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Questions and Answers About
Arthritis and Rheumatic Diseases
This fact sheet answers basic
questions about arthritis and rheumatic diseases. The National Institute of
Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has other fact
sheets and booklets that provide more information about specific forms of
arthritis and rheumatic diseases. NIAMS also has information about exercise
and arthritis, pain and arthritis, and diet and arthritis.
If you have further questions after
reading this information, you may wish to discuss them with your doctor.
What Are Rheumatic Diseases and What
Is Arthritis?
Rheumatic diseases are characterized
by inflammation (signs are redness and/or heat, swelling, and pain) and loss
of function of one or more connecting or supporting structures of the body.
They especially affect joints, tendons, ligaments, bones, and muscles.
Common symptoms are pain, swelling, and stiffness. Some rheumatic diseases
can also involve internal organs. There are more than 100 rheumatic
diseases.
Many people use the word "arthritis"
to refer to all rheumatic diseases. However, the word literally means joint
inflammation. The many different kinds of arthritis comprise just a portion
of the rheumatic diseases. Some rheumatic diseases are described as
connective tissue diseases because they affect the supporting framework of
the body and its internal organs. Others are known as autoimmune diseases
because they occur when the immune system, which normally protects the body
from infection and disease, harms the body's own healthy tissues. Throughout
this fact sheet the terms "arthritis" and "rheumatic diseases" are sometimes
used interchangeably.
Examples of Rheumatic Diseases
- Osteoarthritis--This is the most common type of
arthritis, affecting an estimated 21 million adults in the United States.
Osteoarthritis primarily affects cartilage, which is the tissue that
cushions the ends of bones within the joint. In osteoarthritis, the
cartilage begins to fray and may entirely wear away. Osteoarthritis can
cause joint pain and stiffness. Disability results most often when the
disease affects the spine and the weight-bearing joints (the knees and
hips).
- Rheumatoid arthritis--This inflammatory disease
of the synovium, or lining of the joint, results in pain, stiffness,
swelling, joint damage, and loss of function of the joints. Inflammation
most often affects joints of the hands and feet and tends to be
symmetrical (occurring equally on both sides of the body). This symmetry
helps distinguish rheumatoid arthritis from other forms of the disease.
About 1 percent of the U.S. population (about 2.1 million people) has
rheumatoid arthritis.
- Juvenile rheumatoid arthritis--This is the most
common form of arthritis in childhood, causing pain, stiffness, swelling,
and loss of function of the joints. The arthritis may be associated with
rashes or fevers, and may affect various parts of the body.
- Fibromyalgia--Fibromyalgia is a chronic disorder
that causes pain throughout the tissues that support and move the bones
and joints. Pain, stiffness, and localized tender points occur in the
muscles and tendons, particularly those of the neck, spine, shoulders, and
hips. Patients may also experience fatigue and sleep disturbances.
- Systemic lupus erythematosus--Systemic lupus
erythematosus (also known as lupus or SLE) is an autoimmune disease in
which the immune system harms the body's own healthy cells and tissues.
This can result in inflammation of and damage to the joints, skin,
kidneys, heart, lungs, blood vessels, and brain.
- Scleroderma--Also known as systemic sclerosis,
scleroderma means literally "hard skin." The disease affects the skin,
blood vessels, and joints. It may also affect internal organs, such as the
lungs and kidneys. In scleroderma, there is an abnormal and excessive
production of collagen (a fiber-like protein) in the skin or internal
organs.
- Spondyloarthropathies--This group of rheumatic
diseases principally affects the spine. One common form--ankylosing
spondylitis--not only affects the spine, but may also affect the hips,
shoulders, and knees as the tendons and ligaments around the bones and
joints become inflamed, resulting in pain and stiffness. Ankylosing
spondylitis tends to affect people in late adolescence or early adulthood.
Reactive arthritis, sometimes called Reiter's syndrome, is another
spondyloarthropathy. It develops after an infection involving the lower
urinary tract, bowel, or other organ and is commonly associated with eye
problems, skin rashes, and mouth sores.
- Gout--This type of arthritis results from
deposits of needle-like crystals of uric acid in the joints. The crystals
cause inflammation, swelling, and pain in the affected joint, which is
often the big toe.
