Arthritis—The Crippling Disease

“YOU CAN’T IMAGINE THE PAIN UNTIL YOU’VE EXPERIENCED IT. THE ONLY WAY TO GET RELIEF, I THOUGHT, WOULD BE TO DIE.”—SETSUKO, JAPAN.

“HAVING HAD IT SINCE I WAS 16, I FEEL THIS DISEASE STOLE MY YOUTH.”—DARREN, GREAT BRITAIN.

“I LOST TWO YEARS OF MY LIFE BECAUSE OF BEING BEDRIDDEN.”—KATIA, ITALY.

“ONCE THE PAIN STARTED IN ALL MY JOINTS, MY WHOLE LIFE WAS JUST PAIN.”—JOYCE, SOUTH AFRICA.

THESE are the plaintive expressions of victims of the disease known as arthritis. Arthritis drives millions of sufferers to their physicians each year seeking relief from the pain, immobility, and deformity it can cause.

In the United States alone, arthritis affects more than 42 million people, disabling 1 out of every 6 sufferers. In fact, arthritis is the leading cause of disability in that country. The economic impact of this disease is “roughly equivalent to a moderate recession,” states the National Centers for Disease Control and Prevention, as it costs Americans over 64 billion dollars each year in medical expenses and lost productivity. According to the World Health Organization, surveys involving developing countries, such as Brazil, Chile, China, India, Indonesia, Malaysia, Mexico, Pakistan, the Philippines, and Thailand, showed that the burden of arthritis and other rheumatic diseases in such lands is almost “equal to that in the industrialized world.”

It is a myth that arthritis is only a disease of the elderly. True, people are more seriously affected by it as they grow older. But one of the most common forms, rheumatoid arthritis, commonly affects those between the ages of 25 and 50. In the United States, nearly 3 out of every 5 people with arthritis are younger than 65 years of age. Similarly, in Great Britain, out of 8 million sufferers, 1.2 million are under age 45. More than 14,500 are children.

Each year, the number of arthritis sufferers increases rapidly. In Canada, within the next decade, the number of people with arthritis will increase by one million. While the prevalence of arthritis is greater in Europe than in Africa and Asia, the incidence of this disease is on the rise in those latter continents too. The rising tide of arthritic disease has thus prompted the World Health Organization to declare 2000-2010 the Bone and Joint Decade. During this time doctors and health-care professionals around the world will collaborate in an effort to improve the quality of life for those who suffer from musculoskeletal diseases like arthritis.

What is known about this painful disorder? Who are at risk for developing it? How can those who suffer from arthritis cope with its crippling effects? Will the future bring a cure? Our following articles will discuss these issues.

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X ray: Used by kind permission of the Arthritis Research Campaign, United Kingdom (www.arc.org.uk)

Understanding Arthritis

“AT NIGHT, I LOOK AT MY DEFORMED FEET AND HANDS AND I CRY.”—MIDORI, JAPAN.

ARTHRITIS has plagued humans for centuries. Egyptian mummies give evidence that the disease existed centuries ago. Explorer Christopher Columbus evidently suffered from it. And millions today are afflicted. Just what is this crippling disease?

The word “arthritis” is taken from Greek words meaning “inflamed joints” and is associated with a group of well over 100 rheumatic diseases and conditions.a These diseases may affect not only the joints but also the muscles, bones, tendons, and ligaments that support them. Some forms of arthritis can damage your skin, internal organs, and even your eyes. Let us focus on two diseases commonly associated with arthritis—rheumatoid arthritis (RA) and osteoarthritis (OA).

Joint Architecture

A joint is where two bones meet. A synovial joint is surrounded by a tough capsule that protects and supports it. (See illustration on page 4.) The joint capsule is lined with a synovial membrane. This membrane produces a slippery fluid. Within the joint capsule, the ends of the two bones are covered with a smooth elastic tissue known as cartilage. This prevents your bones from rubbing and grinding against each other. Cartilage acts as a shock absorber as well, cushioning the ends of your bones and distributing stress evenly across your bones.

