What Are Rheumatic Diseases and What Is
Arthritis?
"
An estimated 40 million people in the
United States have arthritis or other rheumatic conditions.
"
What Are Rheumatic Diseases and What Is Arthritis?
There are more than 100 rheumatic diseases. These diseases may
cause pain, stiffness, and swelling in joints and other supporting
structures of the body such as muscles, tendons, ligaments, and
bones. Some rheumatic diseases can also affect other parts of
the body, including various internal organs.
Many people use the word “arthritis” to refer to all rheumatic
diseases. However, the word literally means joint inflammation;
that is, swelling, redness, heat, and pain caused by tissue injury
or disease in the joint. The many different kinds of arthritis
comprise just a portion of the rheumatic diseases. Some rheumatic
diseases are described as connective tissue diseases because they
affect the body's connective tissue—the supporting framework of
the body and its internal organs. Others are known as autoimmune
diseases because they are caused by a problem in which the immune
system harms the body's own healthy tissues. Examples of some
rheumatic diseases are provided on the next page.
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Examples of Rheumatic Diseases
*Osteoarthritis—Also known as degenerative joint disease, osteoarthritis
is the most common type of arthritis, affecting an estimated 20.7
million adults in the United States. Osteoarthritis primarily
affects cartilage, which is the tissue that cushions the ends
of bones within the joint. Osteoarthritis occurs when cartilage
begins to fray, wear, and decay. In extreme cases, the cartilage
may wear away entirely, leaving a bone-on-bone joint. Bony spurs
(pointy bulges of bone) may form at the edges of the joint. Osteoarthritis
can cause joint pain, reduced joint motion, loss of function,
and disability. Disability results most often when the disease
affects the spine and the weight-bearing joints (the knees and
hips).
*Rheumatoid arthritis—Rheumatoid arthritis is an inflammatory
disease of the synovium, or lining of the joint, that results
in pain, stiffness, swelling, deformity, and loss of function
in the joints. Inflammation most often affects joints of the hands
and feet and tends to be symmetrical (occurring equally on both
sides of the body). This symmetry helps distinguish rheumatoid
arthritis from other types of arthritis. About 1 percent of the
U.S. population (about 2.1 million people) has rheumatoid arthritis.
*Fibromyalgia—Fibromyalgia is a chronic disorder that causes
pain and stiffness throughout the tissues that support and move
the bones and joints. Pain and localized tender points occur in
the muscles and tendons, particularly those of the neck, spine,
shoulders, and hips. Patients may experience widespread pain,
fatigue, and sleep disturbances.
*Systemic lupus erythematosus—Systemic lupus erythematosus (also
known as lupus and SLE) is an autoimmune disease in which the
immune system harms the body's own healthy cells and tissues.
In SLE, this can result in inflammation of and damage to the joints,
skin, kidneys, heart, lungs, blood vessels, and brain.
*Scleroderma—Also known as systemic sclerosis, the word scleroderma
means “hard skin.” It refers to several diseases that almost always
affect the skin, blood vessels, and joints. A more serious form
also affects internal organs such as the lungs and kidneys. In
scleroderma, there is an abnormal and excessive production of
collagen (a fiber-like protein) in the skin or internal organs.
*Juvenile rheumatoid arthritis—This is the most common form
of arthritis in childhood, causing pain, stiffness, swelling,
and loss of function in the joints. The arthritis may be associated
with rashes or fevers, or may affect other parts of the body.
*Ankylosing spondylitis—This type of arthritis primarily affects
the spine, but may also cause arthritis in the hips, shoulders,
and knees. The tendons and ligaments around the bones and joints
in the spine become inflamed, resulting in pain and stiffness,
especially in the lower back. Ankylosing spondylitis tends to
affect people in late adolescence or early adulthood.
*Gout—This type of arthritis results from deposits of needle-like
crystals of uric acid in the connective tissue, joint spaces,
or both. Uric acid is a normal breakdown product of purines, which
are present in body tissues and in many foods. Usually, uric acid
passes through the kidney into urine and is eliminated. If the
concentration of uric acid in the blood rises above normal levels,
sodium urate crystals may form in the tendons, ligaments, and
cartilage of the joints. These needle-like crystals cause inflammation,
swelling, and pain in the affected joint. The joint most commonly
affected is the big toe.
*Infectious arthritis—This is a general term used to describe
forms of arthritis that are caused by infectious agents, such
as bacteria or viruses. Parvovirus arthritis, gonococcal arthritis,
and Lyme disease are examples of infectious arthritis. In those
cases caused by bacteria, early diagnosis and treatment with antibiotics
relieve the arthritis symptoms and cure the disease.
