Questions and Answers About Arthritis and Rheumatic Diseases

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Questions and Answers About Arthritis and Rheumatic Diseases

http://www.niams.nih.gov/hi/topics/arthritis/artrheu.htm

This fact sheet answers basic questions about arthritis and rheumatic

diseases. The National Institute of Arthritis and Musculoskeletal and

Skin Diseases (NIAMS) has other fact sheets and booklets that provide

more information about specific forms of arthritis and rheumatic

diseases. NIAMS also has information about exercise and arthritis, pain

and arthritis, and diet and arthritis.

What Are Rheumatic Diseases and What Is Arthritis?

Rheumatic diseases are characterized by inflammation (signs are redness

and/or heat, swelling, and pain) and loss of function of one or more

connecting or supporting structures of the body. They especially affect

joints, tendons, ligaments, bones, and muscles. Common symptoms are

pain, swelling, and stiffness. Some rheumatic diseases can also involve

internal organs. There are more than 100 rheumatic diseases.

Many people use the word " arthritis " to refer to all rheumatic diseases.

However, the word literally means joint inflammation. The many different

kinds of arthritis comprise just a portion of the rheumatic diseases.

Some rheumatic diseases are described as connective tissue diseases

because they affect the supporting framework of the body and its

internal organs. Others are known as autoimmune diseases because they

occur when the immune system, which normally protects the body from

infection and disease, harms the body's own healthy tissues. Throughout

this fact sheet the terms " arthritis " and " rheumatic diseases " are

sometimes used interchangeably.

Examples of Rheumatic Diseases

* Osteoarthritis--This is the most common type of arthritis,

affecting an estimated 21 million adults in the United States.

Osteoarthritis primarily affects cartilage, which is the tissue that

cushions the ends of bones within the joint. In osteoarthritis, the

cartilage begins to fray and may entirely wear away. Osteoarthritis can

cause joint pain and stiffness. Disability results most often when the

disease affects the spine and the weight-bearing joints (the knees and

hips).

* Rheumatoid arthritis--This inflammatory disease of the synovium,

or lining of the joint, results in pain, stiffness, swelling, joint

damage, and loss of function of the joints. Inflammation most often

affects joints of the hands and feet and tends to be symmetrical

(occurring equally on both sides of the body). This symmetry helps

distinguish rheumatoid arthritis from other forms of the disease. About

1 percent of the U.S. population (about 2.1 million people) has

rheumatoid arthritis.

* Juvenile rheumatoid arthritis--This is the most common form of

arthritis in childhood, causing pain, stiffness, swelling, and loss of

function of the joints. The arthritis may be associated with rashes or

fevers, and may affect various parts of the body.

* Fibromyalgia--Fibromyalgia is a chronic disorder that causes pain

throughout the tissues that support and move the bones and joints. Pain,

stiffness, and localized tender points occur in the muscles and tendons,

particularly those of the neck, spine, shoulders, and hips. Patients may

also experience fatigue and sleep disturbances.

* Systemic lupus erythematosus--Systemic lupus erythematosus (also

known as lupus or SLE) is an autoimmune disease in which the immune

system harms the body's own healthy cells and tissues. This can result

in inflammation of and damage to the joints, skin, kidneys, heart,

lungs, blood vessels, and brain.

* Scleroderma--Also known as systemic sclerosis, scleroderma means

literally " hard skin. " The disease affects the skin, blood vessels, and

joints. It may also affect internal organs, such as the lungs and

kidneys. In scleroderma, there is an abnormal and excessive production

of collagen (a fiber-like protein) in the skin or internal organs.

* Spondyloarthropathies--This group of rheumatic diseases

principally affects the spine. One common form--ankylosing

spondylitis--not only affects the spine, but may also affect the hips,

shoulders, and knees as the tendons and ligaments around the bones and

joints become inflamed, resulting in pain and stiffness. Ankylosing

spondylitis tends to affect people in late adolescence or early

adulthood. Reactive arthritis, sometimes called Reiter's syndrome, is

another spondyloarthropathy. It develops after an infection involving

the lower urinary tract, bowel, or other organ and is commonly

associated with eye problems, skin rashes, and mouth sores.

* Gout--This type of arthritis results from deposits of needle-like

crystals of uric acid in the joints. The crystals cause inflammation,

swelling, and pain in the affected joint, which is often the big toe.

* Infectious arthritis--This is a general term used to describe

forms of arthritis that are caused by infectious agents, such as

bacteria or viruses. Parvovirus arthritis and gonococcal arthritis are

examples of infectious arthritis. Arthritis symptoms may also occur in

Lyme disease, which is caused by a bacterial infection following the

bite of certain ticks. In those cases of arthritis caused by bacteria,

early diagnosis and treatment with antibiotics are crucial to get rid of

the infection and minimize damage to the joints.

