How to Manage Arthritis--the Arthritis Action Program

Today, about 43 million Americans--one in six--suffers from arthritis. And some experts predict that by the year 2020, the number of people with the disease could skyrocket to 60 million. Arthritis may not be curable, but there are many ways to slow its progression and ease the pain. Michael Weinblatt, MD, a professor of medicine at Harvard Medical School and the author of The Arthritis Action Program, talks to us about how to manage this common condition.

The Arthritis Action Program is a comprehensive guide to managing the disease: "Everything you always wanted to know about arthritis". The book covers treatment options--like the new COX-2 inhibitors or "super-aspirins" and biological response modifiers, to lifestyle issues like the effect of diet and exercise and complementary approaches like acupuncture, yoga, tai-chi, hypnosis, massage, and prayer.

What is arthritis? Do we know what causes arthritis, and why so many people have the disease?

Arthritis is the medical term for over 100 different diseases that causes the joints to become inflamed or damaged. The two major types of arthritis are osteoarthritis and rheumatoid arthritis. The word is derived from the Greek word arthron, meaning joint, and itis, meaning inflammation. Because there are multiple illnesses associated with arthritis, we don't know what causes it. But age, obesity, and some genetic factors may play a role.

One usually associates arthritis with older people. Can young people or even children also get the disease?

Rheumatoid arthritis is a disease of young people and can last 20 to 30 years. It can also occur in children, in which case it's called juvenile rheumatoid arthritis. Osteoarthritis occurs usually in older people. But if you have injury to the joints, it can occur in younger people. Studies have shown that athletic injuries can hasten the onset of arthritis by about 10 years earlier.

What are the symptoms of arthritis, and how do you know if you're getting it?

The most common symptoms for arthritis are pain and stiffness in the joints, as well as swelling in the joints. For rheumatoid arthritis, people feel pain and stiffness in elbows, angles, and frequently in feet, as well as stiffness when waking up. Other symptoms are difficulties with normal activities, such as walking up and down the stairs, getting into a car, or even fever.

How do you know when to see a specialist?

You should see a rheumatologist, a doctor who specializes in joint disorders, if you're not responding to a particular therapy. You should also see a rheumatologist as soon as a diagnosis is suspected.

Weight reduction and exercise programs

Patients who are overweight are at increased risk for osteoarthritis. Multiply your weight times three, and that's the additional stress you're creating. Weight loss might may prevent the development of osteoarhritis.

Many patients think you shouldn't exercise if you have arthritis. Exercise is a critical component to the management of arthritis. It's important to try to preserve range of motion in the joints. Another critical aspect of exercise is muscle strengthening.

Medications and complementary therapies

Drugs like acetaminophen or Tylenol, available over the counter, may be effective for pain control. But for patients with more severe symptoms, prescription non-steroidal anti-inflammatory drugs (NSAIDs) may be needed. For those who don't take to those, we also use some newer drugs, such as Vioxx or Celebrex.

We also recommend approaches that complement traditional medical treatments. For instance, we are looking at nutritional supplements, such as glucosamine, that may build cartilage. There are studies that note they reduce pain and swelling.

Surgery

In patients who don't respond to the approaches we just talked about, sugeries can be quite miraculous. We do recommend this in patients who are not responding to medical therapy.

And what about rheumatoid arthritis, what kind of treatment approaches are there?

Just as in osteoarthritis, we use anti-inflammatory drugs. But we also add a newer group of drugs called disease modifiers. We're much more aggressive about adding these drugs earlier in the disease.

We're also looking at complementary therapies. Cold-water fish contain a fatty acid that decreases inflammation. You can get these components by taking evening primrose oil or another fatty acid called fish oil.

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