Millions of Americans are being diagnosed with arthritis in their 40s, sometimes even younger. The good news is there's plenty you can do to keep arthritis at bay or minimize aches and pain you may already be feeling.
By Jeannette Moninger
While there are over 100 different arthritis-related conditions, half of the 46 million sufferers in the U.S. have osteoarthritis. In fact, it's estimated that almost 50% of us will be dealing with some form of it by the time we turn 65. The first signs are typically puffy or swollen knees and legs that hurt when straightened or bent. The pain is caused by bone rubbing on bone after cartilage (which acts as a cushion) has broken down. Early symptoms are often attributed to general muscle soreness. "People need to zero in on the pain they're feeling," says Lisa Mandl, M.D., a rheumatologist at the Hospital for Special Surgery, an orthopedic hospital in New York City. "With arthritis, you'll have pain in certain pivot points—like your knees and hips—and less in the surrounding muscle tissue." Plus, muscle aches go away in a few days and feel better with rest and massage; arthritis pain doesn't.
Women between the ages of 25 and 50 are also prone to another form of arthritis: rheumatoid. This condition occurs when the body's immune system mistakenly attacks healthy tissue in the joints, eating up cartilage and bone. While osteoarthritis damages large joints, rheumatoid first targets smaller ones in the wrists, hands, ankles, and feet—causing stiffness, pain, redness and swelling (especially in the mornings). The joints may feel warm and many sufferers experience low-grade fevers, fatigue, and weight loss. As this autoimmune disease progresses, it can spread throughout the body, eventually affecting larger joints and damaging organs like the heart and lungs.
While your instinct may be to take it easy, studies suggest that the best remedy for achy joints is movement. Even if you feel fine right now, physical activity, like walking, is key to keeping joints pain-free, as it helps strengthen muscles and bones and also improves joint flexibility.
Still, you should be careful, as overdoing it may lead to an injury—which in turn makes you more prone to arthritis. Women are up to four times more likely than men to tear knee cartilage, a consequence of hormones as well as anatomical predispositions. Once it is injured, the odds of developing arthritis shoot up dramatically. "Studies suggest that half of women who experience a traumatic knee injury will develop osteoarthritis in that knee within 10 to 15 years," says Steven B. Abramson, M.D., director of the division of rheumatology at New York University's Langone Medical Center. And it's not just knees: Sprained ankles, broken wrists, tennis elbows, and any other distressed joints are equally susceptible.
Like most things health-related, being overweight or obese plays a role in arthritis. "Every extra pound places 4 additional pounds of pressure on your knees," says Patience H. White, M.D., the Arthritis Foundation's chief public health officer. Fortunately, weight loss needn't be dramatic to make a difference: A study published in the Annals of Internal Medicine found that women who lost as few as 11 pounds reduced their risk of osteoarthritis by half.
Initially, over-the-counter remedies may help. Anti-inflammatory drugs like Advil and Motrin are best for alleviating swelling, inflammation and pain, while analgesics like Tylenol provide pain relief. But if you rely on these every day or have to take the maximum allowed dosage in order to function, or if you have symptoms for more than six weeks, make an appointment with a primary care physician or a specialist like a rheumatologist, advises Dr. Mandl. The doctor should inquire about a family history of the disease (many forms of arthritis, including osteoarthritis and rheumatoid arthritis, have genetic links) before making a diagnosis. "Certain blood tests, like the one for rheumatoid factor, can help diagnose rheumatoid arthritis," says Dr. Mandl. Currently there isn't a test for osteoarthritis, but X-rays can help with a diagnosis.
A combination of antirheumatic drugs and immunosuppressants slows the progression of rheumatoid arthritis, and early treatment—within the first six months of symptoms—is key.
Osteoarthritis treatment usually involves steroid shots. While the injections provide fast pain relief, more than three shots in the same spot within a year can damage joints more. An option for osteoarthritis in the knees involves injecting hyaluronic acid, a protein that gives joint fluid its viscosity, into the affected area. In the past doctors administered up to five injections per knee, but a new product, Synvisc-One, provides relief with only one shot. Viscosupplementation, as it's called, can be repeated after six months and may help patients delay or avoid joint replacement surgery.
The typical joint replacement available today lasts only about 20 years, which means the younger you are when you first have it done, the greater the likelihood that you'll need subsequent surgeries. "Still, it should be considered as an option," says orthopedic surgeon Nick DiNubile, M.D., author of FrameWork: Your 7-Step Program for Healthy Muscles, Bones and Joints (Rodale). "When the pain's too much to bear and you've tried all other solutions, surgery can greatly improve quality of life."
Diagnosed with rheumatoid arthritis at age 29
"After I gave birth to my second child, my knees started to throb and swell. Next, my wrists and shoulders hurt. The pain was constant. I blamed my aches on 'mommy fatigue' and the exercises I was doing to shed those pregnancy pounds. But when I confessed to my mom how awful I felt, she immediately knew what was wrong: She had rheumatoid arthritis too. When tests confirmed I had the disease, I was shocked. Surely I was too young to have arthritis. I stopped exercising because of the pain, and I gained 40 pounds, needed a cane to get around, and could barely care for my kids. Things finally started to improve after I began a combination of antirheumatics and immunosuppressants. A physical therapist got me exercising every day—even when the pain was at its worst. But I stuck it out and grew stronger. Today I teach spinning classes at a gym. I've made my health a priority, as I need to be able to keep up with my 16-year-old son and 12-year-old daughter."
St. Clair Shores, Michigan
Diagnosed with osteoarthritis at age 39
"Osteoarthritis runs in my family—my sister, grandmother and aunts have it—yet I never thought it could be the reason my knees hurt, especially since I wasn't even 40 yet. Even after a rheumatologist diagnosed me, I was in denial and hesitant about taking lots of strong medications. But often I was in so much pain that I couldn't even help out in my 10-year-old daughter's classroom. Finally I agreed to let my doctor inject lubricating fluid into my knees. I have this done every six months, and it no longer hurts to climb up and down stairs or to stand for long periods of time or to play hopscotch with my daughter."
Diagnosed with juvenile rheumatoid arthritis at age 8
"When I was a child my parents noticed I'd limp after playing all day. I saw many different doctors, but arthritis was never mentioned. That's not surprising: While 50,000 children in the U.S. today know they have juvenile rheumatoid arthritis, many kids go undiagnosed—and the disorder was even less recognized 30 years ago. I finally learned that I had arthritis at age 8, and even then I wasn't given the best guidance about what I should do to protect my joints. For instance, I was told to rest and now we know it's best to stay active. When I park in a handicap spot and my kids, who are 14 and 9, hop out people sometimes give us strange looks. They don't know that I had my hip replaced at age 33 or that I get steroids injected into my shoulder so I can keep moving."
Originally published in the April 17, 2010, issue of Family Circle magazine.
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