Arthritis: tackling the misconceptions that can cause unnecessary pain and deform
Friday 12 October is World Arthritis Day (WAD) and an important opportunity to raise awareness of arthritic diseases and the considerable challenges people affected by them face. Supported by the ‘Join the Fight against Autoimmune diseases’ campaign, the theme this year is “Waving for World Arthritis Day”, emphasising how difficult physical activity — even simple movements we take for granted, such as waving — can be for sufferers.
According to a recent report, arthritis is the leading cause of disability in the United States, with one in every five American adults currently diagnosed with an arthritic condition and the number of sufferers predicted to rise to 25% of the adult population by 2030[1]. “Arthritis is a serious issue here in South Africa as well,” confirms Dr Marietjie du Plooy, a specialist rheumatologist at the Wits University Donald Gordon Medical Centre in Johannesburg. “The incidence here matches the rest of the world and is, for rheumatoid arthritis alone, somewhere between one and three percent of the population, which means that as many as one and a half million South Africans could be living with an arthritic condition.”
What is arthritis?
Arthritis literally means ‘joint inflammation’ and the term is used to describe the more than 100 diseases that can cause stiffness and swelling in and around the joints, muscles, bones, tendons, ligaments and some internal organs[2]. “Unfortunately, many people mistakenly believe arthritis is a single condition,” Dr du Plooy notes, “which can prevent individuals from getting the correct diagnosis and treatment for their specific disease and result in irreversible damage.”
According to Dr du Plooy, the two most common forms are osteoarthritis and rheumatoid arthritis. In the case of osteoarthritis, the tissue that cushions and protects the bones in a joint (cartilage) wears away. The bones then rub against each other, causing swelling, pain and loss of movement. Ultimately, the joint can lose its alignment and even its shape[3].
While rheumatoid arthritis also results in swollen, stiff and sore joints, particularly in the hands and feet, it is not the result of degenerative wear and tear, but an autoimmune disease. An autoimmune disease occurs when the body’s immune system mistakes its own healthy cells for harmful foreign ones and attacks them. In the case of rheumatoid arthritis, the immune system mistakenly attacks the synovial membrane lining the joints, leading to widespread inflammation and chronic pain[4].
What causes arthritis?
As you might expect, given that the term describes over 100 different diseases, the causes of arthritis depend on the form of arthritis and many arthritic conditions appear to be caused by several factors acting together[5]. Perhaps the least understood are the autoimmune diseases since medical science doesn’t yet know conclusively what causes the immune system to mistakenly attack its own cells, but experts believe that genetics plays a significant role. “Usually, you have a genetic predisposition to the disease and then an external factor like stress or possibly an infection, may trigger it,” confirms Dr du Plooy.
Who is most at risk?
“Again, it depends on the type of arthritis,” observes Dr du Plooy. “The elderly population are more prone to osteoarthritis, for instance. In the case of lupus, it is most common in young females. On the whole, males are more likely to develop gout, while females between the ages of 30 and 50 are most at risk of developing rheumatoid arthritis. In fact, up to the age of 50, arthritic conditions are three times more common in women than men, although, post-menopause, it normalises and the ratio becomes one to one.”
Dr du Plooy is also quick to point out that, contrary to what many people believe, children are also at risk of developing arthritis. “Just as many people consider arthritis part of ‘getting old’ rather than a disease that needs urgent diagnosis and treatment, many also don’t realise that children as young as one can develop juvenile arthritis,” she maintains. “As a result, it can be missed and their symptoms can be confused with clumsiness and being slow.”
New treatments offer hope
Although arthritis is not curable, Dr du Plooy emphasises the fact that many forms of the disease are treatable and controllable. “This is a very exciting time in terms of treatments for arthritis,” she enthuses. “The advent of the disease modifying antirheumatic drugs (DMARDs) has really changed things. The synthetic versions are effective in 80% of cases and the ‘biologic’ treatments, or a combination of both types, usually work for the remaining 20%.”