* Polymyalgia rheumatica--Because this disease involves tendons,

muscles, ligaments, and tissues around the joint, symptoms often include

pain, aching, and morning stiffness in the shoulders, hips, neck, and

lower back. It is sometimes the first sign of giant cell arteritis, a

disease of the arteries characterized by inflammation, weakness, weight

loss, and fever.

* Polymyositis--This is a rheumatic disease that causes

inflammation and weakness in the muscles. The disease may affect the

whole body and cause disability.

* Psoriatic arthritis--This form of arthritis occurs in some

patients with psoriasis, a scaling skin disorder. Psoriatic arthritis

often affects the joints at the ends of the fingers and toes and is

accompanied by changes in the fingernails and toenails. Back pain may

occur if the spine is involved.

* Bursitis--This condition involves inflammation of the bursae,

small, fluid-filled sacs that help reduce friction between bones and

other moving structures in the joints. The inflammation may result from

arthritis in the joint or injury or infection of the bursae. Bursitis

produces pain and tenderness and may limit the movement of nearby joints.

* Tendinitis (Tendonitis)--This condition refers to inflammation of

tendons (tough cords of tissue that connect muscle to bone) caused by

overuse, injury, or a rheumatic condition. Tendinitis produces pain and

tenderness and may restrict movement of nearby joints.

What Causes Rheumatic Disease?

Scientists are studying risk factors that increase the likelihood of

developing a rheumatic disease. Some of these factors have been

identified. For example, in osteoarthritis, inherited cartilage weakness

or excessive stress on the joint from repeated injury may play a role.

In lupus, rheumatoid arthritis, and scleroderma, the combination of

genetic factors that determine susceptibility and environmental triggers

are believed to be important. Family history also plays a role in some

diseases such as gout and ankylosing spondylitis.

Gender is another factor in some rheumatic diseases. Lupus, rheumatoid

arthritis, scleroderma, and fibromyalgia are more common among women.

(See next section for details.) This indicates that hormones or other

male-female differences may play a role in the development of these

conditions.

Who Is Affected by Arthritis and Rheumatic Conditions?

An estimated 43 million people in the United States have arthritis or

other rheumatic conditions. By the year 2020, this number is expected to

reach 60 million. Rheumatic diseases are the leading cause of disability

among adults age 65 and older.

Rheumatic diseases affect people of all races and ages. Some rheumatic

conditions are more common among certain populations. For example:

* Rheumatoid arthritis occurs two to three times more often in

women than in men.

* Scleroderma is more common in women than in men.

* Nine out of 10 people who have lupus are women.

* Nine out of 10 people who have fibromyalgia are women.

* Gout is more common in men than in women.

* Lupus is three times more common in African American women than

in Caucasian women.

* Ankylosing spondylitis is more common in men than in women.

What Are the Symptoms of Arthritis?

Different types of arthritis have different symptoms. In general, people

who have arthritis feel pain and stiffness in the joints. Some of the

more common symptoms are listed in the box. Early diagnosis and

treatment help decrease further joint damage and help control symptoms

of arthritis and many other rheumatic diseases.

Common Symptoms of Arthritis

* Swelling in one or more joints

* Stiffness around the joints that lasts for at least 1 hour in the

early morning

* Constant or recurring pain or tenderness in a joint

* Difficulty using or moving a joint normally

* Warmth and redness in a joint

How Are Rheumatic Diseases Diagnosed?

Diagnosing rheumatic diseases can be difficult because some symptoms and

signs are common to many different diseases. A general practitioner or

family doctor may be able to evaluate a patient or refer him or her to a

rheumatologist (a doctor who specializes in treating arthritis and other

rheumatic diseases).

The doctor will review the patient's medical history, conduct a physical

examination, and obtain laboratory tests and x rays or other imaging

tests. The doctor may need to see the patient more than once to make an

accurate diagnosis.

Medical History

It is vital for people with joint pain to give the doctor a complete

medical history. Answers to the following questions will help the doctor

make an accurate diagnosis:

* Is the pain in one or more joints?

* When does the pain occur?

* How long does the pain last?

* When did you first notice the pain?

* What were you doing when you first noticed the pain?

* Does activity make the pain better or worse?

* Have you had any illnesses or accidents that may account for the

pain?

* Is there a family history of any arthritis or other rheumatic

disease?

* What medicine(s) are you taking?

Because rheumatic diseases are so diverse and sometimes involve several

parts of the body, the doctor may ask many other questions.

It may be helpful for people to keep a daily journal that describes the

pain. Patients should write down what the affected joint looks like, how

it feels, how long the pain lasts, and what they were doing when the

pain started.

