Understanding the arthritis patient

The effect of arthritis and rheumatism on the world economy is beyond calcula tion. In 1982 more than 36 million per sons in the United States suffered from some form of arthri tis or related disease.' No other group of diseases causes so much suffering by so many for so long. More than 25 percent of rheumatic disease sufferers are at least partially handicapped, and about 10 per cent are grossly disabled. 2 Arthritis and rheumatism result in at least 27 million lost work days each year. 3 On a personal level, however, these diseases cause some unique problems of which pastors should be aware. The psy chological impact of arthritis or rheuma tism on sufferers includes depression, despair, helplessness, and loss of self-esteem. Dreams and goals are often thwarted or have to be abandoned. Fam ilies are disrupted. Even children can de velop arthritis, drastically altering a family's lifestyle and the child's future.

There is a higher rate of divorce in families in which one spouse has arthri tis. For a housewife who can no longer perform her household chores, the loss of self-esteem often leads to depression. Ar thritis can be devastating to the ego of a man who can no longer hold a job. The arthritis victim often feels less attractive and less desirable to his or her spouse. For these reasons and more, arthritis pain of ten affects sexual performance. Yet most arthritis patients are stoic.

They learn to live with their disease, but many wonder if they would be better off dead than to continue in constant pain and disability.

A description of arthritis and rheuma tism will help in ministering to people suffering from these diseases. Art/iritis is defined as inflammation in the joints; rheumatism is a more general term used to denote pain and stiffness anywhere in the musculoskeletal system of the body.

There are more than 100 different dis eases that have arthritis or rheumatism as part of their symptom complex. 4 Three of the more common forms of arthritis and rheumatism are osteoarthritis, rheu matoid arthritis, and fibrositis.

Osteoarthritis The most common form of arthritis is osteoarthritis, or more appropriately, de generative joint disease (DJD). DJD is wear-and-tear arthritis. Ninety percent of us have X-ray evidence of DJD by the time we are 40 years old. About 20 per cent of the population have actual symp toms of this type of arthritis. Unlike rheumatoid arthritis, however, DJD is not usually crippling. In its primary form it is not presently identified with a sys temic disease. Dietary fat, crystals from bone, and genetic predisposition have all been proposed as contributing to DJD, but the primary cause is still unknown.

People in physical occupations car penters, construction workers, and pro fessional athletes are more likely to have DJD. Previous trauma or joint dam age often leads to this type of arthritis.

The weight-bearing joints are most com monly affected. DJD is manifested by pain in movement, mild stiffness, and some limitation of movement in the morning, which disappears in five to ten minutes with limbering-up exercises.

Usually there is little or no inflammation of the joints in DJD. Although some in dividuals with DJD become severely dis abled and even require surgery and joint replacement, the majority do reasonably well.

Rheumatoid arthritis In contrast, rheumatoid arthritis (P\A) affects most of the organs of the body.

RA is more likely to cause crippling than DJD. It is a disease of the immune sys tem, which, instead of protecting the body, attacks its own tissues. There is no known cure.

About 1 to 2 percent of the population suffers from RA. 6 Patients often have severe fatigue and total body stiffness in the morning. In some the stiffness lasts all day long. Their joints are swollen, warm, tender, often red, and are affected on both sides of the body at the same time. The hands, wrists, and feet are the most commonly affected joints, but RA may also involve the jaw, neck, shoul ders, elbows, hips, knees, and ankles. It is, however, very rare for the end joints in the fingers to have rheumatoid arthri tis. This distinguishes RA from most other common forms of arthritis.

Untreated, RA goes through periods of severe inflammation followed by peri ods of feeling better, especially with rest.

The natural course of the disease, how ever, is for the joints gradually to lose function as they are systematically and painfully destroyed.

Other organs that can be involved with RA include the eyes, lymph glands, lungs, heart, and spleen. For some the disease will disappear spontaneously, but that is rare. Although the disease cannot yet be cured or prevented, modern med icine can usually alter its course and im prove the prognosis, especially if treat ment is started early enough.