With seven biologic treatments already available and more than 30 others in the pipeline5, Dr du Plooy uses rheumatoid arthritis to illustrate how dramatically the situation has improved. “In the UK, they have summer camps for children with rheumatoid arthritis and, even just fifteen years ago, a lot of the kids used to be in wheelchairs, but now hardly any of them are.”
Early, accurate diagnosis critical
Perhaps unsurprisingly, given the range of effective treatments available, Dr du Plooy urges anyone who suspects they might be suffering from a form of arthritis to get diagnosed and onto treatment as soon as possible. “Early diagnosis and treatment dramatically improves the success of the outcome,” she insists. “It is also important to continue with the treatment and attend regular follow ups. Patients often stay away after a couple of months, once they start feeling better, but low-grade inflammation might be causing ongoing joint damage and, in the case of rheumatoid arthritis, the disease could also be harming the heart and lungs.”
Lifestyle changes can also help sufferers. “It’s important for patients to adopt a healthy lifestyle,” agrees Dr du Plooy. “Exercise can protect or improve mobility and slow the progression of arthritis and, while the evidence suggests that diet only directly influences gout, being overweight or putting on weight will aggravate most arthritic conditions. Before starting any new exercise plan or diet, however, patients should, of course, consult a healthcare professional.”
Tackling misconceptions
Summing up why she believes awareness campaigns like World Arthritis Day are so important, Dr du Plooy highlights the unnecessary pain and irreversible damage arthritis sufferers can experience. “We need to tackle the misconceptions so that people understand there are numerous different types of arthritis, which can develop at any age, and that getting accurately diagnosed is critical,” she notes. “These mistaken ideas, even about the potential side-effects of some of the treatments, are sometimes the biggest barriers to living active, pain free lives.”
Find out more
To learn more about the issues affecting people with rheumatic diseases and World Arthritis Day, visit the European League Against Rheumatism (EULAR) website at www.worldarthritisday.org.
The ‘Join the Fight against Autoimmune diseases’ campaign is a global initiative by Abbott Laboratories that seeks to help raise awareness of autoimmune diseases and to unite and support sufferers. For more information regarding this campaign please contact Dean Krawitz on: 011 326 3428 or 083 768 1433 or visit our Facebook page: http://www.facebook.com/#!/JoinTheFightAgainstAutoimmuneDiseases.
5 important things to know about arthritis5:
1. There are over 100 types of arthritis.
2. Arthritis is treatable and controllable (although not curable).
3. The earlier you start treatment, the better the likely outcome.
4. Sufferers often have co-morbid diseases (each condition is often a risk factor for others).
5. Rheumatoid arthritis is not just a ‘joint’ disease (it can affect your heart, lungs, nerves and blood vessels as well).
Please note: this information and advice is intended for educational purposes only and is not a substitute for professional medical advice. You should always consult your healthcare provider to determine the appropriateness of the information for your own situation or if you have any questions regarding a medical condition or treatment plan.
References:
[1]. Centers for Disease Control and Prevention (CDC). Prevalence of Doctor-Diagnosed Arthritis and Arthritis-
Attributable Activity Limitation — United States, 2007–2009. Morbidity and Mortality Weekly Report (MMWR). 8
October 2010.
2. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Questions and Answers about
Arthritis and Rheumatic Diseases. (NIH Publication No. 12-4999). April 2012. Available at:
www.niams.nih.gov/health_info/Arthritis/arthritis_rheumatic_qa.asp
3. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Fast Facts About Osteoarthritis.
November 2010. Available at: www.niams.nih.gov/Health_Info/Osteoarthritis/osteoarthritis_ff.asp
4. Better Medicine.com. What are autoimmune diseases? Medical Reviewer: Williams, R. MD. May 2011. Available at:
http://www.localhealth.com/article/autoimmune-diseases-1 Last accessed: 14-05-2012
5. du Plooy, M. Data on file — supplied in response to interview questions. 26-09-2012.
