Chapter 1

What Is Arthritis?

IN THIS CHAPTER

Discovering how arthritis affects your body

Becoming aware of the various types of arthritis

Recognizing the signs and symptoms of arthritis

Identifying the major causes of arthritis

Finding out who is most likely to get the various forms of the disease

Considering the treatment options

Ouch! There it goes again! That grinding pain in your hip, those aching knees that make walking from the kitchen to the bedroom a chore, the stiff and swollen fingers that won't allow you to twist the lid off a sticky jar or even sew on a button. Arthritis seems to get to everybody sooner or later - slowing us down, forcing us to give up some of our favorite activities, and just generally being a pain in the neck (sometimes literally!). In more advanced cases, arthritis can seriously compromise quality of life as sufferers surrender their independence, mobility, and sense of usefulness while being relentlessly worn down by pain.

The good news is that you can manage your arthritis with a combination of medical care, simple lifestyle changes, and good old common sense. You don't have to spend your life gritting your teeth from pain, or hobbling around the backyard with a cane. Although you may not be able to run a marathon or do back-flips like you did when you were 13, if you follow the program outlined here, you should be able to do the things you really want to do - such as take a brisk walk in the park, carry a sleeping child upstairs to bed, or swing a golf club with the best of them. Arthritis may affect a lot of people, but thanks to intensive research over the past several years, we now know a lot more about how to handle it.

Remember that arthritis affects the rich and famous just as much as the rest of us. For a look at how certain celebrities have handled their arthritis, see the sidebar "Stargazing: Famous Arthritis Sufferers" at the end of the chapter.

Understanding How Arthritis Affects Your Joints

So what exactly is arthritis, this disease that brings us so much misery and pain? Unfortunately, we can't provide one easy answer to that question, because arthritis involves a group of diseases - each with its own cause, set of symptoms, and treatments. However, these diseases do have the following in common:

• They affect some part of the joint.
• They cause pain and (possibly) loss of movement.
• They often bring about some kind of inflammation.

As for the causes of these different kinds of arthritis, they run the gamut from inheriting an unlucky gene to physical trauma to getting bitten by the wrong mosquito.

The word arthritis, which literally means joint inflammation, comes from the Greek words arthros (joint) and itis (inflammation), and its major symptom is joint pain. Although the same group of ailments can be called rheumatism, it's usually referred to as arthritis, so that's what we call it in this book. The word arthralgia, a term used much less frequently, refers to joint pain alone. According to the CDC, arthritis affects some 58.5 million American adults (one out of every four people) and 300,000 children. That's a big chunk of the population. For a look at how many people are affected by some of the most common forms of arthritis, see "Arthritis by the Numbers" later in the chapter.

Saying hello to your joints

Before you can understand what's wrong with your joints, you need to understand what a joint is and how it works. Any place in the body where two bones meet is called a joint such as the ball and socket hip joint, or the hinge joint at the elbow or knee. Sometimes the bones actually fuse together; your skull is an example of an area with fused bones. But in the joints that can develop arthritis, the bones don't actually touch. As you can see in Figure 1-1, a small amount of space exists between the two bone ends. The space between the ends of the bones keeps them from grinding against each other and wearing each other down.

© John Wiley & Sons, Inc.

FIGURE 1-1: Anatomy of a healthy synovial joint.

Bones are living tissue - hard, porous structures with a blood supply and nerves - that constantly rebuild themselves. Bones protect our vital organs and provide the supporting framework for the body. Without bones, we would be nothing more than blobs of tissue - like tents without supporting poles!

But bones are more than broomsticks that prop us up; fortunately, they don't leave us rigid and awkward. The 200-plus bones that reside in our bodies are connected together in some 150 joints, giving us remarkable flexibility and range of motion. If you don't believe it, just watch a gymnast, ballet dancer, or figure skater execute a handspring, arabesque, or triple axel. But you don't have to be an athlete or contortionist to enjoy the benefits of joint flexibility. Just think about some of the things you do regularly - such as bending a knee or an elbow. Now imagine how limiting it would be if you had fewer joints, or if they didn't move the way they do! (For a few fascinating facts about your joints, see the sidebar "Strange-but-true joint points" on the next page.)

Other structures surrounding the joint, such as the muscles, tendons, and bursae - small sacs of fluid that cushion the tendons like pillows - support the joint and provide the power that makes the bones move. The joint capsule wraps itself around the joint, and its special lining, the synovial membrane or synovium, makes a slick, slippery liquid called the synovial fluid. You can think of the joint capsule as a sealed bag full of WD-40 encasing the joint and filling the little space between the bone ends. Finally, the bone ends are capped by cartilage - a slick, tough, rubbery material that is eight times more slippery than ice and a better shock absorber than the tires and springs on your car! Together, these parts make up the joint, one of the most fascinating bits of machinery found in the body.

Cartilage: The human shock absorber

Cartilage is extremely important for the healthy functioning of a joint, especially if that joint bears weight, like your knee. Imagine for a moment that you're looking into the inner workings of your left knee as you walk down the street. When you shift your weight from your left leg to your right, the pressure on your left knee is released. The cartilage in your left knee then "drinks in" synovial fluid, in much the same way that a sponge soaks up liquid when immersed in water. When you take another step and transfer the weight back onto your left leg, much of the fluid squeezes out of the cartilage. This squeezing of joint fluid into and out of the cartilage helps it respond to the off-and-on pressure of walking without shattering under the strain.

Can you imagine the results if we didn't have this watery cushion within our joints? With the rough, porous surfaces of the bone ends pitted against each other, bones would grind each other down in no time. One thing is certain: Nobody would be getting around too easily without joint fluid and cartilage.

Types of joints

To accommodate the bends, twists, and turns that we all perform without even thinking, the skeletal system is made up of different shapes and sizes of bones, which connect to form different kinds of joints. The joints are categorized according to how much motion they allow:

• Synarthrodial joints allow no movement at all. You can find these in the skull, where the bones meet to form tough, fibrous joints called sutures. Because they don't move, arthritis doesn't affect them.
• Amphiarthrodial joints, such as those in the spine or the pelvis, allow limited movement. Generally, these joints aren't attacked by arthritic conditions as often as others. (A slipped disc is not arthritis.)
• Synovial joints allow a wide range of movement; most of our joints fall into this class. Synovial joints come in all kinds of interesting variations including those that glide, hinge, pivot, look like saddles, or have a ball-and-socket type structure. (For more on these joints, take a look at the section "Looking at the types of synovial joints" later in this chapter.) Because of the synovial joints, you can bend over and pick a flower, kick up your heels while swing dancing, reach for a glass on a high shelf, and turn around to see what's going on behind you. Unfortunately, these joints are also the ones most likely to be hit with arthritis, precisely because they do move!

STRANGE-BUT-TRUE JOINT POINTS

Here are a couple of things you may not know about your joints:

• By the time a fetus is four months old, its joints and limbs are in working order and ready to move.
• A newborn baby has 350 bones, many of which fuse to form the 206 bones of the adult body.
• Cartilage is 65 percent to 85 percent water. (The amount of water in your cartilage generally decreases as you get older.)
• When you run, the pressure on your knees can increase to ten times that of your body weight.
• Not a single man-made substance is more resilient, a better shock absorber, or lower in friction...