I’ve probably thought more about arthritis over the years than most guys my age, because my Mom has had rheumatoid arthritis since before I was born. This week I’ve been thinking about it more than usual, though, for two reasons: one, I’m writing a book on the subject and two, a new arthritis drug has just been in the news.
Most people think of arthritis as an older person’s disease, but as my Mom can tell you, anyone of any age can get it. That’s because arthritis isn’t a single disease: there are more than a hundred forms of it.
The word “arthritis” comes from the Greek words, “arthron,” meaning joint, and “itis,” meaning “inflammation.” Inflammation–swelling, redness, pain–is the body’s response to infection or injury, and results in swelling, redness and pain.
It’s appropriate arthritis is an ancient word, because arthritis has been around forever. Just 10 years ago, rheumatoid arthritis was found in 5,000-year-old skeletons from Alabama. In the 19th century, osteoarthritis was found in Neandarthal bones 150,000 years old.
Today, more than four million Canadians–roughly one in seven–has some form of arthritis. More than 600,000 of them have arthritis so bad that it interferes with day-to-day activities such as walking, dressing or bathing.
Osteoarthritis, the most common form of arthritis (and likely to become even more common as baby boomers age), is really joint failure. A joint is a place where two bones come together. In those joints that allow a wide range of movement, such as the elbow, the connecting ends of the bones are covered in cartilage, a smooth, tough and spongy material that works like a shock absorber. Surrounding the joint is a capsule formed by thick fibers called ligaments, anchored to both bones. This capsule is lined with the synovial membrane, which is full of blood vessels and nerve endings and produces a thick, clear liquid that lubricates the joint, nourishes the cartilage and removes waste products.
In osteoarthritis, the cartilage becomes soft and pitted, losing its elasticity and strength. As it thins, the bone ends rub together, causing pain and causing the bones to thicken, become denser, and develop bony spurs. As the damage continues, pieces of cartilage and bone may be shed into the synovial fluid, inflaming the synovial membrane. Ligaments may either loosen or become more rigid, making it hard to move the joint.
The most severe form of arthritis, rheumatoid arthritis, is quite different. It appears to be a misguided attack by the body’s own immune system on healthy tissue. Though it’s most noticeable in the joints, rheumatoid arthritis really attacks the entire system. It can cause fatigue, low-grade fever, rashes, anemia, dry eyes and mouth, among other symptoms, or even serious complications such as an inflammation of the membrane around the heart or scarring and thickening of lung tissue.
Other common forms of arthritis include ankylosing spondylitis, an inflammation of the joints in the spine; gout, caused by the build-up of crystals of monosodium urate in joints, and lupus, another disease in which the immune system attacks the body. Bacterial and viral infections can also cause arthritis.
The most commonly prescribed drugs for arthritis are “non-steroidal anti-inflammatory drugs,” or NSAIDs. Common NSAIDs include aspirin and iburpofen. There are also stronger, prescription-strength NSAIDs.
All of them can have unpleasant side effects in large doses. That’s because they slow the body’s production of an enzyme called cyclooxygenase, which comes in two forms. Cox-1 is always present and helps direct important housekeeping functions in the body, such as forming a protective lining for the digestive tract. Cox-2 only appears in the presence of inflammation, and helps promote it. While current NSAIDs inhibit Cox-2, easing joint inflammation, they also inhibit Cox-1, leaving the stomach lining vulnerable to ulcers and bleeding.
However, a new type of NSAID has just become available in Canada. Celebrex only inhibits the production of Cox-2, so it shouldn’t have the same unpleasant side-effects. Other Cox-2 inhibitors are currently being tested, as well.
When NSAIDs aren’t enough, doctors turn to corticosteroids, synthetic versions of the hormone cortisol, produced by the adrenal glands. Although coritocosteroids can have dramatic results, they can also have serious side-effects, so they must be used carefully.
Finally, total joint replacement has become an effective last-ditch treatment that can restore mobility in the people most severely affected.
Arthritis strikes people ranging in age from children to seniors, and living with it is no picnic. Here’s hoping there will soon be even better treatments for this disease that affects so many people…like my Mom.