Agony In the Bones
Arthritis is crippling more people, but there are nine key ways to beat the pain
For RA patients, joint replacement can be even more complex. "Some of the patients with osteoarthritis are coming in here because they can't play golf or tennis. Rheumatoid arthritis patients are coming in because they can't get out of a wheelchair or walk," says Mark Figgie, chief of the surgical arthritis service at the Hospital for Special Surgery in New York City. Many are on immune-system-altering drugs that may need to be temporarily stopped before surgery. Their bones are softer, skin is more fragile, and they run a higher risk of infection. And since many joints can be affected, surgeons also have to strategize about which ones to fix first.
Patients need to take care of their new joints, since the life of the implant depends on how much wear it gets. "It's mileage dependent, like a part on your car," says David McAllister, an orthopedic surgeon at UCLA. Even with the new materials, patients under 50 may live long enough to need surgery to tinker with or replace the replacement at some point.
There are other treatments in the offing. An experimental trial with the tried and true (and cheap) antibiotic doxycycline indicates that it stops OA progression by blocking enzymes that help break down cartilage tissue. And earlier this month, researchers reported on the world's first gene therapy for arthritis, in which an anti-inflammatory gene was transplanted into the knuckles of RA patients. The gene was active, but doctors are going to have to conduct longer studies to see if it has a real-world benefit.
For now, arthritis patients are bringing available treatments together in a management program, including drugs, physical therapy, exercise, and surgery. Nora Baldner, the mother who couldn't walk to the back of a supermarket for milk, took glucosamine-chondroitin and had hip replacement operations five years ago. Today she rides her bike and feels pain free. "In the roulette wheel of medical problems," she says, "I think I came out pretty lucky."
BAD TO THE BONE
Joints, the place where two bones meet, are meant to move. The junction is lined by a thin membrane that releases a fluid, which serves as a lubricant. The end of each bone is covered by a cushion of slippery cartilage. Arthritis can damage any, or all, of these crucial parts.
[INSET]
HEALTHY KNEE JOINT
Patella
Cartilage
Membrane
Femur
Tibia
OSTEOARTHRITIS
This disease hits when the protective cartilage starts wearing away, often on one side of the joint. As the space in the joint narrows, more cartilage starts rubbing and eroding, even down to the bone. Knobs of the bone called spurs, start to grow. Bits of cartilage fill the area, irritating the membrane. All of this means the joint grinds painfully whenever it moves. Hips, knees and hands are most commonly affected.
[LABELS]
Cartilage roughens and cracks
Joint fluid
Spurs
Membrane
RHEUMATOID ARTHRITIS
This illness begins when the body's immune system turns on itself, attacking the membrane. It thickens, swelling into the joint, and starts to damage the cartilage. Immune cells also attack cartilage, bone, and surrounding muscles and tendons, and the whole area becomes painfully inflamed. Many joints are affected at once, particularly feet, fingers, knees, and elbows.
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