Physical Examination and Laboratory Tests

The doctor will examine the patient's joints for redness, warmth,

damage, ease of movement, and tenderness. Because some forms of

arthritis, such as lupus, may affect other organs, a complete physical

examination that includes the heart, lungs, abdomen, nervous system,

eyes, ears, and throat may be necessary. The doctor may order some

laboratory tests to help confirm a diagnosis. Samples of blood, urine,

or synovial fluid (lubricating fluid found in the joint) may be needed

for the tests.

Common laboratory tests and procedures include the following:

Antinuclear antibody (ANA)--This test checks blood levels of antibodies

that are often present in people who have connective tissue diseases or

other autoimmune disorders, such as lupus. Since the antibodies react

with material in the cell's nucleus (control center), they are referred

to as antinuclear antibodies. There are also tests for individual types

of ANAs that may be more specific to people with certain autoimmune

disorders. ANAs are also sometimes found in people who do not have an

autoimmune disorder. Therefore, having ANAs in the blood does not

necessarily mean that a person has a disease.

C-reactive protein test--This is a nonspecific test used to detect

generalized inflammation. Levels of the protein are often increased in

patients with active disease such as rheumatoid arthritis, and may

decline when corticosteroids or nonsteroidal anti-inflammatory drugs

(NSAIDs) are used to reduce inflammation.

Complement--This test measures the level of complement, a group of

proteins in the blood. Complement helps destroy foreign substances, such

as germs, that enter the body. A low blood level of complement is common

in people who have active lupus.

Complete blood count (CBC)--This test determines the number of white

blood cells, red blood cells, and platelets present in a sample of

blood. Some rheumatic conditions or drugs used to treat arthritis are

associated with a low white blood count (leukopenia), low red blood

count (anemia), or low platelet count (thrombocytopenia). When doctors

prescribe medications that affect the CBC, they periodically test the

patient's blood.

Creatinine--This blood test is commonly ordered in patients who have a

rheumatic disease, such as lupus, to monitor for underlying kidney

disease. Creatinine is a breakdown product of creatine, which is an

important component of muscle. It is excreted from the body entirely by

the kidneys, and the level remains constant and normal when kidney

function is normal.

Erythrocyte sedimentation rate (sed rate)--This blood test is used to

detect inflammation in the body. Higher sed rates indicate the presence

of inflammation and are typical of many forms of arthritis, such as

rheumatoid arthritis and ankylosing spondylitis, and many of the

connective tissue diseases.

Hematocrit (PCV, packed cell volume)--This test and the test for

hemoglobin (a substance in the red blood cells that carries oxygen

throughout the body) measure the number of red blood cells present in a

sample of blood. A decrease in the number of red blood cells (anemia) is

common in people who have inflammatory arthritis or another rheumatic

disease.

Rheumatoid factor--This test detects the presence of rheumatoid factor,

an antibody found in the blood of most (but not all) people who have

rheumatoid arthritis. Rheumatoid factor may be found in many diseases

besides rheumatoid arthritis, and sometimes in people without health

problems.

Synovial fluid examination--Synovial fluid may be examined for white

blood cells (found in patients with rheumatoid arthritis and

infections), bacteria or viruses (found in patients with infectious

arthritis), or crystals in the joint (found in patients with gout or

other types of crystal-induced arthritis). To obtain a specimen, the

doctor injects a local anesthetic, then inserts a needle into the joint

to withdraw the synovial fluid into a syringe. The procedure is called

arthrocentesis or joint aspiration.

Urinalysis--In this test, a urine sample is studied for protein, red

blood cells, white blood cells, and bacteria. These abnormalities may

indicate kidney disease, which may be seen in several rheumatic

diseases, including lupus. Some medications used to treat arthritis can

also cause abnormal findings on urinalysis.

White blood cell count (WBC)--This test determines the number of white

blood cells present in a sample of blood. The number may increase as a

result of infection or decrease in response to certain medications or in

certain diseases, such as lupus. Low numbers of white blood cells

increase a person's risk of infections.

X Rays and Other Imaging Procedures

To see what the joint looks like inside, the doctor may order x rays or

other imaging procedures. X rays provide an image of the bones, but they

do not show cartilage, muscles, and ligaments. Other noninvasive imaging

methods such as computed tomography (CT or CAT scan), magnetic resonance

imaging (MRI), and arthrography show the whole joint. The doctor may

look for damage to a joint by using an arthroscope, a small, flexible

tube which is inserted through a small incision at the joint and which

transmits the image of the inside of a joint to a video screen.

What Are the Treatments?

Treatments for rheumatic diseases include rest and relaxation, exercise,

proper diet, medication, and instruction about the proper use of joints

and ways to conserve energy. Other treatments include the use of pain

relief methods and assistive devices, such as splints or braces. In

severe cases, surgery may be necessary. The doctor and the patient work

together to develop a treatment plan that helps the patient maintain or

improve his or her lifestyle. Treatment plans usually combine several

types of treatment and vary depending on the rheumatic condition and the

patient.