*Reactive arthritis—This form of arthritis develops after an
infection involving the lower urinary tract, bowel, or other organs.
It is commonly associated with eye problems, skin rashes, and
mouth sores. Reiter's syndrome is an example of reactive arthritis.
*Psoriatic arthritis—This form of arthritis occurs in some patients
with psoriasis, a common scaling skin disorder. Psoriatic arthritis
often affects the joints at the ends of the fingers and is accompanied
by changes in the fingernails and toenails. Some people also have
spinal involvement.
*Bursitis—This condition involves inflammation of the bursae,
small, fluid-filled sacs that help reduce friction between bones
and other moving structures in the joints. The inflammation may
result from arthritis in the joint or injury or infection of the
bursae. Bursitis produces pain and tenderness and may limit the
movement of nearby joints.
*Tendinitis (Tendonitis)—This refers to inflammation of tendons
(tough cords of tissue that connect muscle to bone) caused by
overuse, injury, or related rheumatic conditions. Tendinitis produces
pain and tenderness and may restrict movement of nearby joints.
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What Causes Rheumatic Disease?
The causes of rheumatic diseases vary depending on the type
of disease. Researchers have pinpointed the cause or causes of
some rheumatic diseases, such as infectious arthritis and gout.
The causes of most rheumatic diseases are still under investigation.
In osteoarthritis, excessive stress on the joint, from repeated
injury or inherited cartilage weakness, may play a role. In lupus,
rheumatoid arthritis, and scleroderma, the combination of genetic
factors that determine susceptibility, the influence of certain
hormones, and environmental triggers are believed to be important.
Scientists are also studying the risk factors that determine
why some people develop rheumatic diseases and others do not.
For example, being overweight increases the likelihood that a
person will develop osteoarthritis. The chance of developing osteoarthritis
also increases with age. Genes and family history play a role
in many rheumatic diseases including gout, rheumatoid arthritis,
lupus, ankylosing spondylitis, scleroderma, and some others.
Certain rheumatic conditions, such as lupus, rheumatoid arthritis,
scleroderma, and fibromyalgia, are more common among women (see
below for details). This indicates that hormones or other male-female
differences play a role in the development of these conditions.
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Who Is Affected by Arthritis and Rheumatic Conditions?
An estimated 40 million people in the United States have arthritis
or other rheumatic conditions. By the year 2020, this number is
expected to reach 59 million. Rheumatic diseases are the leading
cause of disability among adults age 65 and older.
Rheumatic diseases affect people of all races and ages. Some
rheumatic conditions are more common among certain populations.
For example:
Rheumatoid arthritis occurs two to three times more often in
women than in men.
*Scleroderma is more common in women than in men.
*Nine out of 10 people who have lupus are women.
*Nine out of 10 people who have fibromyalgia are women.
*Gout is more common in men than in women.
*Lupus is three times more common in African-American women
than in Caucasian women.
*Ankylosing spondylitis is more common in men than in women.
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Common Symptoms of Arthritis
*Swelling in one or more joints
*Stiffness around the joints that lasts for at least 1 hour
in the early morning
*Constant or recurring pain or tenderness in a joint
*Difficulty using or moving a joint normally
*Warmth and redness in a joint
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What Are the Symptoms of Arthritis?
Different types of arthritis have different symptoms. In general,
people who have arthritis have pain and stiffness in the joints.
Some of the more common symptoms are listed in the box on this
page. Early diagnosis and treatment help decrease further joint
damage and help control symptoms of arthritis and many other rheumatic
diseases.
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How Are Rheumatic Diseases Diagnosed?
Diagnosing rheumatic diseases can be difficult because some
symptoms and signs are common to many different diseases. A general
practitioner or family doctor may be able to evaluate a patient
or refer him or her to a rheumatologist: a doctor who specializes
in treating arthritis and other rheumatic diseases.
The doctor will review the patient's medical history, conduct
a physical examination, and obtain laboratory tests and X rays
or other imaging tests. The doctor may need to see the patient
more than once to make an accurate diagnosis.
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Medical History
It is vital for people with joint pain to give the doctor a
complete medical history. Answers to the following questions will
help the doctor make an accurate diagnosis:
*Is the pain in one or more joints?
*When does the pain occur?
*How long does the pain last?
*When did you first notice the pain?
*What were you doing when you first noticed the pain?
*Does activity make the pain better or worse?
*Have you had any illnesses or accidents that may account for
the pain?
*Is there a family history of any arthritis or rheumatic diseases?
