(October 1, 2007) -
Arthritis and related disorders are second only to the common cold as the cause for visiting a physician. Who hasn't had some aches and pains or suffered from low back pain? Rheumatoid arthritis is thought to effect 3% of the U.S. population and if not treated can cause crippling arthritis. Osteoarthritis is ubiquitous in our aging society.
Fortunately, there have been some marvelous advances in the treatment of this group of diseases over the past thirty years. These diseases are cared for by the medical specialty called Rheumatology. We are fortunate to have five practicing rheumatologists in Collier County.
First of all, just what is arthritis? Inflammation is the hallmark of arthritis and can occur in any joint, muscle or tendon. Wherever two bones meet at a moving joint there is normally a thin layer of tissue called synovium, which is responsible for lubricating the joint to allow effortless motion. Ordinarily, we don't even think about how our joints work; however, when someone has arthritis in a joint they are constantly distracted by the pain, swelling, redness, warmth and loss of function.
Arthritis can also involve areas outside of joints, such as tendons, muscles, as well as organs -- heart, lungs -- and the skin. Other inflammatory conditions are included in the category of rheumatology. Examples of these potentially serious diseases are systemic lupus erythematosus, ankylosing spondylitis, scleraderma, and dermatomysitis. Fibromyalgia is another common condition treated by rheumatologists but is not deforming.
Second, what can be done for arthritis? Fortunately, research has changed the course of these diseases. Forty years ago there were facetiously said to be three treatments: aspirin, more aspirin and even more aspirin. Then the non-steroidal anti-inflammatory agents came along, such as Motrin, Naprosyn, and Feldene. These were subsequently supplemented by Celebrex and Vioxx, but, unfortunately, latent side effects caused this class of drugs to be either removed from the market or limited in use. All of these medicines have the common beneficial effect of being anti-inflammatory. They decrease the inflammation in a joint by interfering with the body's response. They, too, have side effects which can affect the stomach and kidneys, as well as other areas of the body.
Enormous benefits from a new class of medications, collectively called “biologics,” have been developed over the past few years. Some of these medicines are from living cells; they include specific antibodies which attack arthritis and genetically- engineered proteins which interfere with the body's inflammatory response. This inflammatory response is normally good but in the disease state can be deleterious.
Lastly, what happens when you have arthritis? The prognosis has improved substantially over the past decades. When did you last see someone with arthritis confined to a wheelchair or stretcher? Granted, orthopedic surgery has been revolutionary, but so have medical treatments. Diagnosed early and correctly -- which is the function of a rheumatologist -- makes a big difference. The newer, more powerful medicines work but need to be carefully monitored. Most people do well for many years and experience decreased suffering from inflammation, as well as improved long term function. Medical science has come a long way, but there is still much to be done in an effort to find better, safer treatments.
No doubt, having the right diagnosis and treatment makes for a better prognosis. We are fortunate to have the ability, in Collier County, to accomplish these goals.