Rest, Exercise, and Diet

People who have a rheumatic disease should develop a comfortable balance

between rest and activity. One sign of many rheumatic conditions is

fatigue. Patients must pay attention to signals from their bodies. For

example, when experiencing pain or fatigue, it is important to take a

break and rest. Too much rest, however, may cause muscles and joints to

become stiff.

People with a rheumatic disease such as arthritis can participate in a

variety of sports and exercise programs. Physical exercise can reduce

joint pain and stiffness and increase flexibility, muscle strength, and

endurance. It also helps with weight reduction and contributes to an

improved sense of well-being. Before starting any exercise program,

people with arthritis should talk with their doctor. Exercises that

doctors often recommend include:

* Range-of-motion exercises (e.g., stretching, dance) to help

maintain normal joint movement, maintain or increase flexibility, and

relieve stiffness.

* Strengthening exercises (e.g., weight lifting) to maintain or

increase muscle strength. Strong muscles help support and protect joints

affected by arthritis.

* Aerobic or endurance exercises (e.g., walking, bicycle riding) to

improve cardiovascular fitness, help control weight, and improve overall

well-being. Studies show that aerobic exercise can also reduce

inflammation in some joints.

Another important part of a treatment program is a well-balanced diet.

Along with exercise, a well-balanced diet helps people manage their body

weight and stay healthy. Weight control is important to people who have

arthritis because extra weight puts extra pressure on some joints and

can aggravate many types of arthritis. Diet is especially important for

people who have gout. People with gout should avoid alcohol and foods

that are high in purines, such as organ meats (liver, kidney), sardines,

anchovies, and gravy.

Medications

A variety of medications are used to treat rheumatic diseases. The type

of medication depends on the rheumatic disease and on the individual

patient. The medications used to treat most rheumatic diseases do not

provide a cure, but rather limit the symptoms of the disease. Infectious

arthritis and gout are exceptions if medications are used properly.

Another example is Lyme disease, caused by the bite of certain ticks,

where symptoms of arthritis may be prevented or may disappear if the

infection is caught early and treated with antibiotics.

Medications commonly used to treat rheumatic diseases provide relief

from pain and inflammation. In some cases, the medication may slow the

course of the disease and prevent further damage to joints or other

parts of the body.

The doctor may delay using medications until a definite diagnosis is

made because medications can hide important symptoms (such as fever and

swelling) and thereby interfere with diagnosis. Patients taking any

medication, either prescription or over-the-counter, should always

follow the doctor's instructions. The doctor should be notified

immediately if the medicine is making the symptoms worse or causing

other problems, such as an upset stomach, nausea, or headache. The

doctor may be able to change the dosage or medicine to reduce these side

effects.

Analgesics (pain relievers) such as acetaminophen (Tylenol)* and

nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are used

to reduce the pain caused by many rheumatic conditions. NSAIDs have the

added benefit of decreasing the inflammation associated with arthritis.

A common side effect of NSAIDs is stomach irritation, which can often be

reduced by changing the dosage or medication. New NSAIDs, including

celecoxib (Celebrex) and rofecoxib (Vioxx), were introduced to reduce

gastrointestinal side effects and offer additional options for

treatment. However, even new medications are occasionally associated

with reactions ranging from mild to severe, and their long-term effects

are still being studied. The dosage will vary depending on the

particular illness and the overall health of the patient. The doctor and

patient must work together to determine which analgesic to use and the

appropriate amount. If analgesics do not ease the pain, the doctor may

use other medications.

* Brand names included in this fact sheet are provided as examples only,

and their inclusion does not mean that these products are endorsed by

the National Institutes of Health or any other Government agency. Also,

if a particular brand name is not mentioned, this does not mean or imply

that the product is unsatisfactory.

Depending on the type of arthritis, a person may be asked to take a

disease-modifying antirheumatic drug (DMARD). This category includes

several unrelated medications that are intended to slow or prevent

damage to the joint and thereby prevent disability and discomfort.

DMARDs include methotrexate, sulfasalazine, and leflunomide (Arava).

Biological response modifiers are new drugs used for the treatment of

rheumatoid arthritis. They can help reduce inflammation and structural

damage of the joints by blocking the reaction of a substance called

tumor necrosis factor, a protein involved in immune system response.

These drugs include etanercept (Enbrel), infliximab (Remicade), and

anakinra (Kineret).

Corticosteroids, such as prednisone, cortisone, solumedrol, and

hydrocortisone, are used to treat many rheumatic conditions because they

decrease inflammation and suppress the immune system. The dosage of

these medications will vary depending on the diagnosis and the patient.

Again, the patient and doctor must work together to determine the right

amount of medication.