*What medicine(s) are you taking?
It may be helpful for people to keep a daily journal that describes
the pain. Patients should write down what the affected joint looks
like, how it feels, how long the pain lasts, and what they were
doing when the pain started.
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Physical Examination and Laboratory Tests
The doctor will examine all of the patient's joints for redness,
warmth, deformity, ease of movement, and tenderness. Because some
forms of arthritis, such as lupus, may affect other organs, a
complete physical examination including the heart, lungs, abdomen,
nervous system, and eyes, ears, and throat may be necessary. The
doctor may order some laboratory tests to help confirm a diagnosis.
Samples of blood, urine, or synovial fluid (fluid found in the
joint) may be needed for the tests.
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Common Laboratory Tests
*Antinuclear antibody (ANA)—This test checks blood levels of
antibodies that are often present in people who have connective
tissue diseases or other autoimmune disorders, such as lupus.
Since the antibodies react with material in the cell's nucleus
(control center), they are referred to as antinuclear antibodies.
There are also tests for individual types of ANA's that may be
more specific to people with certain autoimmune disorders. ANA's
are also sometimes found in healthy people. Therefore, having
ANA's in the blood does not necessarily mean that a person has
a disease.
*Arthrocentesis—Arthrocentesis or joint aspiration is done to
obtain a sample of synovial fluid. The doctor injects a local
anesthetic, inserts a thin, hollow needle into the joint, and
removes the synovial fluid into a syringe. The test provides important
diagnostic information. For example, the test allows the doctor
to see whether crystals (found in patients with gout or other
types of crystal-induced arthritis) or bacteria or viruses (found
in patients with infectious arthritis) are present in the joint.
*Complement—This test measures the level of complement, a group
of proteins in the blood. Complement helps destroy foreign substances,
such as germs, that enter the body. A low blood level of complement
is common in people who have active lupus.
*Complete blood count (CBC)—This test determines the number
of white blood cells, red blood cells, and platelets present in
a sample of blood. Some rheumatic conditions or drugs used to
treat arthritis are associated with a low white blood count (leukopenia),
low red blood count (anemia), or low platelet count (thrombocytopenia).
When doctors prescribe medications that affect the CBC, they periodically
test the patient's blood.
*Creatinine—This blood test is commonly ordered in patients
who have rheumatic diseases to monitor for underlying kidney disease.
*Erythrocyte sedimentation rate (sed rate)—This blood test is
used to detect inflammation in the body. Higher sed rates indicate
the presence of inflammation and are typical of many forms of
arthritis, such as rheumatoid arthritis and ankylosing spondylitis,
and many of the connective tissue diseases.
*Hematocrit (PCV, packed cell volume)—This test and the test
for hemoglobin (a substance in the red blood cells that carries
oxygen through the body) measure the number of red blood cells
present in a sample of blood. A decrease in the number of red
blood cells (anemia) is common in people with inflammatory arthritis
and rheumatic diseases.
*Rheumatoid factor—This test determines whether rheumatoid factor
is
present in the blood. Rheumatoid factor is an antibody found
in the blood of most (but not all) people who have rheumatoid
arthritis. Rheumatoid factor may be found in many other diseases
besides rheumatoid arthritis, and sometimes in normal, healthy
people.
*Urinalysis—In this test, a urine sample is studied for protein,
red blood cells, white blood cells, or casts. These abnormalities
indicate kidney disease, which may be seen in several rheumatic
diseases such as lupus or vasculitis. Some medications used to
treat arthritis can also cause abnormal findings on urinalysis.
*White blood cell count (WBC)—This test determines the number
of white blood cells present in a sample of blood. The number
may increase as a result of infection or decrease in response
to certain medications, or with certain diseases, such as lupus.
Low numbers of white blood cells increase a person's risk of infections.
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Work With Your Doctor To Limit Your Pain
The role you play in developing your treatment plan is very
important. It is vital for you to have a good relationship with
your doctor so that you can work together. You should not be afraid
to ask questions about your condition or treatment. You must understand
the treatment plan and tell the doctor whether or not it is helping
you. Studies have shown that patients who are well informed and
participate actively in their own care experience less pain and
make fewer visits to the doctor than other patients do.
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X Rays and Other Imaging Procedures
To see what the joint looks like inside, the doctor may order
X rays or other imaging procedures. X rays provide an image of
the bones, but they do not show the cartilage, muscles, and ligaments.
