I could have titled this chapter "Dealing With Your Arthritis." I want to emphasize, however, that you can do more than just cope with the disease. You can thrive in spite of it. Do not view yourself as the victim of a problem—you are in control. The problems associated with arthritis do not simply disappear when you start exercising, but you no longer have to give up your life because of your arthritis. A good exercise program helps diminish the pain and disability associated with arthritis and allows you to enjoy some favorite activities. My grandmother was still living independently when she died at the age of 100. In fact, she walked several miles a day until her mid-90s, undeterred by her arthritis. Some of you know that even pain in your hands significantly affects the things you can do and your outlook on life. I know of a woman whose arthritis in her hands became bad enough that she had to stop riding horses, her favorite pastime, because she could not hold the reins. She was caught in a vicious circle of decreasing activity and increasing pain, until her doctor diagnosed her problems as arthritis and she started an exercise program. She began a regular exercise program and now enjoys horseback riding and many other activities.
Types of Arthritis
Knowing about the type of arthritis you have and its causes and symptoms can help you best determine your exercise goals and plans. Arthritis is defined as inflammation of a joint, but it often affects more than just the joint, sometimes compromising the tissues that surround a joint and affecting other bodily systems.
Types of Arthritis
Knowing about the type of arthritis you have and its causes and symptoms can help you best determine your exercise goals and plans. Arthritis is defined as inflammation of a joint, but it often affects more than just the joint, sometimes compromising the tissues that surround a joint and affecting other bodily systems.
Within the joint, the primary tissue affected is the articular cartilage. This tissue covers each inner part of most joints; it helps to disperse forces at the joint surface and allows for smooth movement of the Joint. Loss or irregularities of this cartilage can increase friction within the joint; this is the main manifestation of osteoarthritis. A special lubricant called synovial fluid is produced within the Joint that decreases normal friction and allows the surfaces to glide easily. This process is similar to oil allowing a hinge to move smoothly. Alteration in synovial fluid production is one of the early effects of rheumatoid arthritis.
Osteoarthritis
Osteoarthritis, the most common form of arthritis, accounts for more than 85 percent of arthritis cases. Osteoarthritis is a degenerative disease that affects the hip, knee, back, and hand joints, as well as others. The causes of osteoarthritis are numerous and can include trauma or infection, but often no cause is identifiable. Mechanical stress, combined with abnormal
biomechanics, leads to the initial damage to the joint cartilage, which then starts to break down. Immobilization of a joint, such as being in a cast, can also lead to degenerative articular cartilage changes. Repetitive loading and unloading of the joint forces fluid into and out of the joint, getting nutrition to the articular cartilage. When a joint is immobilized, these compressive forces are absent. As damage to the articular cartilage progresses, the joint space lessens and the bone underlying the cartilage experiences abnormal stresses and deforms.
Doctors diagnose osteoarthritis by correlating a patient's history and physical examination to his or her x-ray and laboratory test results. The amount of joint damage is only predictive of severity of symptoms for a small part of the population, however. Risk factors include female gender, obesity, joint injury, occupation, and smoking.
Osteoarthritis symptoms can develop slowly or rapidly, depending on the cause of the arthritis, presence of other diseases, activity level, and other influences. For the majority of individuals, however, development of symptoms is gradual and slow. The most common complaint is aching within a joint, accompanied by stiffness after sitting for prolonged periods. This stiffness generally lasts less than 30 minutes and is resolved with gentle movement. Many patients report grating with movement of the involved joint, and as the disease progresses, the joint may become deformed and lose motion. As osteoarthritis results from articular cartilage damage, it may be limited to only one joint and, as noted earlier, occurs largely in the weight-bearing joints.
Rheumatoid Arthritis
Rheumatoid arthritis is the second most common joint disease, affecting approximately one to two percent of the adult population, though it can occur at any age. The cause of rheumatoid arthritis is not known, though two primary risk factors are age and female gender. The wrist, knee, hand, and foot joints are most affected. Rheumatoid arthritis is systemic in nature and thus affects tissues throughout the body, with joint involvement being bilateral. Changes in the synovial tissue alter synovial fluid production and ultimately damage the cartilage, bone, and adjacent tissues. Most of the extra-articular tissue changes occur over the long term, though some systemic symptoms are present from the onset.
Symptoms of rheumatoid arthritis usually start slowly and may be systemic complaints such as fatigue, weight loss, weakness, and general joint pain. In contrast to the stiffness felt with osteoarthritis, stiffness with rheumatoid arthritis lasts for more than 30 minutes. One criterion for diagnosis is morning stiffness that lasts at least an hour. Patients will often have periods during which their symptoms are worse, called exac-erbations—the involved joints may be swollen, warm, and painful. As with osteoarthritis, the joint becomes deformed and loses motion as the disease
progresses. Joints are more likely to become unstable with rheumatoid arthritis than with osteoarthritis, perhaps because of the changes In the tissues outside the joint. Because It is systemic, rheumatoid arthritis can affect the heart, lungs, and gastrointestinal systems, among others.
Spondyloarthropathies
Spondyloarthropathies are a group of arthritic diseases that do not fit Into the previous two classifications. Ankylosing spondylitis, Reiter's syndrome, and psoriatic arthritis are the most common arthropathies, with ankylosing spondylitis being the most prevalent—it affects one to two percent of the population. The causes of ankylosing spondylitis are unknown, though risk factors include male gender, age, Caucasian race, and family history. Like rheumatoid arthritis, ankylosing spondylitis is systemic and causes complications throughout the body, for example in the cardiac and pulmonary systems. Joints of the spine are primarily involved, with some unilateral Involvement in other large joints. Inflammation occurs in other tissues, especially at ligamentous attachments. Initial symptoms are backache and stiffness, more so in the morning. The trunk and neck become symptomatic over time and the individual may also complain of weight loss, excessive fatigue, and fever.
As noted in the introduction, there are over 100 types of arthritis, with the three that I have outlined composing the bulk of the diagnoses. The joint pain and stiffness Inherent with all types can be significantly reduced with regular exercise. In the next section I discuss the importance of work-ing with your physician. Your doctor will identify not only what type of arthritis you have, but also Issues related to your personal arthritis history, which will determine the type of program you pursue.
