$Unique_ID{BRK01740} $Pretitle{} $Title{Information for You about Arthritis} $Subject{arthritis joints joint tendinitis bursitis stiffness rheumatoid gout bones elbow knuckle synovial membrane ligaments ligament tendons rheumatic ra immune system Swelling morning tenderness redness warmth fever weakness osteoarthritis rheumatoid systemic lupus erythematosus ankylosing spondylitis scleroderma psoriatic fibrositis autoimmune disease diseases knees knee hand hands feet uric acid probenecid sulfinpyrazone kidneys allopurinol aspirin acetylsalicylic acid gold salts penicillamine nonsteroidal anti-inflammatory drugs NSAIDs CORTICOSTEROIDS immunosuppressive hydroxychloroquine Quackery Ankylosing spondylitis Bursae Cartilage Flare flare-up Remission Synovectomy} $Volume{Y-0} $Log{ Osteoarthritis*0001702.scf Rheumatoid Arthritis*0001703.scf Tendons of the Wrist*0001705.scf Gout Affects the Elbow*0003801.scf Gout Affects the Kidneys*0003802.scf Gout Affects the Knee*0003803.scf Gout Affects the Ankle*0003804.scf Gout Affects the Toes*0003805.scf Gout Affects the Instep*0003806.scf Gout Affects the Hand*0003807.scf Gout Affects the Ear*0003808.scf Progressive Levels of Arthritis*0005601.scf Typical Rheumatoid Hand Deformities*0005602.scf Bursae of the Knee*0016401.scf Gout & the Kidney*0016701.scf} Copyright (c) 1991-92,1993 Health Update by Dr. Allan Bruckheim Information for You about Arthritis ------------------------------------------------------------------------------ What is arthritis? Most people suffer various aches and pains during their lives. Over the years, as aches and discomforts in the joints occur, many people call it arthritis and chalk it up to aging. They're partly right, and partly wrong. Pain in the joints may be arthritis, but arthritis is not just a byproduct of aging. Arthritis is a condition in which one or more joint becomes inflamed ("itis" means inflammation and "arth" means joint), but it is not just one disease and does not affect only the elderly. It can be a crippling, extremely painful condition that harms other vital organs as well as the joints. There are more than 100 forms of arthritis and it's the most common chronic condition in the United States. If you suffer from arthritis pain, you are one of 37 million Americans with the same complaint. You may be very young; 250,000 children have juvenile arthritis. Several types of arthritis predominantly affect women. It almost certainly costs you money in some way; the Arthritis Foundation estimates that arthritis costs more than $13 billion each year in direct medical costs or lost wages. Some forms of arthritis, such as tendinitis and bursitis, can be cured completely with your doctor's advice and care. However, most forms are chronic, which means they last for years, usually for the rest of the patient's life. There are no cures for arthritis, there is only treatment and therapy, which can alleviate pain, relieve stiffness and prevent the disease from progressing and deformities from occurring. Like many chronic diseases, arthritis flare-ups may come and go. Some people may have an attack of rheumatoid arthritis or gout and then be fine for several years, while others have the condition almost continuously. Different people with the same type of arthritis may have a vastly different range of symptoms and so be treated quite differently by the same doctor. Arthritis is not a new disease; it has plagued humanity for a long time. Skeletons from ancient mummies show signs of arthritis. Judging from some of their bones, even dinosaurs may have had some morning stiffness. All forms of arthritis affect the joints of the body, the points where two bones meet. While not all joints are alike, almost all have certain structures that are affected by the inflammation and swelling of arthritis. A basic joint--one like your elbow or knuckle--is made up of two bones that come together. The tips of the bone do not touch within the joint because they are protected by a tough layer of plastic-like cartilage. This smooth material acts as a shock absorber. The area around the joint is enclosed in a lining called the synovial membrane. This membrane creates a slippery liquid called synovial fluid that acts as a lubricant for the joint. The bones of the joint are held together and are attached to the muscles that move them by ligaments and tendons, which are tough cord-like tissues. Ligaments connect the bones to each other while tendons attach muscle to bones. Most joints have several tendons and ligaments. To keep these structures moving smoothly, there are small sacs of fluid called bursae (the singular word is bursa) tucked between the structures. The group of conditions known as arthritis is just one part of all rheumatic diseases, which affect the joints as well as supporting structures like muscles, tendons and ligaments. In arthritis, inflammation of the joint causes swelling, loss of motion, redness and pain. Inflammation is the body's reaction to an injury, enabling it to fight bacteria or viruses. The body's immune system sends special cells to the injured area to fix the problem and repair any damage. When the job is done, the inflammation dies down. In arthritis, inflammation may be out of control. It does not go away after the first attack but returns causing more inflammation and a dangerous cycle starts. Joints become stiff and hard to move and delicate joint structures become swollen and pushed out of place. If inflammation is not stopped, the joint becomes deformed and permanently harmed. How do I know if I have arthritis? The Arthritis Foundation has published the seven warning signs of arthritis. You