Other noninvasive imaging methods such as computed tomography
(CT or CAT), magnetic resonance imaging (MRI), and arthrography
(joint X ray) show the whole joint. The doctor may also use an
arthroscope (a small, flexible tube that transmits the image of
the inside of a joint to a video screen) to examine damage to
a joint. The arthroscope is inserted into the affected joint through
a very small incision in the skin. This procedure, called arthroscopy,
allows the doctor to see inside the joint. Doctors also use arthroscopy
to perform surgery for some types of joint injury.
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What Are the Treatments?
Treatments for arthritis include rest and relaxation, exercise,
proper diet, medication, and instruction about the proper use
of joints and ways to conserve energy. Other treatments include
the use of pain relief methods and assistive devices, such as
splints or braces. In severe cases, surgery may be necessary.
The doctor and the patient work together to develop a treatment
plan that helps the patient maintain or improve his or her lifestyle.
Treatment plans usually combine several types of treatment and
vary depending on the rheumatic condition and the patient.
* Rest, Exercise, and Diet *
People who have a rheumatic disease should develop a comfortable
balance between rest and activity. One sign of many rheumatic
conditions is fatigue. Patients must pay attention to signals
from their bodies. For example, when experiencing pain or fatigue,
it is important to take a break and rest. Too much rest, however,
may cause muscles and joints to become stiff.
Physical exercise can reduce joint pain and stiffness and increase
flexibility, muscle strength, and endurance. It also helps with
weight reduction and contributes to an improved sense of well-being.
Before starting any exercise program, people with arthritis should
talk with their doctor. People with arthritis can participate
in a variety of sports and exercise programs. Exercises that doctors
often recommend include
*Range-of-motion exercises to help maintain normal joint movement,
maintain or increase flexibility, and relieve stiffness.
*Strengthening exercises to maintain or increase muscle strength.
Strong muscles help support and protect joints affected by arthritis.
*Aerobic or endurance exercises to improve cardiovascular fitness,
help control weight, and improve overall well-being. Studies show
that aerobic exercise can also reduce inflammation in some joints.
Another important part of a treatment program is a well-balanced
diet. Along with exercise, a well-balanced diet helps people manage
their body weight and stay healthy. Weight control is important
to people who have arthritis because extra weight puts extra pressure
on some joints and can aggravate many types of arthritis. Diet
is especially important for people who have gout. People with
gout should avoid alcohol and foods that are high in purines,
such as organ meats (liver, kidney), sardines, anchovies, and
gravy.
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Medications
A variety of medications are used to treat rheumatic diseases.
The type of medication depends on the rheumatic disease and on
the individual patient. At this time, the medications used to
treat most rheumatic diseases do not provide a cure, but rather
limit the symptoms of the disease. The one exception is treatments
for infectious arthritis. If caught early enough, arthritis associated
with an infection (such as Lyme disease) can usually be cured
with antibiotics.
Medications commonly used to treat rheumatic diseases provide
relief from pain and inflammation. In some cases, the medication
may slow the course of the disease and prevent further damage
to joints or other parts of the body. This fact sheet describes
the medications most commonly used to treat pain and inflammation.
The doctor may delay using medications until a definite diagnosis
is made, because medications can hide important symptoms (such
as fever and swelling) and thereby interfere with diagnosis. Patients
taking any medication, either prescription or over-the-counter,
should always follow the doctor's instructions. The doctor should
be notified immediately if the medicine is making the symptoms
worse or causing other problems, such as an upset stomach, nausea,
or headache. The doctor may be able to change the dosage or medicine
to reduce these side effects.
Analgesics (pain relievers) such as aspirin; other nonsteroidal
anti-inflammatory drugs (NSAID's) such as ibuprofen (Motrin,'
Advil, Nuprin); and acetaminophen (Tylenol) are used to reduce
the pain caused by many rheumatic conditions. Aspirin and NSAID's
have the added benefit of decreasing the inflammation associated
with arthritis. Certain analgesics, such as aspirin and NSAID's,
can have side effects, such as stomach irritation, that can be
reduced by changing the dosage or the medication. The dosage will
vary depending on the particular illness and the overall health
of the patient. The doctor and patient must work together to determine
which analgesic to use and the appropriate amount. If analgesics
do not ease the pain, the doctor may use other medications, depending
on the diagnosis.
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' Brand names included in this fact sheet are provided as examples
only, and their inclusion does not mean that these products are
endorsed by the National Institutes of Health or any other Government
agency. Also, if a particular brand name is not mentioned, this
does not mean that the product is unsatisfactory.
----------------------------
Corticosteroids, such as prednisone, cortisone, solumedrol,
and hydrocortisone, are used to treat many rheumatic conditions
because they decrease inflammation and suppress the immune system.