- Infectious arthritis--This is a general term
used to describe forms of arthritis that are caused by infectious agents,
such as bacteria or viruses. Parvovirus arthritis and gonococcal arthritis
are examples of infectious arthritis. Arthritis symptoms may also occur in
Lyme disease, which is caused by a bacterial infection following the bite
of certain ticks. In those cases of arthritis caused by bacteria, early
diagnosis and treatment with antibiotics are crucial to get rid of the
infection and minimize damage to the joints.
- Polymyalgia rheumatica--Because this disease
involves tendons, muscles, ligaments, and tissues around the joint,
symptoms often include pain, aching, and morning stiffness in the
shoulders, hips, neck, and lower back. It is sometimes the first sign of
giant cell arteritis, a disease of the arteries characterized by
inflammation, weakness, weight loss, and fever.
- Polymyositis--This is a rheumatic disease that
causes inflammation and weakness in the muscles. The disease may affect
the whole body and cause disability.
- Psoriatic arthritis--This form of arthritis
occurs in some patients with psoriasis, a scaling skin disorder. Psoriatic
arthritis often affects the joints at the ends of the fingers and toes and
is accompanied by changes in the fingernails and toenails. Back pain may
occur if the spine is involved.
- Bursitis--This condition involves inflammation
of the bursae, small, fluid-filled sacs that help reduce friction between
bones and other moving structures in the joints. The inflammation may
result from arthritis in the joint or injury or infection of the bursae.
Bursitis produces pain and tenderness and may limit the movement of nearby
joints.
- Tendinitis (Tendonitis)--This condition refers
to inflammation of tendons (tough cords of tissue that connect muscle to
bone) caused by overuse, injury, or a rheumatic condition. Tendinitis
produces pain and tenderness and may restrict movement of nearby joints.
What Causes Rheumatic Disease?
Scientists are studying risk factors
that increase the likelihood of developing a rheumatic disease. Some of
these factors have been identified. For example, in osteoarthritis,
inherited cartilage weakness or excessive stress on the joint from repeated
injury may play a role. In lupus, rheumatoid arthritis, and scleroderma, the
combination of genetic factors that determine susceptibility and
environmental triggers are believed to be important. Family history also
plays a role in some diseases such as gout and ankylosing spondylitis.
Gender is another factor in some
rheumatic diseases. Lupus, rheumatoid arthritis, scleroderma, and
fibromyalgia are more common among women. (See next section for details.)
This indicates that hormones or other male-female differences may play a
role in the development of these conditions.
Who Is Affected by Arthritis and
Rheumatic Conditions?
An estimated 43 million people in the
United States have arthritis or other rheumatic conditions. By the year
2020, this number is expected to reach 60 million. Rheumatic diseases are
the leading cause of disability among adults age 65 and older.
Rheumatic diseases affect people of
all races and ages. Some rheumatic conditions are more common among certain
populations. For example:
- Rheumatoid arthritis occurs two to three times
more often in women than in men.
- Scleroderma is more common in women than in men.
- Nine out of 10 people who have lupus are women.
- Nine out of 10 people who have fibromyalgia are
women.
- Gout is more common in men than in women.
- Lupus is three times more common in African
American women than in Caucasian women.
- Ankylosing spondylitis is more common in men
than in women.
What Are the Symptoms of Arthritis?
Different types of arthritis have
different symptoms. In general, people who have arthritis feel pain and
stiffness in the joints. Some of the more common symptoms are listed in the
box. Early diagnosis and treatment help decrease further joint damage and
help control symptoms of arthritis and many other rheumatic diseases.
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Common Symptoms of Arthritis
- Swelling in one or more joints
- Stiffness around the joints that lasts for
at least 1 hour in the early morning
- Constant or recurring pain or tenderness in
a joint
- Difficulty using or moving a joint normally
- Warmth and redness in a joint
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How Are Rheumatic Diseases
Diagnosed?
Diagnosing rheumatic diseases can be
difficult because some symptoms and signs are common to many different
diseases. A general practitioner or family doctor may be able to evaluate a
patient or refer him or her to a rheumatologist (a doctor who specializes in
treating arthritis and other rheumatic diseases).
