Arthritis

Arthritis

Activity Is Your Best Defense

For the last couple of months, your 38-year-old walking partner has had trouble with her knee. Some days she has to take the elevator instead of the stairs and drive to the store instead of walking.

It turns out she has arthritis, a joint disease shared by nearly 40 million people. About two-thirds of those--almost 23 million--are women. Although most of us associate arthritis with the elderly, it can strike in childhood, causing inflammation, swelling, pain and joint destruction. There are more than 100 types of the disease, of which osteoarthritis and rheumatoid arthritis are the most widespread.

Osteoarthritis is the most common form. It plagues 16 million adults, 11.7 million of them women. It's not clear what causes osteoarthritis, but experts believe that hormones, body weight, genetics and mechanical problems in the joints may contribute.

Osteoarthritis develops when certain structures that make up a joint--the ligaments, tendons and cartilage--are damaged and the joint shifts out of alignment. Abnormal weight distribution on small areas of cartilage can cause inflammation and eventual joint destruction.

It's Trouble for Women

Researchers aren't sure why osteoarthritis is more common in women, but preliminary research in Taiwan implicates the female hormone estrogen, which has been found in arthritic cartilage.

Body weight is another factor in osteoarthritis, says Cody Wasner, M.D., assistant clinical professor at the Oregon Health Sciences University in Eugene and a spokesperson for the Arthritis Foundation in Atlanta. If you looked at 100 women, he says, the heaviest 25 would be at three to four times greater risk for osteoarthritis than the women who weighed less. Animal studies show that lowering body weight can decrease the severity of arthritis, says Dr. Wasner, partially because joints are better able to stay in place if they're carrying less weight.

Injury is another major cause of osteoarthritis. This is because damage to the joint can cause misalignment and subsequent osteoarthritis, says W. Joseph McCune, M.D., associate professor of internal medicine at the University of Michigan in Ann Arbor.

Osteoarthritis in women ages 30 to 45 usually strikes in the knee, Dr. Wasner says, and arthritic knees are more prevalent in women than in men by a ratio of two to one.

The hands are another osteoarthritis flashpoint for women, with the usual targets being the joints nearest the fingernails. "This kind of arthritis is associated with bumps at those joints," says Dr. Wasner, and women often start developing problems in their thirties and forties. The bumps are known as Heberden's nodes, and women are at ten times greater risk for developing them than men are.

Part of the reason for that, says Dr. Wasner, is genetics. The gene linked to Heberden's is more often passed from mother to daughter. "There's nothing to prevent that from happening," he says. This problem sometimes develops earlier in women who go through early menopause, he notes. While women can't prevent it, early treatment can help them maintain function in their hands.

Another area where osteoarthritis commonly develops is the hip joint, but there the disease strikes men and women at about the same rate.

Osteoarthritis is difficult to diagnose, Dr. Wasner says. That's because early arthritis, say in the hip, may first be noticed as pain in the groin area. Doctors don't realize that the problem is in the hip until the disease becomes serious.

Investing in Joint Preservation

Osteoarthritis is a condition you can try to prevent. Here's how.

Avoid injury. Condition yourself properly for whatever activity you're doing, warm up, stretch, cool down and wear the proper equipment, particularly footwear, Dr. McCune says.

Watch your weight. Since heavy people are at greater risk for osteoarthritis, says Dr. Wasner, try to achieve your ideal weight. Consult with your physician about how to combine exercise and healthy low-fat eating to accomplish this goal.

Stay in shape. Muscles work to stabilize your joints, so the stronger they are, the less susceptible to injury and arthritis they will be. Patients with underlying joint problems should consult a physical therapist, exercise physiologist or an individual trained in exercise science about appropriate exercises and techniques.

Fighting the Pain

If you think you've got osteoarthritis, here's what you can do to cope.

See a doctor. The longer you wait, the more damage can be done to your joints and the harder it will be to treat. Rheumatologists specialize in the treatment of arthritis and can either care for your disease themselves or refer you to a physical therapist or to an orthopedic surgeon if your disease is severe enough to warrant joint replacement. To find a rheumatologist in your area, contact your local chapter of the Arthritis Foundation.

Ice down the pain. For the pain and swelling of arthritis, apply ice, says Dr. Wasner. Ice reduces inflammation because it causes blood vessels to constrict, reducing blood flow and fluid buildup. Ice for 20 to 30 minutes after you exercise or after any strenuous activity in which you've placed excessive demands on your joints, he says. You can buy an ice pack at your pharmacy or make one yourself by putting ice in a plastic bag and wrapping it in a towel so the ice doesn't harm your skin.

Warm up. If you've got joint stiffness, heat can help, says Dr. Wasner. Sit in a hot bath for 20 minutes or apply a heat pack or hot towel for 20 minutes to the joint that's bothering you.

Exercise carefully. Not all leg-strengthening exercises are good for the knees, says physical therapist Mark Taranta, director of the Physical Therapy Practice in Philadelphia. Some exercises, such as squats and knee extensions, can accelerate osteoarthritis. The best are straight-leg raises, because they help strengthen your thigh muscles without straining your joints.