The dosage of these medications will vary depending on the diagnosis
and the patient; again, the patient and doctor must work together
to determine what dose is best for the patient.
Corticosteroids can be given by mouth, in creams applied to
the skin, or by injection. Short-term side effects of corticosteroids
include swelling, increased appetite, weight gain, and emotional
ups and downs. These side effects generally stop when the drug
is stopped. It can be dangerous to stop taking corticosteroids
suddenly, so it is very important that the doctor and patient
work together when changing the corticosteroid dose. Side effects
that may occur after long-term use of corticosteroids include
stretch marks, excessive hair growth, osteoporosis, high blood
pressure, damage to the arteries, high blood sugar, infections,
and cataracts.
Although some rheumatic diseases respond to analgesics and corticosteroids,
others may not. Rheumatoid arthritis, gout, lupus, scleroderma,
and fibromyalgia are some of the rheumatic diseases that routinely
require other medications; these are prescribed to slow the course
of the disease or to treat disease-specific symptoms.
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Heat and Cold Therapies
Heat and cold can both be used to reduce the pain and inflammation
of arthritis. Both therapies come in different forms, and the
patient and doctor can determine which form works best. Studies
have shown heat and cold therapies to be equally effective in
reducing pain, although they are usually avoided in acute gout.
Heat therapy increases blood flow, tolerance for pain, and flexibility.
Heat therapy can involve treatment with paraffin wax, microwaves,
ultrasound, or moist heat. Physical therapists are needed to apply
paraffin wax, or use microwave or ultrasound therapy, but patients
can apply moist heat themselves. Some ways to apply moist heat
include placing warm towels or hot packs on the inflamed joint
or taking a warm bath or shower.
Cold therapy numbs the nerves around the joint (which reduces
pain) and relieves inflammation and muscle spasms. Cold therapy
can involve cold packs, ice massage, soaking in cold water, or
over-the-counter sprays and ointments that cool the skin and joints.
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Hydrotherapy, Mobilization Therapy, and Relaxation Therapy
Hydrotherapy involves exercising or relaxing in warm water,
which helps relax tense muscles and relieve pain. Exercising in
a large pool is easier because water takes some weight off painful
joints. This type of exercise improves muscle strength and joint
movement.
Mobilization therapies include traction (gentle, steady pulling),
massage, and manipulation (using the hands to restore normal movement
to stiff joints). When done by a trained professional, these methods
can help control pain, increase joint motion, and improve muscle
and tendon flexibility.
Relaxation therapy helps reduce pain by teaching people various
ways to release muscle tension throughout the body. In one method
of relaxation therapy, known as progressive relaxation, the patient
tightens a muscle group and then slowly releases the tension.
Doctors and physical therapists can teach patients progressive
relaxation and other relaxation techniques.
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Assistive Devices
The most common assistive devices for treating arthritis pain
are splints and braces, which are used to support weakened joints
or allow them to rest. Some of these devices prevent the joint
from moving; others allow some movement. A splint or brace should
be used only when recommended by a doctor or therapist, who will
show the patient the correct way to put the device on, ensure
that it fits properly, and explain when and for how long it should
be worn. The incorrect use of a splint or brace can cause joint
damage, stiffness, and pain.
A person with arthritis can use other kinds of devices to ease
the pain. For example, the use of a cane when walking can reduce
some of the weight placed on an arthritic knee or hip. A shoe
insert (orthotic) can ease the pain of walking caused by arthritis
of the foot or knee.
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Surgery
Surgery may be required to repair damage to a joint after trauma
(a torn meniscus, for example) or to restore function or relieve
pain in a joint damaged by arthritis. The doctor may recommend
arthroscopic surgery, bone fusion (surgery in which bones in the
joint are fused or joined together), or arthroplasty (also known
as total joint replacement, in which the damaged joint is removed
and replaced with an artificial one).
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Myths About Treating Arthritis
At this time, the only type of arthritis that can be cured is
that caused by infections. Although symptoms of other types of
arthritis can be effectively managed with rest, exercise, and
medication, there are no cures. Some people claim to have been
cured by treatment with herbs, oils, chemicals, special diets,
radiation, or other products. However, there is no scientific
evidence that such treatments are helpful in patients with arthritis
and, moreover, they may actually cause harm with the development
of side effects. Patients should talk to their doctor before using
any therapy that has not been prescribed or recommended by the
health care team caring for the patient.
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What Can Be Done To Help?
