An interesting thing happened to me a few months ago. I was talking with a friend about this column and mentioned the possibility of writing about arthritis. I am a rheumatologist after all, so naturally I am chomping at the bit to talk about this subject. She rolled her eyes and said “no way! Arthritis is for old people. No one will be interested in that.” Not two months later, this same thirty-year-old friend developed joint pain and swelling. She called me scared, confused, and concerned for what was going on and what it meant for her future.
Although this was a new conversation to this woman, it was a common conversation for me: young women developing joint problems and wondering what in the world is going on. There are many misconceptions about arthritis, but the idea that arthritis only occurs in the elderly may be the biggest myth of all. Arthritis can affect anyone at any age. The CDC estimates that 62% of adults with arthritis are less than 65 years old. The average age for diagnosis of Osteoarthritis is 50 and the typical age of onset for Rheumatoid Arthritis is between 30 and 60. Sadly, one in every 250 children in the United States has arthritis! I would bet that every reader of this magazine is in some way affected by arthritis, either personally or through a close relative, maybe even a child. While the rheumatologist in me has been looking forward to talking about this topic, the citizen in me wants to write about something relevant – and this is it. It has been called “the silent disease” because we don’t talk about it and, as I have pointed out, it is often misunderstood. I hope to share with you bit of what I know about arthritis so that we can all be better educated and perhaps more understanding to those of us who are stricken with this problem.
Arthritis comes in many flavors. It is estimated that there are over 100 types of arthritis and it is actually a pretty complicated subject. As an adult rheumatologist, I see women and men from the ages of 18 to 90+ years old, many of whom have arthritis as part of a larger disease. Pediatric rheumatologists are pediatricians that specialize in rheumatic disease affecting children. It is our job to figure out what kind of arthritis a person has and what to do about it. That can be a challenging task in many cases. It doesn’t always look the same and sometimes it is downright perplexing. If you are concerned that you may have arthritis or a rheumatic disease, it is important to see a rheumatologist so that you can get the right answer. In many types of arthritis, early intervention is extremely important.
Another myth that must be debunked is that a lab test can diagnose arthritis. Let me be clear: there is NO lab test that can diagnose any kind of arthritis. There are lab tests that can help to make a diagnosis, but definitive tests simply do not exist. By relying solely on blood tests, arthritis will be overdiagnosed in people who don’t have it and missed in people who actually do. Rheumatoid factor (RF) and antinuclear antibodies (ANA), for example, are two lab tests that are often ordered in people with joint pain. A positive test for either of these can lead to worry, but they do not necessarily mean anything is currently wrong. The reverse is also true: negative blood tests do not exclude arthritis. It takes the big picture to make a diagnosis of arthritis. Clinical history, physical examination, labwork, Xrays, and sometimes other studies are all part of the evaluation. Lab tests can help and are important, but they should not be the final word.
Many folks are walking around with the belief that nothing can be done if you have arthritis. Not true! As I mentioned before, getting the correct diagnosis is of the utmost importance. Because we treat types of arthritis differently, we must know what we are dealing with to approach it properly. The diagnosis also makes a difference with prognosis, or how a person will do later in life. Some types of arthritis will only cause the joints to hurt. Other types, in addition to joint symptoms, can make a person very sick. Regardless of the type, there is always something that can be done. From simple lifestyle modifications to aggressive pharmaceutical treatment, there are comprehensive treatment plans that can help a person feel and function better.
There are also things that we can do to prevent arthritis. First of all, get to and stay at a normal body weight. Being overweight not only puts strain on your joints, it also creates an inflammatory state that can set you up for disease, including arthritis. Obesity is a well-known risk factor for the development of arthritis and if you are overweight you may not respond as well to treatment. Next, eat the right food. There is not one way of eating that will definitively cause arthritis (except perhaps the Standard American Diet), but what you eat does matter to your health and arthritis is no exception. Although nutrition recommendations vary by person, there are general concepts for health that hold true for arthritis. Eat a balanced diet of mostly plants. Avoid processed foods and added sugars. I suggest the Anti-Inflammatory Diet to most people, which is less of a “diet” and more of a sustainable lifestyle. Lastly, exercise regularly. If you muscles are strong, your joints will be more stable. Exercise also helps to combat inflammation, which is a problem in the development of arthritis.
If you experience joint pain, talk to your doctor. Pay attention to your symptoms. Make a note of which joints hurt, when they hurt, what makes the pain better or worse, what time of day your symptoms are the most severe, and whether or not your joints swell. Remember that not all joint pain is arthritis. Don’t be scared if your primary care doctor suggests you see a rheumatologist. Getting the right diagnosis is the first step to getting better. Talk about it. Read about it. One in four women have been diagnosed with arthritis by a doctor. You will find that more people than you think have experienced similar symptoms or know of someone who has. There is support all around, including organizations like the Arthritis Foundation (www.arthritis.org). Arthritis is not “just part of getting older”. Speak up, be proactive in your healthcare, and take care of your body.
Do you have a question for Dr. Cotter or a topic you would like her to address? E-mail her at LOLA at _Drcotterlolamag@gmail.com
Dr. Nicole Cotter is a rheumatologist currently practicing medicine in Shreveport, Louisiana. She is board-certified in Rheumatology and Internal Medicine and is studying Integrative Medicine through the Arizona Center for Integrative Medicine. Dr. Cotter believes that an integrative approach to health is ideal. When not in clinic, you can find her reading, running, cooking with her husband or chasing her two kids.