthen the muscles that support the joint. Endurance exercise strengthens the entire body including the heart and lungs (Lewis 2000).

Exercise is also used in the treatment of arthritis, involving the same exercise types as for prevention and for the same reasons. Exercise is also thought to help arthritis suffers maintain a positive outlook and lose weight which can lead to a reduction in the pain experienced. It is important though, that the exercise programs takes into accounts the individuals condition (NIAMS 1998).

The difficulty in linking exercise to arthritis lies in the balance that needs to be maintained. The Mayo Foundation for Medical Education and Research (2002) describes this saying,

Proper exercises performed on a regular basis are an important part of arthritis treatment, according to the Arthritis Foundation. Twenty years ago, doctors advised exactly the opposite, fearing that activity would cause more damage and inflammation. Not exercising causes weak muscles, stiff joints, reduced mobility, and lost vitality, say rheumatologists, who now routinely advise a balance of physical activity and rest."

Chapter Three: Research Needed

The literature review suggests several areas of research could be extended.

Firstly, it has been seen that long-term damage can be largely prevented with early warning and effective treatment. At the same time, it was seen that arthritis is often misunderstood. The moderate effects can be overlooked and thought of as an inconvenience rather than a disease that requires treatment. By the time medical advice is sought, the damage may already be done. This suggests that greater awareness of the disease may be beneficial so that those suffering from mild effects can seek treatment that prevents the disease developing to more extreme levels.

Much of the current research is also focused on understanding the onset of the disease and the genetic factors involved. It is also suggested that environmental factors may play an important role. What is lacking in the research is a focus on lifestyle factors. It is known that exercise, diet and weight could be contributing factors. Further research on these lifestyle factors could give all individuals the opportunity to prevent the disease through simple lifestyle changes.

Finally, the link between exercise and arthritis is not adequately defined. While there is some evidence that regular evidence can prevent arthritis and assist in treatment, there is a lack of specific knowledge on which exercises are most suitable. It was also seen that in the past doctors advised patients not to exercise as this would worsen the problem. It is likely that this false belief still exists in arthritis sufferers who may avoid exercise as an attempt to avoid further pain. Definite information on suitable exercise programs would assist in ensuring sufferers do not needlessly avoid exercise that could be beneficial to them.

Chapter Four: Learning Outcome

From this overview of arthritis, several important facts have been learned.

Firstly, it is known now that arthritis is not one disease, but several, with the characteristics of each different. This will assist in identifying the problems of clients.

This has also involved learning that arthritis can start at mild levels and degenerate to serious problems if action is not taken. This will assist in ensuring that minor complaints are not ignored but investigated fully. This includes recognizing that arthritis is not only a disease of the aged.

The link between sports and arthritis is also better understood. This includes recognizing that a single sports injury could result in further problems in later years. Also, it is now known that overuse through sports could cause the onset of osteoarthritis.

Finally, it is now known that sports and exercise can prevent arthritis and assist in its treatment. This can be used in treating patients with arthritic conditions, while ensuring the activities they complete helps them rather than hinders them.