Studies show that an estimated 18 percent of Americans who have
arthritis or other rheumatic conditions believe that their condition
limits their activities. People with arthritis may find that they
can no longer participate in some of their favorite activities,
which can affect their overall well-being. Even when arthritis
impairs only one joint, a person may have to change many daily
activities to protect that joint from further damage and reduce
pain. When arthritis affects the entire body, as it does in people
with rheumatoid arthritis or fibromyalgia, many daily activities
have to be changed to deal with pain, fatigue, and other symptoms.
Changes in the home may help a person with chronic arthritis
continue to live safely, productively, and with less pain. People
with arthritis may become weak, lose their balance, or fall in
the bathroom. Installing grab bars in the tub or shower and by
the toilet, placing a secure seat in the tub, and raising the
height of the toilet seat can help. Special kitchen utensils can
accommodate arthritic hands to make meal preparation easier. An
occupational therapist can help people who have rheumatic conditions
identify and make adjustments in their homes to create a safer,
less painful, and more efficient environment.
Friends and family can help a patient with a rheumatic condition
by learning about that condition and understanding how it affects
the patient's life. Friends and family can provide emotional and
physical assistance. Their support, as well as support from other
people who have the same disease, can make it easier to cope.
The Arthritis Foundation (see the list of resources at the end
of this fact sheet) has a wealth of information to help people
with arthritis.
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What Is Some of the Current Research Being Done on Arthritis?
The National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), a part of the National Institutes of Health
(NIH), leads the Federal medical research effort in arthritis
and rheumatic diseases. The NIAMS sponsors research and research
training on the NIH campus in Bethesda, Maryland, and at universities
and medical centers throughout the United States.
The NIAMS supports three types of centers: Multipurpose Arthritis
and Musculoskeletal Diseases Centers (MAMDC's), Specialized Centers
of Research (SCOR's), and Core Centers.
The MAMDC's foster a multidisciplinary approach to the many
problems of arthritis and musculoskeletal diseases and develop
new capabilities for research into other diseases. Centers develop
and carry out research in basic or laboratory and clinical science,
professional and patient education, and epidemiology and health
services.
Each SCOR focuses on a single disease: currently, rheumatoid
arthritis, systemic lupus erythematosus, osteoarthritis, osteoporosis,
and scleroderma. By doing laboratory and clinical studies under
one roof, these centers aim to speed up basic research on the
causes of these diseases and to hasten transfer of advances from
the laboratory to the bedside and improve patient care.
Core Centers promote interdisciplinary collaborative efforts
among scientists engaged in high-quality research related to a
common theme. By providing funding for facilities, pilot and feasibility
studies, and program enrichment activities at the Core Center,
the Institute reinforces and amplifies investigations already
ongoing in NIAMS program areas. Core Centers are currently targeted
for skin diseases (Skin Disease Research Core Centers) and for
musculoskeletal disorders (Core Centers for Musculoskeletal Disorders).
Some current NIAMS research efforts in rheumatoid arthritis,
osteoarthritis, lupus, and scleroderma are outlined below.
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Rheumatoid Arthritis
Researchers are trying to identify the causes of rheumatoid
arthritis in the hope that understanding the cause will lead to
new treatments. They are examining the role that the endocrine
(hormonal), nervous, and immune systems play, and the ways in
which these systems interact with environmental and genetic factors
in the development of rheumatoid arthritis. Some scientists are
trying to determine whether an infectious agent triggers rheumatoid
arthritis. Others are studying the role of certain enzymes (specialized
proteins in the body that carry out biochemical reactions) in
breaking down cartilage. Researchers are also trying to identify
the genetic factors that place some people at higher risk than
others for developing rheumatoid arthritis.
Moreover, scientists are looking at new ways to treat rheumatoid
arthritis. They are experimenting with new drugs and “biologic
agents” that selectively block certain immune system activities
associated with inflammation. Recent studies suggest that these
represent promising approaches to treatment. Other investigators
have shown that minocycline and doxycycline, two antibiotic medications
in the tetracycline family, have a modest benefit for people with
rheumatoid arthritis.
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Osteoarthritis
Researchers are working to understand what role certain enzymes
play in the breakdown of joint cartilage in osteoarthritis and
are testing drugs that block the action of these enzymes. In addition,
a gene that may be linked to an inherited form of osteoarthritis
has recently been discovered.
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Systemic Lupus Erythematosus
Researchers are looking at how genetic, environmental, and hormonal
factors influence the development of systemic lupus erythematosus.
They are trying to find out why lupus is more common in certain
populations. There has been very promising progress in identifying
the genes that may be responsible for lupus. Promising areas of
treatment research include biologic agents; newer, more selective
drugs that suppress the immune system; and efforts to correct
immune abnormalities with bone marrow transplantation. Clinical
studies are underway to determine the safety of estrogens for
hormone replacement therapy and birth control in women with lupus.