Corticosteroids can be given by mouth, in creams applied to the skin, or

by injection. Short-term side effects of corticosteroids include

swelling, increased appetite, weight gain, and emotional ups and downs.

These side effects generally stop when the drug is stopped. It can be

dangerous to stop taking corticosteroids suddenly, so it is very

important that the doctor and patient work together when changing the

corticosteroid dose. Side effects that may occur after long-term use of

corticosteroids include stretch marks, excessive hair growth,

osteoporosis, high blood pressure, damage to the arteries, high blood

sugar, infections, and cataracts.

Hyaluronic acid products like Hyalgan and Synvisc mimic a naturally

occurring body substance that lubricates the knee joint. They are

usually injected directly into the joint to help provide temporary

relief of pain and flexible joint movement.

Devices Used in Treatment

Transcutaneous electrical nerve stimulation (TENS) has been found

effective in modifying pain perception. TENS blocks pain messages to the

brain with a small device that directs mild electric pulses to nerve

endings that lie beneath the painful area of the skin.

A blood-filtering device called the Prosorba Column is used in some

health care facilities for filtering out harmful antibodies in people

with severe rheumatoid arthritis.

Heat and Cold Therapies

Heat and cold can both be used to reduce the pain and inflammation of

arthritis. The patient and doctor can determine which one works best.

Heat therapy increases blood flow, tolerance for pain, and flexibility.

Heat therapy can involve treatment with paraffin wax, microwaves,

ultrasound, or moist heat. Physical therapists are needed for some of

these therapies, such as microwave or ultrasound therapy, but patients

can apply moist heat themselves. Some ways to apply moist heat include

placing warm towels or hot packs on the inflamed joint or taking a warm

bath or shower.

Cold therapy numbs the nerves around the joint (which reduces pain) and

may relieve inflammation and muscle spasms. Cold therapy can involve

cold packs, ice massage, soaking in cold water, or over-the-counter

sprays and ointments that cool the skin and joints.

Capsaicin cream is a preparation put on the skin to relieve joint or

muscle pain when only one or two joints are involved.

Hydrotherapy, Mobilization Therapy, and Relaxation Therapy

Hydrotherapy involves exercising or relaxing in warm water. The water

takes some weight off painful joints, making it easier to exercise. It

helps relax tense muscles and relieve pain.

Mobilization therapies include traction (gentle, steady pulling),

massage, and manipulation. (Someone other than the patient moves stiff

joints through their normal range of motion.) When done by a trained

professional, these methods can help control pain, increase joint

motion, and improve muscle and tendon flexibility.

Relaxation therapy helps reduce pain by teaching people various ways to

release muscle tension throughout the body. In one method of relaxation

therapy, known as progressive relaxation, the patient tightens a muscle

group and then slowly releases the tension. Doctors and physical

therapists can teach patients a variety of relaxation techniques.

Assistive Devices

The most common assistive devices for treating arthritis pain are

splints and braces, which are used to support weakened joints or allow

them to rest. Some of these devices prevent the joint from moving;

others allow some movement. A splint or brace should be used only when

recommended by a doctor or therapist, who will show the patient the

correct way to put the device on, ensure that it fits properly, and

explain when and for how long it should be worn. The incorrect use of a

splint or brace can cause joint damage, stiffness, and pain.

A person with arthritis can use other kinds of devices to ease the pain.

For example, the use of a cane when walking can reduce some of the

weight placed on a knee or hip affected by arthritis. A shoe insert

(orthotic) can ease the pain of walking caused by arthritis of the foot

or knee. Other devices can help with activities such as opening jars,

closing zippers, and holding pencils.

Surgery

Surgery may be required to repair damage to a joint after injury or to

restore function or relieve pain in a joint damaged by arthritis. The

doctor may recommend arthroscopic surgery, bone fusion (surgery in which

bones in the joint are fused or joined together), or arthroplasty (also

known as total joint replacement, in which the damaged joint is removed

and replaced with an artificial one).

Nutritional Supplements

Nutritional supplements are often reported as helpful in treating

rheumatic diseases. These include products such as S-adenosylmethionine

(SAM-e) for osteoarthritis and fibromyalgia, dehydroepiandrosterone

(DHEA) for lupus, and glucosamine and chondroitin sulfate for

osteoarthritis. Reports on the safety and effectiveness of these

products should be viewed with caution since very few claims have been

carefully evaluated.

Myths About Treating Arthritis

At this time, the only type of arthritis that can be cured is that

caused by infections. Although symptoms of other types of arthritis can

be effectively managed with rest, exercise, and medication, there are no

cures. Some people claim to have been cured by treatment with herbs,

oils, chemicals, special diets, radiation, or other products. However,

there is no scientific evidence that such treatments cure arthritis.