should be aware of them and should consult your physician if you spot them. -- Swelling in one or more joints -- Early-morning stiffness -- Recurring pain or tenderness in any joint -- Inability to move a joint normally -- Obvious redness and warmth in a joint -- Unexplained weight loss, fever or weakness, combined with joint pain -- Symptoms such as these that last for more than two weeks What are the forms of arthritis? While there are more than 100 forms of arthritis, the most common are osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, gout, juvenile arthritis and ankylosing spondylitis. Other forms of arthritis are scleroderma, infectious arthritis, psoriatic arthritis, fibrositis, tendinitis and bursitis. Each of these diseases has a different cause and may require different medications and treatments. Only a physician can differentiate between these diseases. If you have any of the symptoms, please consult your doctor. OSTEOARTHRITIS The most common kind of arthritis is osteoarthritis ("osteo" means bone). It is also known as hypertrophic arthritis and degenerative joint disease. In osteoarthritis, the cartilage and connective tissues of the joints have started to break down or wear thin. The ends of the bones start to overgrow, become thickened and form bone spurs. What's left of the cartilage becomes rough and the bones themselves start to rub together, making movement difficult. However, there is little inflammation in the joint itself and pain can vary from mild to excruciating. The motion of the joint becomes more limited as the disease progresses. There are no other symptoms of this disease. Osteoarthritis is thought to be caused by normal wear and tear on the joints. That's why the symptoms--pain and stiffness--usually begin slowly, then get worse gradually with age if treatment and medication are not followed. X-rays of almost anyone over age 60 will reveal some signs of osteoarthritis, but only a few people have pain or stiffness. Continued injury to a joint will also bring on osteoarthritis. Retired football players often suffer severe osteoarthritis in their 30's and 40's. Older ballet dancers may have osteoarthritis of the toes and ankles because of the stress placed on these joints over their careers. The joints most commonly hit by osteoarthritis are the fingers, hips, knees and spine. It may affect only one or two joints, or hit one knee and spare the other. When the fingers are involved, bony knobs may appear on the knuckles. These growths, which may be painful, can be unsightly, but most people who have them will retain fairly good use of the fingers and hands. RHEUMATOID ARTHRITIS Rheumatoid arthritis is an autoimmune disease that affects the joints and can also affect other parts of the body. Autoimmune diseases are conditions in which the body's immune system starts to attack healthy tissue. Researchers believe rheumatoid arthritis may be triggered by a virus that confuses the immune system and causes it to mistakenly attack joint tissue, especially the synovial membrane. This is a theory because the virus itself has not been found yet. Emotional stress, while it does not cause rheumatoid arthritis, appears to make attacks worse. Rheumatoid arthritis is one of the most serious forms of arthritis and is very hard to control. This is a disease that discriminates against women; three out of four rheumatoid arthritis sufferers are women. The disease usually starts when a person is between age 20 and 50, but has been seen in younger and older people as well. This disease is unpredictable and highly variable. Different people with rheumatoid arthritis may be affected differently; some may have a very mild case, while others are crippled. One person may have one flare-up of rheumatoid arthritis and never be affected again, while another has attacks every few months. Rheumatoid arthritis usually affects many joints at once, with the knees, hands and feet being commonly hit. Often, joints will be hit symmetrically, that is, in a matching pattern on both sides of the body. In addition to affecting joints, severe rheumatoid arthritis may cause problems in the lungs, eyes, spleen, lymph glands and skin. The symptoms of rheumatoid arthritis are painful, red, swollen joints. The joints may feel warm to the touch and the patient may run a fever or be very tired. Some people may lose weight due to lack of appetite. If the disease progresses--which does not always happen joint motion is lost and the joints become twisted out of shape. Fingers may become bent out of shape and legs may stiffen into one position. Because rheumatoid arthritis can be a disease that progresses, most physicians treat it in a systematic manner, using milder drugs at first and proceeding to stronger medications when necessary. In severe cases, very strong drugs are used that may have some severe side effects. SYSTEMIC LUPUS ERYTHEMATOSUS Like rheumatoid arthritis, systemic lupus erythematosus is an autoimmune disease. It is called systemic because many organs in the body are affected, including the skin, kidneys and lungs. Lupus, as the disease is called for short, is a leading cause of kidney failure in the United States. The majority of lupus sufferers are women, and the disease is slightly more common among blacks. There is another related disease called discoid lupus erythematosus, with a rash that forms discs on the skin. This is a milder form of lupus. Lupus can start in any organ, and thus the symptoms and severity of the condition can vary greatly. One of the earliest symptoms of lupus is a rash over the nose and cheeks that resembles a butterfly. Arthritis is another early