34 Things You Need to Know About Arthritis

This painful joint disease is actually a collection of more than 100 ailments— and it affects people of all ages

This painful joint disease is actually a collection of more than 100 ailments— and it affects people of all ages.

Arthritis. If the word makes you think about older folks with creaky knees and jumbo bottles of ibuprofen, you need an update. Arthritis now strikes an estimated 91 million American adults, according to a new study, and 30 percent of them are ages 18 to 64. By far the most common type, which affects 57 percent of Americans with arthritis, is osteoarthritis, followed by gout (27 percent of cases), psoriatic arthritis (14 percent), and rheumatoid arthritis (3 percent). There is no cure for any of them, but science has made several breakthroughs in understanding how to treat the inflammation and pain that come with the condition as well as how to halt the underlying joint damage. The first line of defense: Educate yourself.

OSTEOARTHRITIS

(OA): Wear and tear of the cartilage cushion between joints that can often cause—and in some cases result from—chronic inflammation.

1 Old-fashioned X-rays are the best diagnostic tool. A Washington University study noted that X-rays can diagnose OA as accurately as magnetic resonance imaging (Mri)—and they do it faster and more cheaply. Identifying arthritis early gives you time to turn to lifestyle changes (see page 111) before irreversible damage is done to your knees (the most common pain point) or other joints. 2 The customary treatment for OA doesn’t repair joints. Up to 85 percent of osteoarthritis sufferers try nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen. Though they can be effective at getting you through the day, says Kelli Allen, PHD, a researcher at the Thurston Arthritis Research Center, they don’t protect joints from progressive damage and may have serious side effects. 3 When people with osteoarthritis used NSAID gels, drops, or patches, half said their pain fell by 50 percent or more over 12 weeks. Because these versions are rubbed onto your skin, less of the drug gets into your bloodstream, which reduces the risk of gastrointestinal bleeding, heart problems, and other side effects. That said, do not use these topical treatments if you have kidney disease or are also taking oral NSAIDS. 4 A 2018 study of 240 osteoarthritis patients showed that those who took opioids were in slightly more pain after a year than those who took non-opioid medication. The researchers aren’t sure why, but given that these drugs can be very addictive, they recommend against opioids.

5 Arthritis hurts your heart by contributing to chronic inflammation, reducing physical activity, and increasing NSAID use—all factors in cardiovascular risk. All told, researchers estimate that OA boosts your odds for heart disease by 24 percent. (Psoriatic and rheumatoid arthritis raise the odds even higher.)

6 Australian researchers who reviewed the evidence for 20 topselling herbs and dietary supplements used to treat osteoarthritis concluded that three—boswellia serrata extract, pine bark extract, and curcumin—are most effective in reducing inflammation and pain in the short term.

7 Cortisone injections don’t help in the long term. “A single shot can ease pain,” says Timothy Mcalindon, MD, MPH, chief of rheumatology at Tufts Medical Center. But a recent study found that repeated shots of cortisone, a steroid, not only didn’t control pain but also actually led to more joint damage.

8 The jury is still out on other injectable treatments. Hyaluronic acid injections are designed to add more shock-absorbing fluid to joints, but research on their effectiveness is mixed. Similarly, new injectables using your own fat, bone marrow, platelet-rich plasma, or stem cells promise relief, but Dr. Mcalindon says “the research isn’t sufficient to show if they actually work” to ease pain and rebuild joints.

9 Insomnia is an often undertreated side effect of arthritis, but there are fixes. Lack of sleep can intensify sensitivity to pain, a problem for OA patients, according to a Johns Hopkins University study. Cognitive behavioral therapy, which helps people change the distorted thinking that can worsen pain levels, has been shown to increase the amount of time osteoarthritis sufferers slept—and presumably decreased their pain.

10 A new device called Coolief uses specialized electrodes to send water-cooled radio waves into the tissue around your knee, which temporarily deactivate nerves. Patients reported greater, longer-lasting pain relief (up to 12 months) with Coolief than with cortisone injections.

11 Stem cells could save joints— someday. Scientists have programmed stem cells to grow new cartilage on a 3-D template shaped like the ball of a hip joint. Using gene therapy, they have also activated the new cartilage to release antiinflammatory molecules to fend off a return of arthritis. But the stem cell therapy offered for knee osteoarthritis in many clinics isn’t yet a proven cure.

RHEUMATOID ARTHRITIS

(RA): The immune system attacks the fluid that lubricates joints, causing inflammation and destroying cartilage.

12 A new drug could prevent RA. Early results from one study showed that for people with mild joint aches and high inflammation levels, one shot of rituximab cut the risk of developing rheumatoid arthritis in half. The drug blocks production of compounds that trigger inflammation.

13 So could vitamin D. In another study, researchers found that people with low blood levels of vitamin D, which boosts immune function, were at higher risk for RA. (One great free source of vitamin D: sunshine.)

14 It’s possible to put rheumatoid arthritis into remission. While there’s no way to reverse joint degeneration, getting treated within six months of the onset of pain and stiffness can curb symptoms and prevent further damage. Unfortunately, a 2016 national survey found that it took people with RA four years and visits to at least three different doctors to get a proper diagnosis.