Moreover, some may lead to serious side effects. Patients should talk to

their doctor before using any therapy that has not been prescribed or

recommended by the health care team caring for the patient.

Work With Your Doctor To Limit Your Pain

The role you play in planning your treatment is very important. It is

vital for you to have a good relationship with your doctor in order to

work together. You should not be afraid to ask questions about your

condition or treatment. You must understand the treatment plan and tell

the doctor whether or not it is helping you. Research has shown that

patients who are well informed and participate actively in their own

care experience less pain and make fewer visits to the doctor.

What Can Be Done To Help?

Studies show that an estimated 18 percent of Americans who have

arthritis or other rheumatic conditions believe that their condition

limits their activities. People with arthritis may find that they can no

longer participate in some of their favorite activities, which can

affect their overall well-being. Even when arthritis impairs only one

joint, a person may have to change many daily activities to protect that

joint from further damage and reduce pain. When arthritis affects the

entire body, as it does in people with rheumatoid arthritis or

fibromyalgia, many daily activities have to be changed to deal with

pain, fatigue, and other symptoms.

Changes in the home may help a person with chronic arthritis continue to

live safely, productively, and with less pain. People with arthritis may

become weak, lose their balance, or fall. In the bathroom, installing

grab bars in the tub or shower and by the toilet, placing a secure seat

in the tub, and raising the height of the toilet seat can help. Special

kitchen utensils can accommodate hands affected by arthritis to make

meal preparation easier. An occupational therapist can help people who

have rheumatic conditions identify and make adjustments in their homes

to create a safer, more comfortable, and more efficient environment.

Friends and family members can help a patient with a rheumatic condition

by learning about that condition and understanding how it affects the

patient's life. Friends and family can provide emotional and physical

assistance. Their support, as well as support from other people who have

the same disease, can make it easier to cope. The Arthritis Foundation

has a wealth of information to help people with arthritis. (See the list

of resources.)

What Research Is Being Done on Arthritis?

The National Institute of Arthritis and Musculoskeletal and Skin

Diseases (NIAMS), a part of the National Institutes of Health (NIH),

leads the Federal medical research effort in arthritis and rheumatic

diseases. The NIAMS sponsors research and research training on the NIH

campus in Bethesda, land, and at universities and medical centers

throughout the United States. Research activities include both basic

(laboratory) and clinical (involving patients) research studies to

better understand what causes these conditions and how best to treat and

prevent them.

The NIAMS currently supports three types of research centers that study

arthritis, rheumatic diseases, and other musculoskeletal conditions:

Multidisciplinary Clinical Research Centers (MCRCs), Specialized Centers

of Research (SCORs), and Core Centers. A list of these centers and their

locations can be obtained from the Institute (listed at the end of this

fact sheet).

The MCRCs are programs that focus on clinical research designed to

assess and improve outcomes for patients affected by arthritis and other

rheumatic diseases, musculoskeletal disorders (including bone and muscle

diseases), and skin diseases. Each center studies one or more of the

diseases within the NIAMS mission and provides resources for developing

clinical projects using more than one approach.

Each SCOR focuses on a single disease. Currently, rheumatoid arthritis,

systemic lupus erythematosus, osteoarthritis, osteoporosis, and

scleroderma are being studied. Combining laboratory and clinical studies

under one roof speeds up research on the causes of these diseases and

hastens transfer of advances from the laboratory to the bedside to

improve patient care.

Core Centers promote interdisciplinary collaborative efforts among

scientists doing high-quality research related to a common theme. By

providing funding for facilities, pilot and feasibility studies, and

program enrichment activities at the Core Center, the Institute

reinforces investigations already underway in NIAMS program areas.

Current centers include Rheumatic Diseases Research Core Centers, Skin

Disease Research Core Centers, and Core Centers for Musculoskeletal

Disorders.

Research registries provide a means for collecting clinical,

demographic, and laboratory information from patients and, sometimes,

their relatives. These registries facilitate studies that could

ultimately lead to improved diagnosis, treatment, and prevention. NIAMS

currently supports research registries for rheumatoid arthritis,

antiphospholipid syndrome (an autoimmune disorder), ankylosing

spondylitis, lupus and neonatal lupus, scleroderma, juvenile rheumatoid

arthritis, and juvenile dermatomyositis.

Some current NIAMS research efforts in rheumatic diseases are outlined

below.

Biomarkers

Recent scientific breakthroughs in basic research have provided new

information about what happens to the body's cells and other structures

as rheumatic diseases progress. Biomarkers (laboratory and imaging

signposts that detect disease) help researchers determine the likelihood

that a person will develop a specific disease and its possible severity

and outcome. Biomarkers have the potential to lead to novel and more

effective ways to predict and monitor disease activity and responses to

treatment. The NIAMS supports research on biomarkers for rheumatic and

skin diseases, including a new initiative on osteoarthritis. Additional

studies on specific rheumatic diseases follow.