symptom. Lupus patients may become anemic and, because of a low white cell count, may come down with many infections and illnesses. Often, lupus patients are very sensitive to the sun. Sunburn may trigger a flare-up of lupus, so people with lupus should wear a strong sunscreen or blocking cream when outdoors on sunny days. As with rheumatoid arthritis, a physician will treat lupus with the mildest drug that will hold symptoms in check and then will proceed to stronger medications. GOUT Gout is an unusual form of arthritis caused by the inability of the body to properly handle a chemical called uric acid. Unlike rheumatoid arthritis and lupus, gout hits men almost exclusively. Uric acid is normally found in the bloodstream. It is a byproduct of the breakdown and rebuilding of proteins, especially proteins that are rich in substances know as purines. Gout patients have much higher levels of uric acid than people without gout. Levels of uric acid in the blood become so high that crystals start to form, like rock candy in a sugar solution. These crystals may be deposited in the kidneys (where they can create kidney stones and cause damage) and in the cartilage of the ears and joints. On the ear, the deposits form painless little lumps, but in the joints, the crystals act like sand in a fine motor. The prime location for uric acid crystals to form is in the joint of the big toe. Other joints may also be involved, including the knees, ankles, hands and wrists. For some reason, gout rarely causes a problem in the hips, shoulders and spine. A gout attack will begin quite suddenly. Abruptly, the toe will become agonizingly painful. It may swell up quickly and turn red as inflammation sets in. The inflammation then causes conditions that further damage the cartilage of the joint. It used to be thought that gout was the result of years of overindulgence and gluttony, and that a gout sufferer deserved his suffering, but this is not so. Gout is an inherited condition that may run in families. Although diet can help control gout, overindulgence does not cause it. Several drugs have been developed that help control the pain of gout and the levels of uric acid in the bloodstream. Two drugs, probenecid and sulfinpyrazone, lower uric acid levels by making the kidneys secrete more uric acid. Another drug, allopurinol, slows down the rate at which uric acid is created by the body. Gout is the only form of arthritis that can be controlled with diet to some extent. Although the body can create uric acid on its own, certain foods contain a lot of purines and eating them raises the blood levels of uric acid. Foods to avoid include organ meats (liver, sweetbreads, etc.), salmon, sardines, anchovies and gravies. Other foods, such as meats, beans, poultry, bran and wheat germ, have moderate amounts of purines and should be eaten in moderation. All other foods are low in purines and are safe. JUVENILE ARTHRITIS Several forms of arthritis affect children and differ from the types that affect adults. Each type of juvenile arthritis has different symptoms and may appear at any time. Juvenile arthritis may affect only one joint or it may involve many and, depending on the type of arthritis, may also affect other organs in the child. One piece of good news about juvenile arthritis is that often the child recovers completely and does not suffer any permanent damage to the joints. Others, however, may have arthritis throughout their lives. A major type is juvenile rheumatoid arthritis, which is relatively similar to rheumatoid arthritis in an adult. The symptoms for juvenile rheumatoid arthritis are fever, fatigue, skin rash, swelling and pain in the muscles and joints, slowed growth, and an inflammation of the eyes. Sometimes the first sign of juvenile rheumatoid arthritis can be seen when the child is holding a joint still because it hurts to move it. If the joint is held still for too long, it may become stiff and the muscles around it may tighten and contract. The various types of juvenile rheumatoid arthritis are treated differently, but for the most part, they are treated in the same ways as similar forms of arthritis that affect adults. However, one type of medication used in adults, corticosteroids, is not used often with children, because these drugs can stunt growth and cause softening of the bones. ANKYLOSING SPONDYLITIS This condition is an arthritis that primarily affects the spine. Ankylosing spondylitis may be inherited, but it may also be, at least in part, an autoimmune disease. It hits men, predominantly. Women who are affected have milder cases. In spondylitis, inflammation occurs around the joints of the spine and pelvis, rather than inside them, as in other forms of arthritis. In response to the inflammation, the vertebrae and other involved bones overgrow and fuse together, causing the spine to stiffen as the disease progresses. The ligaments of the ribs may also stiffen and make breathing difficult. Exercise and posture control are extremely important in treating ankylosing spondylitis. Exercise can help reduce stiffness, and keeping the spine straight will help prevent it from fusing into a bad position. What are the treatments for arthritis? The two most common treatments for arthritis are medication and physical therapy. Some combination of these may help prevent the arthritis from becoming worse, while helping the patient retain as much mobility in the joints as possible. It cannot be said often enough: no two people with arthritis will receive the same treatment. One person's osteoarthritis may respond to hot baths and light exercise, while another person must use strong medication