Easing Arthritis: Research offers new hope for people with common joint disease

By Mary Anne Dunkin

When Linda Saisselin was diagnosed with arthritis 10 years ago, she managed pretty well despite pain and swelling, which at that time was confined to her hands. She continued to fill out the paperwork required by her job as a social worker. She played the piano in her free time. But four years later, when arthritis affected her knees, pain plagued her every step. Living in New York City, Saisselin relied on walking and public transportation to get her everywhere. But walking became more and more difficult. Getting on and off the subway was even worse. Medicines to control the pain affected her concentration at work. Finally, when she could bear the pain no more, she had a total joint replacement—surgery to replace her own damaged joint with a new artificial one—on the more painful of the two knees. Today, at 65, Saisselin enjoys hiking with her husband and holding her new grandson. Except for occasional swelling and pain in her hands, she is practically pain free.

A Common and Growing Problem

Linda Saisselin is one of an estimated 43 million Americans with arthritis, a problem that is becoming more common as the population ages. By 2030 as many as 67 million Americans (one-fourth of the adult population) will have arthritis, according to CDC estimates. For many, that will mean daily pain, high medical costs and difficulty holding a job or doing everyday tasks, such as going up stairs, getting in and out of chairs, opening jars and buttoning shirts.

Although commonly referred to as if it were a single disease, arthritis is actually a term used for more than 100 conditions that cause pain, swelling and stiffness in the joints. (See "Forms of Arthritis") Osteoarthritis (OA), the type Saisselin has, is the most common of the diseases. It affects 21 million Americans— about 10 times as many people as the second most common, rheumatoid arthritis (RA). RA is more common in women than men. It usually starts in the middle adult years. OA affects both sexes almost equally. It grows more common with age. One-third of people 65 and older have OA of the knee that can be seen on X-ray.

In OA, joint cartilage—the smooth, spongy tissue that covers the ends of the bones where they meet to form joints— breaks down. Bony growths, called spurs, form in the joints. The joints most likely to be affected are the hips and knees and those of the fingers, neck and lower back. In RA, the body's immune system—which normally defends us against invaders such as viruses and bacteria—attacks the membrane lining the joints. The joints usually affected are those of the hands, wrists, shoulders, elbows, knees, ankles and feet. If not stopped, this attack can cause joint damage and deformity.

In recent years, research has led to great advances in treating RA. For many people, drugs that modify the immune system improve symptoms and prevent joint damage. But for OA, treatment does little to help the disease's progression. For most people, treatment consists of medicine to control pain followed by surgery when pain is no longer controllable.

But there's hope on the horizon. Many scientists, including David T. Felson, M.D., MPH, chief of the Boston University Clinical Epidemiology Research Training Unit, believe research holds clues for better treating the disease and perhaps more importantly, preventing its development.

"I was always interested in things that were really common and where prevention was possible," says Dr. Felson, who has authored some 140 published studies on OA. Most of those studies were funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). "That wasn't possible in rheumatoid arthritis, although rheumatoid arthritis treatment is quite wonderful now. In osteoarthritis, treatment isn't so wonderful now, but prevention is a bigger opportunity."

The good news, says Dr. Felson, is that strategies to prevent the disease are the same ones that may help prevent its progression. In most cases the best medicine for osteoarthritis isn't medicine at all, but measures you can take and lifestyle changes you can make yourself.

Non-Medicine Relief

For Saisselin, improvement came not just from her surgery, but from the physical therapy and lifestyle changes that followed. "I saw so much benefit from physical therapy that the physical therapist suggested it would be good for me to join a gym," she says. "Then, after I joined the gym, I started thinking, 'I just exercised for an hour, and now I'm going to put a cookie in my mouth?'"

As a result of her new exercise program and approach to eating, Saisselin lost 25 pounds. By the time she went back to the doctor for her six-month check-up, she realized the pain in the knee not replaced was gone, too.

Arthritis specialists, including Dr. Felson, say weight loss is one of the best things people can do for OA—either to prevent or ease it. "What we have found is that at every level of weight, a little bit higher increased the risk of OA for women," he says. "So if you take normalweight women and compare them to very thin women, normal-weight women are at higher risk." Conversely, he says, at every level of weight, if you lost a little weight, it would decrease your risk. And if you had pain in your knees it would likely help with that.

What's Ahead?

Other key areas of NIAMS-supported OA research involve understanding the basic processes of the disease and looking for drugs that might help rebuild lost joint cartilage. Researchers are also working to identify biomarkers—signs in the body's tissues, blood or cells that can enable doctors to determine what is happening or going to happen in the body. Dr. Felson believes one day doctors will be able to tell from biomarkers—such as a specific gene or low vitamin K levels—who is at greatest risk of suffering joint damage. Then they can prescribe preventive therapies for those people.

In the meantime, preventive measures such as losing weight (if necessary), exercising and eating more broccoli are good ideas for everyone. And, says Dr. Felson, they may well prevent more than arthritis.