The doctor will review the patient's
medical history, conduct a physical examination, and obtain laboratory tests
and x rays or other imaging tests. The doctor may need to see the patient
more than once to make an accurate diagnosis.
Medical History
It is vital for people with joint pain
to give the doctor a complete medical history. Answers to the following
questions will help the doctor make an accurate diagnosis:
- Is the pain in one or more joints?
- When does the pain occur?
- How long does the pain last?
- When did you first notice the pain?
- What were you doing when you first noticed the
pain?
- Does activity make the pain better or worse?
- Have you had any illnesses or accidents that may
account for the pain?
- Is there a family history of any arthritis or
other rheumatic disease?
- What medicine(s) are you taking?
Because rheumatic diseases are so
diverse and sometimes involve several parts of the body, the doctor may ask
many other questions.
It may be helpful for people to keep a
daily journal that describes the pain. Patients should write down what the
affected joint looks like, how it feels, how long the pain lasts, and what
they were doing when the pain started.
Physical Examination and Laboratory
Tests
The doctor will examine the patient's
joints for redness, warmth, damage, ease of movement, and tenderness.
Because some forms of arthritis, such as lupus, may affect other organs, a
complete physical examination that includes the heart, lungs, abdomen,
nervous system, eyes, ears, and throat may be necessary. The doctor may
order some laboratory tests to help confirm a diagnosis. Samples of blood,
urine, or synovial fluid (lubricating fluid found in the joint) may be
needed for the tests.
Common laboratory tests and
procedures include the following:
Antinuclear antibody (ANA)--This test
checks blood levels of antibodies that are often present in people who have
connective tissue diseases or other autoimmune disorders, such as lupus.
Since the antibodies react with material in the cell's nucleus (control
center), they are referred to as antinuclear antibodies. There are also
tests for individual types of ANAs that may be more specific to people with
certain autoimmune disorders. ANAs are also sometimes found in people who do
not have an autoimmune disorder. Therefore, having ANAs in the blood does
not necessarily mean that a person has a disease.
C-reactive protein test--This is a
nonspecific test used to detect generalized inflammation. Levels of the
protein are often increased in patients with active disease such as
rheumatoid arthritis, and may decline when corticosteroids or nonsteroidal
anti-inflammatory drugs (NSAIDs) are used to reduce inflammation.
Complement--This test measures the
level of complement, a group of proteins in the blood. Complement helps
destroy foreign substances, such as germs, that enter the body. A low blood
level of complement is common in people who have active lupus.
Complete blood count (CBC)--This test
determines the number of white blood cells, red blood cells, and platelets
present in a sample of blood. Some rheumatic conditions or drugs used to
treat arthritis are associated with a low white blood count (leukopenia),
low red blood count (anemia), or low platelet count (thrombocytopenia). When
doctors prescribe medications that affect the CBC, they periodically test
the patient's blood.
Creatinine--This blood test is
commonly ordered in patients who have a rheumatic disease, such as lupus, to
monitor for underlying kidney disease. Creatinine is a breakdown product of
creatine, which is an important component of muscle. It is excreted from the
body entirely by the kidneys, and the level remains constant and normal when
kidney function is normal.
Erythrocyte sedimentation rate (sed
rate)--This blood test is used to detect inflammation in the body. Higher
sed rates indicate the presence of inflammation and are typical of many
forms of arthritis, such as rheumatoid arthritis and ankylosing spondylitis,
and many of the connective tissue diseases.
Hematocrit (PCV, packed cell
volume)--This test and the test for hemoglobin (a substance in the red blood
cells that carries oxygen throughout the body) measure the number of red
blood cells present in a sample of blood. A decrease in the number of red
blood cells (anemia) is common in people who have inflammatory arthritis or
another rheumatic disease.
Rheumatoid factor--This test detects
the presence of rheumatoid factor, an antibody found in the blood of most
(but not all) people who have rheumatoid arthritis. Rheumatoid factor may be
found in many diseases besides rheumatoid arthritis, and sometimes in people
without health problems.