and undergo physical therapy. One woman with rheumatoid arthritis may get sufficient pain relief with aspirin, while another may require injections of gold salts weekly. If you have arthritis, follow your doctor's advice. Don't accept medications from a friend or neighbor, and take their advice about arthritis with a grain of salt. What's good for them may be unsafe for you. However, if you feel your condition is not getting better with the drug or therapy you are using, sit down and talk about it with your physician. You must remember that with all treatments for arthritis--especially medications--there is what is known as the risk/benefit ratio. All drugs have side effects, ranging from minor to severe. The risk of these side effects must be weighed against the benefits of taking the drug. This is why drugs such as corticosteroids--which have many serious side effects--are reserved for severe cases of arthritis that have not responded to other medications. In such cases, the risks of the drug are outweighed by the benefits. In a less severe case, the risks of corticosteroids would be too great and other drugs could provide the same benefits with fewer side effects. Even something as simple as rest has a risk/benefit ratio. Arthritis victims should not overextend themselves and should get as much rest as possible, but too much rest and inactivity can cause joints to stiffen and immobilize. Medications The following medications are the ones most commonly used in the treatment of arthritis. Bear in mind that not all of these are used for all forms of arthritis. For example, gold salts and penicillamine are used in treating rheumatoid arthritis, but not for osteoarthritis. Gout calls for specialized drugs that reduce uric acid levels. You can be an informed drug consumer. If you ever have questions about your medications, ask your doctor or pharmacist. When your doctor prescribes a medication for you, make sure you know its name, whether it's a brand name or a generic name (for example, Bayer is a brand name for the generic aspirin). Make sure you know how often you should take the medication and how many pills or capsules to take each time. Some drugs must be taken on an empty stomach, while others should be taken with meals. Ask your doctor or pharmacist which way to take your medications. Your doctor should also discuss the side effects of your medications, so you'll know what to expect. ASPIRIN Don't be amazed if your physician prescribes aspirin (acetylsalicylic acid) for your arthritis. The majority of all cases of arthritis will respond to this inexpensive and easily available drug. Aspirin, which has been used to treat arthritis for more than 100 years, is a pain reliever and an anti-inflammatory medication. This means that while it relieves the discomfort in the joint, it also reduces the inflammation. Aspirin reduces fever. Your doctor may tell you to take more aspirin tablets than you are used to taking. The anti-inflammatory properties of aspirin are not effective at the dose you would take for a headache. Because you may be asked to take high doses of aspirin, your doctor may need to check the aspirin levels in your blood periodically. Large amounts of aspirin are helpful in treating arthritis, but too high a dose is toxic. When you buy aspirin, check the box to see how much of the drug is in each tablet. The usual strength for a regular tablet is 325 mg (milligrams) of aspirin. An "extra strength" tablet usually contains 650 milligrams. Your doctor will tell you how many tablets of which size to take. Store brand aspirin is the same product as brand name aspirin and will usually save you money. It is also usually cheaper to buy the largest bottle of aspirin tablets available. If a bottle has a "child-proof" top that you have trouble with, ask your pharmacist to put the tablets into an easy-open container, but be sure to keep all pill containers out of reach of children. If your aspirin tablets ever develop a vinegary odor, they may be too old. Throw them out and buy a new supply. Check the product you buy to see whether it contains other ingredients, such as caffeine. Some aspirin products (such as Bufferin and Ascriptin) contain small amounts of antacid, which may help if aspirin upsets your stomach. Others, such as Ecotrin, have a special coating. Talk to your doctor before switching products. Do not switch to a "nonaspirin" pain reliever, such as Tylenol or Datril, unless your doctor approves. These products contain acetaminophen, which is a pain reliever but not an anti-inflammatory agent. Your doctor may prescribe salicylates instead of aspirin. These drugs are close cousins of aspirin and have many of the same properties. But since lower doses of salicylates are needed, fewer tablets or capsules a day may provide the same benefits as aspirin. There are several salicylates on the market. Like all other drugs, aspirin and salicylates have side effects. Aspirin can irritate the lining of the stomach, causing an upset stomach or heartburn. Try taking aspirin with meals or with a glass of milk to protect the stomach a bit. Another common side effect from aspirin is ringing in the ears or a mild loss of hearing. Tell your doctor if you experience either of these, so he or she can check the level of aspirin in your blood. If the levels are correct, and if the problem isn't too annoying, you may be asked to simply tolerate the hearing problem. Aspirin also interferes with the clotting of blood; you may notice that you bruise more easily while taking aspirin. Aspirin will not be prescribed for anyone who has a problem with bleeding or is taking blood-thinning drugs. Some people are allergic to aspirin, and may react with an asthma attack, hives, runny nose or hay fever. These individuals should never take aspirin or salicylates. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS Aspirin and salicylates are part of a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). As their name suggests, these drugs reduce inflammation but are not related to the drugs known as steroids. Researchers believe that NSAIDs relieve pain and inflammation by blocking the action of chemicals in the body called prostaglandins. NSAIDs are chemically related to aspirin. A person who cannot tolerate the side effects of aspirin often will be able to take an NSAID with no problem. If you are allergic to aspirin, however, you may also be allergic to NSAIDs, so your doctor must exercise care in prescribing them. A major benefit of NSAIDs is that you can take fewer tablets per day and achieve the same effects as with aspirin. However, NSAIDs are usually far more expensive than aspirin, and since arthritis is a chronic disease and you might need to take medication for years, the expense could be a drawback. Except for the 200 mg size of ibuprofen, all NSAIDs are prescription drugs. Advil, Nuprin, Medipren and various store brands of ibuprofen are available without a prescription. The prescription-strength brands of ibuprofen are Motrin and Rufen. Generic ibuprofen is also available. Other names for NSAIDs (brand names are in parentheses) are piroxicam (Feldene), sulindac (Clinoril), indomethacin (Indocin), naproxen (Naprosyn), tolmetin (Tolectin) and fenoprofen (Nalfon). Each drug is different and may have different side effects, although for the most part the side effects of all NSAIDs are similar to those for aspirin. If you do experience side effects to one drug, your doctor may switch to another. Because every person with arthritis reacts differently to medications, it may take some time to find out which drug at which dose level is right for you. CORTICOSTEROIDS Corticosteroids are drugs that are related to cortisone, a chemical the body makes in the adrenal glands. These drugs suppress the symptoms of inflammation and allergy. When they were first used in 1949, they were hailed as miracles, but the side effects of corticosteroids were later found to be severe. Over the years, the proper use and dosage sizes of corticosteroids have been found for treating arthritis. The effects of corticosteroids can be amazing in reducing swelling and pain. But these drugs are still used very cautiously because of their side effects and are reserved for very severe cases of arthritis or bad flare-ups of the condition. Corticosteroids can be given orally or by injection. In severe cases of osteoarthritis, a corticosteroid may be injected directly into the involved joint. This type of injection minimizes the side effects of the drug, but the procedure cannot be done more than a few times into the same joint without the possibility of causing damage. A direct injection would be reserved for a painful, immobilized joint, and would reduce swelling for a time. During the time the injection is effective, an exercise program can be started that will keep the joint mobile. Because of the generalized nature of severe rheumatoid arthritis, oral corticosteroids may be prescribed. The side effects may include weight gain due to water retention, increased blood pressure and a depressed immune system. Long-term use of corticosteroids will also cause osteoporosis, weakening of the bones. If your doctor prescribes a corticosteroid drug, take it exactly as he or she tells you. Do not take more than the prescribed amount and do not stop taking the drug suddenly. Corticosteroids suppress the natural output of the adrenal glands and to suddenly stop taking them can cause a reaction. Your doctor will instruct you on how to lower the dose slowly when you need to stop. SPECIAL DRUGS FOR RHEUMATOID ARTHRITIS Researchers have created several drugs for use in treating rheumatoid arthritis, including gold salts, penicillamine and immunosuppressive drugs. These are all considered remissive drugs, because they can cause rheumatoid arthritis to subside for a while. Drugs normally used to treat malaria and cancer have also been found to be effective against rheumatoid arthritis. All of these drugs take a long time to show effect, however, so you may be taking them for months before seeing any improvement. If aspirin, NSAIDs and corticosteroids do not control rheumatoid arthritis, your doctor may prescribe the antimalarial drugs chloroquine or hydroxychloroquine; they may be added to NSAID therapy. However, these antimalarial drugs can cause damage to the retinas of the eyes, so you may be asked to go to an ophthalmologist for screening. Your doctor may decide to prescribe either gold salt injections or tablets. Gold salts take a long time to work and are not always effective. It may be several months before you and your doctor know whether gold salts will have any effect, so you must be patient. If injections are used, you can expect to require a weekly shot for up to six months. If treatment is effective and continues, you may need a shot only once or twice a month. Your doctor will test your blood regularly and watch you carefully for side effects. Side effects of gold salts injections include skin rashes, sores in the mouth, kidney problems and low blood counts. If there is a skin rash, it may be aggravated by exposure to sunlight. Because gold salts can be toxic, your doctor may treat you with small doses of gold salts for a week or two to test for a reaction. Bear in mind that many people who