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Health Talk 

Dr. Madelaine Feldman, (2633 Napoleon Ave., Suite 530, 899-1101), a rheumatologist in private practice, a member of the clinical faculty of Tulane School of Medicine and president of the Rheumatology Alliance of Louisiana, discusses arthritis and the forms it takes.

Q: What is rheumatoid arthritis (RA) and how does it differ from osteoarthritis (OA)?

A: In general, when we look at arthritis, we divide it into two main categories: degenerative arthritis, sometimes called osteoarthritis, and inflammatory arthritis. By far, the most common form of arthritis is osteoarthritis. It is a degenerative process that begins in the cartilage, usually secondary to injury or aging. In some people, the cartilage repair system just shuts down at a certain age and is not able to keep up with the everyday wear and tear on our joints. The other major category of arthritis is inflammatory -- of which the most common form is rheumatoid arthritis. Gout and psoriatic arthritis are other forms of inflammatory arthritis. Inflammation (swelling, heat, redness and pain) in the joints is caused by our own immune cells and is the hallmark of this disease. Rheumatoid arthritis is actually one of the many autoimmune diseases.

Q: What is autoimmune disease and what are some other examples?

A: The autoimmune diseases are characterized by the body's own immune system mistakenly fighting against itself. The different diseases have varying symptoms, depending on where the majority of the immune action is taking place. One of the most well-known autoimmune diseases is systemic lupus erythematosis. The symptoms of this disease can vary from just a mild rash with joint aches to severe kidney or brain involvement. As with most of the autoimmune diseases that rheumatologists treat, females are more commonly affected than males. An exception to this is ankylosing spondylitis. Other autoimmune diseases are Sjogren's syndrome, scleroderma, polymyositis, dermatomysitis, Bechet's desease and sarcoidosis. Sarcoidosis, which most commonly affects the lungs, is more common in young African-American males. Although it is not common, many of these diseases can be associated with a vasculitis. This is when the immune system actually attacks your own blood vessels.

Q: What are the major symptoms of rheumatoid arthritis?

A: We tend to see pain and swelling of the small joints (usually symmetric) in rheumatoid arthritis. For example, the small joints of the hands and feet are common sites for rheumatoid arthritis. One of the most difficult symptoms to treat in RA is fatigue. A symptom that can help distinguish RA from OA is morning stiffness. Many patients with RA have stiffness that can last for hours or even all day, whereas OA morning stiffness is usually gone within 30 to 45 minutes. Weight loss, fever, and a general feeling of "yuckiness" can be associated with active RA. Twenty percent of rheumatoid patients may have Sjogren's syndrome, an autoimmune condition associated with dry eyes and/or dry mouth.

Q: What are the major symptoms of osteoarthritis?

A: Pain in the joints, sometimes associated with decreased function are the most common symptoms of OA. The joints affected most often by OA are the hands and the weight-bearing joints (knees, hips and back.) The distribution of joints in the hands is slightly different between OA and RA. There are three sets of knuckles in your hands ... osteoarthritis tends to hit the ones in the middle of the finger and those closest to the fingernail. Rheumatoid arthritis tends to involve the middle joint of the finger and the joints that connect the fingers to the hand. Although both forms of arthritis cause pain, there tends to be less inflammation in osteoarthritis. The enlargement of the OA joints comes more from increased bone formation and spurs and less from soft tissue and fluid. There can be loss of range of motion in both RA and OA, depending on the amount of damage to the joint.

Q: Is there a cure?

A: If the definition of "cure" is that the disease process is gone and does not return even after stopping the treatment, then we have no cures for arthritis. Once again, it is important to distinguish between osteoarthritis, rheumatoid arthritis and the many other kinds of inflammatory arthritis when talking about treatment. It should be mentioned that non-steroidal, anti-inflammatory drugs are used to treat the symptoms and not the disease process. In OA, there are new experimental procedures involving cartilage transplant, and there is much research underway to better understand the genetics of this disease. In regards to rheumatoid arthritis, the introduction of the class of drugs known as the "biologics" has been a watershed event in the long-term prognosis of these patients. Gout is an example of a type of arthritis that can be nearly cured if the right type of medication can be taken life long.

Q: Does arthritis lead to more serious conditions or diseases?

A: Again we have to differentiate between inflammatory and degenerative arthritis. Many types of inflammatory arthritis can have what are known are "extra-articular" manifestations. Those are symptoms unrelated to the joint problems. For example, various types of lung and heart conditions can be associated with an inflammatory arthritis. There are also a number of inflammatory eye diseases that are associated with arthritis. Joint pains can even sometimes precede the bowel manifestations of Crohn's disease or ulcerative colitis. Rheumatoid arthritis and lupus are independent risk factors for heart attacks, so patients with these conditions must be very careful to keep control of other risk factors such as high blood pressure, blood sugar, hyperlipidemia and smoking. Osteoarthritis does not have extra- articular manifestations. However, any type of chronic pain condition can lead to depression associated with a decreased quality of life. Total joint replacements for OA give some patients a new lease on life once they are able to resume activities without the constant pain.

Q: Anything else people should watch out for?

A: Lifestyle choices such as diet and exercise are important for everyone but are perhaps even more important for patients with arthritis. Weight loss can reduce pain in weight-bearing joints such as the knees and hips. Maintaining abdominal-muscle tone is extremely important in decreasing back pain. One of the most important activities I recommend to patients with arthritis is weight training. Stronger quadraceps can decrease knee pain and stronger upper body muscles just make doing nearly everything, easier. Increasing muscle mass and tone also helps you lose weight and increase your energy by raising your metabolism.

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