Synovial fluid examination--Synovial
fluid may be examined for white blood cells (found in patients with
rheumatoid arthritis and infections), bacteria or viruses (found in patients
with infectious arthritis), or crystals in the joint (found in patients with
gout or other types of crystal-induced arthritis). To obtain a specimen, the
doctor injects a local anesthetic, then inserts a needle into the joint to
withdraw the synovial fluid into a syringe. The procedure is called
arthrocentesis or joint aspiration.
Urinalysis--In this test, a urine
sample is studied for protein, red blood cells, white blood cells, and
bacteria. These abnormalities may indicate kidney disease, which may be seen
in several rheumatic diseases, including lupus. Some medications used to
treat arthritis can also cause abnormal findings on urinalysis.
White blood cell count (WBC)--This
test determines the number of white blood cells present in a sample of
blood. The number may increase as a result of infection or decrease in
response to certain medications or in certain diseases, such as lupus. Low
numbers of white blood cells increase a person's risk of infections.
X Rays and Other Imaging Procedures
To see what the joint looks like
inside, the doctor may order x rays or other imaging procedures. X rays
provide an image of the bones, but they do not show cartilage, muscles, and
ligaments. Other noninvasive imaging methods such as computed tomography (CT
or CAT scan), magnetic resonance imaging (MRI), and arthrography show the
whole joint. The doctor may look for damage to a joint by using an
arthroscope, a small, flexible tube which is inserted through a small
incision at the joint and which transmits the image of the inside of a joint
to a video screen.
What Are the Treatments?
Treatments for rheumatic diseases
include rest and relaxation, exercise, proper diet, medication, and
instruction about the proper use of joints and ways to conserve energy.
Other treatments include the use of pain relief methods and assistive
devices, such as splints or braces. In severe cases, surgery may be
necessary. The doctor and the patient work together to develop a treatment
plan that helps the patient maintain or improve his or her lifestyle.
Treatment plans usually combine several types of treatment and vary
depending on the rheumatic condition and the patient.
Rest, Exercise, and Diet
People who have a rheumatic disease
should develop a comfortable balance between rest and activity. One sign of
many rheumatic conditions is fatigue. Patients must pay attention to signals
from their bodies. For example, when experiencing pain or fatigue, it is
important to take a break and rest. Too much rest, however, may cause
muscles and joints to become stiff.
People with a rheumatic disease such
as arthritis can participate in a variety of sports and exercise programs.
Physical exercise can reduce joint pain and stiffness and increase
flexibility, muscle strength, and endurance. It also helps with weight
reduction and contributes to an improved sense of well-being. Before
starting any exercise program, people with arthritis should talk with their
doctor. Exercises that doctors often recommend include:
- Range-of-motion exercises (e.g., stretching,
dance) to help maintain normal joint movement, maintain or increase
flexibility, and relieve stiffness.
- Strengthening exercises (e.g., weight lifting)
to maintain or increase muscle strength. Strong muscles help support and
protect joints affected by arthritis.
- Aerobic or endurance exercises (e.g., walking,
bicycle riding) to improve cardiovascular fitness, help control weight,
and improve overall well-being. Studies show that aerobic exercise can
also reduce inflammation in some joints.
Another important part of a treatment
program is a well-balanced diet. Along with exercise, a well-balanced diet
helps people manage their body weight and stay healthy. Weight control is
important to people who have arthritis because extra weight puts extra
pressure on some joints and can aggravate many types of arthritis. Diet is
especially important for people who have gout. People with gout should avoid
alcohol and foods that are high in purines, such as organ meats (liver,
kidney), sardines, anchovies, and gravy.
Medications
A variety of medications are used to
treat rheumatic diseases. The type of medication depends on the rheumatic
disease and on the individual patient. The medications used to treat most
rheumatic diseases do not provide a cure, but rather limit the symptoms of
the disease. Infectious arthritis and gout are exceptions if medications are
used properly. Another example is Lyme disease, caused by the bite of
certain ticks, where symptoms of arthritis may be prevented or may disappear
if the infection is caught early and treated with antibiotics.
Medications commonly used to treat
rheumatic diseases provide relief from pain and inflammation. In some cases,
the medication may slow the course of the disease and prevent further damage
to joints or other parts of the body.
The doctor may delay using medications
until a definite diagnosis is made because medications can hide important
symptoms (such as fever and swelling) and thereby interfere with diagnosis.