Rheumatoid Arthritis

Researchers are trying to identify the cause of rheumatoid arthritis in

order to develop better and more specific treatments. They are examining

the role that the endocrine (hormonal), nervous, and immune systems

play, and the ways in which these systems interact with environmental

and genetic factors in the development of rheumatoid arthritis. Some

scientists are trying to determine whether an infectious agent triggers

rheumatoid arthritis. Others are studying the role of certain enzymes

(specialized proteins in the body that spark biochemical reactions) in

breaking down cartilage. Researchers are also trying to identify the

genetic factors that place some people at higher risk than others for

developing rheumatoid arthritis.

Moreover, scientists are looking at new ways to treat rheumatoid

arthritis. They are experimenting with new drugs and " biologic agents "

that selectively block certain immune system activities associated with

inflammation. Newly developed drugs include etanercept (Enbrel) and

infliximab (Remicade). Followup studies show promise for their

effectiveness in slowing disease progression. Studies for additional new

drugs continue. Other investigators have shown that minocycline and

doxycycline, two antibiotic medications in the tetracycline family, have

a modest benefit for people with rheumatoid arthritis. Research

continues in this area.

Novel studies using imaging technologies are underway as well. These

techniques help identify targets for new drugs by allowing researchers

to see changes in cells during the disease process.

Osteoarthritis

The NIAMS has embarked on several innovative approaches to understand

the causes and identify effective treatment and prevention methods for

osteoarthritis. Through a public/ private partnership, researchers are

identifying biomarkers for osteoarthritis to help develop and test new

drugs. Imaging studies designed to better identify joint disorders and

assess their progression are taking place as well.

The National Center for Complementary and Alternative Medicine and the

NIAMS at the National Institutes of Health are currently funding a study

on the usefulness of the dietary supplements glucosamine and chondroitin

sulfate for osteoarthritis. Previous studies suggest these substances

may be effective for reducing pain in knee osteoarthritis. Researchers

are also investigating whether they prevent the loss of cartilage.

Some genetic and behavioral studies are focusing on factors that may

lead to osteoarthritis. Researchers recently found that daughters of

women who have knee osteoarthritis have a significant increase in

cartilage breakdown, thus making them more susceptible to disease. This

finding has important implications for identifying people who are

susceptible to osteoarthritis. Other studies of risk factors for

osteoarthritis have identified excessive weight and lack of exercise as

contributing factors to knee and hip disability.

Researchers are working to understand what role certain enzymes play in

the breakdown of joint cartilage in osteoarthritis and are testing drugs

that block the action of these enzymes.

Studies of injuries in young adults show that those who have had a

previous joint injury are more likely to develop osteoarthritis. These

studies underscore the need for increased education about joint injury

prevention and use of proper sports equipment.

Systemic Lupus Erythematosus

Researchers are looking at how genetic, environmental, and hormonal

factors influence the development of systemic lupus erythematosus. They

are trying to find out why lupus is more common in certain populations,

and they have made progress in identifying the genes that may be

responsible for lupus. Researchers also continue to study the cellular

and molecular basis of autoimmune disorders such as lupus. Promising

areas of research on treatment include biologic agents; newer, more

selective drugs that suppress the immune system; and bone transplants to

correct immune abnormalities. Contrary to the widely held belief that

estrogens can make the disease worse, clinical studies are revealing

that it may be safe to use estrogens for hormone replacement therapy and

birth control in women with lupus.

Scleroderma

Current studies on scleroderma are focusing on overproduction of

collagen, blood vessel injury, and abnormal immune system activity.

Researchers hope to discover how these three elements interact to cause

and promote scleroderma. In one study, researchers found evidence of

fetal cells within the blood and skin lesions of women who had been

pregnant years before developing scleroderma. The study suggests that

fetal cells may play a role in scleroderma by fostering the maturation

of immune cells that promote the overproduction of collagen. Scientists

are continuing to study the implications of this finding.

Treatment studies are underway as well. One study in particular is

looking at the effectiveness of oral collagen in treating scleroderma.

Fibromyalgia

Scientists are looking at the basic causes of chronic pain and the

health status of young women affected by fibromyalgia. The effectiveness

of behavior therapy, acupuncture, and some alternative medical

approaches for dealing with pain and loss of sleep are being tested.

Researchers are also studying whether certain genes contribute to this

disease.

Spondyloarthropathies

Researchers are working to understand the genetic and environmental

causes of spondyloarthropathies, which include ankylosing spondylitis,

psoriatic arthritis, inflammatory bowel disease, and reactive arthritis

(Reiter's syndrome), as well as related conditions of the eye. They are

also looking at new imaging methods that will help with early and

accurate diagnosis, guide treatment, and detect responses to treatment.

