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What is arthritis?


Welcome to the inaugural post for Exercise With Arthritis! I'm excited to kick off what I hope will be an informative and engaging foray into a topic that affects so many. According to the CDC, almost one quarter of the adult population of the United States carries a diagnosis of arthritis of some kind.

https://www.cdc.gov/arthritis/data_statistics/national-statistics.html

In order to understand how to live beyond arthritis, it's important to know exactly what we are dealing with. Arthritis is a chronic, progressive condition that causes pain and stiffness in joints. It comes from "arthro-" meaning a joint and "-itis" meaning inflammation. As it stands, arthritis is chronic and irreversible; in other words, we can't *yet* grow back cartilage in joints. However, we have an abundance of evidence in the medical literature that speaks to how we diminish symptoms and maximize function!

For the first post - and likely the first several posts - I will keep the discussion to the topic of osteoarthritis. Osteoarthritis is a type of arthritis, which many physicians will call "wear and tear" arthritis. The ends of our bones are covered in cartilage, a soft and smooth material that acts as a shock absorber for you, and much like the surface of anything which experiences repetitive wear, the cartilage over your bones will eventually wear out.

When cartilage wears thin, or even becomes worn away completely, the bone underneath the cartilage undergoes changes: growing and thickening in ways that not only cause pain but also such that we can identify those changes on an x-ray. Most physicians will determine the severity of your arthritis by a combination of how bad your symptoms are and how your x-ray looks.

Because this is meant to be both understandable and educational, I thought I would list the features by which radiologists grade osteoarthritis or OA:

  • grade 0: this joint looks great without any OA features

  • grade 1: possible thinning of the cartilage with a very small amount of bone spurring

  • grade 2: bone spurs definitively seen on x-ray, still only possible thinning of the cartilage

  • grade 3: lots of bone spurs, definite thinning of the cartilage, thickening of the bones underneath the thin cartilage, and perhaps even a change in how the knee is shaped

  • grade 4: large bone spurs, significant cartilage thinning, lots of thickening of bone under the thin cartilage, and an apparent change in the shape of the knee.

Image 1. See the example of grade 4 knee osteoarthritis above. Note the slippage of the left knee compared to the right (Note: the x-ray above denotes the left side of the image as the right knee. This is done by convention because x-rays can be taken from front-to-back [AP] or back-to-front [PA]).

Now for the good stuff, right?? The two most effective ways of improving the pain and function of any joint affected by osteoarthritis are reducing the force that joint experiences and moving it! Most joints affected by osteoarthritis are hips and knees, so the most logical way to decrease the force that these joints experience is weight loss. In the same way, increased weight is a risk factor for osteoarthritis! This makes perfect sense if you think about the joint as a wear-and-tear mechanism. If you put more weight or force onto anything that moves, that thing will wear out more quickly: axles on a truck, tires on a car, lead in a pencil.

Regarding motion and arthritis, many people will tell you that pain is brought on by moving a joint affected by arthritis, which is absolutely correct...in the short term. However, the long-term benefits of movement in joints affected by arthritis have been established and re-established many times over. The short reason is that use of any part of the body results in its maintenance and upkeep. If you don't use your heart much in the way of physical activity, then the heart's blood vessels become stiff and narrow and will be unable to meet any increased demand later should the need arise. Similarly, the brain is incredibly dependent upon mentally challenging problems that require it's use to maintain brain volume and size. Joints are no different. Movement of joints over the long term promotes maintenance of existing cartilage, more fluid within that joint (which brings nutrients), and strengthening of the bones themselves along with the muscles that attach to that joint.


I hope I've made a compelling case for at least thinking more about exercise as a way to improve pain and function in arthritis. Please check back weekly for new blog posts! I'm going to try and have at least one if not two every week.

Stay moving!

TDS

Selected reading:

Poddar SK, Widstrom L. Nonoperative Options for Management of Articular Cartilage Disease. Clinics in Sports Medicine. 2017;36(3):447-456. doi:10.1016/j.csm.2017.02.003.

Sinusas K. Osteoarthritis: Diagnosis and Treatment. American Academy of Family Practice. 2012;85(1):49-56.


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