are put on gold salt therapy must give it up because of side effects. There is an oral form of gold salts called Ridaura. Here again, it may be months before there are any signs of the drug taking effect, or it may not be effective for you at all. Ridaura has fewer side effects than injections, but can cause severe diarrhea. Penicillamine is another remissive drug used for rheumatoid arthritis. It commonly produces the same side effects and toxic reaction that gold salts do, but can be used in some people who cannot take gold salts. Here again, the drug will probably take some time to show an effect. Immunosuppressive drugs are also used in some cases. These drugs suppress the immune system, and since it's the immune system that causes rheumatoid arthritis, the drugs can make the disease go into remission. However, they have many side effects, and since the entire immune system is suppressed, little is left to fight off colds and infections. Rest and exercise You may not consider rest and exercise to be therapy for arthritis, but they are both very important parts of your treatment. The two go hand in hand. Too much exercise can cause soreness and more inflammation, but too much rest can cause joints to stiffen. The right amounts of rest and exercise for you will depend on the severity of your condition, and your needs may change as your arthritis does. Resting must be as regular as exercising. Rest allows your muscles to relax. You don't have to lie down or take a nap. Simply sitting down and relaxing at some time during the day will help your joints and muscles recover from your activities. Your doctor may suggest that you take short walks daily or attend an exercise class on a regular basis. He or she may also recommend that you swim regularly. Swimming is an excellent way to stay limber, since the buoyancy of water takes some weight off your joints. You can either swim or exercise in the water. Besides keeping your joints in condition, regular exercise helps keep the rest of you fit. Exercise can help control weight, which in turn will reduce the stress on arthritic joints. Regular walking or swimming is also good for your cardiovascular health. Your doctor may also suggest that you perform special exercises every day. These will help keep your joints limber, or help loosen joints that have become immobile. The purpose of the exercises is to keep your body functioning as much as possible, while at the same time preventing further damage. A physical therapist can teach you some of these procedures and determine whether you're doing them correctly. If you have very severe arthritis, regular physical therapy sessions may be required, where the therapist helps you move your limbs to help keep them supple. SUGGESTED EXERCISES One easy but helpful exercise for the hands and ringers is to simply bend your wrist back and forth slowly several times, then make an "O" with your thumb and index finger. Make an "O" using the next finger, and touch each finger to your thumb five times. Repeat this with the other hand. Your doctor can recommend other hand and finger exercises as well. For your knees, sit comfortably in a straight-backed chair with your bare feet on the ground. Slowly raise your lower leg so that your whole leg is straight, then slowly lower it again. Do this with each leg several times a day. For the ankles, do the same exercise with one extra movement. Raise your lower leg until your leg is straight. Now bend your ankle until your foot points back at you and curl your toes back and forth. Point your foot away from you and curl your toes back and forth. Lower your leg slowly. Repeat this using the other foot and leg. (Always make sure you exercise both legs equally.) You may feel very stiff the first few times you do any exercises, but it's important to keep doing them. After a few weeks you will probably notice some improvement. If any exercise is painful or makes you feel uncomfortable, consult your doctor or physical therapist. Heat and cold treatments Your doctor may recommend that you use heat and cold to treat your arthritis. You may already know that a warm bath or shower helps ease your stiffness and aching for a while; it is a good way to relax your muscles. And because your body floats in water, a bath also takes some weight off your joints for a while. Hot packs, heating pads and hot-water bottles can also be helpful in easing pain. Be careful not to use too hot a setting and never sleep with a heating pad or rest on top of one. If you have a metal replacement joint, talk to your doctor before using any heating devices, because the metal within you may heat up. You may think cold would make arthritis worse, but cold treatments can sometimes case arthritis stiffness and pain. The cold seems to numb the joints and give some people a few pain-free hours. One method for cold treatment is to simply dip affected hands or feet into a pail of cold water. The water should not be so cold that it is a shock. Another arthritis therapy consists of combining the two treatments as a contrast bath. This is easiest done with the hands or feet. Just prepare two pails of water, one hot and one cold. Soak the pained joint in the hot water and then switch to the cold water. Surgery Surgery can be an option for someone suffering from arthritis that's so severe it has completely damaged a joint. Surgery used to be reserved for only the most severe cases, but now, with better techniques and materials, joint surgery is done earlier in the course of a disease and on younger individuals. Synovectomy is a procedure whereby some of the synovial fluid and membrane are removed. Another