Contrary to the widely held belief that estrogens can make the
disease worse, recent data suggest that these drugs may be safe
for some women with lupus.
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Scleroderma
Current studies on scleroderma are focusing on three areas of
the disease: overproduction of collagen, blood vessel injury,
and abnormal immune system activity. Researchers hope to discover
how these three elements interact with each other to cause and
promote scleroderma. In one recent study, researchers found evidence
of fetal cells within the blood and skin lesions of women who
had been pregnant years before developing scleroderma. The study
suggests that fetal cells may play a role in scleroderma by maturing
immune cells that promote the overproduction of collagen. Scientists
are continuing to study the implications of this finding.
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Where Can People Find More Information About Arthritis?
Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
404/872–7100
800/283–7800, or call your local chapter (listed in the telephone
directory)
World Wide Web address: http://www.arthritis.org/
This is the main voluntary organization devoted to arthritis.
The foundation publishes free pamphlets on many types of arthritis
and a monthly magazine for members that provides up-to-date information
on arthritis. The foundation also can provide physician and clinic
referrals.
American College of Rheumatology/Association of Rheumatology
Health Professionals
1800 Century Place, Suite 250
Atlanta, GA 30345–4300
404/633–3777
Fax: 404/633–1870
World Wide Web address: http://www.rheumatology.org/
This association provides referrals to rheumatologists and physical
and occupational therapists who have experience working with people
who have rheumatic diseases. The organization also provides educational
materials and guidelines about many different rheumatic diseases.
National Arthritis and Musculoskeletal and
Skin Diseases Information Clearinghouse (NAMSIC)
National Institutes of Health
1 AMS Circle
Bethesda, Maryland 20892–3675
301/495–4484
TTY: 301/565–2966
Fax: 301/718–6366
NIAMS Fast Facts–For health information that is available by
fax 24 hours a day,
Call 301/881–2731 from a fax machine telephone.
World Wide Web address: http://www.nih.gov/niams/
This clearinghouse, a public service sponsored by the NIAMS,
provides information about various forms of arthritis and rheumatic
disease. The clearinghouse distributes patient and professional
education materials and also refers people to other sources of
information.
----------------------------
Key Words
*Analgesic: A medication or treatment that relieves pain.
*Ankylosing spondylitis: A rheumatic disease that causes arthritis
of the spine and sacroiliac joints and, at times, inflammation
of the eyes and heart valves.
*Antibodies: Special proteins produced by the body's immune
system that help fight and destroy viruses, bacteria, and other
foreign substances (antigens) that invade the body. Occasionally,
abnormal antibodies develop that can attack a part of the body
and cause autoimmune disease. These abnormal antibodies are called
autoantibodies.
*Antigen: A foreign substance that stimulates an immune response.
*Arthrography: An x-ray procedure that provides a detailed image
of the joint when air or a contrast substance is injected into
the joint space.
*Arthroscopy: A procedure performed with an arthroscope (a small,
flexible tube that transmits the image of the inside of a joint
to a video monitor). Arthroscopy is used for diagnosis as well
as treatment of some types of joint injury. The arthroscope is
inserted through a small incision in the skin near the affected
joint.
*Bursa (plural, bursae): A small sac of tissue located between
bone and other moving structures such as muscles, skin, or tendons.
The bursa contains a lubricating fluid that allows smooth gliding
between these structures.
*Bursitis: A condition involving inflammation of the bursae.
*Cartilage: A resilient tissue that covers and cushions the
ends of the bones and absorbs shock.
*Collagen: The main structural protein of skin, bones, tendons,
cartilage, and connective tissue.
*Connective tissue: The supporting framework of the body and
its internal organs.
*Computed tomography (CT or CAT): A diagnostic technique that
uses a computer and an x-ray machine to take a series of images
that can be transformed into a clear and detailed image of a joint.
*Corticosteroids: Potent anti-inflammatory hormones that are
made naturally in the body or synthetically for use as drugs.
The most commonly prescribed drug of this type is prednisone.
*Fibromyalgia: A chronic disorder characterized by widespread
musculoskeletal pain, fatigue, and tenderness in localized areas
of the neck, spine, shoulders, and hips called “tender points.”
*Fibrous capsule: A tough wrapping of tendons and ligaments
that surrounds the joint.
*Gout: A type of arthritis resulting from deposits of needle-like
crystals of uric acid in the connective tissue, joint spaces,
or both.