For example, when you walk, run, or jump, the pressure exerted on your hips and knees can be four to eight times your body weight! While most of the impact is absorbed by the surrounding muscles and tendons, the cartilage helps your bones to tolerate this load by compressing like a sponge.

Rheumatoid Arthritis

In the case of rheumatoid arthritis (RA), the body’s immune system launches an all-out attack on its joints. For some unknown reason, a large volume of blood cells—including T cells, which are key players in the body’s immune system—rushes into joint cavities. This triggers a cascade of chemical events that result in the joint becoming inflamed. The synovial cells may begin to proliferate uncontrollably, forming a tumorlike mass of tissue called a pannus. The pannus, in turn, produces destructive enzymes that destroy the cartilage. Bone surfaces may now stick together, causing restricted motion—and excruciating pain. This destructive process also weakens the ligaments, the tendons, and the muscles, causing the joint to become unstable and partially dislocated, oftentimes leaving a deformed appearance. Usually RA affects joints in a symmetrical pattern, afflicting the wrists, knees, and feet. Upwards of 50 percent of individuals diagnosed with RA also develop nodules or bumps under the skin. Some develop anemia and dry, painful eyes and throat. Fatigue and flulike symptoms, including fever and aching muscles, accompany RA.

RA is highly variable in effect, onset, and duration. In one person the pain and stiffness may come on slowly over a period of weeks and even years. For another, the onset may be quite sudden. For some people, RA lasts for a few months and then leaves without noticeable damage. Others may experience periods of worsening symptoms called flares, followed by periods of remission during which they feel better. And in some patients the disease continues active for many years, relentlessly disabling them.

Who are at risk for RA? “It’s most common in women in their middle years,” notes Dr. Michael Schiff. However, Schiff further states that “it can affect anyone at any age including children, as well as men.” For those with relatives who have rheumatoid arthritis, the risk increases. Several studies further suggest that smoking, obesity, and a history of blood transfusion are all significant risk factors.

Osteoarthritis

“Osteoarthritis,” states the Western Journal of Medicine, “is in many ways like the weather—ubiquitous, often unnoticed, sometimes dramatic in its effects.” Unlike RA, osteoarthritis (OA) rarely spreads to other body parts but concentrates its erosive influence in one or just a few joints. As cartilage is slowly eroded, bone begins grinding against bone. This is accompanied by bony outgrowths called osteophytes. Cysts may form, and the underlying bone thickens and becomes deformed. Other symptoms include knobby knuckles, grating and grinding sounds that emanate from arthritic joints, and muscle spasms, along with pain, stiffness, and loss of mobility.

In times past, OA was thought to be just another consequence of old age. However, experts have abandoned that long-held belief. The American Journal of Medicine states: “There is no evidence that a normal joint, subject to common stresses, will break down over the life of a person.” Then what causes osteoarthritis? Efforts to understand its exact cause are “plagued by controversy,” according to the British magazine The Lancet. Some investigators propose that damage to a bone, such as microfractures, may occur first. This, in turn, may trigger bony outgrowths and cartilage deterioration. Others think that OA starts in the cartilage itself. As it degenerates and frays, they reason, stress increases on the underlying bone. Pathological changes occur as the body attempts to repair the damaged cartilage.

Who are at risk for OA? While age alone does not cause OA, the loss of joint cartilage is experienced more frequently with increasing age. Others at risk may include those who have some abnormality in the way their joint surfaces fit together or who have weak leg and thigh muscles, legs of unequal length, or a misalignment of the spine. Trauma to a joint caused either by an accident or by an occupation in which repetitive motions overuse a joint can also set the stage for osteoarthritis. Once deterioration begins, being overweight can exacerbate OA.