Research on new treatments is also underway.

The Health Partnership Program: A Local Diversity Outreach Initiative in

the Rheumatic Diseases

In the winter of 2000, the NIAMS launched the Health Partnership Program

(HPP), a local model of research and service that addresses disparities

in preventing and treating rheumatic diseases in multicultural

communities. The initiative focuses on four key areas: (1) public health

education, (2) patient care, (3) access to clinical investigations, and

(4) recruitment for research careers. The partnership includes community

leaders and organizations representing the populations being served.

They promote awareness of the program and its services and advise the

Institute on community outreach activities.

One component of the HPP is the NIAMS Community Health Center located in

Washington, DC. The health center provides a platform for conducting

health disparities research by implementing the four key areas of the

HPP. The center offers patients quality health care and health

information in a community clinic setting. Patients are also given the

option of participating in clinical studies. More information about the

HPP is available at www.niams.nih.gov/hi/outreach/index.htm.

Where Can People Find More Information About Arthritis and Rheumatic

Diseases?

* National Institute of Arthritis and Musculoskeletal and Skin

Diseases (NIAMS)

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484 or

877-22-NIAMS (226-4267) (free of charge)

TTY: 301-565-2966

Fax: 301-718-6366

E-mail: niamsinfo@...

www.niams.nih.gov

NIAMS provides information about various forms of arthritis and

rheumatic diseases and bone, muscle, joint, and skin diseases. It

distributes patient and professional education materials and refers

people to other sources of information. Additional information and

updates can be found on the NIAMS Web site. Listings of clinical trials

recruiting patients who have or are at risk of developing a rheumatic

disease can be found at www.ClinicalTrials.gov.

* American Academy of Orthopaedic Surgeons

P.O. Box 2058

Des Plaines, IL 60017

Phone: 800-824-BONE (2663) (free of charge)

www.aaos.org

The academy provides education and practice management services for

orthopaedic surgeons and allied health professionals. It also serves as

an advocate for improved patient care and informs the public about the

science of orthopaedics. The orthopaedist's scope of practice includes

disorders of the body's bones, joints, ligaments, muscles, and tendons.

For a single copy of an AAOS brochure, send a self-addressed stamped

envelope to the address above or visit the AAOS Web site.

* American College of Rheumatology/Association of Rheumatology

Health Professionals

1800 Century Place, Suite 250

Atlanta, GA 30345-4300

Phone: 404-633-3777

Fax: 404-633-1870

www.rheumatology.org

This association provides referrals to rheumatologists and physical and

occupational therapists who have experience working with people who have

rheumatic diseases. The organization also provides educational materials

and guidelines about many different rheumatic diseases.

* Arthritis Foundation

1330 West Peachtree Street

Atlanta, GA 30309

Phone: 404-872-7100 or 800-283-7800 (free of charge)

or call your local chapter (listed in the telephone directory)

www.arthritis.org

This is the main voluntary organization devoted to arthritis. The

foundation publishes free pamphlets on many types of arthritis and a

monthly magazine for members that provides up-to-date information on

arthritis. The foundation can provide physician and clinic referrals.

The American Juvenile Arthritis Organization (AJAO) is under the

umbrella of the Arthritis Foundation. It shares the same address, phone

numbers, and Web site.

Acknowledgments

The NIAMS gratefully acknowledges the assistance of Barri Fessler, M.D.,

Cleveland Clinic Foundation, OH; H. Klippel, M.D., Arthritis

Foundation, Washington, DC; Reva Lawrence, M.P.H., NIAMS, NIH;

Matteson, M.D., Mayo Clinic, Rochester, MN; and Barbara Mittleman, M.D.,

NIAMS, NIH in the preparation and review of the current and earlier

versions of this fact sheet.

The mission of the National Institute of Arthritis and Musculoskeletal

and Skin Diseases (NIAMS), a part of the National Institutes of Health

(NIH), is to support research into the causes, treatment, and prevention

of arthritis and musculoskeletal and skin diseases, the training of

basic and clinical scientists to carry out this research, and the

dissemination of information on research progress in these diseases. The

National Institute of Arthritis and Musculoskeletal and Skin Diseases

Information Clearinghouse is a public service sponsored by the NIAMS

that provides health information and information sources. Additional

information can be found on the NIAMS Web site at www.niams.nih.gov.

This fact sheet is not copyrighted. Readers are encouraged to duplicate

and distribute as many copies as needed.

Additional copies of this fact sheet are available from:

National Institute of Arthritis and Musculoskeletal

and Skin Diseases (NIAMS) Information Clearinghouse

National Institutes of Health (NIH)

1 AMS Circle

Bethesda, MD 20892-3675

NIH Publication No. 02-4999