*Hydrotherapy: Therapy that takes place in water.
*Infectious arthritis: Forms of arthritis caused by infectious
agents, such as bacteria or viruses.
*Inflammation: A typical reaction of tissue to injury or disease.
It is marked by four signs: swelling, redness, heat, and pain.
*Joint: The place where two or more bones are joined. Most joints
are composed of cartilage, joint space, fibrous capsule, synovium,
and ligaments.
*Joint space: The area enclosed within the fibrous capsule and
synovium.
*Juvenile arthritis: A term used to refer to the types of arthritis
that affect children. Juvenile rheumatoid arthritis is the most
common type.
*Ligaments: Stretchy bands of cordlike tissues that connect
bone to bone.
*Lupus: A type of immune disorder known as an autoimmune disease
that can lead to inflammation of and damage to joints, skin, kidneys,
heart, lungs, blood vessels, and brain.
*Lyme disease: A disease caused by the bacterium Borrelia burgdorferi
in which arthritis is often a prominent symptom. Rash, heart disease,
and nervous system involvement may also occur.
*Magnetic resonance imaging (MRI): A diagnostic technique that
provides high-quality cross-sectional images of a structure of
the body without X rays or other radiation.
*Manipulation: A treatment by which health professionals use
their hands to help restore normal movement to stiff joints.
*Microwave therapy: A type of deep heat therapy in which electromagnetic
waves pass between electrodes placed on the patient's skin. This
therapy creates heat that increases blood flow and relieves muscle
and joint pain.
*Mobilization therapies: A group of treatments that include
traction, massage, and manipulation. When performed by a trained
professional, these methods can help control a patient's pain
and increase joint and muscle motion.
*Nonsteroidal anti-inflammatory drugs (NSAID's): A group of
medications, including aspirin, ibuprofen, and related drugs,
used to reduce inflammation that causes joint pain, stiffness,
and swelling.
*Osteoarthritis: A type of arthritis that causes the cartilage
in the joints to fray and wear. In extreme cases, the cartilage
may wear away completely.
*Polymyalgia rheumatica: A rheumatic disease that involves tendons,
muscles, ligaments, and tissues around the joints. Pain, aching,
and morning stiffness in the neck, shoulders, lower back, and
hips characterize the disease. It is sometimes the first sign
of giant cell arteritis (a disease of the arteries characterized
by inflammation, weakness, weight loss, and fever).
*Polymyositis: A rheumatic disease that causes weakness and
inflammation of muscles.
*Psoriatic arthritis: Joint inflammation that occurs in about
5 to 10 percent of people with psoriasis (a common skin disorder).
*Reactive arthritis: A form of arthritis that develops after
an infection involving the lower urinary tract, bowel, or other
organs.
*Rheumatic: A term referring to a disorder or condition that
causes pain or stiffness in the joints, muscles, or bone.
*Rheumatoid arthritis: An inflammatory disease of the synovium,
or lining of the joint, that results in pain, stiffness, swelling,
deformity, and loss of function in the joints.
*Rheumatologist: A doctor who specializes in diagnosing and
treating disorders that affect the joints, muscles, tendons, ligaments,
and bones.
*Risk factor: Something that increases a person's chance of
developing a disease, such as age, gender, ethnicity, and genetics
(family history).
*Scleroderma: A disease of the connective tissues and blood
vessels that leads to hardening of the skin. Scleroderma can also
damage internal organs such as the kidneys, lungs, heart, or gastrointestinal
tract.
*Synovial fluid: Fluid released into movable joints by surrounding
membranes. The fluid lubricates the joint and reduces friction.
*Synovium: A thin membrane that lines a joint and releases a
fluid that allows the joint to move easily.
*Tendinitis (tendonitis): Inflammation of tendons caused by
overuse, injury, or related rheumatic conditions.
*Tendon: Tough, fibrous cords of tissue that connect muscle
to bone.
*Transcutaneous: Through the skin.
*Ultrasound: A treatment that uses sound waves to provide deep
heat and relieve pain.
The National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), a part of the National Institutes of Health
(NIH), leads the Federal medical research effort in arthritis
and musculoskeletal and skin diseases. The NIAMS supports research
and research training throughout the United States, as well as
on the NIH campus in Bethesda, MD, and disseminates health and
research information. The National Arthritis and Musculoskeletal
and Skin Diseases Information Clearinghouse (NAMSIC) is a public
service sponsored by the NIAMS that provides health information
and information sources. Additional information can be found on
the NIAMS Web site at http://www.nih.gov/niams/.
January 1999
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