Dr. Tim Spector states: “Osteoarthritis is a complex disease that has definite environmental risk factors but there is also a strong genetic component.” Particularly susceptible to OA are middle-aged and older women with a family history of the disease. Unlike the disease osteoporosis, high rather than low bone density precedes the occurrence of OA. Some researchers also cite damage from free oxygen radicals and a deficiency of vitamins C and D as factors.

Treatment

Treatment for arthritis usually involves a combination of medication, exercise, and life-style modification. A physical therapist may initiate a therapeutic exercise program. It may incorporate range-of-motion, isometric, aerobic, and isotonic or weight-bearing exercises. These have been shown to improve a multitude of symptoms including joint pain and swelling, fatigue, malaise, and depression. The benefits of exercise are seen even in the very elderly. Exercise can also limit bone-density loss. Some claim that a measure of pain relief has also been achieved through various forms of heat and cold therapy and acupuncture.b

Because weight loss can significantly reduce joint pain, diet can be a major component of arthritis management. Some have also claimed that a diet that includes calcium-rich foods such as dark, leafy green vegetables, fresh fruits, and cold-water fish rich in omega-3 fatty acids—and that cuts down on processed foods and saturated fats—can not only help achieve weight loss but also reduce pain. How? Some say that such a diet inhibits the inflammatory process. There are also claims that diets that eliminate meat, milk products, wheat, and vegetables belonging to the nightshade family, such as tomatoes, potatoes, peppers, and eggplant, have also been effective for some.

In some cases a surgical procedure called arthroscopy is recommended. This involves inserting an instrument right into a joint, allowing a surgeon to remove the synovial tissue producing the destructive enzymes. This procedure has limited effectiveness, however, as inflammation often recurs. Even more drastic a procedure is joint arthroplasty, in which the entire joint (usually a hip or a knee) is replaced with an artificial one. This surgery has a longevity of 10 to 15 years and is often highly effective in eliminating pain.

More recently, doctors have tried less invasive treatments, such as viscosupplementation, where hyaluronic fluid is injected directly into a joint. This is most commonly performed on the knees. Injecting substances that stimulate cartilage repair (chondroprotective agents) has also had a measure of success, according to some European studies.

While no drug has been found to cure arthritis, many drugs reduce pain and inflammation, and some have shown promise in slowing the progression of the disease. Analgesics, or painkillers, as well as corticosteroid therapy, nonsteroid anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), immunosuppressants, biologic response modifiers, and drugs genetically engineered to interfere with the immune response are all part of the arsenal being used to provide relief from the debilitating symptoms of arthritis. However, relief may come at a high price, as all of these types of drugs can cause serious side effects. Weighing the potential benefits and risks presents a challenge for both the patient and the doctor.

How have some who have suffered the ravages of arthritis been able to cope with this painful disease?

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OBESITY, SMOKING, AND A HISTORY OF BLOOD TRANSFUSION MAY INCREASE ONE’S RISK OF DEVELOPING RHEUMATOID ARTHRITIS

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ALTERNATIVE THERAPIES

Some therapeutic agents are thought to be safer, with fewer side effects, than traditional treatments. Among these are oral type II collagen, which some researchers claim has had success in reducing swollen joints and pain in rheumatoid arthritis (RA). How? By inhibiting proinflammatory and destructive cytokines, namely interleukin-1 and tumor necrosis factor α. A few natural nutrients have also reportedly shown some ability to inhibit these same destructive elements. They include vitamin E, vitamin C, niacinamide, fish oils that are high in eicosapentaenoic acid and gammalinolenic acid, borage seed oil, and oil of evening primrose. In China, Tripterygium wilfordii Hook F, an herbal remedy, has been used for years. Reportedly, it has had a measure of success in reducing the effects of RA.

