May is Arthritis Awareness Month. Millions of Americans suffer from arthritis or joint inflammation. Learn more about arthritis care at The UVM Medical Center.
Is arthritis treatable or reversible? To answer this question we must first better understand what we mean when we use the term. The musculoskeletal system is composed of bones that are linked together by tendons and ligaments. The muscles attached to the bones contract (tighten) providing movement. At the end of each bone is a cap of cartilage. Cartilage is a dense, smooth surface that allows the bony ends to move (glide) around each other with very little friction. If cartilage is lost or the underlying bone becomes denser, this gliding mechanism is compromised.
The term arthritis refers to any change in the joint that results in pain, stiffness, and loss of range of motion. Arthritis can develop from many different causes, including injury, excess stress (obesity), inflammation, or genetic predisposition.
Our joints are remarkably engineered, and in most people, the musculoskeletal system can be expected to function well for 50+ years. While there are many different types of arthritis, the most common type is osteoarthritis (OA). OA is associated with aging and commonly affects the fingers, knees, hips, and low back. While there is no “cure” for OA, there are effective strategies that relieve pain and preserve function.
Analgesics (acetaminophen) and anti-inflammatory medications (ibuprofen, naproxen) can provide pain relief. Strengthening the muscles around a joint that has osteoarthritis can be of great benefit. For example, with knee osteoarthritis, strengthening the quadriceps muscle protects the joint and preserves function. Working with a physical therapist or an exercise therapist can be very beneficial for individuals with OA. Water exercises can relieve stress on the joint and can provide benefit for people with hip, knee, and low back problems.
Rheumatologists provide care for patients with arthritis and related conditions. A rheumatologist is an Internal Medicine doctor who has taken additional training and is board-certified in Rheumatology.
The second most common type is “inflammatory arthritis.” It typically affects people at a younger age than OA. The most common example of an inflammatory arthritis is rheumatoid arthritis (RA). RA can be a severe illness, causing joint deformity, disability, and in rare cases death. However, there has been remarkable progress in the treatment of RA over the last 30 years. The introduction of newer medications starting with methotrexate in the 1970s and the biologic agents 20 years ago has revolutionized the treatment of RA. These new medications are also used in the other types of inflammatory arthritis, such as psoriatic arthritis and the spondyloarthropathies (ankylosing spondylitis).
Biologic agents are extremely effective in reducing joint inflammation and preventing joint damage.
I have had the good fortune to be witness to the evolution of rheumatology and our understanding of arthritis and the development of effective therapies. With our aging population, rheumatologists frequently see patients in their 60s, 70s, and older, who want to maintain an active and vibrant lifestyle. With the knowledge that we have gained about how the musculoskeletal system works, and the remarkable advances in therapies, this goal is within reach.
Sheldon Cooper, MD, MACR, is a rheumatologist at The University of Vermont Medical Center and professor at the University of Vermont College of Medicine.