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Whether it’s a painful knee, a stiff hip joint, or suspected gout in a big toe, it’s likely you have become one of the millions of people each year who find themselves wondering, “What is arthritis and its different forms, and how do I deal with it?”
You wake up feeling stiff and sore, a feeling that doesn’t quite leave you throughout the day. Over-the-counter pain relievers aren’t quite keeping up with the pain, and you’re not quite able to keep up with your grandkids when they ask you to play in the yard. Rather than suffering in silence, equip yourself with solid information so you can speak knowledgeably to your doctor. In this patient-empowered age, the two of you will be able to find a solution that helps.
First order of business: Determine what you have.
What Is Osteoarthritis?
Over time, cartilage loses much of its elasticity and strength and becomes more likely to tear and split when stressed. As a result, its cushioning properties diminish, leading to the most common form of arthritis: osteoarthritis (OA), or “wear and tear” arthritis.
About 60 percent of adults over age 60 have joint degeneration as revealed by X-rays. Though it most often occurs in weight-bearing joints such as the hips, knees, ankles, and spine, OA can affect the shoulders, hands, and feet as well.
What Are the Risk Factors for OA?
A combination of factors makes a person more likely to develop osteoarthritis:
- Obesity: The more you weigh, the more stress you put on your ankles, hips, knees, and spine. It’s estimated that each additional pound of body weight puts three extra pounds of stress on your knees as you walk. Losing weight lowers your risk for OA, and may help slow the development of the disease once you get it.
- Injury: Previous injury to a joint seems to put you at higher risk of developing post-traumatic arthritis in that joint later on.
- Overuse: If your daily behavior involves repeated, heavy use of a joint, especially accompanied by bending, then you are at higher risk of developing arthritis in that joint. This is especially true of the spine and the knee.
- Genetics: Some people are born with defects in the cells (chondrocytes) needed to make and maintain the collagen that is a key component of joint cartilage.
- Anatomy: Some studies suggest that certain abnormalities in your anatomy—including unequal leg lengths and flat feet—may lead to problems with OA.
- Smoking: Smoking has been linked to greater cartilage loss and more pain in people who already have OA.
- Diabetes: People with type 2 diabetes are at greater risk of OA, although obesity (a prime type 2 diabetes risk factor) may be more to blame than the diabetes itself.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is an autoimmune disease of the joint lining, or synovium, and is the most common form of inflammatory arthritis.
With RA, a faulty immune system engages in “friendly fire,” triggering a gradual destructive attack on the joints, as well as on organs throughout the body. The joint lining becomes inflamed and swollen, releasing enzymes into the joint capsule that, over time, eat away at the bone and cartilage. As the cartilage is destroyed, the cushion between bones is lost, and the bone rubbing against bone becomes increasingly painful.
What Are the Risk Factors for RA?
Though the precise causes of RA are unclear, several factors may increase your risk:
- Being female: Though it can affect anyone, including children, RA affects women twice as often as men.
- Getting older: The incidence of RA increases with age, with onset usually occurring between 30 and 50 years of age.
- Infection: There is some suggestion that exposure to an infection, such as a virus or bacterium, may cause an abnormal immune system reaction in those who are already susceptible to RA, thus triggering the disease.
- Obesity: Emerging evidence has identified a potential link between obesity and the development of RA. Like RA, obesity has been linked to inflammation, and fat tissues and cells produce substances involved in inflammation and immunity.
- Genetics: Inheriting specific genes may make you more likely to develop RA. For instance, HLA-DR4, a genetic marker associated with RA, is found in as many as 60 to 70 percent of Caucasians with the disease, compared to only 30 percent of the general population.
- Inflammatory pathways: Proteins known as cytokines are involved in inflammatory diseases such as RA.
- Smoking: Use of tobacco has been directly linked with an increased risk for developing RA, and with greater disease severity. On a positive note, some evidence suggests that compared to those who continue to smoke, RA patients who quit smoking may see improvements in joint tenderness, swelling, stiffness, and disease activity.
- Gum disease: Emerging research continues to uncover an association between gum (periodontal) disease and RA. Both conditions are characterized by damage from a wayward immune response and inflammation.
What Is Gout?
Another form of arthritis, gout, occurs when uric acid crystals are deposited in the joints. Uric acid forms when the body metabolizes substances called purines, which are found in a variety of foods.
Gout is one of the few types of arthritis in which diet seems to play a genuine role. Some studies have found that drinking water or skim milk may help prevent gout attacks, while consuming meat, seafood, and sugary drinks and fruits may increase gout risk. So if you have gout, your doctor likely will recommend a diet that limits purine-rich foods and beverages.
If you’re at increased risk of gout or already have it, consider the following steps.
- Avoid high-purine foods and beverages: Organ meats (liver, kidneys, hearts, sweetbreads, brains); game meats (venison); anchovies, fish eggs, sardines, herring, mackerel, trout, cod, haddock, scallops and mussels; veal, turkey, gravy, broth, bouillon, and consommé; and beer and distilled spirits.
- Limit moderate-purine foods to occasional consumption: Asparagus, cauliflower, green peas, kidney beans, lima beans, spinach, and mushrooms; beef, ham, chicken, duck, and pork; crab, oysters, and shrimp; oats and oatmeal, wheat germ and bran, and whole-grain breads and cereals.
Vitamin C may have a role in reducing the risk of gout. One study found that men with higher intakes of vitamin C through food and supplements had a reduced risk, while another found that vitamin C supplementation significantly reduced levels of uric acid, which can accumulate and form the crystals that cause gout pain. (See also our posts “Gout Foods: Keep These 6 Items in Your Diet” and “Foods to Avoid with Gout.”)