Seminar Reports on Aches & Pains of Middle, Later Years
"Osteoarthritis is a disease of the joints, while osteoporosis is a disease of fragile bones. At least $50 billion a year is spent on medical costs and lost wages due to these two conditions." That's what Dr. Joan McGowan, chief of the Musculoskeletal Diseases Branch and director of the Bone Diseases Program at NIAMS, told the standing-room-only crowd at an arthritis and osteoporosis seminar sponsored recently at NIH by the Office of Research on Women's Health.
Speaker Dr. Rosemarie Hirsch, an NIAMS rheumatologist, said more than 37 million Americans have some form of arthritis, and "by the year 2020, 60 million Americans are projected to have arthritis." She said arthritis literally means joint inflammation but is often used to refer to more than 100 different rheumatic diseases that can affect children and adults. Her discussion focused on three diseases that affect women more than men: osteoarthritis, rheumatoid arthritis (RA), and lupus.
"Osteoarthritis is the most common form of arthritis," said Hirsch. The disease ranges from mild to severe and may cause pain, stiffness and tenderness around joints. It most often affects the hands, feet, knees and hips.
RA is less common than osteoarthritis, but not rare. In the joint with rheumatoid arthritis, the lining becomes inflamed, leading to destruction of tissue, which can result in chronic pain and deformity. Possible causes of rheumatoid arthritis may include a genetic susceptibility combined with environmental factors such as bacteria or viruses.
Lupus is less common than either osteoarthritis or rheumatoid arthritis. It tends to occur in women in their reproductive years, but can affect older individuals. Its frequency is higher in Blacks and Hispanics. In lupus, the immune system attacks the body's healthy cells and tissues. The disease is characterized by periods of flares and remissions.
Hirsch highlighted several discoveries. In osteoarthritis, defective collagen genes have been identified in some families. In rheumatoid arthritis, a group of genes with the same amino acid sequence have been identified as susceptibility markers. In lupus, a gene on chromosome 1 has been linked with susceptibility to lupus in Caucasians, Asians, and African Americans. In the area of cartilage research, Hirsch said medications that counteract cartilage-destroying enzymes have been identified. Improved implants for replacing areas of worn cartilage and better artificial joints for longer lasting joint replacements also are being investigated. Finally, Hirsch discussed biologics (messenger molecules that allow communication in or between cells), which can be used to enhance or interfere with immune system activity in arthritis inflammation.
Dr. Ethel S. Siris, professor of clinical medicine at Columbia University College of Physicians and Surgeons, discussed diagnosis and treatment options for osteoporosis. She said low bone mass is the single most predictive factor for osteoporosis, a disease that affects more than 25 million Americans. She noted that bone is a living dynamic tissue. Peak bone mass is achieved at 20-30 years and then declines with age. At menopause, with diminished levels of estrogens, there is rapid bone loss.
Siris said osteoporosis causes 1.3 million fractures a year of the wrist, vertebrae, and hips. "About half the people who break their hips end up in nursing homes," she said, "and in the year following the fracture, 20 percent will die. The lifetime risk of death due to hip fracture is comparable to the risk of death from breast cancer." Osteoporosis is a silent disease, she said, recommending that people at risk have a noninvasive test called dual x-ray absorptiometry that will scan the spine, hip, and arm in order to measure bone density.
"Every woman at menopause should consider taking estrogen since it is highly effective against osteoporosis and heart disease, and may protect the brain from Alzheimer's disease," she concluded. "Women who take estrogen can reduce their fracture risk by 50 percent."
Dr. Kate Lorig, associate professor at Stanford University School of Medicine, discussed self-management and how to break the pain cycle. She said several things are important in managing a chronic disease: take medicine, exercise, go to the doctor; learn how to get on with your life; and learn how to deal with your emotions.
"In arthritis," she said, "the biggest problem is pain. If you make a small change in the amount of pain, you may be able to lessen the disability." She said not all pain comes from the disease. Other things such as tense and deconditioned muscles, depression, fatigue and stress all may contribute. She said exercise is important for people with arthritis, and recommended it be done in gradually increasing amounts 4-5 times a week. Another technique is to substitute distraction for pain. Keep your mind occupied, think of something else, she advised.
Finally, Lorig noted that we constantly talk to ourselves and our emotions are ruled by what we say. "You should pay attention to the messages that you give yourself, and make an effort to change your mental messages," she said. "Management of your pain is up to you."
The next seminar in the ORWH series, "Elder Options and Care Giving," will be held from 2 to 4 p.m. on June 5 in Lipsett Amphitheater, Bldg. 10.
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