The arthritis epidemic: Where are we in 2018?

Arthritis is a growing public health burden that is alarmingly common, affecting nearly 50 million adults in the United States.

While the prevalence of arthritis is somewhat related to the aging population and the “Baby Boomer” generation now reaching their 60s and 70s, it is also due to an increasing frequency of arthritis in younger people in their 40s and 50s.

Reasons for this are not entirely clear, as there does not appear to be clearly identifiable causes like overuse or genetics. While arthritis does run in some families, suggesting an inherited tendency, there is no single gene that has been uniformly linked in a manner that medical science might use to predict who as it risk for this disease and how we might cure it.

There is also not a clear link to activity level as arthritis can sometimes be seen in sedentary people and not in those who have run in countless marathons. Like many diseases, the causes at a population level and the complex cellular mechanisms that result in joint degeneration are multifactorial. This renders a true cure extremely difficult to develop.

Arthritis involves the wear and destruction of the cartilage that makes up the surface of our joints.

Cartilage provides a smooth frictionless gliding surface that allows joints to move while simultaneously transmitting forces across joints in a distributed fashion.Cartilage is amazingly complex in its architecture and withstands millions of cycles of use and abuse.

Unfortunatey, it does not possess and intrinsic healing capacity so that it cannot correct wear and damage when they occur. Because of this, incremental damage can have a snowball effect leading to mechanical changes in the joint that reduce its ability to effectively withstand the forces of daily activity. Thus, cartilage wear often becomes a progressive degenerative problem that can ultimately lead to pain, stiffness, weakness and deformity.

There is much interest today in biological therapies that promote tissue regeneration. Recently, an entire industry has developed around the concept of regenerative medicine for treatment of arthritis.

The great pitch of such therapies is that stem cells or other injectable fractions of blood can infiltrate an arthritic joint with the biological tools that are necessary to convince cartilage to regrow and function like normal cartilage.

While this concept sounds promising, evolutionary biology is so much more complex at a cellular level with signaling pathways and cascades of molecular activity that we are just beginning to understand. Thus, to think the injection of damaged tissue with a high concentration of cells with the potential to differentiate into connective tissue will actually result in such differentiation and regeneration is really just a great hope at this point with very little scientifically valid data to back the claims that such therapies profess (and often at great cost to the patient).

Because a significant component of the pathogenesis of arthritis involves mechanical changes to the joint, biologically-based therapies are only part of the story. And while there is promise in this field based on the precedent of successful biological therapies for other diseases like cancer, to date we have not solved the arthritis riddle.

Fortunately, arthritis is neither contagious within or between people, though some people do have a proclivity to develop multiple arthritic joints. It is also not a fatal condition. As such, the first line of defense in the management of arthritis is learning to live with it. This requires a self-management wellness approach that puts the individual in control of the condition. So what can you do to stave off the progression of this common condition? As follows is a list of recommendations that are proven by scientific research.

• Weight control. There is a well-accepted association between obesity and arthritis. Part of the current weight epidemic results from our tendency toward inactivity as a culture and part of it stems from the abundance of processed food that is rich in carbohydrates and poor in nutrients. While it is often difficult for people with arthritis to lose weight through physical activity, modification of one’s diet to reduce sugar and carbohydrate intake can lead to weight reduction without significant quantity or calorie restriction. Educate yourself about nutrition and which foods may be beneficial or harmful for people with arthritis.

• Exercise: Non-impact exercise is proven to be good for people with arthritis. A sedentary lifestyle leads to stiffness, weakness and weight gain. Walking, swimming, biking and low-level, non-impact resistance exercises promote improved joint function and improved mental outlook. There are many excuses people come up with to avoid this, but lack of time just means that one does not prioritize this important part of self-management. The first step is always the hardest, but the rewards are worth it.

• Lifestyle modification: Foregoing activities that damage already worn joints makes intuitive sense. Once a joint is not able to efficiency transmit force due to loss of cartilage, excess force will simply result in further damage. It can be hard for people to give up activities that have taken on the status of ritual in their lives but there are many other activities which can be supplemented with equal passion and less pain. Many people feel that giving up certain things like running is like a “life sentence,” but this is simply a frame of mind like mourning and grief that can be overcome with time and perseverance.

This content was originally published here.

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