Patients taking any medication, either prescription or over-the-counter,
should always follow the doctor's instructions. The doctor should be
notified immediately if the medicine is making the symptoms worse or causing
other problems, such as an upset stomach, nausea, or headache. The doctor
may be able to change the dosage or medicine to reduce these side effects.
Analgesics (pain relievers) such as
acetaminophen (Tylenol)* and nonsteroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen are used to reduce the pain caused by many rheumatic
conditions. NSAIDs have the added benefit of decreasing the inflammation
associated with arthritis. A common side effect of NSAIDs is stomach
irritation, which can often be reduced by changing the dosage or medication.
New NSAIDs, including celecoxib (Celebrex), were introduced to reduce
gastrointestinal side effects and offer additional options for treatment.
However, even new medications are occasionally associated with reactions
ranging from mild to severe, and their long-term effects are still being
studied. The dosage will vary depending on the particular illness and the
overall health of the patient. The doctor and patient must work together to
determine which analgesic to use and the appropriate amount. If analgesics
do not ease the pain, the doctor may use other medications.
* Brand names included in this fact
sheet are provided as examples only, and their inclusion does not mean that
these products are endorsed by the National Institutes of Health or any
other Government agency. Also, if a particular brand name is not mentioned,
this does not mean or imply that the product is unsatisfactory.
Depending on the type of arthritis, a
person may be asked to take a disease-modifying antirheumatic drug (DMARD).
This category includes several unrelated medications that are intended to
slow or prevent damage to the joint and thereby prevent disability and
discomfort. DMARDs include methotrexate, sulfasalazine, and leflunomide (Arava).
Biological response modifiers are new
drugs used for the treatment of rheumatoid arthritis. They can help reduce
inflammation and structural damage of the joints by blocking the reaction of
a substance called tumor necrosis factor, a protein involved in immune
system response. These drugs include etanercept (Enbrel), infliximab (Remicade),
and anakinra (Kineret).
Corticosteroids, such as prednisone,
cortisone, solumedrol, and hydrocortisone, are used to treat many rheumatic
conditions because they decrease inflammation and suppress the immune
system. The dosage of these medications will vary depending on the diagnosis
and the patient. Again, the patient and doctor must work together to
determine the right amount of medication.
Corticosteroids can be given by mouth,
in creams applied to the skin, or by injection. Short-term side effects of
corticosteroids include swelling, increased appetite, weight gain, and
emotional ups and downs. These side effects generally stop when the drug is
stopped. It can be dangerous to stop taking corticosteroids suddenly, so it
is very important that the doctor and patient work together when changing
the corticosteroid dose. Side effects that may occur after long-term use of
corticosteroids include stretch marks, excessive hair growth, osteoporosis,
high blood pressure, damage to the arteries, high blood sugar, infections,
and cataracts.
Hyaluronic acid products like Hyalgan
and Synvisc mimic a naturally occurring body substance that lubricates the
knee joint. They are usually injected directly into the joint to help
provide temporary relief of pain and flexible joint movement.
Devices Used in Treatment
Transcutaneous electrical nerve
stimulation (TENS) has been found effective in modifying pain perception.
TENS blocks pain messages to the brain with a small device that directs mild
electric pulses to nerve endings that lie beneath the painful area of the
skin.
A blood-filtering device called the
Prosorba Column is used in some health care facilities for filtering out
harmful antibodies in people with severe rheumatoid arthritis.
Heat and Cold Therapies
Heat and cold can both be used to
reduce the pain and inflammation of arthritis. The patient and doctor can
determine which one works best.
Heat therapy increases blood flow,
tolerance for pain, and flexibility. Heat therapy can involve treatment with
paraffin wax, microwaves, ultrasound, or moist heat. Physical therapists are
needed for some of these therapies, such as microwave or ultrasound therapy,
but patients can apply moist heat themselves. Some ways to apply moist heat
include placing warm towels or hot packs on the inflamed joint or taking a
warm bath or shower.
Cold therapy numbs the nerves around
the joint (which reduces pain) and may relieve inflammation and muscle
spasms. Cold therapy can involve cold packs, ice massage, soaking in cold
water, or over-the-counter sprays and ointments that cool the skin and
joints.
