It may begin as slight morning stiffness. For the lucky person with arthritis, that's as far as it goes. But for millions of others, arthritis can become a disabling, even crippling, disease.
(Roman Emperor Diocletian exempted citizens with severe arthritis from paying taxes, no doubt realizing that the disease itself can be taxing enough).

One in seven Americans--nearly 40 million--has some form of arthritis. That number will climb as the baby boomers age. By 2020, about 60 million Americans will have arthritis, according to The National Arthritis Data Workgroup of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The disease is physical, but also exacts a mental, emotional and economic toll.

"Chronic illness impacts a person's entire lifestyle--work, family and recreation," says Gail Wright, Ph.D., a rehabilitation psychologist at the University of Missouri, Columbia. To improve quality of life, doctors and health educators increasingly advise combining drug treatment with education, social support, and moderate forms of exercise.

Arthritis means joint inflammation. In a normal joint, where two bones meet, the ends are coated with cartilage, a smooth, slippery cushion that protects the bone and reduces friction during movement. A tough capsule lined with synovial membrane seals the joint and produces a lubricating fluid. Ligaments surround and support each joint, connecting the bones and preventing excessive movement. Muscles attach to bone by tendons on each side of a joint. Inflammation can affect any of these tissues.

Inflammation is a complex process that causes swelling, redness, warmth, and pain. It's the body's natural response to injury and plays an important role in healing and fighting infection.

Joint injury can be caused by trauma or by the wear and tear of aging. But in many forms of arthritis, injury is caused by the uncontrolled inflammation of autoimmune disease, in which the immune system attacks the body's own tissues. In severe cases, all joint tissues, even bone, can be damaged.

What is a joint?

A joint--the knee, the ankle, the wrist, the elbow--is an area where two bones meet. The ends of the bones are padded with a protective coating called cartilage. Osteoarthritis, the most common form of arthritis, occurs when that protective coating wears away, usually as one ages, and the two bones begin to rub against one another.

The general term arthritis includes over 100 kinds of rheumatic diseases, most of which last for life. Rheumatic diseases are those affecting joints, muscle, and connective tissue, which makes up or supports various structures of the body, including tendons, cartilage, blood vessels, and internal organs.

The most common type of arthritis is osteoarthritis, affecting more than 16 million Americans. This degenerative joint disease is common in people over 65, but may appear decades earlier. It begins when cartilage breaks down, sometimes eroding entirely to leave a bone-on-bone joint in extreme cases. Any joint can be affected, but the feet, knees, hips, and fingers are most common. It may appear in one or two joints and spread no further. Painful and knobby bone growths in the fingers are common, but usually not crippling. The disease is often mild, but can be quite severe.

Second most common is rheumatoid arthritis, which affects 2.5 million Americans. It can strike at any age, but usually appears between ages 20 and 50. The hands are most commonly affected, but it can affect most joints of the body. Inflammation begins in the synovial lining and can spread to the entire joint. Highly variable and difficult to control, the disease can severely deform joints. Some people become bedridden. Others continue to run marathons.

An autoimmune disease affecting the whole body, rheumatoid arthritis can also cause weakness, fatigue, loss of appetite, muscle pain, and weight loss. Blood tests may reveal anemia and the presence of an antibody called rheumatoid factor (RF). However, some people with RF never develop rheumatoid arthritis, and some people with the disease never have RF. In about one in six, the disease becomes severe and can shorten life. Researchers hope to find ways to predict which patients should be treated more aggressively.

Two Most Common Forms of Arthritis

Compare the appearance of a normal joint with these two most common forms of arthritis.

Normal Joint: In a normal joint (where two bones come together), the muscle, bursa and tendon support the bone and aid movement. The synovial membrane (an inner lining) releases a slippery fluid into the joint space. Cartilage covers the bone ends, absorbing shocks and keeping the bones from rubbing together when the joint moves.

Osteoarthritis: In osteoarthritis, cartilage breaks down and the bones rub together. The joint then loses shape and alignment. Bone ends thicken, forming spurs (bony growths). Bits of cartilage or bone float in the joint space.

Rheumatoid Arthritis: In rheumatoid arthritis, inflammation accompanies thickening of the synovial membrane or joint lining, causing the whole joint to look swollen due to swelling in the joint capsule. The inflamed joint lining enters and damages bone and cartilage, and inflammatory cells release an enzyme that gradually digests bone and cartilage. Space between joints diminishes, and the joint loses shape and alignment.

Ups and Downs: With so many kinds of arthritis, which can appear and progress unpredictably, diagnosis and treatment can be trying for both physician and patient. Diagnosis depends on integrating a host of factors, including the possibility that a person may have two forms of the disease.

The normal ups and downs of chronic, painful disease further complicate matters. "Just about any painful condition will wax and wane on its own," says rheumatologist Dennis Boulware, M.D., University of Alabama, Birmingham.

A worsening or reappearance of the disease is called a flare. Remissions bring welcome relief, but can also obscure whether symptoms decreased on their own or due to treatment.

Proper treatment depends on correct diagnosis of the specific disease, and varies with severity and location, as well as from person to person. But treatment need not wait for a final diagnosis because initial treatment options, such as anti-inflammatory drugs and exercise, are similar for many forms of the disease. Treatment should begin early to reduce joint damage.

When treated with Ostobolan there are clinical estimations of reduction or complete disappearance of pains in joints, extension of motor performance and a significant improvement of the whole quality of life.

Anti-inflammatory agents generally work by slowing the body's production of prostaglandins, substances that play a role in inflammation. Many have an analgesic, or painkilling, effect at low doses. Usually, higher, sustained doses are required to see sufficient anti-inflammatory activity for treating arthritis.

Most people with arthritis never need surgery, but when all else fails, it can dramatically improve independence and quality of life by reducing pain and improving mobility. The surgeon may remove damaged or chronically inflamed tissue, or replace the joint entirely. Artificial replacements are available for all of the most commonly affected joints.

In the past, doctors often advised arthritis patients to rest and avoid exercise. Rest remains important, especially during flares. But doing nothing results in weak muscles, stiff joints, reduced mobility, and lost vitality. Now, rheumatologists routinely advise a balance of physical activity and rest. Exercise offers physical and psychological benefits that include improved overall fitness and well-being, increased mobility, and better sleep.

Joints require motion to stay healthy. That's why doctors advise arthritis patients to do range-of-motion, or flexibility, exercises every day--even during flares. Painful or swollen joints should be moved gently, however.

Strengthening and endurance activities are also recommended, but should be limited or avoided during flares. Arthritis patients should consult their doctors before starting an exercise program, and begin gradually. Exercises must be individualized to work the right muscles while avoiding overstressing affected joints. Doctors or physical therapists can teach proper ways to move.

Muscle strength is especially important because strong muscles better support and protect joints.
"Several studies show that if you improve muscle strength, you decrease pain," Boulware says. Joints will probably hurt during exercise, but shouldn't still hurt several hours later.

Arthritis - Osteoporosis

"There's a fine line between doing too much and too little"