procedure involves opening up the joint and removing the diseased cartilage and bits of overgrown bone; this can reduce pain in the joint, but the relief may not be permanent. There are also procedures to fuse a joint to relieve pain, but unfortunately these also result in loss of motion of the joint. There are now surgical procedures for replacing hips, knuckles and knees. In some cases, joints can be repaired rather than replaced, using either new bone cements or pieces of bone from elsewhere in the body. Joint replacement has become a relatively common operation, but it is not without risk and may be more useful for certain forms of arthritis, such as osteoarthritis and rheumatoid arthritis. Bear in mind that a replacement joint does not last forever, and may need to be replaced after a number of years. Life expectancy for a replacement joint is now about 10 years. Replacement joints are made of metal or plastic pieces that are cemented into the natural bone when the diseased joint is removed. It is possible for the new joint to come loose, especially in an active person. This is why joint replacement is usually done in less active elderly people. A younger person might have to go through two or three replacements on the same joint over his or her lifetime. Infection is another risk of joint replacement. An infected replacement joint would have to be removed. Remember that no surgical procedure is risk-free. If surgery is being considered, you should sit down with your physician and the orthopedic surgeon who will perform the operation, and have them explain all of the pros and cons of the procedure. Joint protection If you have arthritis, your joints are your weak points and you must protect them. They are already under a certain amount of stress and there are ways that you can avoid adding more. As a general rule, use a stronger joint to protect a weaker one. If your hands are weak, don't carry things in them for long periods of time. For example, a woman might substitute a shoulder purse for a clutch purse. Push a door open with your shoulder or the side of your body rather than with your hands. Try not to sit or stand in one position for too long to avoid stiffening. Get into the habit of changing your body position every 15 to 20 minutes. Make your work areas work for you. Organize the kitchen or office so that most items you need are within easy reach. Make sure your work surfaces are at a comfortable height. Sit whenever you can, including while ironing or doing office work. Even better, sit in an office chair with wheels and move around your work space in that. If you must push with your hands, do it right. Don't compress your fingers under your hand, because this puts pressure on your knuckles. If you are pushing up from a chair, for example, let your ringers hang over the edge and push up with your palm. Devices to make life easier There are many aids and devices you can use to make life a little easier. Some can be bought and some can easily be made to help you do your work and live independently. Attach straps to drawers so you can put an arm through and pull with your forearm rather than using your hands. Use a button hook to help with buttons. Put a paper clip into a zipper-pull to make it larger and easier to handle. Doorknobs can be replaced with levers. Faucets and toilet handles can be replaced with larger ones or built up so that they are easier to use. Put a handle or grip bar on the edge of the bathtub to make it easier to get in and out. Black foam padding that is adhesive on one side (normally used as pipe insulation) can be added to pencils and toothbrushes to make them larger and easier to handle. A regular clip clothespin can be attached to the controls of small appliances to make them easier to turn. The Arthritis Foundation publishes a list of helpful devices and hints for people with arthritis; the address of the Arthritis Foundation is at the end of this booklet. Sex and arthritis Any long-term ailment will have an effect on a person's sex life, and arthritis is no exception. Arthritis can cause pain and discomfort, can limit movement, and can change the way you feel about your body. All of these changes may interfere with sexual enjoyment, but that doesn't mean that your sex life is over. People with arthritis can have an enjoyable, satisfying life, that includes sex. One of the oldest myths around is that somehow older people, especially those with arthritis, either should not have or will not enjoy sex. This simply is not so. Sex can be a wonderful way to release tension and frustration while communicating with your loved one. Communicating is a key word. Talk with your loved one about your needs and how you feel. Part of communicating will include the two of you accepting the changes that have happened in your body. If you feel resentful and angry over your illness and how it has changed you, do not assume that your partner feels the same way or has rejected you. Be aware that your loved one may fear that hugging you or holding you too tightly may hurt you. Make sure he or she knows how you feel. In order to keep sex a vital part of your relationship, try planning ahead. Plan to make love at a time of day when you are less tired or sore and take a pain reliever earlier to ensure that it will provide greatest relief at the right time. If a hot shower or bath loosens up your joints and helps you relax, take one before you retire to the bedroom. Quackery Arthritis is a disease that has no cure. People with arthritis spend a lot of money for medical care, and, unfortunately, a lot of money is spent on unproven and worthless remedies as well. The