Dear Doctors: I'm a 63-year-old woman and a longtime runner. I thought the pain in my left foot might turn out to be arthritis. I was sort of right -- it's rheumatoid arthritis. Why do you get it? Does it spread or get worse?
Dear Reader: Arthritis is an umbrella term that refers to a group of conditions that affect the joints. They are marked by inflammation, localized pain, stiffness and swelling. When people say arthritis, they are often referring to osteoarthritis, which is the most common form of this condition. Also known as OA, it is known as a "wear-and-tear" disease. It develops when changes within the joint lead to a gradual breakdown of the protective cartilage. Although osteoarthritis can occur at any age, it is most common in older adults, whose lifetime of movement often begins to take a toll on their joints.
Rheumatoid arthritis, or RA, mirrors the symptoms of osteoarthritis. Both result in damage to the joints, but for different reasons. In osteoarthritis, a combination of factors causes the protective cartilage to gradually break down. These include injury or trauma, biomechanical stresses and age-related changes that alter the balance of cartilage replacement. That is, the slick, bouncy coating on the ends of the bones begins to break down faster than it can be replaced. In RA, it's the person's own immune system that is causing the damage. For reasons that are not yet fully understood, immune cells launch a sustained attack on the tissue that lines the joints. The resulting inflammation can begin to damage cartilage, and in some cases, it even erodes bone.
There is no single test that confirms RA. Rather, it is diagnosed with a combination of a physical exam, imaging tests and blood tests. The latter can be particularly helpful, as they identify antibodies associated with the disease, as well as markers of inflammation. Primary among them is an antibody known as rheumatoid factor, which is present in three-fourths of people who develop RA. Doctors also look for an antibody known as anti-cyclic citrullinated peptide, or anti-CCP.
RA is a progressive disease. That means if left untreated, it can cause increasing and widespread joint damage. While there is no cure at this time, prompt treatment under the care of a rheumatologist can slow progression. Your doctor will have two goals: to manage your symptoms and to slow the progress of the disease. The former focuses on a variety of supportive and lifestyle therapies tailored to each person's specific needs. Physical and occupational therapy and the use of supportive gear and devices can ease stress on the joints. Lifestyle changes such as quitting smoking, limiting alcohol and eating a healthful diet help with disease management and benefit overall health.
While lifestyle changes are helpful, medications play the central role in treatment. These range from nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to manage pain, to several types of disease-modifying drugs meant to modify or block certain immune pathways. The good news is that with early treatment and continued care, for some people, remission is possible.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