[Diagram on page 4, 5]

(For fully formatted text, see publication)

HEALTHY JOINT

BURSA

MUSCLE

CARTILAGE

TENDON

JOINT CAPSULE

SYNOVIAL MEMBRANE

SYNOVIAL FLUID

BONE

RHEUMATOID ARTHRITIS JOINT

LOSS OF SPACE

BONE AND CARTILAGE DESTRUCTION

INFLAMED SYNOVIAL MEMBRANE

OSTEOARTHRITIS JOINT

LOOSE CARTILAGE PARTICLES

CARTILAGE DESTRUCTION

BONE SPUR

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Source: Arthritis Foundation

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Arthritis can afflict people of any age

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A program of exercise and proper diet can bring some relief

Hope for Arthritis Sufferers

“ARTHRITIS is not a major cause of mortality like heart disease or cancer,” says Dr. Fatima Mili, “but it has a great impact on the quality of life.” Arthritis can affect all aspects of a person’s life. Just what are some of the problems confronting those suffering with arthritis? Is it possible to cope?

Katia,a aged 28, from Italy, says: “Since being diagnosed with arthritis at the age of 20, my whole life has changed. I’ve had to quit my job and give up my career in the full-time ministry because of the pain.” Pain is a universal problem among arthritis sufferers. Alan, aged 63, from England, says: “You always have pain somewhere in your body, though it may be moderate.” Fatigue is another challenge. “Even if you could put up with the pain and swelling,” says Sarah, aged 21, “the tiredness is unbearable.”

Emotional Pain

According to 61-year-old Setsuko, of Japan, struggling each day with chronic pain can also “wear you out emotionally and mentally.” Why, simply trying to grip a pencil or the telephone can be a challenge! Kazumi, aged 47, laments: “Even ordinary things that a child can do have become impossible for me.” Sixty-year-old Janice, who can no longer spend much time on her feet, says: “It’s discouraging because I can’t do what I used to.”

Such limitations can cause frustration and negative feelings about oneself. Gaku, aged 27, is one of Jehovah’s Witnesses and says: “Not being able to share fully in the evangelizing work or fulfill congregation assignments makes me feel that as a person I have no value whatsoever.” Francesca, who has battled with arthritis since the age of two, speaks of “being sucked deeper and deeper into a whirlpool of despair.” Such despair can have adverse spiritual effects. Joyce, a Witness from South Africa, admits that she began isolating herself from Christian meetings. “I just could not face seeing anybody,” she explains.

A sufferer may also have much anxiety regarding the future—fear of becoming immobile and dependent on others, fear of being left without a care giver, fear of falling and breaking bones, fear of not being able to provide for one’s family. Yoko, aged 52, admits: “When I’d see deformities occurring, I’d become fearful that they would increase.”

Family members too may suffer emotional pain, being confronted every day with the suffering of their loved one. Some couples may even experience severe marital strain. A woman in England, named Denise, says: “After 15 years of marriage, my husband announced, ‘I can’t put up with your arthritis anymore!’ He left me and our 5-year-old daughter.”

Arthritis thus presents huge challenges both to sufferers and their families. Nevertheless, many are successfully coping! Let us take a look at how some are doing so.

Respecting Your Limitations

Getting proper rest is essential if you are an arthritis sufferer; it can minimize fatigue. This does not mean, though, that you should drop out of life. Timothy explains: “You need to keep active so as not to let arthritis take you over mentally because if it does, you’ll just sit there and feel the pain.” Rheumatologist William Ginsburg of the Mayo Clinic observes: “There’s a fine line between doing too much and too little. Sometimes people have to be reminded to slow down and listen to their disease.”

This may entail changing the way you view your limitations. Daphne, from South Africa, relates: “I’ve had to be realistic and know that my ability to do certain things has not gone away; I just had to do them in a much slower manner. Rather than become anxious or frustrated, I simply do a little at a time.”

