Health

For the 66 million American adults suffering some form of arthritis, that constant joint pain can be debilitating. It comes from a variety of causes including lupus, Lyme disease and gout. Fortunately, advancements in the study of rheumatology are providing better diagnoses and new treatments, allowing patients like Ryan to lead relatively normal lives.

Of more than 100 types of arthritis, the two most common are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis, or RA, is an autoimmune disease. "It’s a systemic inflammatory disease," says rheumatologist Dr. Harley Cohen. No one is quite sure what triggers it, but the antibodies in rheumatoid patients go haywire and attack healthy cells. As this happens, the tissues around joints become painfully swollen and hot to the touch. Prolonged stress and pressure can permanently damage cartilage, leaving patients with sore, stiff joints after the inflammation subsides. "They feel like they constantly have the flu," says Cohen.

For arthritis caused by autoimmune malfunctions like RA, the biggest developments are coming from a class of drugs called biologic response modifiers, BRMs. Born out of the immunosuppressants used in transplant and cancer patients, arthritis BRMs target the immune responses themselves. The drugs suppress turncoat antibodies, preventing inflammation and the accompanying joint damage. BRM drugs like Enbrel, Remicade, Methotrexate and Humira are the most sophisticated treatments available to RA patients.

"My whole body was just basically crippled," says Ryan, describing the effects of his first RA episode. Today—thanks to BRMs—it’s hard to picture the trim, 66-year-old retired trial lawyer laid up with joint pain. For Ryan, weekly injections of Methotrexate and biweekly injections of Humira are a small trade-off for long periods of remission. "It’s a heck of a lot better than being crippled," he says.

There are limitations to BRMs. At upwards of $13,000 per year, BRMs can be prohibitively expensive for uninsured or underinsured patients. Even for patients who can afford the treatments, they are not cures for the chronic illness. "Once they stop the medication, it comes back," warns Cohen. Even so, as long as a patient adheres to the regimen, there are more options available to treat RA than ever before.

Osteoarthritis—the sore joints associated with aging—may be the most well-known form of arthritis, but it is surprisingly one of the hardest to treat. Osteoarthritis occurs when the cartilage that cushions joints has been damaged as a result of natural wear and tear. Some cartilage damage is to be expected as most people age, but people with a family history of osteoarthritis are at higher risk of developing severe symptoms.

"I have no cartilage in either knee," says Jay Spencer, a retired sports photographer in Naples. "They say it’s because when I covered football, I was on my knees so much." Spencer wears two knee braces and winces when he talks about the pain of standing for any substantial period of time. "I’ve always been a hellfire-and-damnation-I’m-gonna-get-the-picture kind of guy," says Spencer. "I’m still that kind of guy, but I just can’t do it."

It is not uncommon for patients of osteoarthritis to ask their doctors about BRM drugs. But because there is no trigger like the immune response in RA, the BRMs are useless for osteoarthritis patients. There is little preventive medicine available for osteoarthritis. By the time cartilage is damaged enough to cause pain, there’s no way to turn back the clock. Treatment instead focuses on pain management and prevention of further damage.

Prescription painkillers and steroid shots can ease joint pain, though the effects are temporary. "That was great for Wednesday, Thursday," says Spencer of his mid-week cortisone shot. "Then Friday, the pain came back."

Depending on the location of the damage, the best option for managing severe osteoarthritis is to get rid of the problem joint altogether. "Joint replacement is a big thing in treatment," says rheumatologist Dr. Catherine Kowal. An invasive surgery is always a serious commitment, but the past few years have seen dramatic improvements in prosthetic joints. "Some of the polymers are much more resilient," says Kowal. Better compounds and antibody-coated implants reduce the odds of rejection or infection. "It’s been a lifesaver," she says.

Of all the arthritis therapies available, some of the most helpful steps a patient can take are their own. "Keeping active is No. 1, exercise is No. 2, no matter what kind of arthritis you have," says Kowal. Exercise can reduce stress on joints by building muscles that relieve the pressure on damaged cartilage. Exercise also helps manage excess weight, which puts an unnecessary load on weakened joints, compounding the problem that causes pain.

It’s never too late to start an activity regimen, even for patients who have been rendered sedentary by their symptoms. "Once we get their pain under control, we’ll send them to physical therapy," says Cohen of his patients.

Some forms of exercise are better than others. "If you already have arthritis, the best exercises you can do are in warm water," says Kowal. Water exercise has little resistance, is low impact and is easiest on already-stressed joints. Stationary bicycles, walking, stretching and yoga are also manageable activities for arthritis patients. Kowal stresses that supportive footwear is important for everyone, not just people with joint pain.

Until recently, arthritis patients were compelled to stoically resign themselves to the pain. But as Cohen points out, the unprecedented amount of current arthritis research means treatments and the quality of patient lives are only expected to improve. "The golden age of rheumatology is really starting now," Cohen says.