15 Early arthritis clinics are showing great promise. Focused on treating rheumatoid arthritis patients with a recent diagnosis, clinics have opened at the University of Rochester Medical Center, Oregon Health and Science University, and many private facilities. In one study, 89 percent of RA sufferers treated at an early arthritis clinic got disease-modifying antirheumatic drugs (DMARDS) in three months, compared with 50 percent who got care elsewhere. The clinic’s patients had higher remission rates as a result.

16 Menopause worsens the symptoms of rheumatoid arthritis. A 2018 study of 8,189 women in the journal Rheumatology confirms something women with RA have long experienced: Joint degeneration speeds up after menopause. Early menopause can trigger the disease too.

17 Rheumatoid arthritis can raise your risk for certain types of cancer. Lung cancer, lymphoma, and multiple myeloma are more common in people with RA, partly due to inflammation and partly because RA drugs suppress the immune system.

18 One DMARD does not fit all. “DMARDS can put RA into remission, but a drug may stop working after several years. Some people have to try several before they find the one that works best,” says David Daikh, MD, PHD, outgoing president of the American College of Rheumatology.

19 Tumor necrosis factor (TNF) is an inflammatory protein responsible for pain and cartilage degeneration in RA, and drugs called TNF inhibitors can sometimes block it. And if one TNF inhibitor—such as etanercept (Enbrel) or adalimumab (Humira)—doesn’t work, try another. In a recent study, 43 percent of patients who didn’t respond to one type of TNF inhibitor responded positively to a different one. 20 Biologic drugs—such as etanercept (Enbrel), golimumab (Simponi), and adalimumab (Humira)—are engineered from human genes. They work by targeting specific parts of the inflammation process rather than suppressing the immune system in general (as older DMARDS do), so they tend to have fewer side effects. Unfortunately, they are also more expensive than traditional medications.

21 Genetic profiling could soon pinpoint which drug classes or even individual drugs will work for you. In a new multisite study published this May in the journal Arthritis & Rheumatology, researchers analyzed joint tissue from 41 rheumatoid arthritis patients to determine which gene variations each individual had and how they responded to each type of drug. Next they hope to predict which patients will respond best to specific drugs based on their genetic signature, saving time and money.

22 Nerve stimulation could reduce joint damage. In one small study, when patients with rheumatoid arthritis were zapped with mild electrical current to the vagus nerve (which passes through your neck to your abdomen), the charge reduced their levels of TNF, the same inflammatory protein targeted by TNF inhibitors. Some also had less swelling and tenderness.

PSORIATIC ARTHRITIS

(PSA): An autoimmune disease in which the immune system attacks healthy joint tissue, PSA affects about 30 percent of people with psoriasis, a condition marked by red, scaly patches on the skin.

23 PSA is not RA. Psoriatic arthritis is often misdiagnosed as rheumatoid arthritis, but the cause and many treatments are different. Until 2013, the medications approved by the FDA to treat psoriatic arthritis were RA drugs. Since then, several new treatments for those with PSA have become available.

24 Getting a timely diagnosis can prevent permanent joint damage. “In psoriatic arthritis, erosive joint changes can begin within six months of first symptoms,” says rheumatologist Sergio Schwartzman, MD. “But for many people, there can be a five-year delay in receiving a diagnosis.” A growing number of combined dermatology/rheumatology clinics may help reverse the trend.

25 Psoriatic arthritis sufferers are six times more likely to have the inflammatory bowel disease (IBD) known as Crohn’s disease, according to a study of more than 174,000 women. Chronic inflammation underlies both Crohn’s and PSA, and some of the medications used to treat arthritis may lead to or exacerbate IBD symptoms. (Other PSA drugs, though, can help IBD symptoms.) People with PSA are also at higher risk for diabetes, osteoporosis, kidney disease, other autoimmune diseases, and many other conditions.

GOUT

Caused by uric acid crystals in joints (most often in the big toe). 26 The number of people diagnosed with gout doubled between 1960 and 1990, and rates have risen about 25 percent since. The use of certain medications for high blood pressure—especially loop and thiazide diuretics—are among the top reasons for the increase. Foods and drinks rich in compounds called purines (such as alcohol, bacon, and sweets) also contribute to the formation of uric acid crystals, as does being overweight and sedentary.

27 Tomatoes, which can increase uric acid levels, could be a gout trigger for some people, a study from 2015 found. They were the fourth most common food trigger after seafood, alcohol, and red meat.

28 It Bears repeating: Cherries can lower the risk of a gout attack. In a 2012 study, researchers followed people with gout for a year and found that those who either ate fresh cherries or took cherry extract throughout the year were 37 percent less likely to have recurrent attacks.

29 Gout drugs can be effective, but they can also have drawbacks. In a 2018 study of more than 6,000 people with gout, those who took febuxostat were 34 percent more likely to die from heart disease than people who took allopurinol, another common gout drug. But allopurinol can cause liver problems, while another older gout drug, colchicine, can cause severe diarrhea.