Arthritis Foundation estimates that almost $2 billion is spent yearly on quack medicines and therapies. Sadly, people with arthritis are easy to exploit. Too many people who have aching joints doctor themselves. Because arthritis tends to come and go naturally, a person who puts on a copper bracelet and feels better thinks the bracelet had something to do with it. The only benefit you can get from wearing copper jewelry is if it looks nice on your wrist. Often, dishonest merchants look for ways to make a buck by selling an arthritis cure. They may sell herbal remedies by mail that contain nothing more than a little aspirin, and they may back up their claims with "testimonials" from people who have been cured. The pills you receive won't help you, and will definitely hurt you in the wallet. Remember, if a remedy or therapy looks too good to be true, it probably is. Never believe anyone who says a drug is completely safe. Nothing is completely risk-free. If you ever have any questions about remedies or therapies that you read about in magazines, talk to your doctor. It is a talk that will probably save you some time and money. Always consult your doctor Arthritis, a chronic disease that affects many people and causes much suffering, is the constant focus of research and investigations. New therapies and new medicines to deal with arthritis are being developed even as I write this booklet. Every effort has been made to give you the very latest information about this disease and to offer ideas and suggestions of a practical nature that can help arthritis patients deal with their affliction. Nonetheless, it is possible, even probable that new developments will occur as the weeks progress. It is therefore essential that you continue to consult your private physician, so that you may benefit from the latest therapies or discoveries and receive the personalized treatment that is most effective in your case and deals with your special problems and needs. More help is available The Arthritis Foundation can provide more information about osteoarthritis, as well as self-help guides and publications that tell you where to buy devices to help you perform daily tasks when stiff joints make bending difficult. The foundation can also put you in touch with other people with similar problems. Support groups offer a sympathetic ear when you're feeling depressed or frustrated, as well as encouragement to stick with your treatment program. Look in the phone book for your local chapter of the Arthritis Foundation, or contact the national organization at 1314 Spring St., NW, Atlanta, Ga. 30309. Telephone: (404) 872-7100. The National Rehabilitation Information Center (NARIC) is government funded and provides broad-based information and referral services, as well as computer searches, for a nominal charge. Telephone: 1-800-34-NARIC. The Arthritis Information Service of Alabama is a community program jointly sponsored by The Multipurpose Arthritis Center of the University of Alabama and the National Institutes of Health. Call toll-free: 1-800-345-6780 Glossary Ankylosing spondylitis--a form of arthritis of the joints of the spine that can cause these joints to fuse or grow together. Arthritis--inflammation of a joint. Autoimmune disease--a disease in which the body's immune system is out of control and attacking healthy tissue. Bursae--small sacs of fluid that keep muscles, bones, ligaments and tendons from rubbing and that help absorb shocks. Bursitis--inflammation of a bursa. Cartilage--rubbery or plastic-like material that covers the ends of bones and prevents them from rubbing and absorbs shock. Chronic disease--one that lasts for years and has no cure. Flare or flare-up--an episode in which symptoms either reappear or become worse. Gout--a disease in which the body produces too much uric acid, which forms into crystals and collects in joints. This leads to attacks of painful arthritis. Immune system--the natural defense system of the body against disease or injury. Inflammation--a normal reaction of the body to injury or disease, in which swelling, pain, redness and warmth occurs in the area affected. Joint--a point in the body where two bones meet. Juvenile arthritis--any of several forms of arthritis that occur in children. Ligament--a strong cord-like material that connects bones to each other. Osteoarthritis--the chronic breakdown of cartilage in certain joints; it is the most common form of arthritis and may be due to wear and tear. Remission--a period in which symptoms of a disease are reduced or disappear for a time. Rheumatic disease--diseases that affect muscles, ligaments, tendons, joints and sometimes other organs. Rheumatoid arthritis--an autoimmune form of arthritis that causes inflammation in the joints and may cause systems problems as well. Systemic disease--one that can affect the entire body rather than just one area. Systemic lupus erythematosus--a disease that affects the joints as well as skin, muscles and other parts of the body. Tendinitis--an inflammation of a tendon. Tendon--a strong cord-like material that connects muscles to bones. Uric acid--a chemical naturally formed in the body that, in gout, forms into crystals that collect in the joints and cause pain and damage. ------------------------------------------------------------------------------ ACKNOWLEDGMENT: Research by Valerie DeBenedette; technical review by Dr. Gabriel Zatlin. For additional copies of Arthritis, send $2.75 to Arthritis, P.O. Box 4406, Orlando, Fla. 32802-4406. Make checks payable to Newspaperbooks. Multiple copy discounts are available. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.