It is also a good idea to become acquainted with various assistive devices that might be available, perhaps discussing these with your doctor or physical therapist. Keiko relates: “We’ve installed a stair lift. Turning knobs hurt my wrists, so we changed them. Now I can open all the doors by pushing with my head. We installed lever-type handles on all the water taps in the house so that I could at least do some housework.” Another arthritis sufferer named Gail says: “My car and house keys are attached to a long handle, making it easier for me to turn them. My comb and brush are on long extensions and can be adjusted to different angles for combing and brushing.”

Family Support—“A Tower of Strength”

Carla, from Brazil, says: “My husband’s support has been crucial. The fact that he went with me on my visits to the doctor gave me courage. We discovered together how the disease affects my body, what its symptoms are, and what treatment would be necessary. I felt better because he could understand what I was going through.” Yes, husbands or wives who accept the limitations of their mates and who are willing to become educated regarding their condition can be an enormous source of strength and support.

Bette, for example, took on cleaning jobs when her husband’s arthritis curtailed his construction work. Kazumi’s husband not only nursed her but also did the housework that she could not do. Further, he trained their children to do what they could to help out. Says Kazumi: “My husband has been a tower of strength. Without his help I would be in a far worse state.”

A woman named Carol, from Australia, offers this caution: “Be careful not to crowd a schedule with too much activity. Feelings of inadequacy easily creep in on me if I cannot keep up with the family.” Rendered with true understanding and consideration, family support can be a tower of strength for sufferers.

Spiritual Aid

Katia says: “When a person suffers from an illness like this, she is convinced that no one knows what she is going through. This makes it important to turn to Jehovah God, knowing that he really understands our physical and emotional condition. (Psalm 31:7) Having a good relationship with him has given me the peace of mind to live almost serenely with my illness.” The Bible appropriately calls Jehovah “the God of all comfort, who comforts us in all our tribulation.”—2 Corinthians 1:3, 4.

Prayer can thus be a powerful source of comfort to someone suffering chronic pain. Kazumi relates: “During the long nights when I cannot sleep because of the pain, I have tearfully poured out my heart to Jehovah, asking him for strength to endure the pain and for wisdom to face all my difficulties. Jehovah has definitely answered me.” Francesca has likewise experienced God’s loving support. She says: “I’ve seen the fulfillment of the words at Philippians 4:13: ‘For all things I have the strength by virtue of him who imparts power to me.’”

Oftentimes, Jehovah God provides support through the Christian congregation. Gail, for example, tells of the help she received from her spiritual brothers and sisters in the local congregation of Jehovah’s Witnesses. “Their love helped me not to become depressed,” says Gail. In a similar vein, when Keiko was asked, “Is there anything you can think of that has been good in your life?,” she replied: “Yes, all the love and sympathy I get from everyone in the congregation!”

In congregations of Jehovah’s Witnesses, overseers take the lead in rendering such support. Setsuko says: “I can’t describe how great the effect is on a person fighting illness when the elders listen and give comfort.” However, as an arthritis sufferer named Daniel reminds us, “our spiritual brothers and sisters can only help if we let them.” It is therefore important that sufferers stay in contact with fellow Christians, doing their very best to attend congregation meetings. (Hebrews 10:24, 25) There they can receive the spiritual encouragement needed to endure.

Suffering Will End

Arthritis sufferers are grateful to the medical profession for the advances that have been made thus far. However, even the best treatments fall far short of being a real cure. In the long run, sufferers can find their greatest comfort in embracing God’s promises of a new world.b (Isaiah 33:24; Revelation 21:3, 4) In that world ‘the lame one will leap up as a stag does.’ (Isaiah 35:6) Arthritis and all the other diseases afflicting mankind will be gone forever! Peter, a victim of spinal arthritis, thus says: “I can see a light at the end of this dark tunnel I’m traveling through.” A Christian woman named Giuliana likewise says: “I think of each day that passes as a battle won, one day less to endure before the end comes!” Yes, the time when there will be not only the end of arthritis but also the end of all suffering has drawn near!

[Footnotes]

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There are many devices that help sufferers lead productive lives

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Loving support can be found at Christian meetings