Aches and pains of muscles and/or tendons are frequently referred to as softtissue rheumatism and affect most of us at some time or another. Tennis elbow, Achilles tendonitis (heel pain), frozen shoulder, bursitis, and fibrositis are ex amples of soft-tissue rheumatism. Exces sive physical stress, trauma, emotional stress, and lack of adequate rest are responsible in part for these conditions.

They generally become more common with age. Fortunately, these conditions are not life-threatening and most often get better with such treatment as heat, massage, and some prescribed medications.

Fibrositis Fibrositis is a common but often un recognized form of rheumatism. Al though not life-threatening, it is very painful and difficult to treat. Most com monly middle-aged women suffer with this condition, although men and women of most age groups can be af fected. It is characterized by five or six specific "trigger points" of tenderness on the human body.

These patients hurt all the time. They are often depressed, frequently they are awakened from their sleep by pain, and they do not respond well to medication alone. Doctors often diagnose fibrositis sufferers as malingerers or complainers because they can find nothing wrong.

Lab tests are normal. There is no sign of other disease. Nothing the doctor can do seems to help, but these people do have a medical problem that in many cases seems to be related to lack of deep-sleep patterns.

Studies by Dr. Jon Russell, a leading expert in fibrositis research at the Uni versity of Texas Medical School, San Antonio, indicate that physical condi tioning by anaerobic exercise may help this disease more than any other treat ment, probably because it increases deep-sleep patterns. Certain medica tions and physical therapy also seem to help these patients feel better. Sleeping pills do not seem to help, and quick relief is seldom achieved.

Diagnosis of a specific type of arthritis can sometimes be extremely difficult even for a rheumatologist. Various forms of arthritis are treated differently, and early diagnosis is often essential to limit potential damage. Because the conse quences of inadequate treatment are only gradually realized, an arthritis patient should consider very carefully his physi cian's background training in arthritis.

The best physicians are those who recog nize their strengths and limitations, and ask for consultation in areas outside their expertise.

Treatment Quackery is a serious problem in treat ing arthritis. People with chronic pain are vulnerable to hucksters, swindlers, and some well-meaning but naive indi viduals who make unsubstantiated claims for products. The Arthritis Foun dation estimates that $1 billion will be spent this year on unproven treatments for arthritis and rheumatism. Studies have estimated that 94 percent of all pa tients with rheumatic disease have tried an average of 13 unproven remedies each. 7 The waxing and waning nature of ar thritis and rheumatism makes sufferers of these diseases ideal targets for quackery.

Studies have shown that a placebo im proves the aches and pains of about 30 percent of arthritis patients. Psychologi cal testing indicates that those helped by a placebo are usually among the most suggestible 30 percent of the population.

Unproven treatments such as acupunc ture, copper bracelets, vitamin C (one gram daily), vaccines, hormones, and topical creams do not significantly ex ceed the placebo success rate for arthritis. 8 Other treatments that do not usually help may actually be harmful.

These include DMSO, hyperbaric oxy gen, Vuron, Liefcort, Gerovital, snake and ant venoms, uranium or radon mines, chuifong toukuwan, (a Chinese herbal remedy that contains cortisone in unregulated amounts), motor oil, and cocaine. 10 The most important problem with un proven remedies is that the patient may suffer increased damage to joints and other tissues that legitimate treatment might have helped to slow down or stop.

A physician who is knowledgeable and experienced in the treatment of rheu matic diseases can make a difference for most patients.

Preliminary studies by Dr. Edwin Krick, at Loma Linda University, indi cate that a low protein diet does reduce the intensity of arthritis in many pa tients, but diet is not a cure for arthritis.

Avoidance of certain foods, especially milk products, has been shown to make a difference in the arthritis of a few pa tients, but not most.

Probably the most important advance ment in arthritis therapy in the past 25 to 30 years is the development of good sur gical joint replacements for those with severely damaged joints. The results are often very gratifying to the arthritis sufferer.

Arthritis and rheumatism are not one, but more than 100 different diseases.

Proper care requires the help of a physi cian with the knowledge and experience to keep joint and other organ damage at a minimum. Arthritis sufferers deserve more attention to their plight from soci ety and from individuals, especially in the areas of treatment and research. In addition, they need our compassionate help with the many physical and emo tional struggles unique to chronic disease sufferers.