Capsaicin cream is a preparation put
on the skin to relieve joint or muscle pain when only one or two joints are
involved.
Hydrotherapy, Mobilization Therapy,
and Relaxation Therapy
Hydrotherapy involves exercising or
relaxing in warm water. The water takes some weight off painful joints,
making it easier to exercise. It helps relax tense muscles and relieve pain.
Mobilization therapies include
traction (gentle, steady pulling), massage, and manipulation. (Someone other
than the patient moves stiff joints through their normal range of motion.)
When done by a trained professional, these methods can help control pain,
increase joint motion, and improve muscle and tendon flexibility.
Relaxation therapy helps reduce pain
by teaching people various ways to release muscle tension throughout the
body. In one method of relaxation therapy, known as progressive relaxation,
the patient tightens a muscle group and then slowly releases the tension.
Doctors and physical therapists can teach patients a variety of relaxation
techniques.
Assistive Devices
The most common assistive devices for
treating arthritis pain are splints and braces, which are used to support
weakened joints or allow them to rest. Some of these devices prevent the
joint from moving; others allow some movement. A splint or brace should be
used only when recommended by a doctor or therapist, who will show the
patient the correct way to put the device on, ensure that it fits properly,
and explain when and for how long it should be worn. The incorrect use of a
splint or brace can cause joint damage, stiffness, and pain.
A person with arthritis can use other
kinds of devices to ease the pain. For example, the use of a cane when
walking can reduce some of the weight placed on a knee or hip affected by
arthritis. A shoe insert (orthotic) can ease the pain of walking caused by
arthritis of the foot or knee. Other devices can help with activities such
as opening jars, closing zippers, and holding pencils.
Surgery
Surgery may be required to repair
damage to a joint after injury or to restore function or relieve pain in a
joint damaged by arthritis. The doctor may recommend arthroscopic surgery,
bone fusion (surgery in which bones in the joint are fused or joined
together), or arthroplasty (also known as total joint replacement, in which
the damaged joint is removed and replaced with an artificial one).
Nutritional Supplements
Nutritional supplements are often
reported as helpful in treating rheumatic diseases. These include products
such as S-adenosylmethionine (SAM-e) for osteoarthritis and fibromyalgia,
dehydroepiandrosterone (DHEA) for lupus, and glucosamine and chondroitin
sulfate for osteoarthritis. Reports on the safety and effectiveness of these
products should be viewed with caution since very few claims have been
carefully evaluated.
Myths About Treating Arthritis
At this time, the only type of
arthritis that can be cured is that caused by infections. Although symptoms
of other types of arthritis can be effectively managed with rest, exercise,
and medication, there are no cures. Some people claim to have been cured by
treatment with herbs, oils, chemicals, special diets, radiation, or other
products. However, there is no scientific evidence that such treatments cure
arthritis. Moreover, some may lead to serious side effects. Patients should
talk to their doctor before using any therapy that has not been prescribed
or recommended by the health care team caring for the patient.
Work With Your Doctor To Limit Your
Pain
The role you play in planning your
treatment is very important. It is vital for you to have a good relationship
with your doctor in order to work together. You should not be afraid to ask
questions about your condition or treatment. You must understand the
treatment plan and tell the doctor whether or not it is helping you.
Research has shown that patients who are well informed and participate
actively in their own care experience less pain and make fewer visits to the
doctor.
What Can Be Done To Help?
Studies show that an estimated 18
percent of Americans who have arthritis or other rheumatic conditions
believe that their condition limits their activities. People with arthritis
may find that they can no longer participate in some of their favorite
activities, which can affect their overall well-being. Even when arthritis
impairs only one joint, a person may have to change many daily activities to
protect that joint from further damage and reduce pain. When arthritis
affects the entire body, as it does in people with rheumatoid arthritis or
fibromyalgia, many daily activities have to be changed to deal with pain,
fatigue, and other symptoms.
