well as nail changes. Psoriatic arthritis can affect joints anywhere in the body, including the spine, the fingers, and the toes, which can swell up like little sausages.
Rheumatoid arthritis (RA): An autoimmune disease, RA causes the body to mistakenly attack its own joints, causing inflammation and swelling of the tissues surrounding the joint, resulting in joint pain and swelling. Over time, there can be a loss of cartilage, causing shrinkage of the space between the bone ends, which increases pain and decreases mobility; irreversible joint deformity can even occur. RA often affects the same joint on both sides of the body (for example, both wrists) and is two to three times more likely to strike women compared to men. (For more on this, see the sidebar “Why are Women More Likely to Get Arthritis,” near the end of the chapter.)
ARTHRITIS BY THE NUMBERS
Arthritis affects a surprisingly large number of us, as you can see by the following numbers:
Over 58 million adult Americans currently suffer from arthritis, or 1 in 4 of us. It is the leading cause of disability among adults in the U.S.
Women are more likely than men to get arthritis, which currently affects one in four women compared to one in five men. They are also far more likely to develop rheumatoid arthritis than men and to experience worse pain.
By 2040, it’s projected that that the number of U.S. adults with doctor-diagnosed arthritis will have increased by 49 percent to an estimated 78.4 million (nearly 26 percent of the population).
In 2013, the total national cost of treating arthritis was $140 billion. It is the reason behind more than 100 million outpatient visits and 6.6 million hospitalizations annually.
Osteoarthritis is by far the most common type of arthritis, affecting more than 30 million Americans, most of whom develop the disease after the age of 45.
Gout is the second most prevalent form of arthritis in the U.S., affecting 8.3 million sufferers, followed by rheumatoid arthritis at 1.3 million. Sjögren’s afflicts 1-4 million and fibromyalgia afflicts 4 million, but not all of them will have arthritis.
About 1.5 million American adults have rheumatoid arthritis (RA), which mostly strikes women, while gout tends to favor men.
Some 1 in 1,000 U.S. children under the age of 17 have some form of joint disease, which translates to an astonishing 300,000! Of those, 50,000 have juvenile idiopathic arthritis (JIA).
Arthritis most often strikes in the knees and the hips, most likely because both are weight-bearing joints and can easily be injured. To fight the pain and disability that can result, there are about 500,000 hip replacements and 750,000 knee replacements performed in the U.S. every year.
Classifying arthritis as a “major player”
In the following conditions, arthritis is present and is usually a major part of the syndrome, but is not the primary disease process:
Lyme disease: Caused by a certain type of bacteria transmitted to humans via tick bites, Lyme disease brings about fever, a distinctive red skin lesion in the shape of a bull’s-eye, problems with the nerves and/or heart, and arthritis. Antibiotics are the treatment of choice for this disease.
Reactive arthritis: An inflammation of the joints, reactive arthritis strikes along with or shortly after the onset of an infection, often one that is intestinal or sexually-transmitted. The three problems generally associated with reactive arthritis are arthritis, conjunctivitis (inflammation of the eyelid’s lining), and urethritis (inflammation of the urethra).
Scleroderma: The word scleroderma means hard skin. This is a rare autoimmune condition that involves an attack on tiny blood vessels in many places in the body, and overproduction of collagen in places it doesn’t belong. The skin and other organs can stiffen. Joints can become inflamed, and tightness of the skin overlying the joints can make them even harder to move. An autoimmune disease, scleroderma usually attacks adults rather than children.
Systemic lupus erythematosus: This is yet another disease caused by an immune system gone wrong. In lupus, the body attacks its own tissue, causing inflammation, joint pain, stiffness, permanent damage to the joints, and exhaustion. Although lupus most often affects women of child-bearing age, it does strike some men and can occur at nearly any age, including childhood and post-menopause.
Describing arthritis as a “minor player”
In these conditions, arthritis may appear, but is a minor part of the syndrome.
Bursitis and tendonitis: Caused by overusing or injuring a joint, bursitis is the inflammation of the fibrous sac that cushions the tendons. Tendonitis is the irritation of the tendons, which attach the muscles to the bones.
Paget’s disease: With Paget’s disease, the breakdown and rebuilding of bone speeds up. The resulting bone is larger but also softer and weaker, making it more likely to fracture. These weakened and deformed bones cause arthritis to develop in their respective joints, which typically include those of the hip, skull, spine, knee, and ankle. The cause is unknown.
Polymyalgia rheumatica (PMR): With this condition, severe stiffness can suddenly strike in the lower back, hips, shoulders, and neck, making it difficult even to get out of bed. The pain is similar to that of RA, often without evidence of any active arthritis. PMR can occur by itself or together with a life-threatening inflammation of the blood vessels called giant cell arteritis (GCA). Symptoms of GCA can occur before, after, or at the same time as PMR, and include headaches, scalp tenderness, hearing problems, vision loss or changes, and tongue or jaw pain after prolonged chewing.HYPERSENSITIVE FINGERS AND TOESPrompted by arterial blood vessel spasm, Raynaud’s phenomenon is a condition that can make the fingers, toes, nose, or nipples extremely sensitive to cold and to emotional upsets, turning them blue/violet or white in color. It sometimes occurs in conjunction with (or as a result of) other arthritis-related conditions including lupus, scleroderma, RA, and myositis, but can also be caused by repetitive trauma or injuries to the nerves of the hands or feet, smoking, certain medications, or chemical exposure. Typical attacks of Raynaud’s phenomenon include tingling, numbness and whitening of the fingers (without affecting the thumb), and pain or redness when blood circulation returns.There's no single blood test for Raynaud's: most doctors diagnose the disease based on signs and symptoms. Treatment generally involves wearing gloves, socks, and hats to maintain total body warmth, and avoiding workplace triggers, such as vibrating tools, freezers, and exposure to air conditioning vents. In severe cases of Raynaud’s, doctors prescribe medication to dilate the blood vessels. See Chapter 5 for more on Raynaud’s phenomenon.
Sjögren’ssyndrome: Another autoimmune disease, Sjögren’s syndrome (usually referred to simply as Sjögren’s) causes inflammation of the tear glands and saliva glands, leading to dryness of the eyes and mouth, hazy vision, cracks at the corners of the mouth, and cavities. Inflammation of the brain, nerves, thyroid, lungs, skin, liver, kidneys, and, of course, the joints may also be present.
Experiencing arthritis as a “companion condition”
These following conditions are linked to arthritis; that is, arthritis may be present, but it constitutes another separate