Do stairs properly. Stairs place substantial stress on your knees. Practice the following technique when going up and down: Going up, lead with your "good" leg; this makes that leg carry most of the weight and do most of the work. On the way down, lead with your "bad" leg; this again allows your good leg to absorb the most stress, says Taranta.

Replace doorknobs. Rotating handles and doorknobs can be difficult for arthritic hands, so replace the ones in your home with lever- and latch-type devices, says Dr. Wasner.

Help your hands. If you've got arthritis in your hands, says Taranta, ask your doctor about splints that can hold your wrists and hands in a comfortable position.

Pick up a cane. Using a cane can help ease hip pain by lessening stress on the hip. It may also prolong the time before you have to resort to more serious treatment, such as surgery. It's hard for people to even consider using a cane, says Dr. Wasner. Just remember that you might get more mileage out of your hip if you do, he says.

The "Other" Arthritis

Rheumatoid arthritis affects between 2 and 3 million people, or 1 to 2 percent of adults, says Dr. McCune. Nearly 1.5 million are women, experts say.

Rheumatoid arthritis is a mystery. It can develop gradually or suddenly, says Dr. McCune, and what causes it is unclear. For some reason, certain cells in the immune system misbehave, and their activity causes the cells that line joints to proliferate and start destroying the bone and cartilage they're supposed to protect. The lining of the joint becomes inflamed, causing pain and stiffness. The bone and cartilage sometimes become eroded, causing disability.

The joints most commonly affected are those in the hands, wrists, knees, ankles and toes, says Philip Mease, M.D., clinical associate professor of rheumatology at the University of Washington School of Medicine in Seattle. It appears less often in the elbows, hips, shoulders, neck and low back, he says. Rheumatoid arthritis "tends to affect both sides of the body in a symmetrical fashion," he says. "Flares tend to act in concert."

Genetics is considered to be the major risk factor for rheumatoid arthritis, he says.

One of the unusual things about the disease in women is that it often goes into remission during pregnancy. Studies have shown that more than 75 percent of pregnant women who have it experience improvement during the first and second trimesters. Some researchers believe this remission is due to hormone changes.

Other researchers say remission in pregnancy is related to the genetic makeup of the fetus. In a study at the Fred Hutchinson Cancer Center in Seattle, J. Lee Nelson, M.D., and her colleagues found that the greater the difference between the genetic makeup of the fetus and that of the mother, the more likely that arthritis would go into remission during pregnancy. The researchers suspect that a genetically different fetus somehow signals the maternal immune system, with the interesting effect that the arthritis subsides.

Fighting Back

Rheumatoid arthritis typically strikes in a woman's forties and fifties, the most productive time of life, says Ernest Brahn, M.D., associate professor of medicine in the Division of Rheumatology at the University of California, Los Angeles, School of Medicine. "It's a disease of working-age women," he says. "It affects their capacity to work, to take care of their family."

You can't prevent rheumatoid arthritis, researchers say. But if you know you are at risk because it runs in your family, or if you already have it, here's what you can do.

Keep bones and muscles strong. The greater your level of physical fitness before you get arthritis, the better you'll be able to fight the disease, says Dr. McCune. Lift weights, do aerobic exercise at least three times a week for 30 minutes a session and take enough calcium to get the Daily Value of 1,000 milligrams.

Don't overdo it. If a particular task takes a number of hours, do it in segments with rest breaks in between, Dr. Brahn suggests. Doing this will help prevent stress on joints and avoid pain.

Keep moving. While arthritis pain makes you want to do the opposite--that is, sit still--it's important to maintain some level of activity, says Dr. Brahn. Ask your rheumatologist about seeing a physical therapist, who can give you exercises to maintain your joints' mobility. As far as sports are concerned, swimming is good, says Dr. Brahn, because it enables you to work your joints through their range of motion without having to fight gravity.

Be persistent. It's important to do your exercises even when you are feeling good, says Dr. Brahn.

Exercise your healthy parts. "A major strategy in arthritis is to make sure the unaffected part of the body gets as much real exercise as possible," says Dr. McCune. So if your hands are sore, try riding an exercise bike that doesn't require you to use your hands, he says.

Be informed about medications. Arthritis medications range from nonsteroidal anti-inflammatory drugs like ibuprofen to very strong prescription drugs like methotrexate (Mexate) and cyclophosphanide (Cytoxan). Ask your doctor how the medication works, what its side effects are, whether it will affect your fertility and what impact it will have on your bones and heart.

Get help. If you suspect you have rheumatoid arthritis, see a rheumatologist, says Dr. Brahn. The longer you wait, the more destruction the disease can cause and the harder it will be to get pain relief, he says. To find a rheumatologist in your area, contact the Arthritis Foundation. Or you can check the Directory of Medical Specialists, which may be available at your local library, for a list of board-certified rheumatologists, suggests Dr. Brahn.