Changes in the home may help a person
with chronic arthritis continue to live safely, productively, and with less
pain. People with arthritis may become weak, lose their balance, or fall. In
the bathroom, installing grab bars in the tub or shower and by the toilet,
placing a secure seat in the tub, and raising the height of the toilet seat
can help. Special kitchen utensils can accommodate hands affected by
arthritis to make meal preparation easier. An occupational therapist can
help people who have rheumatic conditions identify and make adjustments in
their homes to create a safer, more comfortable, and more efficient
environment.
Friends and family members can help a
patient with a rheumatic condition by learning about that condition and
understanding how it affects the patient's life. Friends and family can
provide emotional and physical assistance. Their support, as well as support
from other people who have the same disease, can make it easier to cope. The
Arthritis Foundation has a wealth of information to help people with
arthritis. (See the list of resources.)
What Research Is Being Done on
Arthritis?
The National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS), a part of the National
Institutes of Health (NIH), leads the Federal medical research effort in
arthritis and rheumatic diseases. The NIAMS sponsors research and research
training on the NIH campus in Bethesda, Maryland, and at universities and
medical centers throughout the United States. Research activities include
both basic (laboratory) and clinical (involving patients) research studies
to better understand what causes these conditions and how best to treat and
prevent them.
The NIAMS currently supports three
types of research centers that study arthritis, rheumatic diseases, and
other musculoskeletal conditions: Multidisciplinary Clinical Research
Centers (MCRCs), Specialized Centers of Research (SCORs), and Core Centers.
A list of these centers and their locations can be obtained from the
Institute (listed at the end of this fact sheet).
The MCRCs are programs that focus on
clinical research designed to assess and improve outcomes for patients
affected by arthritis and other rheumatic diseases, musculoskeletal
disorders (including bone and muscle diseases), and skin diseases. Each
center studies one or more of the diseases within the NIAMS mission and
provides resources for developing clinical projects using more than one
approach.
Each SCOR focuses on a single disease.
Currently, rheumatoid arthritis, systemic lupus erythematosus,
osteoarthritis, osteoporosis, and scleroderma are being studied. Combining
laboratory and clinical studies under one roof speeds up research on the
causes of these diseases and hastens transfer of advances from the
laboratory to the bedside to improve patient care.
Core Centers promote interdisciplinary
collaborative efforts among scientists doing high-quality research related
to a common theme. By providing funding for facilities, pilot and
feasibility studies, and program enrichment activities at the Core Center,
the Institute reinforces investigations already underway in NIAMS program
areas. Current centers include Rheumatic Diseases Research Core Centers,
Skin Disease Research Core Centers, and Core Centers for Musculoskeletal
Disorders.
Research registries provide a means
for collecting clinical, demographic, and laboratory information from
patients and, sometimes, their relatives. These registries facilitate
studies that could ultimately lead to improved diagnosis, treatment, and
prevention. NIAMS currently supports research registries for rheumatoid
arthritis, antiphospholipid syndrome (an autoimmune disorder), ankylosing
spondylitis, lupus and neonatal lupus, scleroderma, juvenile rheumatoid
arthritis, and juvenile dermatomyositis.
Some current NIAMS research efforts in
rheumatic diseases are outlined below.
Biomarkers
Recent scientific breakthroughs in
basic research have provided new information about what happens to the
body's cells and other structures as rheumatic diseases progress. Biomarkers
(laboratory and imaging signposts that detect disease) help researchers
determine the likelihood that a person will develop a specific disease and
its possible severity and outcome. Biomarkers have the potential to lead to
novel and more effective ways to predict and monitor disease activity and
responses to treatment. The NIAMS supports research on biomarkers for
rheumatic and skin diseases, including a new initiative on osteoarthritis.
Additional studies on specific rheumatic diseases follow.
Rheumatoid Arthritis
Researchers are trying to identify the
cause of rheumatoid arthritis in order to develop better and more specific
treatments. They are examining the role that the endocrine (hormonal),
nervous, and immune systems play, and the ways in which these systems
interact with environmental and genetic factors in the development of
rheumatoid arthritis. Some scientists are trying to determine whether an
infectious agent triggers rheumatoid arthritis. Others are studying the role
of certain enzymes (specialized proteins in the body that spark biochemical
reactions) in breaking down cartilage. Researchers are also trying to
identify the genetic factors that place some people at higher risk than
others for developing rheumatoid arthritis.
