Arthritis affects many but does not have to be debilitating

Today I want to talk with you about arthritis. There are three primary types of arthritis: gout, rheumatoid arthritis and osteoarthritis. You may have been diagnosed with one or more of them. Although all arthritis causes inflammation and pain, there are significant differences between the three diseases.

Each of these diseases is a unique problem with the joints. While you may have more than one disease, one will not become another (in other words, severe osteoarthritis will not become gout or rheumatoid arthritis). They are distinctly different diseases leaving their own unique fingerprints on your life.

Rheumatoid arthritis (RA) will be the first of the three to show up. There are juvenile varieties which are devastating and begin very early in life, but generally RA will begin between 30 and 50 years old and affects women three times more often than men. More than 2 million Americans have RA. Next comes gout, affecting mostly men between the ages of 40 and 59. Another 2 million folks have gout. Osteoarthritis (OA), the most common arthritis, starts the latest and affects about 20 million people. Under age 55, men are more likely than women to have OA, but by 70 years old, women are in the lead. An estimated 70 percent of folks will show some signs of arthritis on X-ray, but only half of them will have symptoms.

RA usually affects the wrists, ankles and small joints of the hands and feet. Even when other larger joints are affected, the disease affects the joints bilaterally (both the left and the right are affected). Gout most commonly affects the great toe, but may affect the heels, ankles and wrists. Less commonly a knee may become involved. Initially, gout is normally felt only in one joint, but more joints may become painful if you are not diligent about treatment. Osteoarthritis affects primarily the weight bearing joints of the body: knees, hips and spine.

RA is diagnosed through blood tests which look for the rheumatoid factor, and elevated sedimentation rate (sed rate) and elevated CRP. Folks with RA are often anemic. Blood tests can be misleading, though. About 80 percent of folks with RA are "seropositive" which means their blood tests positive for the rheumatoid factor (an antibody). The other 20 percent are "seronegative" meaning their blood does not show the antibody.

RA is extremely variable. Some patients will complain of severe pain and yet their x-rays don't show much joint damage. For others, the reverse is true. For this reason, diagnosis and treatment of RA is highly individualized, and your doctor must consider your whole picture: medical history, physical examination, blood tests and imaging studies.

Gout results from the build up of uric acid crystals in the joints. Either your body makes too much uric acid or it doesn't get rid of enough. (That is a complex statement which would require more space than I have here to develop. I will write more about gout another time.) Suffice it to say that blood tests and urine studies will help develop the picture, but the best test to determine if you have gout is to draw fluid from the joint and have it examined for uric acid crystals.

OA is the "wear and tear" arthritis. It is sometimes called degenerative joint disease. X-rays and other imaging studies will show the damage to the cartilage and changes to the bone structure of your joints including bony overgrowth (osteophytes) or bone spurs.

The most disabling arthritis is RA. RA is severely destructive to the joints with damage showing on imaging studies within two years of initial diagnosis. For this reason, doctors treating RA patients often lean more toward aggressive management rather than conservative care. With appropriate medication, it is still possible for you to live a good life with RA, but your risk of disability is high. More than 30 percent of those diagnosed with RA report a work limitation due to their disease. Sixty percent are unable to work 10 years after their initial diagnosis.

RA has the potential to affect other organs. For that reason, RA patients may live 10-15 fewer years. While that statistic is scary, it may also be misleading since life expectancy takes into consideration many things such as overall health and lifestyle choices.

Gout is the least disabling, but may be the most painful arthritis we are discussing today. An acute episode of gout may last two weeks causing you severe pain with every twitch of the toe excruciating. The joint is angry and looks red and swollen. The idea of walking is almost unbearable. With appropriate medication and rest, your symptoms will resolve completely. You may be vulnerable to future episodes, though, if you don't pay attention to your doctor's orders.

OA is the least painful, least disabling arthritis which is not to say that the pain of OA can't be significant. Folks with OA complain of severe stiffness and achiness in the affected joints that is a problem first thing in the morning, but lasts less than 30 minutes. By the time they've been up, moving around a bit, the pain subsides and then returns again in the evening after an active day.

One of the hallmark signs of RA is the pain which lasts longer than 30 minutes in the morning. Since morning is not the best time for you, you will need to schedule your appointments for late morning or early afternoon when you are at your best. Gout patients have time of it. For the two weeks or so they are battling their symptoms, the pain is unrelenting. You will need to cancel appointments that you have and re-schedule after your attack subsides.

ABOUT THE WRITER:
Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com