Arthritis (Severe)

What is Arthritis?

While often referred to as if it were a single disease, arthritis is actually an umbrella term used for a group of more than 100 medical conditions that collectively affect nearly 46 million adults and 300,000 children in America alone. While the most common form of arthritis -- osteoarthritis (OA) -- is most prevalent in people over 60, arthritis in its various forms can start as early as infancy. Some forms affect people in their young-adult years as they are beginning careers and families and still others start during the peak career and child-rearing years.

The common thread among these 100-plus conditions is that they all affect the musculoskeletal system and specifically the joints - where two or more bones meet. Arthritis-related joint problems include pain, stiffness, inflammation and damage to joint cartilage (the tough, smooth tissue that covers the ends of the bones, enabling them to glide against one another) and surrounding structures. Such damage can lead to joint weakness, instability and visible deformities that, depending on the location of joint involvement, can interfere with the most basic daily tasks such as walking, climbing stairs, using a computer keyboard, cutting your food or brushing your teeth.

For many people with arthritis, however, joint involvement is not the extent of the problem. Many forms of arthritis are classified as systemic, meaning they can affect the whole body. In these diseases, arthritis can cause damage to virtually any bodily organ or system, including the heart, lungs, kidneys, blood vessels and skin. Arthritis-related conditions primarily affect the muscles and the bones.

Together, arthritis and related conditions are a major cause of disability in the United States, costing the U.S. economy more than $124 billion per year in medical care and indirect expenses such as lost wages and production - and costing millions of individuals their health, their physical abilities and, in many cases, their independence. And unless something changes, the picture is going to get worse. As the population ages, the number of people with arthritis is growing.

Understanding Arthritis: Eradicating Myths

Arthritis has been recognized for perhaps thousands of years. Unfortunately, many misconceptions about this chronic condition have been around for almost as long. We will try to debunk some of these myths about arthritis and provide some key definitions along the way.

Myth #1: Arthritis is just aches and pains.
One common myth is that arthritis is just another name for the aches and pains people get as they grow older. While it is true that arthritis becomes more common as people as people age, arthritis may begin at any age, including childhood. Conversely, some elderly people never develop arthritis. Many forms of arthritis or musculoskeletal conditions are self-limited and get better without specific treatment. Others, such as rheumatoid arthritis, may be quite serious and may affect the body's internal organs as well as the joints.

A simple way to organize arthritis-related conditions is to group them into categories based on whether they affect only one joint or area of the body (localized conditions) or many joints and organs over the entire body (generalized conditions). Localized conditions include two subgroups. The first subgroup includes conditions that affect the soft tissues surrounding joints or bones directly. These are known as soft-tissue, localized conditions, and include tendinitis and bursitis. The second subgroup includes conditions that affect one or a few joints, such as a single knee or hip. A common example of this second subgroup is osteoarthritis of a single joint, although osteoarthritis often affects more than one joint.

Likewise, generalized conditions can be divided into two subgroups. In the first subgroup, widespread muscle and soft tissue discomfort in which there is no evidence of swelling or inflammation includes a very common condition called fibromyalgia. Conditions in this subgroup are not associated with damage to the structure of the joints. The second subgroup includes conditions in which inflammation affects the entire body, such as rheumatoid arthritis. Other conditions in this subgroup include gout, ankylosing spondylitis and psoriatic arthritis, generalized conditions of inflammation throughout the body in which joint pain is the major symptom. Other generalized inflammatory conditions include polymyositis, which affects primarily muscles; systemic lupus erythematosus (lupus), which may affect the skin, kidneys or other organs; and vasculitis, which may affect any organ.

These four groups of musculoskeletal conditions are not mutually exclusive, and a person may have more than one type of rheumatic disease. For example, people with rheumatoid arthritis may experience tendinitis, bursitis and fibromyalgia more commonly than people in the general population. In addition, when joints become badly damaged as a result of the chronic inflammation of rheumatoid arthritis, they are called "end stage." At this point, they may look similar to joints that have reached "end stage" in people with osteoarthritis, even though the destruction was caused by different mechanisms.

Myth #2: Arthritis isn't really a serious health problem.
Taken collectively, the various types of arthritis and rheumatic diseases are the most common chronic health condition in the population, affecting about one in every three adult Americans and nearly 300,000 children. These conditions become even more common among older people. Even in people under 65, arthritis is a major cause of work disability. For example, fewer than 50 percent of rheumatoid arthritis patients younger than 65 who are working at the onset of the disease are still working 10 years later.

In addition, the impact of arthritis on society is substantial. By some estimates, the costs associated with arthritis may amount to $86.2 billion annually. The costs of arthritis may be categorized into three groups: direct, indirect and intangible. Direct medical costs, such as physician (and other health professional) fees, charges for laboratory tests and X-rays, drugs, assistive devices, surgeries and other costs, are the most obvious. However, a substantial part of the economic burden come from indirect costs, such as lost wages due to work disability. In addition, people experience intangible costs, such as the need for a spouse or relative to take time off from work to bring a patient to a caregiver, travel for medical care, or money spent to remodel the home to meet the needs of a person with arthritis, and many others.

Myth #3: Not much can be done to alleviate the pain and disability of arthritis.
Unfortunately, there are no cures for most chronic rheumatic diseases. You may think that little can be done to help your arthritis, but this is not true. Some improvement in the pain and loss of function is possible in almost everyone with arthritis. Furthermore, the disease process that may lead to joint destructions can be controlled effectively in most people - particularly those with rheumatoid arthritis. More can be done today to ease the pain of arthritis and to slow joint destruction than ever before.

Many people with serious types of arthritis, which were severely disabling as recently as a generation ago, are now leading full and productive lives, thanks in part to many developments, including new drugs and treatments, exercise programs, surgeries and self-management. As a person with arthritis, your future is full of possibilities that were only a dream 25 years ago.

One of the most exciting changes in recent years has been the growing understanding that the patient has an important role to play in the management of his or her arthritis. This change in emphasis is sometimes referred to as a biopsychosocial model of disease management, to distinguish it from the traditional biomedical model, in which the outcomes of diseases are thought to be determined almost exclusively by the actions of health professionals. The wonderful advances in drugs, surgeries and other medical treatments are an important component of a biopsychosocial model of disease management, but this model also incorporates the key contribution of patients, families and support networks to the outcome.

Principles of Arthritis Management

1. Each person is an individual and should be viewed as a person with a type of arthritis, rather than as a type of arthritis seen in a person.

2. There is no best treatment for everyone who has a particular type of arthritis, as each individual may respond differently to different treatments.

3. No single type of arthritis is always better or worse than another type.

4. Information and input from a person with arthritis can be as valuable in diagnosis and management as information from laboratory tests and X-rays.

5. In arthritis management, the emphasis is on improving function of joints and relieving pain.

6. Your doctor and health-care team need your involvement to help you to the fullest extent. People with arthritis and health professionals are partners in care.

7. Something can always be done to improve the situation for a person with arthritis.

More information available at http://www.arthritis.org

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