Moreover, scientists are looking at
new ways to treat rheumatoid arthritis. They are experimenting with new
drugs and "biologic agents" that selectively block certain immune system
activities associated with inflammation. Newly developed drugs include
etanercept (Enbrel) and infliximab (Remicade). Followup studies show promise
for their effectiveness in slowing disease progression. Studies for
additional new drugs continue. Other investigators have shown that
minocycline and doxycycline, two antibiotic medications in the tetracycline
family, have a modest benefit for people with rheumatoid arthritis. Research
continues in this area.
Novel studies using imaging
technologies are underway as well. These techniques help identify targets
for new drugs by allowing researchers to see changes in cells during the
disease process.
Osteoarthritis
The NIAMS has embarked on several
innovative approaches to understand the causes and identify effective
treatment and prevention methods for osteoarthritis. Through a public/
private partnership, researchers are identifying biomarkers for
osteoarthritis to help develop and test new drugs. Imaging studies designed
to better identify joint disorders and assess their progression are taking
place as well.
The National Center for Complementary
and Alternative Medicine and the NIAMS at the National Institutes of Health
are currently funding a study on the usefulness of the dietary supplements
glucosamine and chondroitin sulfate for osteoarthritis. Previous studies
suggest these substances may be effective for reducing pain in knee
osteoarthritis. Researchers are also investigating whether they prevent the
loss of cartilage.
Some genetic and behavioral studies
are focusing on factors that may lead to osteoarthritis. Researchers
recently found that daughters of women who have knee osteoarthritis have a
significant increase in cartilage breakdown, thus making them more
susceptible to disease. This finding has important implications for
identifying people who are susceptible to osteoarthritis. Other studies of
risk factors for osteoarthritis have identified excessive weight and lack of
exercise as contributing factors to knee and hip disability.
Researchers are working to understand
what role certain enzymes play in the breakdown of joint cartilage in
osteoarthritis and are testing drugs that block the action of these enzymes.
Studies of injuries in young adults
show that those who have had a previous joint injury are more likely to
develop osteoarthritis. These studies underscore the need for increased
education about joint injury prevention and use of proper sports equipment.
Systemic Lupus Erythematosus
Researchers are looking at how
genetic, environmental, and hormonal factors influence the development of
systemic lupus erythematosus. They are trying to find out why lupus is more
common in certain populations, and they have made progress in identifying
the genes that may be responsible for lupus. Researchers also continue to
study the cellular and molecular basis of autoimmune disorders such as
lupus. Promising areas of research on treatment include biologic agents;
newer, more selective drugs that suppress the immune system; and bone
transplants to correct immune abnormalities. Contrary to the widely held
belief that estrogens can make the disease worse, clinical studies are
revealing that it may be safe to use estrogens for hormone replacement
therapy and birth control in women with lupus.
Scleroderma
Current studies on scleroderma are
focusing on overproduction of collagen, blood vessel injury, and abnormal
immune system activity. Researchers hope to discover how these three
elements interact to cause and promote scleroderma. In one study,
researchers found evidence of fetal cells within the blood and skin lesions
of women who had been pregnant years before developing scleroderma. The
study suggests that fetal cells may play a role in scleroderma by fostering
the maturation of immune cells that promote the overproduction of collagen.
Scientists are continuing to study the implications of this finding.
Treatment studies are underway as
well. One study in particular is looking at the effectiveness of oral
collagen in treating scleroderma.
Fibromyalgia
Scientists are looking at the basic
causes of chronic pain and the health status of young women affected by
fibromyalgia. The effectiveness of behavior therapy, acupuncture, and some
alternative medical approaches for dealing with pain and loss of sleep are
being tested. Researchers are also studying whether certain genes contribute
to this disease.
Spondyloarthropathies
Researchers are working to understand
the genetic and environmental causes of spondyloarthropathies, which include
ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, and
reactive arthritis (Reiter's syndrome), as well as related conditions of the
eye. They are also looking at new imaging methods that will help with early
and accurate diagnosis, guide treatment, and detect responses to treatment.
Research on new treatments is also underway.
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(National Institute of Arthritis and Musculoskeletal and Skin Diseases)
(National Institute of Arthritis and Musculoskeletal and Skin Diseases)
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